Operating in the Dark

Twelve year old girl and her brothers were playing around the house, and she was accidentally shot with an AK-47. We don't know the specific circumstances of why or how it happened. It just did. Nor does it matter to us, of course. Not part of the job description. We are here to do all we can irregardless of who, what, how, or why.

The bullet ended up causing some internal damage. Double chest tubes were placed and open abdominal surgery was performed, including liver and stomach repair. Stable for the case but critically ill, she needed immediate MEDVAC to a higher level of care. At the level III hospital, they will be able to perform diagnostic tests that we just can't perform at Charlie Medical, such as an extensive CT scan looking for subtle damage and/or hidden bleeding that won't be found unless you know exactly where to look.

Little known fact: Ar Ramadi is run entirely on generators. Every light bulb, DVD player, TV, you name it is run from a generator. Walk anywhere on base and you will quickly notice the maddening and inescapable drone of a nearby generator. Unlike the stable power grids in Western countries, generator power fluctuates, causing routine brownouts and surges. Brave is the soul who uses a computer on Ar Ramadi without surge protection. Generator power also happens to be a lot less reliable. The picture below was taken as the power went out during the middle of the case. "Grab the flashlights" RH quips as one of the corpsman runs outside to start the axillary generator for our lone OR light. Monitors and anesthesia machine had to rely on battery backup for 20 minutes while we waited for power to be restored. As for our case, not a beat was missed. We kept right on operating in the dark.

Stable for the flight to Al Asad, I was able to give a liberal amount of pain and sedation medications to keep her comfortable for the helo ride. The image below was taken in-flight. I have her in a protective bag we refer to as a "hot pocket" to prevent evaporating heat loss at altitude. The doors are all open, and a lot of air is streaming through during flight. Oxygen tank slipped between her legs, I have the ventilator and monitor placed on a folded blanket pad on her lower legs. We are ever vigilant to ensure anything placed on the patient has thick padding to prevent any discomfort. I left myself an IV port taped on her shoulder for quick access as I give blood and medications during the flight. Just off to the side is my flight bag, an extra oxygen tank, and a portable suction unit. No time to sight see during the flight. It's an endless loop of assessing vital signs, ensuring the ventilator is working correctly, the oxygen tank isn't empty, and checking her to make sure she is comfortable and isn't waking up. For her to awaken in this environment would be a frightening, disorienting, and frustrating experience......so I do all I can to keep her peaceful and blissfully asleep for the ride.

After dropping our patient off at the medical helo pad at Al Asad, we fly directly to the "fuel farm". Aircrew told me repeatedly we were "on fumes" as the helo sat on the medical pad, resulting in a mad dash to grab flight equipment and make a run for it. After a top-off, we race back to Ramadi with the Cobra Gunship close behind.

A hot and hazy day in Anbar. Put a little damper on my ride back, since I was hoping to take some pictures. This was my second time flying to Al Asad during the day, and I'm already starting to see some familiar landmarks along the route, crossing over the Euphrates River several times. The desert is made of endless swaths of flats, dunes, crags, and ranges of rustic browns and tans. But for all of her beauty, she is still devoid of greenery or overt signs of life. The only exception being the major bodies of water: lakes, rivers, and their tributaries. Anything small just evaporates in the torrential heat. In these select and reserved locations the desert wells up and seems to burst with life. Thick foliage and luscious date groves reveal a vivid palate of colors as they cling tenaciously to the river bank. Beautiful..........

Surveyed a few homesteads clustered close to the water banks. They have taken advantage of the fertile strip of land running parallel to the water and are actively cultivating small orchards and tending farms along the Euphrates and small tributaries. A lack of equipment, and possibly know how, is preventing any of the farmers from truly efficient irrigation farming, the modern day practice of storing water to tightly control soil saturation. Instead, they have either fallen back, or never stepped forward, from flood irrigation. At least once a day, the family turns out for the "bucket brigade" as they form a chain a short distance from the river to their crops. They just fill the buckets from the Euphrates, and dump it on the fields. Despite the hardships the Iraqi people endure, an encouraging sign that life sustains and thrives........with suffering comes perseverence. With perseverence, character. And with character.......hope.

