When the Gulf War (Desert Storm) was close to starting, I wanted to deploy and do my share. My problem was that I was in R&D Command and not deployable unless the command agreed. I had a deal worked out to deploy to the Gulf as an OR nurse/manager and my Lab Commander (a fellow Vietnam vet) agreed. Then the R&D Command HQ top staff intervened and killed the assignment. I was told that they wanted to field an R&D team to the Gulf and they wanted me to be part of it, or I could sit the whole thing out. With no other option, I agreed.
The 4-man Casualty Data Assessment Team deployed for about 3 weeks, starting in late February. Although originally planned to deploy directly to the Gulf, the short duration of combat changed the plan, as casualties were already being sent to Germany. Two team members, a physician and an NCO, went to the 2nd General Hospital at Landstuhl. A Medical Service Corps Captain went to the 98th General Hospital in Nuernberg. I went to the 97th General Hospital in Frankfurt. We interviewed a total of 256 patients, of which 198 were combat wounded. Catching the patients was very difficult, as they were constantly being moved - with evacuation back to the States sometimes happening within a day to two days of their arrival in Germany.
The team's mission was to collect medical management data from combat and non-combat casualties. As part of that, any information of tactical or equipment-related value was also to be noted and passed on to the relevant command. After reviewing any records available and taking notes to help guide our questioning, we interviewed each patient to find out:
1. As much information as they could give us about how they were injured or wounded.
2. Any information that was related to the tactical situation and/or equipment related, either good or bad.
3. Their impressions of the medical care they had received at each point in the evacuation chain, starting on the battlefield.
4. Any specific positives or negatives from their observation of how the evacuation and care system worked.
5. We reviewed their medical records to see whether they accurately reflected the care that had been given prior to arrival in Germany.
Findings included:
1. With some rare exceptions, injury-to-surgery time in the combat zone was 4-6 hours.
2. Primary caregivers for about 1/3rd of the battlefield casualties were Combat Lifesavers. This was a new and controversial role, pioneered by the US Army Rangers in Granada in the '80s. Combat Lifesavers were (and still are) infantrymen who receive EMT training and carry a small set of emergency medical supplies, in addition to their Basic Load. The findings of the significance of the care given by Combat Lifesavers in Desert Storm gave legitimacy to their role and helped to ensure that future planning of combat medical care included them. The role has actually expanded since that time and most combat soldiers take EMT training. Since the platoon medic may be wounded, dead or miles away in an armor/mechanized unit, Combat Lifesavers have saved many lives since Operation Desert Storm. As the role has been accepted by the Army leaders, entire units now take Combat Lifesaver training, making them much more self-sufficient in the field.
3. Kevlar helmets and vests prevented or limited many wounds to the head and thorax that would have been more serious or fatal with older "steel pots" and flak jackets.
4. A negative finding: Many of the patients, like the survivors of the warehouse/barracks in Dhahran hit by a Scud missle which killed 27, really needed professional counseling. Their stories were heartbreaking and their mental pain needed help just as badly as their physical injuries. That help didn't seem to be available on short notice with such rapid evacuation going on. After hearing about the psych "teams" that were supposed to have been deployed to combat PTSD, I was very frustrated by not seeing these patients receiving counseling quickly. I found that, as a former combat soldier myself, the hospital staff "steered" me toward particular patients who really needed someone experienced to talk to. Since talking to the patients was my main reason for being there, I was happy to comply. I did the best that I could to help the patients from my perspective of someone who had "been there", but counseling was beyond both my scope of practice and my comfort level. Although I cared and tried to help, they needed and deserved someone with both experience and skills to help them to re-balance their lives after such trauma. I directed the staff to request psych consults for several of the patients, but many of them were evacuated back to the States before that happened. Only one example - several of the soldiers I spent time with were injured when the Scud missile hit the warehouse/barracks in Dhahran. There were two American units, one USAR and the other National Guard. It was a pure scene from Hell as it was described to me by the soldiers. One of them, a young Specialist, was mentioned by others for his heroic actions in the aftermath of the explosion. He was sitting on a bunk talking with his best friend when there was an explosion, the lights went out and part of the building collapsed on them. He was blown off the bunk and injured. As it turned out, his friend was killed. He found his way outside, helping another soldier. After that, he made several more trips into the building, part of which was burning and there was additional hazard because of the collapsed structure and the fire, which caused the Americans' ammo to start cooking off. He finally collapsed and was taken to a hospital. A neck injury, which was closing off his airway, nearly cost him his life and he spent several days intubated in an ICU. When I sat down with him, we talked about many things, including all that went on after the missile hit. He was in a lot of psychological pain. He went to his footlocker and pulled out a medal box containing a Purple Heart. He looked at me, tears in his eyes, and said "They gave me this, but my buddy's dead.". I thought, "Don't go down that road, kid.", having been there and done that myself. I did what I could to assure him that, because of his brave actions, other soldiers were alive and that his friend would have been proud of him, but I knew my limitations. I went to the Head Nurse and told her that this soldier really needed a psych consult right away. Shortly after that, I met with his NCOIC, who had also been wounded. I asked him to make sure that people kept an eye on him. He said they would. It was Friday afternoon and the Psych department wouldn't accept a referral from a nurse. The soldier's doctor was tied up in surgery. As it turned out, the Psych department didn't work on weekends (shameful) and those soldiers were evacuated back to the States by Monday.
I briefed the Commander of US Army Medical R&D Command (Major General Travis) and his staff, as well as some senior staff officers from Walter Reed Army Medical Center after returning from the mission. I stressed the need for counseling that so many of these soldiers had. As I found out later, that was ignored and it was decided that the best thing for them would be to send them back to the familiar environment of their hometowns as soon as possible. About a year or so later, I read about a class-action suit filed against the Army by many of the soldiers, including several that I interviewed, because they were never given the access to counseling that they needed. It made me very angry and I wondered once again whether nothing was learned from Vietnam.
This photograph ran in an article in the Medical R&D newsletter about the mission.
