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Afganistan was i ready for that- langcake


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  • 1. WAS I READY FOR THAT? Mary Langcake FRACS SQNLDR RAAFSR Director of Trauma St George Hospital Sydney NSW
  • 2. NO!
  • 3. READY FOR WHAT?  The Mission  The training  The reality  Coping?  The aftermath  Progress report  Personal balance sheet  How can one be ready?
  • 4. THE MISSION  AUSMTF2 – 22 July – 04 Oct 2008  Deployed to Tarin Kowt in Uruzgan, Afghanistan  Tasked to:  augment the Dutch Role 2e hospital in TK  provide Combat Health Support to NATO-led International Security Force (ISAF) including Afghan Security Forces (ANSF), and eye-, life- and limb- saving health support to local nationals (LN)
  • 5. THE MISSION  AUSMTF2 – the team  RAAF – PAF and SR  Specialist MO's – General and Orthopaedic Surgeons, Anaesthetists  Nurses – Perioperative and Intensive Care  Medical Assistants – OT and ICU  OIC – Perioperative Nurse with subunit command experience
  • 6. THE TRAINING  MRE  Netherlands April 2008  met and trained with 420 Hosp Cie  reviewed equipment  rehearsed casualty scenarios  rehearsed MASCAL
  • 7. THE TRAINING  Force Prep – RAAF  information re culture, conditions, welfare, support  classified information about risks etc  RSO&I – MEAO  acclimatisation – 50o C, dusty  briefings  weapons training  TCCC
  • 8. THE REALITY One of the highest rates of battlefield trauma experienced by a solitary ADF surgical and intensive care capability in recent history
  • 9. THE REALITY CASELOAD In 75 days 132 presentations to theatre – 78% emergency 158 surgical procedures – 81% emergency 26% ISAF – 50% AS >29% - <16yo Casemix general – 43% orthopaedic - 57% 41% penetrating trauma: GSW, Blast, Knife 
  • 10. THE REALITY  MASCAL  Sept 2 2008 – SOTG came under sustained , heavy enemy fire  high velocity firearms, RPGs, mortars  Fire fight lasted approx 4 hours  11 casualties  9 evacuated – 7 → Role 2e 2 → FST
  • 11. THE REALITY  Penetrating injuries from both GSW and blast fragmentation  One soldier critically injured with life-threatening wounds  Remainder – fragmentation injury +/- GSW  Multiple procedures into the early hours of the morning  FST casualties admitted and required RTT  Critically injured soldier underwent re-look laparotomy then evacuated to Landstuhl
  • 13. COPING – RSO&I  Struggled with rapid fire exercise due to knee  520 C on day of weapons training heat exhaustion  Threatened with RTA  Confidence shaken
  • 14. COPING – TARIN KOWT • Casemix outside of civilian experience
  • 15. COPING - TARIN KOWT High operational intensity  no time to “pick yourself up, dust yourself off and start all over again”
  • 16. COPING – TARIN KOWT • No “personal space” • Environment
  • 17. CHILDREN  8 yo boy  GSW (L) thigh, exit ® flank  Shocked  DCL – stabilised  Turned over for debridement of flank wound bradycardia, BP  died on the operating table – “missed” injury to IVC
  • 18. CHILDREN  13 yo boy  Accidental shotgun wound (L) thigh  Shocked  Leg pulseless, paralysed, anaesthetic
  • 19. ILDREN morrhage control Fix femur mpt to revascularise % of SFA missing uccessful attempt to scularise AKA
  • 20. MOTIONAL DISTRESS ut of my depth ot good enough ividly reliving failure to save child nsomnia norexia
  • 21. E AFTERMATH old I was “a disappointment” as an officer Confirmed my belief “crashed and burned” wo days later – flight out delayed by dust storm MASCAL – trauma team leader Off duty after 0200
  • 22. E AFTERMATH mmunition removed from magazine Weapon disabled without my knowledge
  • 23. E AFTERMATH fraid to go back to civilian practice in case I made mistakes
  • 24. E AFTERMATH id not initially seek help My fault for not being up to the challenge lanned to resign from RAAF elt humiliated upported by RAAF to take leave of absence from vilian employment
  • 25. E AFTERMATH rofessional help Diagnosed major depression and PTSD On-going management
  • 26. OGRESS REPORT till “relive” events on occasion
  • 27. OGRESS REPORT Poster girl for how we got it wrong” ime heals all wounds he positives outweigh the negatives have gained more than I lost Would like to “get back on the horse”
  • 28. RSONAL BALANCE SHEET ROS Friendship Teamwork Afghanis Experience in trauma Acquiring new skills Service • CONS – Demands of casemix – Emotional challenges – PTSD
  • 29. OW CAN ONE BE “READY”? RAIN FOR CASEMIX mprove pre-deployment training Simulations Work as teams Paediatric trauma experience Visit trauma centres with high caseload of penetrating trauma CSTARS Senior visiting surgeons program to Landstuhl Emergency War Surgery Course - Lackland Air Force Base, US
  • 30. TTER PSYCHOLOGICAL SUPPORT ORE DEPLOYMENT  More opportunity to speak with those who have been before “forewarned is forearmed”  More time off before leaving – I was making calls about patients at the airport  Don’t deploy members with history of psychological illness?  Would have precluded >50% of the team  But be aware they may have greater need of psychological support even if they continue to perform “above and beyond the call”
  • 31. TTER PSYCHOLOGICAL SUPPORT DEPLOYMENT  Only a Padre on base  Phoning home not always an option due to OPSEC  Individuals may take multiple hits with little if any down time to “pick themselves up”  Requires good team leadership but other deployment issues often a higher priority particularly during high
  • 32. OW CAN ONE BE “READY”? ind some space even if it is under the covers! ell people if you are struggling, don’t expect hem to guess ealise the “goalposts” are different and be repared to accept it (tough in reality) orgiveness – yourself, others
  • 34. “We have to do the best we can. This is our sacred human responsibility.” Albert Einstein
  • 35. THANK YOU