Update: I receive many curious inquiries as to how our patients fair after they are taken to a larger hospital. The surgical team keeps tabs on patients two ways. First, we have a computer program on a secured terminal in the office that allows us to track patients not only in-theatre, but all the way to Landstuhl or the States'. Second, our surgeon calls the accepting surgeon the day after. He will call daily if the patient is serious or unstable, then passes down patients' status to the rest of the team.

The little girl I flew to Al Asad is doing great. The CT scan showed a little fluid collection around her liver, which is to be expected considering the injury. She went back to surgery the next day and was weaned from the ventilator the day I brought her. My friend at Al Asad emailed and said our girl instantly became the ICU princess.

Hearts and Minds

Some of the top commanders and colonels in the area toured Charlie Medical yesterday. RH, our head surgeon and detachment commander, gave them a tour of the OR and our capabilities. While discussing area topics and patient care for the local populous and Iraqi Forces, the colonel had some genuinely positive encouragement regarding the care we are rendering in Ramadi.

As stated in previous posts about Doha, and her sister Gofran, they are the orphaned children of an influential local family. The colonel said, in no uncertain terms, that the care we are providing to civilians, naming these children specifically, has resulted in a calming effect on the city.
He is quoted as saying those surgical procedures have done more recently to stem the violence than 30 raids could ever do.
Bravo Zulu to Charlie Medical and the Surgical Team......

Darwinian Award

Sitting in EVAC this afternoon. Jarhead just started 5 minutes ago on the Armed Forces Network, and I haven't seen it yet. Rolling past the opening credits, with a phalanx of trucks crossing the desert in a hazy mirage, Charlie Medical reverberates with a detonation. "Wait, that wasn't the TV." This one rattles the windows for about 4 seconds....big one.
We all look at each other and give out a collective sigh...and wait for the radio to start chattering. Within 30 seconds, we start getting some garbled messages, so we hold tight a little longer. Then the bad news cracks across the air waves loud and clear "VBIED".
I walk across the way to my hut to pick up stethescope, trauma shears, and a portable oxygen saturation reader. Others start hauling down our supply of litters as other medics start opening up the mass casualty supplies.
Within ten minutes, all of Charlie Medical is present and accounted for. Trauma bay gets a once over to make sure all monitors have cables, oxygen tanks are full and ready to go. We aren't waiting to hear if we are getting casualties......it's an assumption. The only question is how many and how bad is it going to be.
Sure enough, a patient rolls in with second degree burns over 60% of his body. But the soldiers that bring him say he was burned friday. Huh? Apparently, the patient was seen and released at Ramadi General, but obviously is in need of more extensive care. We are approached by the family, so we see what we can do for him. In the meantime, we are worried about the casualties that will be streaming in any second. Someone echoes what we are all thinking "what's going on here, we should be seeing casualties already?"
As we assess and start dressing the burn patient's wounds and hanging antibiotics, the first sergeant walks through from Tactical Command and tells the surgeon "No casualties from the VBIED".
We all have this incredulous "what the....?" look on our faces. Turns out the VBIED driver only managed to blow himself up. His incompetence has an end result of one death....his own. This is a first for me, and I'll take it as a sign the insurgents are scraping the bottom of the bad guy gene pool at this point.

The VBIED driver gets my nomination for Darwinian Award for the month of May.

Ramadi all-nighters

1:06AM brings a loud rap on our door "11 in-bound. Mikes unknown".

Knocking the fuzz out of my head as we all stumble around the room putting our uniforms back on. Hopping around on one foot, I avoid a collision with D squared just as someone flips the lights on.

Feeling like I'm floating to the back of Charlie medical, I run down a mental checklist of how many patients, where we are going to triage them, and making little bets in my mind that this could be a long night.

15 minutes later, the TOC announces "Casualites are being diverted to Ramadi General". This is the local civilian hospital. They must be closer to the scene than we are, but are a little less cabable. We have been supporting them with supplies and keep in contact with them, but the back of my mind is telling me this is going to be more than they can handle.

