The Med Unit held a Combat Life Support -- CLS -- refresher for the SecFor guys a few days ago, and they let me tag along to try to pick up some pointers. I had gotten a two-day intro to CLS before I came to Afghanistan and loved it, and I was grateful that they let me sit in for the refresher even though I was never officially certified. It also shows a certain willingness to pitch in during emergencies rather than just being cargo; "good that you're trying to be more than just self-loading baggage," the XO said.
The SecFor guys can't shake their happy-go-lucky nature, so CLS class was a quick classroom refresher followed by an hour of cavorting in the sun for the practical exercise. The classroom time really just sought to reinforce the need to tourniquet early and often, although I did learn a few new and exciting medical nuggets. For example:
-- If bullets are still flying, everyone -- including the medics -- should be shooting back. "The single best medicine on any given battlefield is FIRE SUPERIORITY," we were told.
-- All CLS certified personnel can put in IVs. Generally speaking, CLS-certified personnel shouldn't bother putting in IVs, since too often people get distractedly obsessed with doing so and the patient bleeds to death while they're looking for the vein. (I never learned to put in IVs; doc promised to teach me if I swing by the Med Unit).
-- Don't get shot in the chest. That's really the big take home message of combat medicine. If you get shot in the chest, you'll probably end up with a sucking chest wound, and then air will build up in the chest cavity, and then the medics will have to stab you in the chest, through the ribs, with a gigantic, 14-gauge hollow needle to relieve the pressure so your lung doesn't collapse. "You'll thank them," the instructor told us. I'm not sure I believe that.
After classroom time, we walked down to the running trail. It was a perfect day for hanging out in the dust practicing medicine -- sunny and clear, hot with just a little bit of breeze. We split into groups of five, and I invited myself along with four of the Guam guys rather than sticking with the one other civilian who'd been in the training. The Guamanians bring a laid-back, fun-loving island attitude to everything they do, and it made it hard to recreate the actual stress of real-world combat medicine. "Trust me," the instructor said. "Doing this during actual combat SUCKS."
We started at the tourniquet station, but it was a little chaotic as people were still dividing into groups and figuring out where they should go, and we weren't sure if we should start or not. "Do you have any questions about tourniquets?" the instructor at the station asked. No one did. Before anyone could practice putting one on, the medic leading the training shouted "ROTATE! GO! GO! GO! Combat HUSTLE!"
My group took "Combat HUSTLE!" to mean "sprint between stations," and we did -- the Guam guys shouting GO! GO! GO! GO! GO! the entire way.
We arrived en mass at the stretcher station. "That sergeant over there is down and needs a stretcher!" the instructor said, waving towards a guy reclining in the dust. "Go get him!" The stretchers are stored folded into a small square, and getting them extended out to a usable format is apparently difficult; you have to unfold it, pull on it, and then twist the handles simultaneously to get a flat platform on which the patient can rest. The Guam guys wrestled with it for about 20 seconds when another group (slower than ours -- they apparently didn't get the "combat hustle" memo) showed up. "Looks like we're double booked," the instructor said. "You guys can go ahead and rotate."
As soon as she said the word rotate, the Guam guys started shouting "GO! GO! GO!" again, and we were off, sprinting like idiots. The instructor for the next station was standing next to mound of dirt, not unlike a snow-fort you might make if were living in place that had snow instead of several inches of hot dust on the ground. "All right!" said the instructor. "One of you has been shot in the chest!" I clutched my chest and threw myself theatrically into the dirt, hyperventilating. "I've been shot in the chest!" I shouted. "DAKOTA'S BEEN SHOT IN THE CHEST!" the Guam guys shouted. "Bang bang!" said the instructor. "They're shooting at you!"
One of the Guam guys grabbed me from behind, sliding his arms under my armpits and lifting me from the shoulders; another grabbed my legs at the knee, and the two of them picked me up more or less effortlessly and carried me behind the dirt pile. They dropped me and then joined the other guys, who were peering over the top of the dirt pile with index fingers and thumbs extended, pantomiming shooting and shouting "bang bang bang bang bang!" (Only one of the four pantomimed holding a rifle; finger pistols were the order of the day). "Ok!" shouted the instructor. "Treat the patient!"
