Thursday, May 28, 2009

Another skill to save your buddy

I mentioned previously that the medics and I were (finally!) going to treat some simulated patients during a base defense exercise. Well, it went fair. In the course of the day, we touched four or five casualties and, since the proctors had no medical knowledge, we really weren't being critiqued. The lack of supplies may have made a difference as well. Everyone knows how hard it is to care for simulated patients (really your peers describing their wounds to you) while using simulated supplies.

That all changed in the last three days while our group completed the Combat Lifesaver course. This is an Army-developed curriculum designed to give typical soldiers some skills to save themselves or their buddies in the event of a traumatic injury. The soldiers are taught the four leading causes of death on the battlefield (hemorrhage, pneumothorax, airway compromise and hypothermia) and how to correct them. They learn to stop serious bleeding of an extremity using a combat tourniquet. They are taught how to recognize a chest wound, apply a chest seal dressing and even how to decompress a collapsed lung by inserting a needle through the chest wall.

The soldiers are also instructed in the use of a nasopharyngeal airway and how to insert an intravenous catheter (IV) into their partner's arm. The course culminates with seven-man teams entering a darkened simulation room that has fog machines and sound effects. The team must assess four casualties (utilizing some of the best simulation technology available), perform the necessary interventions and prepare their patients for air evacuation. The photo shows two airmen treating their simulated casualty.

The two medics assigned to the team and I have had a great three days instructing portions of the course, providing oversight during practical segments and observing during the final exercise. We have also had an opportunity to gain some incredible knowledge from the medics who instruct the course. These dedicated individuals have all spent time in combat zones around the globe and are enthusiastic to teach the average troop these necessary skills.

The simulation exercise was an eye-opener for many. I had a discussion with an instructor about how these men are trained to “shoot to kill” and have no qualms doing it to save themselves or their buddies. Yet, I was amazed how the cocky infantry soldier can freeze when faced with medical casualties whose lives hang in their hands. As a nurse and health-care provider, the opposite is so true—the idea of firing a weapon to harm another individual causes me some hesitation!

The idea for this course is to provide a foundation of knowledge that we now get to build on. We will definitely spend some time assessing a casualty and proper placement of tourniquets. The military works from a theory of muscle memory, and I plan to apply this approach to these lifesaving skills.

The skill the soldiers were most apprehensive about was starting an IV. They talked a big game, trying to sound tough to their buddies, but when the needle hit the arm, many became a bit squeamish and a few even passed out. I continue to reassure the troops that an IV is not an immediate intervention in battlefield medicine, as the military uses the latest in interosseous technology, making an IV nearly obsolete on the battlefield. But, it is another fear conquered, another skill learned, something else to add to their virtual “battlefield toolbox” and take along for reassurance.

Is the training of a non-medical individual to perform these procedures a concept we medical people have a hard time with? YES! I do worry they will believe they are now “medics” and “experts” in combat care. But, if we don't teach them how to save their buddy, we are doing them a disservice. Most combat fatalities would be lost, whether medical personal administered care or not, but the individuals who survive often do so because of the care their buddies rendered in the field. There are only three of us medics on this mission and we can't be everywhere at once. I will rest easier knowing we gave these soldiers one more skill set to help them and their buddies return home safely. Ensuring we all come home together is the ultimate goal of our year in Afghanistan.

Sunday, May 24, 2009

Memorial Day

I am often overcome by thoughts of those who gave the ultimate sacrifice, those lives lost to fight tyranny, overcome strife or stand up for what they know is right. For those of us preparing to enter a combat zone, Memorial Day takes on increased significance.

Before I go too far, I should point out that the day would likely slide by unnoticed as the training goes on. We were not given the typical three-day weekend to celebrate or even the day off. And, really, what would we have done if we had the time off? None of us have a car here. We are restricted to post (with a few exceptions) and, when we do leave, it is in uniform. We were invited to a local Memorial Day concert Friday evening, but between a long day of training and fighting off a virus, I chose to fall into bed shortly after dinner. A few friends did attend and said it was fun; the support of the local community was evident, something many soldiers don't experience often.