Most of the staff drifting off. Trying to quickly re-capture what they missed of slumberland, and I don't blame them. A few, including myself, decide to stay awake for a while to see what develops.

1:36AM and I hear the tell-tale drone of armored track vehicles. Several of them. Eric says "well?" I'm throwing my stethescope back around my neck "This can only mean one thing. Lets get busy."

Two M-113's arrive filled with casualties. They bring along a full compliment of humvees and Strykers filled with heavily armored and weaponized soldiers "IED blast!" they say. "We thought Ramadi General was taking this one?" "Hey, just following orders. We don't know anything" they say as we immediately start unloading patients and begin triage. Two walking wounded hop out: this is an encouraging sign, even though their tuniks are splattered with blood. They are quickly ushered to the side, and a few medics start tending to some superficial wounds. Then we start hauling stretchers out.......here we go.

Eric and I take station two. Iraqi casualty is on his stomach and moaning something so incoherent even the interpreter has no idea what he's saying. His entire lower back is covered in a makeshift damage control bandage. Eric starts taking it off to assess what the heck it is, when unmentionables start spilling out. I tell him "Umm, you better put that back!" He agrees promptly, as I gather some sterile supplies to re-dress the gaping wound. I quickly re-pack his back, and five of us struggle to turn him over: we need a proper assessment, IV lines, and vital signs. On his stomach, I can't even tell if he's still breathing. We get him turned over, and I'm finding abnormalities all over......arms and legs aren't supposed to be jello in my hands. "X-ray! I need films as soon as you get a chance." Get an IV, Eric is assessing his airway. RH, our head surgeon, is looking over my shoulder "bring him back to the OR now. We have our first case." The X-ray tech is asking me what films we want. "chest, KUB, better get a pelvis, oh, and all estremities, too. Just get everything..." My patient is sliding downhill, so RH decides abdominal surgery needs to happen sooner rather than later so we can visualize and repair damage. We perform multiple bowel resections and Chad flies him to Al Asad as soon as possible. He was unstable for a bit, but does well for the flight.

This was the beginning of the end of our sleep. We get word of more incoming casualties during the first case: American unit hit by an IED next. At least one "urgent surgical". The lone OR is tied up with Iraqi Police, so we tell the Army Tactical Command to set up a landing zone to fly the American casualties to Taquaddum. A short flight, and it makes sense to tap into other Anbar medical resources. More Iraqi's pour in throughout the night: a GSW victim is in the trauma bay, so I break out of the OR to assess: our two surgeons are scrubbed in, and they need a discriminant eye to hover for a few minutes to see if he needs to be taken back to the OR. We already have another patient on standby and waiting to come back. GSW to the chest, and the Army PA (physician assistant) and our Independent Duty Corpsman are placing a chest tube on the affected side. They drain any blood and avert a hemothorax. Two PA's and I use an ultrasound to assess his heart, and the pericardial window is void of blood: fantastic sign. We are sending him to Ramadi General now that he is stabilized.......thankfully the bullet didn't hit anything major.

With no end in sight, we have another trauma case come in with more penetrating abdominal injuries just as we are finishing another case. The room is quickly sterilized to the best of our ability just as we roll the next patient in. He's in good shape, considering, and doesn't appear to be in too much pain. More bowel resections, and we finish our last patient for the night as the sun gently crests over the horizon signaling a new day in the Anbar Province. The surgical team cleans the OR for the last time tonight, washes up, and we meet behind Charlie Medical for breakfast to cap an exhausting night. The chow hall is a welcome site: eggs, gravy, biscuits, and fresh fruit. Bellies full, stamina depleted, we simultaneously collapse into bed ever ready to do it all over again.

