Portal de Periódicos da CAPES

A Hero

2008; Wiley; Volume: 15; Issue: 12 Linguagem: Inglês

10.1111/j.1553-2712.2008.00078.x

1553-2712

Vikhyat S. Bebarta,

Disaster Response and Management

Today was the most stirring and gruesome day in Iraq for me. The emergency department (ED) received a radio call from our helicopter medic crew. They were bringing in four “Urgents” (critically ill patients). Unfortunately, we do not receive much information from these calls, only the number of patients, category of severity, and estimated time of arrival. He was 2 mics (minutes) out, but we could already hear the rhythmic thumping of the Blackhawk’s rotators. The medic’s voice was tense. “Caretaker ED, we’re bringing 2 Urgent litters, and . . . 2 Urgent ambulatory . . . we don’t have IV access yet . . . we’ll be there in 2 mics.” Just prior to their arrival, we received a phone call informing us that an improvised explosive device (IED) had exploded under a Bradley tank and set it ablaze. The incoming patients were likely from this calamity; the uncertainty and ambiguity in combat, also known as the “fog of war,” usually prevents us from being sure of what is arriving. The first patient arrived, screaming in pain from his 50% body surface area burns, an unmistakable life-threatening injury. Unfortunately, we had seen similar injuries this week; the insurgents had changed their tactics to set off larger explosives along the roads. Before the other patients arrived at the ED, another medic radioed in that his chopper crew was bringing us another four patients, badly burned, for a total of eight U.S. Army soldiers. This barrage of critical patients surpassed our usual capacity and we recruited other emergency physicians and surgeons not on duty. The injured men of this fighting group were of an elite infantry division—self-disciplined, resilient, and brawny. However, as each litter patient rolled in on a rickshaw (military gurney), they were either silent, in mental shock, or crying out from the intense pain. All but one soldier had 50%–70% deep second- and third-degree skin burns. Because of their oral, laryngeal, and pulmonary burns, each required intubation and mechanical ventilation. The experience was harrowing—the stern men shrieking from pain, the ambient stench of charred tissue, and the bravery for which these soldiers may die. One of the young men I took care of was awake and conversant. He appeared to be only a few years out of high school, although the burns and grime marred his face. To determine his injuries, I asked him to recall the events. He was disoriented and his searing injuries distracted him. He had been either ejected from the vehicle or instinctively fled the vehicle immediately and unscathed after the bombing. However, his fellow soldiers were still in the flame-engulfed Bradley tank. In his words, “I went back in to get my medic!” I only had one technician by my side for this difficult tracheal intubation; all of the other physicians, nurses, and emergency technicians were frantically treating other patients. I administered the induction and paralytic agents, while he preoxygenated the patient and assisted me as I placed the endotracheal tube in the patient’s singed oropharynx and through his soot-covered and edematous vocal cords. I sedated him with pain medication and placed him on a mechanical ventilator. My patient had arrived with inhalational injury and burns covering 70% of his skin surface, a nearly lethal injury. He was still alive, but barely. He was rushed to the operating room and followed in-line by his peers. By a fortunate act, the flight surgeons assembled several available aircraft and all eight patients were urgently flown out of Iraq to Landstuhl Regional Medical Center in Germany within hours of the explosion. They were escorted to Germany by a critical care air transport team (CCAT team), headed by an emergency physician, and to the San Antonio military burn center by the military burn team. Seven days later, a soldier from my patient’s fighting unit came to our emergency department for a minor injury. He informed us that my patient had died shortly after arriving in Texas. The young soldier told us that my patient not only saved his medic, but he also returned to the blazing Bradley tank several more times, to save the remaining soldiers trapped to die in the detonated vehicle. He alone had rescued his team. When he went back into the fiery and searing tank, he had to have known he would not survive. The members of this cohesive combat unit were saved due to one luminary, one hero. These are the men and women fighting bravely everyday without recognition. To hear of these stories on television or read them in a newspaper sounds mundane and pedestrian, but to witness the event and care for the patient is unsettling. This and similar experiences, faced almost every day in Iraq, challenge our individual character and deepen our compassion as military physicians. I am thankful for the valiant and resolute troops, their devoted and tender families, and the compassionate and dedicated physicians, nurses, and medical technicians deployed in support of Operation Enduring Freedom and Operation Iraqi Freedom.