By Donna Miles
American Forces Press Service
BAGRAM AIRFIELD, Afghanistan, May 5, 2011 - A registry established six years ago to track casualty information from Iraq and Afghanistan is providing valuable data that's saving wounded warriors' lives, the commander of the theater hospital here reported.
The Defense Department launched what has grown to become the world's largest database of combat injuries in 2005. It captures details about wounds received, medical care provided at combat support hospitals, aboard ships and aircraft and throughout a patient's treatment, as well as the results.
Tellez called this knowledge base a huge advantage in helping medical care providers to identify treatments that proved most effective in treating patients with similar wounds. "It is how we follow statistically, over time, what made the difference," he said.
The registry, he said, provides insight from how much fluid to give patients to what types of blood products to administer to the best way to keep airways open, body temperatures controlled or infection rates down.
"It is making our course of care better and the management of care better," Tellez said. "It is a very dynamic, ongoing quality assurance of care."
He cited examples of the lessons that are improving the care wounded warriors receive and promoting the healing process. Tourniquets, for example, once discouraged for fear they could cause limb loss, now are embraced as a valuable life-saving tool. "We have learned that if you stop the bleeding, stop the hemorrhaging, you have a good chance of living," Tellez said.
Stomach wounds heal faster and are less prone to infection if left open, the registry revealed.
For patients suffering head trauma, doctors have learned the benefit of removing the skull cap until brain swelling goes down. When the skull cap was replaced too quickly, patients tended not to do so well, Tellez said.
"So, many times, that skull cap is now removed and later reconstructed. The brain is less swollen and less traumatized," he said.
After reconstruction and recovery, Tellez said, it's nearly impossible to detect that the patient ever had a large skull defect. "That is because we have learned how to better manage these types of wounds," he said.
The staff at the hospital applies these lessons daily in treating wounded warriors. During the first three months of 2011, they treated more than 2,300 trauma patients, with about 800 of them suffering the most severe "Level 1" injuries, Tellez said.
"It is a very dynamic trauma center," he said. "We are busy."
Despite the severity of injuries treated here, statistics show that the expertise of the hospital's medical staff– enlightened through the joint registry is making a difference. Ninety-eight percent of wounded troops who live to receive care at the Bagram facility ultimately survive, Tellez said.
"I would rival our care to [that offered at] any large tertiary-care center in America," he said.
Lessons learned here are extending beyond the combat zone, and are being embraced by civilian medical centers, Tellez noted.
"The things we are doing here have been adopted by many of the trauma centers in the U.S. and around the world," he said. "They are looking to us to improve the way they provide trauma care."
NATO International Security Assistance Force
Friday, May 06, 2011
By Elaine Sanchez
American Forces Press Service
WASHINGTON: Black-and-white photos of Vietnam-era veterans line the wall at a Veterans Affairs center. Some are smiling and others are gazing at a distant point, but in all, an unseen light catches the emotion in their eyes.
The photographer, Stacy Pearsall, a veteran of the more recent wars, strove to capture the character and the experience etched in their faces while listening to their recollections of war.
"Their stories are amazing," she said.
This line of photos on a wall in a VA center in Charleston, S.C., serves not only as Pearsall's veteran tribute, but also a milestone in her recovery from physical and emotional wounds of war.
Just a few months earlier, Pearsall had nearly given up hope of working as a photographer again or of taking photos that didn't serve as a haunting reminder of a painful past.
Pearsall's photography career took off while she was in the Air Force. As a combat photographer, she took thousands of pictures over the course of her Air Force career, earning her accolades and awards from leaders at all levels of her chain of command.
She traveled extensively for her job, so she felt prepared when she was tasked to deploy to Baghdad in September 2003.
As part of her duties, Pearsall documented a school rebuilding process, and when the school marked its opening with a ceremony in February 2004, she attended. After the ceremony, as the unit prepared to head out, the Humvee she was riding in was making a tight turn on a dead-end street when a roadside bomb detonated.
Pearsall was sitting behind the driver's seat. The impact threw her forward, and her head hit the back of the seat. But more concerned about her ears, which were bleeding from the concussive sound, she didn't feel the neck pain until hours later. She was seen by a doctor who chalked it up to whiplash, and she was back out on a mission the next day.
Months later, the headaches and vertigo lingered, as did the severe neck pain. But concerned about her Air Force career, Pearsall didn't seek treatment. Her deployment ended in March, and she became a student at Syracuse University for a year to hone her photography skills.