Salvation Council's Tough Stance

An interesting interview took place a few days ago in Baghdad with the head of the Anbar Salvation Council, Sheik Hamid al-Hais. He eludes to the surge in police recruits over the past few months in Anbar Province, and has some hard-hitting statements about our struggle with Al Qaeda in the area. We have the local and regional sheiks aligned with us, and the results are impressive and cannot be discounted. Critical daily incidents are down significantly in the area compared to a year ago, and the emergency response units we are guiding through training on-base are the reason. Loyal to their tribes, these men are patrolling their lands and protecting their own from Al-Quaeda's purposeful targeting of innocents and attempts at destabilization. Our success in Anbar is directly tied to theirs...

"We have our own tribal legal system and this is constant and cannot be changed. Murderers must be killed under tribal law and unless we use this force against terrorism, terrorism will continue to rise."
The Salvation Council is part of a movement called the Anbar Awakening run by Sheikh Abdulsattar Abu Risha, whose alliance of tribal leaders united against the threat posed to Anbar province by Al-Qaeda's militants.
Anbar's mainly Sunni population once largely supported attacks on US forces and Iraq's Shiite-led government.
Many, however, have become sickened by Al-Qaeda's attacks on civilians and tribal leaders and are angered by the insurgents' interference in the region's traditional ways of life.
Since October, sheikhs have funnelled thousands of tribal fighters into the police and "emergency response units", which now fight alongside US and government forces while retaining their loyalty to their sheikhs.

Hais, who despite his tough talk looks urbane and cosmopolitan in his smart business suit and neat moustache, says he can now field 15,000 armed fighters, most of them now nominally in the police but still under his orders.
How many of these were once in the resistance, fighting the Americans? "Fifty percent and maybe more," he said.
And why did they change sides? "Because of the behaviour of Al-Qaeda. Al-Qaeda did not distinguish between the innocent and the guilty. They killed the resistance, they killed sheikhs, they killed everyone," http://news.yahoo.com/s/afp/20070515/wl_mideast_afp/iraqunrestsecurity

Our search continues.....

We still have abducted personnel in the area, and the efforts to find them persist day and night. Please keep these men and their loved ones in your thoughts and prayers......

U.S., Iraqi Units Continue Search for Missing SoldiersAmerican Forces Press Service
WASHINGTON, May 18, 2007 – Search efforts continue for three missing U.S. soldiers who are believed to have been abducted by al Qaeda on May 12 in Quarghuli Village, Iraq. Soldiers from the 2nd Brigade Combat Team, 10th Mountain Division (Light Infantry), from Fort Drum, N.Y., and the 4th Brigade, 6th Iraqi Army Division, have been conducting non-stop searches for the missing soldiers -- all assigned to the 4th Battalion, 31st Infantry Regiment, 2nd BCT -- since their abduction. http://www.defenselink.mil//news/newsarticle.aspx?id=46072

Week two, much progress

"These guys are doing much better."

"Tight groups, good range discipline."

"They seem locked on compared to last week. I'm impressed."

Just some of the comments I heard as I spent another afternoon at the weapons range providing medical coverage for the special forces trainers and Iraqi Police SWAT recruits. This marks the second week of a three week course. There is a noticable difference right away: they arrive and assemble in formation. The Iraqi Police Captain pictured below is a dynamic presence this time. His authority is palpable as he barks out orders that are followed without hesitation. The Iraqi Police have great weapons presence now: no waving the muzzle around while loading. No need for well-timed ducking on my part. Movements are crisp and in unision to command, rounds on target, foreshadowing a force to be reckoned with.

Doha's older sister, Gofran

"She just can't stop smiling! I think she's even happier than her sister." Someone says as we play around and socialize with Gofran, Doha's older sister. She has the sweetest smile and I can sense her warm disposition as she looks down with a sheepish grin and plays with the fuzz off her new pink bunny. We just can't help ourselves when the children come in, and I ran to my "stash" to bring her a few more toys.

Also injured in an insurgent attack in February, Gofran has a large chunk of shrapnel embedded in her right thigh. She of course commands all of the attention in Charlie Medical this morning.

