Heroes 2011
'I didn't have a lot of good options'
View Gallery (4 images)
At first, it looked to be an all too common injury at one of the busiest trauma hospitals in Afghanistan: a cartridge — used as shrapnel in a roadside bomb blast — lodged in the skull of an Afghan soldier. But when radiologist Dr. (Lt. Col.) Anthony Terreri took a closer look at a high-resolution CAT scan March 18, 2010, he saw that the round was not entirely made of metal.
He showed the scan to Bagram Air Field’s head trauma surgeon, Air Force Dr. (Maj.) John Bini.
“You could see that it was a metal jacket with something else inside,” Bini said.
That something else was about 5 grams of explosive.
Bini called the bomb squad.
Removing unexploded ordnance from a patient is one of the lesser-used skills of military trauma surgeons. Nearly all surgeons go their entire career without ever encountering such a case. But Bini knew the protocol, having taught classes on that very subject to students at Wilford Hall Medical Center at Lackland Air Force Base in Texas.
“We have certain principles,” Bini said. “One is you try to recognize these things before it ends up in your operating room.”
But it was too late for that, as the soldier had just been wheeled into surgery. So Bini evacuated the hospital but for a few surgeons and patients in mid-operation. All the electrical equipment was shut off out of fear that a stray spark could ignite the round.
Anesthesiologist Maj. Jeffrey Rengel put on body armor and administered anesthesia intravenously, counting the drips per minute. The patient’s vitals were taken with a blood pressure cuff and battery-operated heart monitor wrapped around his toe.
The explosive ordinance disposal team arrived and confirmed what the doctors had first recognized — that the metal object was, in fact, a live 14.5mm high-explosive round.
“At the end of it, you could see an impact detonator,” Bini said.
Found all over Afghanistan, the Soviet-era machine gun ammunition, which is about 2.5 inches in length, was likely packed around the roadside bomb to increase the blast’s power and cause further damage as shrapnel. Though the round does not typically have a sensitive fusing system, there was no telling whether the blast had compromised it.
Bini decided that he, among the surgeons, would have to remove the ordnance from the soldier’s head.
“You’re taught to use your most expendable person,” he said. “But I didn’t have a lot of good options. Everyone else was operating, and my neurosurgeon wasn’t expendable. He was the only U.S. neurosurgeon in the entire country. His surgical skill was much more valuable than my fingers.”
Were the round to ignite, it would have nowhere to go, meaning that Bini’s fingers and face would receive the full brunt of the resulting explosion.
Bini threw on his own body armor and joined Rengel in the operating room, along with a member of the EOD team, who offered him a piece of advice just prior to the surgery: not to drop the ordnance.
With that in mind, Bini made a circular incision around the bullet, pulling back the scalp to reveal the round, wedged underneath the right side of the soldier’s skull bone.
He grabbed the bullet with his hand and pulled it out. The EOD team member took the round and disposed of it. The neurosurgeon was called in to finish the surgery. A few weeks later, the Afghan soldier was released from the hospital without any major cognitive damage, only a bit of weakness in the left side of his face.
Accounts of live-ordnance removal are rare in the medical literature, but a retrospective study found 36 cases going back to World War II, Bini said. Of those 36 patients, 32 survived the removal of the ordnance from their bodies.
Bini was awarded the Bronze Star for his recent tour in Afghanistan, not only for the removal of the round but also for the 2,600 surgeries he and his team of doctors performed.
He said the story of the unexploded ordnance, widely covered in the media, had overshadowed much of the team’s other work at Bagram, including treating 13 patients injured when a shura meeting was bombed. The team also used a catheter to perform dialysis on a 13-year-old Afghan girl dying of kidney failure, and saved the lives of eight patients who were on ventilators when the electricity went off.
“Some of that stuff,” Bini said, “is a lot more amazing than cutting out a little piece of metal.”