She had become accustomed to hiding her pain and the emotional after-effects of combat from others, but was unable to keep them from a friend -- a fellow photographer and Vietnam veteran -- who recognized the signs of post-traumatic stress. He connected her with a Vet Center, where she began counseling.
"It definitely helped me work through a lot of emotions and stress," she said. "I knew whatever I said to [my therapist] wouldn't go back to my active-duty command. There was no threat of losing my career."
After school, Pearsall went on back-to-back deployments, first to Africa, then to Lebanon and finally, back to Iraq. The difference between her first and second Iraq deployments was like night and day, she said. In 2003, she never fired her weapon, but in 2007, she fired it constantly.
Her unit experienced heavy casualties in Diyala province. Pearsall saw bodies of Iraqis who had been executed and mutilated, and comrades shot just a few feet away, which she later had to photograph. People getting wounded or killed was a daily occurrence, she said.
A series of back-to-back events took their toll. Pearsall lost three teammates, and a day later, her video partner was wounded and evacuated. Another friend had been shot in the head right in front of her. "Nothing prepares you for the death of your friends," she said.
Her photos from that time are haunting.
In one photo, three soldiers are gathered in a dimly lit room, faces downward as if in reflection, a single light shining through a window. Two days before, their teammate had been shot in the head just 10 feet away from where they were standing. In another photo, two soldiers are comforting each other, one close to tears, after the loss of a friend the day before.
"I'm eternally tied to the photographs that I made and those soldiers who were in those photographs," she said.
The photographer said she had to keep her emotions in check, for her teammates and for the troops who served under her. "I think I handled things pretty well by just not addressing the emotions at the time," she said.
Pearsall was injured again -- further damaging her neck -- when a roadside bomb detonated during a mission. A few months later, her unit was ambushed. She was running out to help a wounded soldier in the street when a cord attached to her helmet snapped her back. Her head slammed on a Stryker vehicle, again injuring her neck.
The next morning, she felt neck pain unlike anything she had felt before, and she knew it was time to get help. The doctors did an X-ray and she was on a helicopter that day. Her neck injury had grown so severe, the doctors told her, that if she had jolted her head one more time, it would have severed her spinal cord.
Pearsall's greatest fear -- losing her career -- was now at hand, she said. And her husband, a strong source of support, was deployed at the time. "It was a really ugly time in my life," she said.
The years of wearing 85 pounds of gear had wreaked havoc on her neck. The doctors told her she wouldn't be able to work as a photographer or pursue another passion, riding horses, again.
But Dr. Patrick Lovegrove, an Air Force flight surgeon at the time, offered her hope through prolotherapy treatment -- which involves insertion of a 4-inch needle down to the bone -- that lasted for more than two years. Pearsall was able to get off of the pain killers and finally on the road to physical recovery.
Invested in her recovery, her doctor separated from the Air Force, but continued to donate his services to her until the therapy ended in 2009 and she switched over to the VA system.
"I'll always owe him a debt of gratitude," she said. The therapy enabled her to ride horses and take photos again, but she knew she'd always have some degree of pain from her degenerative condition.
"It was either adapt to life or shrivel up and die," she said. Pearsall chose to adapt.
But the loss of her Air Force career affected her, as did the emotional wounds of war that she had pushed aside to focus on her physical recovery. She started seeing a mental health therapist about a year after her deployment.
"The military told me I couldn't be a photographer for them anymore," she said. "Mentally, that put me on a roller coaster. What am I good for?"
Pearsall found an answer at the VA medical center in Charleston. While she sat for hours in waiting rooms, she began to notice the men and women around her. Most of the veterans there were from the Vietnam era, and she reached out to hear their stories. She felt inspired to bring her camera and take their portraits, leading to the project that now fills a wall there.
"Just because I was disabled, didn't make me unable," she said. "Once I wrapped my own mind around that, I could do more."
Pearsall plans to keep up her veteran portrait work at VA hospitals in Georgia and North Carolina, then here, and to Maryland and Virginia as well. In another effort aimed at helping veterans, Pearsall provides horse therapy to veterans through a nonprofit group.
Most recently, Pearsall offered to have her story documented for the Defense Department's "Real Warriors" campaign in hopes of encouraging other veterans and servicemembers to seek help. The campaign in sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, and it features stories of service members who sought psychological treatment and continued successful military or civilian careers. Her profile is now posted on the Real Warriors website, http://realwarriors.net/.