Tim and I remove the shrapnel embedded between the fascia and her thigh muscle. D squared is in the background getting supplies while Eric and Katie provide light facemask anesthesia. The piece of shrapnel is one inch in diameter, and comes out with a two inch incision and some gentle tugging. The cavity itself looks good: no infection and no muscle or bone damage. After a brief postoperative recovery period, Gofran is on her way with her brother again with some instructions, extra supplies, and a follow-up appointment. She leaves us minus a hunk of shrapnel, but gains an armful of toys and many new friends.

A short public affairs video about the medical and surgical teams at Camp Ramadi taking you through some VBIED attack footage.
http://www.youtube.com/watch?v=9RFL1Dut9Ok

Iraqi SWAT training

"These guys are funny that way. Sometimes they act like 15 year olds in a 30 year body. "

"How do you mean?"

"Well, take for instance yesterday on the range. I was walking down the line looking at groupings and commenting 'tight group, or good job on that one' you know, that sort of thing." He says "And this one guy, see the one with the tan cammo t-shirt and cap? Anyway, he gets all defensive on me and basically says 'what about mine! Very nice, no? I am good shot!' So I had to make sure they all got complimented."

The Iraqi police recruit that felt left out was former Republican Guard, so he certainly has a reputation to protect. I somewhat empathize. I was talking to one of the special forces guys at the weapons range. Some medical personnel from the surgical team spent the afternoon providing medical coverage for the SF instructors as they took Iraqi police recruits through tactical weapons training.

As Ramadi continues to improve on security, it was felt that now is the time to give the police force extra training. The Ramadi police colonel was asked to go around the different substations and find his 'best' men to begin training for a possible Iraqi SWAT team. I spent the day out there with them as the trainers put them through the paces.

This afternoon was sort of a mixed bag: on one hand, I am witnessing the future of a Country. The success and our ability to eventually draw down our forces here hinges on their progress. And I saw some bright spots: a few with good range and weapon discipline. Of course, this is my own little microcosm of perspective. However, I also confess we have a ways to go. Waving your rifle around as you load a full magazine wasn't instilling any confidence, and I found myself creeping behind the Humvee at times. The penchant to shoot 'Rambo' style from the hip was eyebrow raising. They ended the afternoon shooting their U.S. Govt. issued Glock19s, some employing the SnoopDog 'wanksta' style of shooting, aka palm down. Although amusing, that got a few head shakes, too.

Also got an opportunity to shoot the AK-47 and a few other weapons in the special forces platoon. The rifle on the left is the M107. This is a .50 caliber long range scoped sniper rifle. The rifle on the right is a MK48 machine gun. Both were powerful weapons, but the M107 is the most powerful and largest rifle in the military's arsenal. Effective target range is 1400-2000 meters. Impressive. This weapon is said to have devastating 'target effect'; read: what it hits tends to disintegrate. It is also considered to be a 'target multiplier'; read: impact of the round destroys multiple targets that lie in close proximity. In other words, if you aim this at personnel, you wouldn't want to be the guy standing next to him either. Order of operations for the M107:

• SF trainer sets the scope sight for an ammo can 500 yards away
• He describes how to load, where the safety is, and how we have to keep our face at least 6" from the scope if we want to keep our nose intact; I break out of a heat coma as he immediately commands my full attention with that comment
• Furthermore, we have to have our bodies lined directly behind the weapon to absorb the kick, and we don't want any skin or our face anywhere near the ejection port; people have lost their eyesight
• I no longer want to go first, so I slowly creep behind Mark
• Mark goes first, and not only survives but says "Holy blank, you gotta try this"
• My turn: I load my round and begin to sight in the ammo can. I constantly remind myself that I have to breathe, too
• I get sight alignment / sight picture and slowly squeeze the trigger wondering if I can still fly patients with a disarticulated shoulder
• The first round goes off, and my world just went dark. I am aware of my surroundings again after a short 3 seconds
• I fire three rounds total, stagger to my feet, and get a few chuckles as I stumble back with a sheepish grin from ear to ear
• The ringing in my ears and the feeling like I'm talking in a tin can only lasts a few hours
• Worth it.........

