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........