They got out a kind of bandage made of plastic called a chest seal ("wounds from neck to navel get a piece of plastic"), pressed one to the front of my chest and the other to the back where the exit wound would be. "Anything else?" the instructor asked. "NEEDLE DECOMPRESSION!" they shouted simultaneously. (One thing's for sure: you can't fault the Guam guys for enthusiasm). They got out the ridiculous needle for chest decompression, counted down the correct number of ribs, and then indicated they'd stab it in right there. "Good," said the instructor. "Not good," I said. "You didn't say anything about anesthetic."
"ROTATE!" they called, and off we sprinted.
The next station was on pressure bandaging. "Your buddy's bleeding heavily from the arm and leg! Fix him up!" the instructor said, waving to another instructor lying on the ground. Two of the Guam guys sprung into action, one with an Israeli bandage (a wrap with a piece of plastic embedded in it to act as a fulcrum for putting pressure on wounds) and the other with quick-clot laced bandages and an ace wrap. It quickly appeared to devolve into a competition to see who could use the most gauze, resulting in a mummy-like conglomeration that may or may not have been effective stopping blood flow but that was definitely fun to look at. "We would've just tourniqueted him anyways," they said.
Pressure bandaging was the last stop, and all the groups came back together; it had been a fun training and everyone was in a good mood, laughing, drinking water, and standing in the shade of the ambulance practicing different ways of carrying patients. "Fireman's carry!" they shouted. "Assisted walking! Doberman!"
"What's the Doberman?" I asked. "Well, you get down on all fours and straddle the patient," I was told. "He wraps his arms around your neck, and you drag him forward on all fours, like you're a doberman." One guy threw himself on the ground to demonstrate, lying face up on his back in the dirt. The other guy got down on all fours on top of the patient, as promised, and the patient put his arms around his neck and interlocked his fingers so he could be dragged forward. The medic took about single step, dragging the patient about a foot. The patient shrieked and let go -- apparently the act of dragging him had filled up the seat of his pants with a good amount of hot, fine-powder dust.
"All right, listen up!" the lead medic shouted. "We're not done! There was an IED attack! We've got a MasCal! The patients are just over that hill -- GO! You've got FIVE MINUTES till the med-evac birds get here!"
(A MasCal is a "MASs CasuALty event." The wonkiness of the abbreviation had never occurred to me until I typed it out).
We all ran over the hill, and all the medics who had previously been stations instructors had arranged themselves in various positions. I was in the first wave that scattered to deal with patients, while a second wave ran off to get supplies. I took the farthest patient, a guy who'd pulled his foot up into his pants to simulate losing a foot. I took his tourniquet from him -- everyone carries a first aid kit for the medics to use; you in essence carry your own medical supplies to be used on yourself -- and put it on his leg as instructed, as close to the joint as possible.
"Too high," he told me. "For a foot wound like this, you'd want it lower, so more of the leg could be saved once they got me into surgery." I moved it to below the knee. The lead medic came up behind me, stopping briefly to grab a shoe ("Didja lose this?" she asked the patient) before heading over. "Tourniquet's WAY too low," she told me. "Put it as close to the joint as possible." I looked at the patient and he looked sheepish, and I moved the tourniquet. Just then, two helicopters flew over head. "The birds are here! Move the patients! GO GO GO!" (The helicopters weren't part of the training; it just so happens that the running trail abuts one of the helipads, and the trainers got lucky in the timing of the landing).
A Guamanian ran up with a stretcher. They loaded the patient on and then started jogging him towards the ambulance. "Combat speed!" they said, promptly dropping him into the dust. "Try again!" they shouted, hauling him back up and, eventually, wobblingly, over the finish line.
CLS training was outstandingly fun and a good little refresher of how to use everything in the med kits we all carry, but I largely put it out of my mind until I got an email this morning, asking if I'd mind if Public Affairs used my photo in their newsletter. They try to find bizarre looking photos for the newsletter and then have people write in with captions for them, a la the New Yorker. A shot of me and one of the Guam guys sprinting between stations had been chosen. "Everyone," they told me, "will appreciate what appears to be a random civilian being chased by a crazed Guamanian."
I for one look forward to the captions.