Deja Vu, Monsieur

Sit down to dinner with Tim, D squared, and Eric. Chaplain is a few tables down and comes over with his radio: "Guess what guys? GSW to the chest 15 mikes out."
Five minutes later "chaps" is leaving "Sorry guys, but the patient just rolled up." Eric is up and gone in a flash. This seems to be the recurring chow routine. Still missing at least a sip of coffee before we check out. Tim and I collect the leftover trays and make our way.

Patient hits the trauma bay:
Entrance wound to his left chest, but no time to look for an exit wound yet. First up is starting some big IV's, a central line, and several Army personnel on the left placing a chest tube. Eric is at the head of the bed and gets the patient intubated. Chest tube in place, and we get an initial flood of blood: hemothorax. "Can we re-infuse it?" someone asks. "No, we don't have the autotransfuser connected. We will have to connect one as soon as we can" I say as the patient continues to slide downhill. "That's it, we need to open his chest." says Eric with a sense of urgency. Clammy patina and color is quicky turning ashen, the color of cold gravy. Our surgeon: "Grab the lines, grab the chest tube. We are going to the OR now." I'm somehow grabbing IV's, pulling off trauma bay monitors, and balancing the chest tube collection chamber while on the move.

Operating Room:
Anesthesia machine on, hot line powered up, barely controlled chaos as everyone flies around the room: grab sterile instrument sets, hang the fluids on pressure bags and crank up the fluid rates. Eric says "I want 4 units of packed blood cells now. Who is the runner, and I need you to move now" as the patient looks, well, blank. "Someone feel again for a pulse." No pulse, chest compressions started, our two surgeons throwing on sterile garb while simultaneously starting the thoracotomy. No time-every second is more precious than the last. Eric and I are pushing fluids and now blood as fast as our hands can move. Extra hands are recruited to help us pump blood and fluids even faster.





The temperature outside: 110. For the first time, the OR temp is climbing beyond comfort. We just have to turn the AC on for relief. V and D squared walk over to turn it on, and....nothing. We know the heat works-been using it for months. We know the fan works-been using it for a few weeks. We now know the AC units are down-both of them. In no time, everyone is drenched in sweat. On call for this flight, I'm stuck with the flight suit on. As soon as the patient is stabilized I will be working on a flight to Al Asad as quickly as possible. Suit is soaked before the case is over, and my night has just begun.

I have it easy compared to the guys scrubbed in. They are wearing sterile gowns/mask/gloves on top of uniforms. No chance to step out of the room for relief or to hydrate, they are on the verge of heat exhaustion after an hour. Eric becomes the official Gatorade representative.












Blood arrives. Eric and I both grab one along with blood tubing. "Just keep the blood coming, and we are activating the blood bank as of now. Make it happen". The Army moves lightening fast, the Big Voice is calling out basewide for donors, and we have life saving whole blood in what seems to be minutes. The whole blood is a huge score for the patient: we are now giving him warm oxygen-carrying hemoglobin along with replacing the clotting factors he is losing to his injuries. Martin resects the patient's left lung: the round went right through it. Arterial line placed and Martin finishes damage control and is satisfied he stopped all of the thorasic bleeding. He starts closing the chest back up and places two new chest tubes to drain any residual blood. Blood chemistry and hematocrit counts are almost perfect despite the significant losses of the patient's own volume. Another save.

Flight:
It's nightfall. Around 10 PM and the temperature is still 100 degrees.
So much for desert temperatures dropping precipitously at night. Yeah, I always heard that one too.
Patient does well. I'm giving blood in flight, groping for IV lines, changing out the oxygen tank, tweaking the ventilator settings to prevent high airway pressures, writing down vital signs and medications given on a piece of tape on my flight suit, and searching for the drug access port so I can give some sedation and paralytics.
We touch down on the medical helo pad, and I run ahead to give report to the accepting physician.
The Blackhawk is in no hurry to go back to Ramadi. It's their bird and my priority status was just relegated to "passenger". They go to the "dust off" and we sit there for 30 minutes before going to the fuel farm for more JP-5. The helo is blacked out, and the rotor spin drowns out any chance at hearing anything. The adrenaline rush is winding down now that I safely passed my patient off to the Army CSH, so I close my eyes and shut down mentally for a few moments.

