Mass Casualty

Kandahar, Afghanistan


One of the ROLE 3 Operating Rooms

"Mass Casualty," or "MASCAL" in our lexicon, is a term most of us would rather not hear.  Something truly bad has happened, to a lot of people.  Our trauma bays fill up all at once and a mass page goes out to all hands involved in handling trauma.  This was what we were supposed to be training for in Fort Lewis, Washington during the month leading up our arrival in Kandahar.

A true MASCAL can be gruesome in many ways.  There will undoubtedly be casualties who are dead on arrival, likely several mangled or severely wounded persons, and a triage bay will need to be set up to prioritize care.  We get the word triage from the French verb trier, meaning to sort.  A sad reality of a true MASCAL is that some casualties that arrive alive will be quickly sorted into the expectant category, meaning that they will be expected to die.  These patients are given medications to make them comfortable - morphine for example - but generally they will not be placed in one of the other categories once committed to this one. The other categories are delayed (care can be delayed), immediate (life, limb or eyesight is at risk), and minor.  Obviously, patients can be upgraded or downgraded as the MASCAL plays out.  Traditionally the unit dentist or oral surgeon is the Triage Officer, the person who has to play God on this bloody stage.  I believe I may be tasked to be the next Triage Officer when we move into the new hospital.  I do not look forward to this task, however necessary it may be.

Yesterday at 1:30 am I got the mass page, the one everyone else got too.  "12 casualties inbound.  Plane crash.  Report to the trauma bay."  It didn't explicitly say "MASCAL" but you got the message.  This was the real deal.  My roommate and I stumbled quickly into the inky black night.  It was surrealistically quiet as we rushed toward the ROLE 3.  Helicopters could be heard spanking the air in the distance.

I arrived to see the beehive of activity in the trauma bay.  The staff were remarkably quiet and workmanlike.  I was happy to see that.   There were no truly mangled bodies or people "actively trying to die," as we say.  Four had already been pronounced dead on arrival.

This is in the newspapers by the way, I am not divulging state secrets.  A V-22 Osprey had crashed for reasons as yet unclear.  You may have heard of the Osprey:  it is a twin rotor, half-plane/half-helicopter which rotates its rotors forward like a plane once it is airborne.  It looks like something out of Avatar.  I was actually surprised to see 5 of them flying in formation a few days ago here on post.  The last I had heard of the Osprey, Congress was thinking of canceling the program because of its terrible track record during the operational testing phase.  A few years back 19 Marines were killed in an Osprey crash.  There were numerous other close calls and crashes that I recall reading about.  No doubt this latest accident will call the platform into question again.

The casualties were prioritized but there was no need for a Triage Officer.  Patients were prioritized based on their clinical picture and what their CT scans looked like.  Excellent care was rendered.  We busted our asses for the next 15 or so hours, and the medevac assets were mobilized.  The most severely wounded should be at a higher echelon of care as I write this.  I made it back home to my cave yesterday afternoon and passed out.

Kandahar Post Office.  Flag at half mast, again.