The true meaning of this American holiday hit tonight while I was in church. We managed to wrap up training ahead of schedule and the medics and I slipped into a crowded chapel for the contemporary service. Church here is always a time of reconciling mission with faith; I celebrate Jesus while wearing a pistol on my hip and a rifle at my feet. But to worship with 50 other soldiers, sailors and airmen, all training to enter a combat zone, and give thanks to those who went before, really drives the message home. We are so lucky to live in a country where you can choose your destiny, where freedom is celebrated and where a stranger is willing to lay down his or her life to allow us these opportunities.

So, today, fellow Americans, while you bask in the sun at the pool or grill with friends, spend a few minutes to remember those who paid the ultimate sacrifice for our freedom and know there are many, many more men and women taking up the cause so we can all live free.

Sunday, May 17, 2009

Not in Kansas Anymore...

Most days here, I feel like Dorothy in the Wizard of Oz. Can you just imagine the headline: "16 yr Air Force NP whisked away by tornado to the Dark Side"? I haven't touched a real patient in three months. I have managed to "simulate" some impressive traumatic-wound care, usually overseen by cadre with no medical background. One of my fellow providers laughed that she could have said just about anything and, as long as it was said with confidence, the observers would laud her performance!

What have I been doing? I have learned how to shoot a long rifle and a pistol (and done a pretty good job at it!). I have called fire commands to a gunner while riding in a HMMWV (and out-performed several Army teams). I have endured foot marches, daily physical training and radio courses. We have even undergone HMMWV rollover training in an impressively designed simulator. And, right now, I am currently living in a drafty tent, sleeping on a cot while manning a simulated FOB (forward operating base).

Tomorrow, my medics and I finally get to do our jobs. Tomorrow we are in charge of "base defense" and, as part of our responsibilities, we will be standing up an aid station to care for the simulated injuries we expect to sustain. We have reconned our assigned building, prepositioned some supplies, planned for some staff training on our responsibilities and gathered some supplies to simulate treatment. We are giddy with excitement! After a month and a half of "playing Army," we get our chance to show our stuff.

Yes, we are definitely NOT in Kansas anymore, but tomorrow we just might get a chance for a day trip back to visit. I'll let you know how it goes!

Wednesday, May 13, 2009

About Me!

Hi! I am Lori, aka the High Plains Practitioner. What does that mean? Well, I am an active duty Air Force Major, family nurse practitioner who is currently training to deploy to Afghanistan. I am also a wife, mother, daughter, sister, friend and lots more. I was asked by the publishing folk at the Honor Society of Nursing, Sigma Theta Tau International, to document my experience in Afghanistan over this next year, so this blog came to be.

Many people ask: Why the Air Force? My typical response – the Air Force choose me. I was attending Saline High School (in Saline, Michigan, a small town about 5 miles outside Ann Arbor) and interviewed extensively for an AF Academy slot. At one interview (my last), I was asked if I was ready to make the AF my career. As a typical teenager, my response went something like: “I don't even know what I am doing Friday night; how can I answer that question?” I then went on to attend Indiana University where, at my parents suggestion, I enrolled in the AF ROTC (Reserve Officer Training Corps) and discovered I really enjoyed the people and the structure the detachment provided me. Next thing I knew, I was awarded a four-year nursing scholarship and the rest is history!

Since entering active service in the fall of 1993, I have experienced an amazing career. I met my husband within months of arriving at Travis Air Force Base in beautiful northern California and we were married two years later. We have since lived in Ohio, Nevada, Washington, DC and are currently stationed in the southwest United States. Each assignment has been interesting – some more than others! Ohio is where we got our first “boy” - a golden retriever puppy named Tahoe. Nevada is where our human children arrived (Goose, our girl, in 2001 and Ham, our boy, in 2003). We had fantastic neighbors in DC who we continue to count as friends today. Our current assignment is one we went to hesitantly but have learned to love. We experience great schools, a true family-focused community and play as much golf as possible. Who could complain?!

For those of you who stuck with this to the end–thank you! I am excited to develop this blog to showcase the mission we are doing in Afghanistan and the role of NPs in rebuilding this war-torn country. For the rest of you, there will be plenty about my first deployment, my experience being away from my family and silly things that happen over the next 12 months. I am looking forward to this experience. Thank you for sharing it with me!