Sensory deprived moments: Strapped into my jump seat sandwiched between the crew chief and flight medic as the turning rotors rock me into a rythmic trance after hours of trauma, surgery, and flying. The cabin feels like a miniature furnace late into the night. Smelling the requisite aroma of hot engine exhaust, hydraulic fluid, and a dozen other lubricants, propellents, ect. But this is a dedicated patient evacuation helicopter, so take the normal industrial smells and add a mixture of flight suits soaked in sweat, the patient, and the faint metallic smell of blood, old and fresh. A smell I will not soon forget........

Minor Setbacks

Heading towards the chow hall for lunch, and we feel the tell-tale concussion of a detonation. "Sure hope that's a controlled det" quips D squared. If an engineering team or EOD team finds a roadside IED or weapons cache, they destroy it on the spot if possible. So hearing random detonations is a somewhat common occurence.
Fifteen minutes later, we are just about to sit down, and another faint shock wave is felt from inside the chow hall.

"You feel that one too?" Says D squared.

"It's gotta be controlled detonations."

"So close together? I don't think so, they aren't announcing anything" he says as the "big voice" remains silent about controlled det warnings. "Lets hurry up and try to finish our food. This might be another one of those days."

We sit down and quickly try to get through a tray of food. As a few minutes tick by, I suddenly feel the need to speed through my tuna wrap and macarroni salad. Other medical personnel nearby have radios, and they squawk to life after a few bites. Eric jumps up and heads to another medical table to clarify. Sure enough, the Army TOC starts sending out staccato messages of "inbound patients, I say again patients are inbound to Charlie Medical". Trays are hastily snatched up as we make our way next door to Charlie Medical. Little did we know those couple of bits of food were going to have to carry us through another afternoon of trauma patients. Never got a chance to take a sip of that coffee.
The "big voice" picks this moment to come to life: "clear all roads to Charlie Medical. I say again, clear all roads to Charlie Medical." The big voice chimes in all afternoon as waves of patients come in for treatment.

Despite today's setback, the intel we are receiving mirrors what is in the media: Ramadi and the Anbar Province are improving. Sunni leadership in Anbar have formed the Anbar Salvation Council (ASC), and are working with U.S. leadership. The ASC is officially opposed to al-Qaeda, and is working towards stabilization of the region. Sheik Fassal Al-Giood of the ASC states "al-Qaeda has not stopped attacking Anbar. Today's incident is a reaction to our work."
As stated in a previous post, Doha gets a second chance, Ramadi has seen a surge of new police recruits and officers. Much of the raw infusion of new officers is due to the ASC leadership supporting regional stability and sending their tribesmen to the recruiting stations to become officers.
After all is said and done, Charlie Medical treats 15 blast casualties. The critical are flown with an En-Route Care RN to Al Asad. An update from a good friend at the Army CSH at Al Asad said one of the patients remained in critical condition this evening, and will require intubation and a ventilator at least overnight.
http://news.bbc.co.uk/2/hi/middle_east/6631663.stm
The last two photos were taken off the AP wire.

Milblog Documentary

A link to a documentary produced last year featuring some of the most prominent 'milbloggers' at that time. Most are still active in the community, and continue to inform.
After watching, I came away agreeing with the comments they were making "it started as a fluke", "I thought it would be a better way to inform family and friends", "once I started getting emails and feedback, I felt I now had a responsibility to everyone". I echo those sentiments, and feel this is one of the few ways to "humanize" the war, to lend a voice that would otherwise never be heard.
The title is Talking to Somebody without Talking to Anybody. I have a slightly different take: When I sit down to write an entry, I feel as if I am reaching out to talk to Everybody. Just my interpretation.



Side note: YouTube has portions of the Milblog Conference recently posted in the past two days.

Remembering Sgt. Mike Stokley

Sgt Mike Stokley, son and husband, is remembered by his father, Robert, at the 2007 Milblog Conference in Washington D.C. A message about the price we pay, and who pays it.....