"My hope is that if they watch my story, they'll find a way to offload their burden," she said. "Everyone wears a different amount, but it's not necessary to carry it around with you all the time."
Pearsall said the stigma that kept her from getting help has been greatly reduced through projects such as the Real Warrior campaign and through efforts by the Defense and Veterans Affairs departments.
For servicemembers still leery about getting care, Pearsall recommended online support networks, blogs and forums where people can go and shed their burdens. "You'll see you're not alone," she said. "The loss of sleep, nightmares, anxiety, road rage -- they're products of war."
Pearsall also hopes leaders will gain a greater understanding of mental health issues and, above all, avoid judgment.
"Be positive and supportive," she said. "You're the first in line for that service member."
While it's been difficult to discuss, Pearsall said, she believes it's important to share her story.
"If I get one person to get help if they're having issues, then I feel like I've been successful," she said. (Issued on May 4, 2011)
Army Spc. Chris Jankowski, Army Spc. Joshua Philbeck and Army Staff Sgt. Lawrence Washington take time to reflect on their departed friends during some down time in Buhriz, Iraq, Jan. 27, 2007. U.S. Air Force photo by Stacy Pearsall
By Donna Miles
American Forces Press Service
RAMSTEIN AIR BASE, Germany: Minutes after takeoff here, Air Force Col. (Dr.) Charles Chappuis jumped to his feet aboard a C-17 Globemaster III aircraft to check on Army Spc. Adam Castagna, one of three critical patients under his care being transported to the United States for advanced medical care.
Castagna was among 24 patients aboard the April 29 aeromedical evacuation flight to Joint Base Andrews, Md. Seven patients were in critical condition, requiring two critical-care teams –- in this case, an Air National Guard team and an active duty team –- to monitor them continually during the eight-hour flight.
Eleven days earlier, 14 days shy of his 2nd Stryker Cavalry Regiment's redeployment to Vilseck, Germany, Castagna had been on a patrol in the Panjwai district of Afghanistan's Kandahar province. An enemy attack on his platoon, and the explosion that ensued resulted in the wounding of his right eye and liver which ultimately cost 37-year-old Castagna his spleen, his younger brother, Mike, explained.
In past conflicts, patients with wounds as severe as Castagna's never could have been transported so early in their recovery. But the critical care air transport teams have changed all that, said Air Force Lt. Col. (Dr.) Raymond Fang, trauma director at Landstuhl Regional Medical Center in Germany.
The teams not only speed up the process of moving patients to increasingly more advanced care closer to their loved ones, but also free up hospital space needed for newer battlefield casualties.
"We can't hold everybody at Bagram [Airfield in Afghanistan], and we can't hold everybody until they are well at Landstuhl," Chappuis said. "We have to keep them moving, because there are more coming. And if we don't move them, then we reach our chokepoint. So our goal is to progressively move them until they are back in the United States."
With every patient move, he said, the goal is to provide "not only first-class care, but a step up in the advancement of care."
The critical-care teams work closely with primary-care and trauma teams to ensure patients' movement through that continuum of care is as safe and smooth as possible. "We get them to as good as we can get them before they get on the aircraft" to minimize, and ideally, eliminate complications, Chappuis said.
With about 750 pounds of high-tech medical equipment that essentially turns an aircraft into an airborne intensive-care unit, the teams ensure there's no lapse in patient care during transport.
"Our environment has been described as a flying ICU, and I think we provide the equivalent high-tech medicine that you would get if you were in an ICU in Washington, D.C.," Chappuis said. "We have all the drugs and all the equipment to monitor the patients. And I think the proof of that is our success rates are so good."
In January, the Air Guard readopted the critical-care transport team mission, which it had phased out about six years ago, bringing welcomed support to active-duty and Air Force Reserve teams that had been conducting the mission, along with a wealth of civilian trauma-care experience.
Chappuis, for example, has 30 years of surgical experience under his belt. When not in uniform with the Louisiana Air National Guard, he works as a professor of clinical surgery at Louisiana State University School of Medicine and as chief of surgery at the University Medical Center in Lafayette, La.
