ROLE 3 Welcomes Us

Kandahar, Afghanistan

The Master Chief, our senior enlisted,  welcomed us last week with the following profound statement: "You're still in a shithole, but it's the best shithole in all of Afghanistan!"  Another boast we can make is that we clearly will be working in the best hospital in all Afghanistan, but not yet.

The medical detachment is called ROLE 3.  It is a NATO establishment run by the US Navy.  Bagram AFB is north of us by about an hour by air, with very robust medical capabilities as well.  Camp Bastion is our cousin to the west, with similar capabilities, but we are technically more capable than Bastion, based on subspecialties present here.  Trauma is our business, all of us.

 MRAPs


There are other smaller bases, called Forward Operating Bases, to which a casualty can be medevacced for damage control surgery.  From the FOB, once the casualty was stabilized, the wounded soldier (or local national) would be transported to us, or one of the other two "big boys."

One would imagine that these state of the art trauma facilities would be bright and shiny, with all the bells and whistles needed to stabilize these often very mangled wounded men and women.  I was a bit surprised to see the half-cylinder tents that contained the trauma bays and operating rooms.  Inside these canvas "walls" there is also an ER, a small medicine ward, a dental clinic, a radiology "suite", and a detainee holding area for sick or wounded detainees.  Before I came out here they were described to me as "ghetto." That's fair.  We get the job done, though, as I saw first hand today.

In about a month we will move into the best hospital in all Afghanistan.  The Germans are building the new NATO ROLE 3.  It's going to be quite an improvement, a brick and mortar two storied structure that looks more impressive than many tertiary care facilities I've seen in the US.

Today we had a continuation of an orientation scheduled - a mock mass casualty in which we - the FNG's ("f*kg new guys") - would run a trauma from offloading at the ambulance drop-off point, until the patient went to the OR.  We ran one reasonably chaotic scenario.  Before we could run the second of four scenarios, 4 actual casualties came barreling in, some very sick folks.  Suicide bomber.  We had had about a 15 minute heads up, during which time the actual trauma teams assembled.  The FNG's got to watch the organized chaos of airway-breathing-circulation, ripping off of clothes, chest tubes, central lines, intubations of airways... I was tapped to put in a central line into one of the casualties, a straw sized catheter into the femoral vein.  However, the casualties already had good IV access, but my "sweat pumps" were running on high.

It was exciting to watch, and we were impressed that the organized chaos produced rapid results.  Within minutes the casualties were in the OR getting their initial surgeries.  Soon we won't be observers, we'll be "do-ers," and hopefully we'll be able to  the chaotic ballet that we were able to observe.  We will.


Kandahar Marathon - you've got to be kidding, right?  (nope).  Missed it...