AF medical team integral part of mass casualty exercise

by Army Sgt. 1st Class Raymond J. Piper
Defense Media Activity

8/1/2012 - CAMP ATTERBURY, Ind. (AFNS) -- The "walking wounded," arrived first to the field hospital set up by the 779th Medical Wing. The warbling siren from an ambulance heralded the arrival of patients on litters. The doctors, nurses and medical technicians greeted them with the initial care that could save their lives or at a minimum alleviate some of their suffering.

The Joint Base Andrews unit is part of the nearly 9,000 service members and Department of Defense civilians taking part in Vibrant Response 13, which is designed to test the ability of the DoD to respond to a nuclear disaster on U.S. soil.

The unit is part of a joint homeland support mission designed to step in when there is a disaster that goes beyond the scope of local authorities and local medical facilities to handle the injured.
"We are available at their request to come in and setup our EMEDS unit and provide attitudinal hospital and surgical support to the local authorities," said Maj. (Dr.) Patrick Huck, a general surgeon with the 779th.

The 779th arrived July 28 and began to set up their field hospital made up of several interlinked tents to provide an emergency room, a surgery, an intensive care ward and a pharmacy.

"These patients are complicated by having radiological exposure, so that does put it in a little bit of a different light from what we traditionally deal with," Huck said .

As the patients arrived, their clothes were replaced with hospital gowns due to the risk of contamination from radioactive particles. They used wet wipes and water to remove any particles from exposed skin.

"If there are radiation particles on the patients, 90 to 95 percent of them could be removed when they take off their clothing," said Maj. Elisa Hammer, bio-environmental engineer.
Hammer and her team are one part OSHA and one part EPA. They ensure that the environment that the staff works in remains safe from hazards.

"We advise on decontamination and detect contamination, so based on that, just like OSHA, we can protect our providers," she said. "At the same time we want to get outside to get an environmental health assessment and a good feel for what's around our area."

Medical technicians and nurses began the screening process to take stock of the injuries and begin treatment for the wounded. Common questions that the roleplayers might have heard in a regular doctor's visit, but now cots replaced the usual sterile environment of a normal examination room. The usual banks of equipment to test for blood pressure are all portable and ready to be moved to another patient if needed.

"You have to rapidly assess them, get them stable and if they were able to go home, send them home or to the FEMA tent. If they weren't we would move them to another part of the hospital for further care," said Maj. (Doctor) Michael Maine, a family practice doctor.

The injuries from the blast were varied, and the airmen saw both the effects of radiation exposure, leading to abdominal pains, nausea and itching all over the patients' skin, and the direct effects from the blast where victims were thrown or slammed against something, creating injuries from the impact. Additionally people further from the initial blast could still suffer burn injuries.

Given the chaotic nature of the aftermath as first responders arrive and as people try to escape, the hospital would still see normal trauma from car crashes and falls.

"We have learned a lot as far as how much radiation a human is suppose to have and the different injuries that they can have when they get exposed to a significant amount of radiation," said Staff Sgt Rewa Price, an ER tech. "The kind of injuries you're going to see might be similar, like nausea, vomiting; however, it's related to radiation."

As the patients filtered through emergency room, being screened and treated, an ambulance brought in a training mannequin, simulating someone who was close to the area of the detonation of the nuclear device. From the blast, he received an abdominal wound caused by blunt trauma that resulted in a ruptured spleen. Doctors, nurses and medical technicians worked to keep him stabilized as the observer/controller told them the results of their examination.

"I saw the patient in our emergency room, evaluated him per our advanced trauma life support protocol, and we recognized that he had a condition that required surgical support. We stabilized him ... and brought him to the operating room and performed surgery on the patient to repair the hemorrhage," Huck said.

All of the wounds are simulated and in some ways that makes everything more difficult, according to Maj. Maj. Matthew Uber, a nurse anesthetist.

"Although they do their best to make the victims look traumatically injured, anyone who has been deployed in a war-time situation knows the stakes are lot different when you know there is a life on the line," he said. "The adrenaline doesn't surge when you get a mannequin patient, so the cohesiveness of the team develops more in a real-world scenario."

He explained though the wounds aren't real, setting up the mobile hospital and working through the different scenarios shows the potential shortfalls that may exist.
"It's great that we are doing that now for a potential homeland response because that (mission) brings a lot of unique problems," Uber said.

Huck agrees that the realism does not lie in the patient care, but rather in t he coordination of the care patients receive, transporting them through the hospital and making sure they have the supplies they need to take care of the wounded if it should happen for real.

The joint nature of the exercise provides the participants with a unique opportunity even if members of the unit have worked with other services in the past.

"It's great when the forces work together," Uber said. "Initially I think there is always that thought 'we do things differently,' but we find, especially in the medical field, that we have a lot more in common than differences and it breaks down those barriers quickly."

He continued, "The training in trauma is pretty much universally prescribed by civilian authorities. Advanced trauma life support is the same whether you're Army, Air Force or Navy, so I think we speak the same language as far as trauma, physiology, air way breathing, circulation. Universally I believe trauma is the same language to every branch. The challenges and differences probably come in equipment, capability, expectation of what we have whether it be supplies or equipment."

Price has been working with contingency air medical staging facilities throughout her 10-year career and said that this was an extremely different mission than what she was use to.
"I'm trying to apply that prior knowledge that I have working with our wounded warriors overseas and at home," she said. "It's a lot of blast injuries, which is quite similar (to a war zone), but then the radiation injuries and things like that are new where it's a learning experience."

They have learned a lot so far, such as how much radiation a person is suppose to have and the different type of injuries that they can have when they are exposed to significant amounts of radiation, Price said.

"The kind of injuries you're going to see might be similar, like nausea and vomiting; however, it's related to radiation," she added.

Although Uber doesn't expect there will be mortar fire coming into the hospital, he said, that doesn't mean it'll necessarily be easier.

If an event such as nuclear attack was to happen in downtown Chicago, they would be facing an entirely different patient population than they do with military members.
One discussion Uber and his team had was about the weight standards of their operating tables.

"Typically in a deployed environment, we deal with active duty military or Afghan forces where there is a potentially a healthier population," he said. "If this did happen in downtown Chicago, we might see a much different patient population that might exceed some of the standards we have here."

In addition the hospital would face many medical issues beyond the surgical trauma. He explained they might see heart failure, diabetes and other ailments that would keep a civilian out of the military because their focus would be on treating the local population.

A challenge that Maine sees is that many of their assets from the larger staff at a normal hospital will be unavailable.

"What you have here is what you're sent out with ..., so you make the decision right there with the capabilities you have. That can be a challenge not having multiple access to specialists," Maine said.

Although the mission poses many challenges and be it a natural or man-made disasters the airmen are ready to help people on American soil, when called.

Uber said, "I'm not excited about the possibility of what would trigger the mission, whether it be a nuclear or chemical or even a natural disaster type of an event, but I look forward to the fact that we would be able to help the civilian population and work with local authorities."