In addition to being a Kentucky Air Guardsman, Air Force Lt. David Worley, the team's critical care nurse, works in his civilian capacity as a cardiac catheterization lab nurse at a hospital in Louisville, Ky. Air Force Tech. Sgt. Chris Howard, from the North Carolina Air National Guard, works as a respiratory therapist for the team, and also as a civilian at Carolinas Medical Center Pineville near Charlotte, N.C.
"From a Guard standpoint, we bring a tremendous amount of experience from the civilian world," Chappuis said. "We do this almost every day at home, and it brings a tremendous amount of medical experience to the fight."
Air Force Lt. Col. Kathleen Flarity, commander of aeromedical evacuation at Bagram, called incorporating the Air Guard into critical care teams "a great idea." The biggest plus, she said, is the wealth of clinical experience the Guardsmen bring to the mission.
"They are phenomenal –- really smart, talented people," she said.
Air Force Staff Sgt. Napolean Gifford, an active-duty respiratory therapist with the 10th Expeditionary Aeromedical Evacuation Flight, said he's happy to work side by side with experienced Guard critical-care teams.
"It really helps, because they bring a lot of trauma experience from working at large trauma centers," said Gifford, a Douglas, Ga., native.
With a steady load of patients being transported from the combat theater to Landstuhl and on to Andrews, Fang welcomed the expanded the pool of military professionals qualified to conduct critical-care air transport missions, noting that the number of people with their experience is limited, and the training experience in the Guard broadens the pool of people qualified to serve on the teams.
Developing the clinic skills and abilities for critical-care transport teams takes years, Chappuis explained. Beyond the traditional critical-care skill sets, it requires about five weeks of highly specialized training.
The training culminates with a demanding two-week Center for Sustainment of Trauma and Readiness Skills, or C-STARS, training at the University of Cincinnati in Ohio, where simulation that replicates realistic scenarios subjects trainees to the most extreme rigors they'll face in critical-care transport.
"It is kind of like the 'Wizard of Oz,'" Chappuis said. "There is somebody in the back room controlling the computer and videotaping everything, and then there is another person in the room actually watching you. And you are graded every time you go through the simulation."
Successful completion of C-STARS is required before deploying for CCAT duty. "By the time you complete the course, you have demonstrated if you can cut it or not," Chappuis said. "If you don't make the cut at C-STARS, then you don't deploy."
While the teams are trained and equipped to treat the most severe medical complications in the most challenging in-flight situations, Fang said, the goal is to ensure a calm, controlled airborne experience.
"They are almost like the firemen," he said of the critical-care teams. "You want them on the plane if the patient has problems, but ideally, it is a standard ICU shift. And in most ICU shifts, you don't see people running around like crazy. You have it calm, and there is a plan, and you take care of the patient."
Mike Castagna praised the care the transport team and every other military medical professional has provided since his brother was wounded. "The care he has gotten every step of the way has been exceptional," he said. "It has far exceeded anything I have ever seen in a civilian hospital."
Castagna's movement through his continuum of care hasn't been without its roller-coaster moments. He received initial care at the Kandahar Airfield Hospital, then the Staff Sgt. Heathe N. Craig Joint Theater Hospital at Bagram before making the seven-hour aeromedical evacuation flight her to get treatment at Landstuhl. During that flight, one of Castagna's arteries burst, and a critical-care transport team immediately put him on life support, his brother said.
Castagna's entire family and his fiancée flew to Germany to be with him, fearing the worst. But accompanying his brother during the flight to Andrews, Castagna marveled at his progress since the live-saving intervention.
"Literally, in a day and a half, he went from being on life support to talking with us," he said.
Guardsmen say the chance to make a difference for wounded warriors like Castagna makes then want to be part of the all-volunteer mission. "Nobody called us up and said, 'Hey, it is your turn,'" Chappuis said.
Howard, at Ramstein for a six-month deployment, said he jumped at the critical-care air transport opportunity as soon as the Air Guard adopted the mission. "It's satisfying," he said. "For me, it was a way to give back."
"The opportunity to come here and help kids get home is a great opportunity for me, and that is why I chose to do it," agreed Worley. "It's a very good mission. It's what we would want for our own families."
That's exactly what Chappuis said he tells his wife when he explains why he volunteered.
"I have grown children. If it was one of my children, I would want the absolute best care for them to make these multiple flights from Afghanistan or Iraq back to the United States," he said. "And if that is my desire for my children, I should be ready to pony up and do it myself." (Issued on May 3, 2011)
Air National Guard