A great article about En-Route Care Nursing by the Marine Corps. News. Features a few colleagues "roughing it" at Taquaddum (not that I'm complaining). We went through training at Camp Lejune, including water survival and flight training, and now cross the desert together keeping patients stable while racing them to higher levels of care.
http://www.usmc.mil/marinelink/mcn2000.nsf/main5/92253599E321409A852572C200170567?opendocument

Doha gets a second chance

"Well, I say we just keep her. She can stay in the barracks with us."

"She is so cute, I would just love to adopt her as my own. Is it ok if we just 'claim' her as ours?"

Just a few of the comments I hear as I wade through medics and corpsman on my way to see Doha. She's the MVP of Charlie Medical this morning and is coming in to get pins extracted from her femur. A few days ago, Tim removed the rod that connected the two parts of her leg together when it was broken during a VBIED attack. This morning, we remove the last of the hardware as the most recent radiograph films show excellent healing.

She lost her father in the attack. He was no ordinary Ramadi citizen, but one of the more influential leaders of this emerging province. His deep commitment to the safety and well-being of Ramadi directly resulted in a phenomenal push for Iraqi Police recruits. This one man takes most of the credit for the robust police force we now have in Ramadi and the surrounding areas of Habbaniya and Khalidiyah. His legacy of faith and passion for his Country still reverberate in this area, as his death resulted in another wave of new recruits that showed up for training after the attack.

We remain encouraged by the positive reports we are receiving about life in the surrounding areas. New markets and restaurants are opening every week, and although Doha was orphaned and her life forever changed on that day, lets hope that a renewed Ramadi and Anbar Province will give her the life she deserves: a life without fear or repression; a life filled with opportunity to take her second chance and do great things.......

Had a great conversation with Badgers Forward today at lunch. He's responsible for keeping our convoy and patrol routes clear of IED's. Badgers Forward runs an insightful blog about life in the Sunni Triangle and his responsibilities as he spends time on the road between Ar Ramadi and Fallujah.
http://badgersforward.blogspot.com/

This week in Washington is the annual "milblogger" conference. By coincidence, the Army has recently published a 79 page regulation directed at Army milbloggers stating mandatory registration of all blogs by Army personnel and personal email scrutiny.
Blogs have become a powerful tool for the ranks and continue to attract a lot of attention from leadership both in Washington and in the field. The concern is that authors are not educated about or aware of operational security, and are giving away valuable information via their entries.
Is it just me, or do I have more at stake to ensure I don't give out operational details more than anyone else? I know the vast majority of milbloggers are acutely aware of this paradox and potential risk, and we carefully scrub any information that could lead to information gathering.
One of the first thing on my plate upon arriving in-theatre was to notify my command that I was going to operate a blog while deployed. After some initial questioning and general flak, I was given the nod and was warned to protect confidentiality, privacy, and above all OPSEC. I also happen to know that Central Command has reviewed my blog along with our public affairs officer. I can't say I felt "embraced" by leadership, but at least they felt comfortable enough to allow me to lend my voice. If one phrase described their attitude, it would be "vague tolerance".
My fear: there may be a general crackdown on milblogging without any real evidence to support operational risk management. My opinion: without us, you will never get the stories from the "trenches" so to speak. These are the stories the media either never hears about, or refuses to publish.
Freedom of speech is the concept of the inherent human right to voice one's opinion publicly without fear of censorship or punishment. Please do your part and support all of the milbloggers out there who play by the rules, and breath life into the daily struggle.

"Once milblogs are outlawed, only outlaws will have milblogs-you can quote me on that" Greyhawk, publisher of the Mudville Gazette

http://blog.wired.com/defense/2007/05/the_army_has_is.html
http://blog.wired.com/defense/2007/05/white_house_wei.html
http://time-blog.com/swampland/2007/05/let_slip_the_blogs_of_war.html
http://www.blackfive.net/main/2007/05/new_opsec_regul.html
http://www.defensetech.org/archives/003467.html

Ortho/Trauma Team

Ready, willing, and able. You call, we answer.

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