MISAWA AIR BASE, Japan — Before he deployed to Iraq in March, Lt. Col. Mark Coakwell’s most exciting combat experience was watching fighters take off with bombs for war.

“The big excitement was they came back without bombs,” said Misawa’s chief of aerospace medicine.

That all changed this spring, when Coakwell and Maj. Li-ing Chang, a general surgeon at Misawa, deployed to Baghdad for three months on an Aerospace Expeditionary Force rotation.

The doctors were thrust into the heart of battle, where the wounded showed up at their tent by the hundreds and writing death certificates for young soldiers was part of the job.

They sewed up bullet holes and amputated legs — images of war that won’t go away soon.

“This was the real deal,” Coakwell said.

Coakwell, Chang and Maj. Richard Terracciano, executive nurse of surgical services at Misawa, recently shared their experiences of pulling medical duty for the 447th Expeditionary Medical Squadron at Camp Sather in Baghdad International Airport.

Terracciano was deployed there from July 8 to Nov. 15, 2003, when the Air Force’s AEF rotations were 120 days.

All three operated and slept in flak vests, routinely “hit the deck” for cover, stabilized patients with limited supplies and equipment and kept their cool under fire.

The wounded ranged from U.S. soldiers injured in roadside blasts to an Iraqi father and two boys hurt throwing grenades at a U.S helicopter. The Misawa team also treated Iraqi detainees from a nearby prison, coalition troops and foreign diplomats.

Air Force medical personnel typically “tend to be back out of the major action” on deployment, said Coakwell, speaking from his own experience — seeing patients with colds or stomach viruses, not blast wounds.

“You just see the routine day-to-day stuff; you don’t see the battle injuries, so this was a very unique experience for me from a medical standpoint,” Coakwell said.

It was Chang’s first deployment. “To operate and hear a ‘boom’ go off next to you and wonder ‘Do I hit the deck or do I keep operating?’ That’s new to me,” she said.

Fix ’em up …

Expeditionary medical support — commonly referred to as EMEDS — lets Air Force medical personnel get close to the battle. The concept for the service’s lightweight field hospital evolved after Operation Desert Storm, when the Air Force saw a need to get its medical folks to the fight faster.

The Misawa team was part of a smaller EMEDS unit designed “to travel with the attacking front,” Chang said. Its entire operating room packs up into one pallet and five backpacks, to be carried by a five-member surgical team, she said.

About 30 active-duty, National Guard and Reserve personnel made up the Camp Sather EMEDS. The unit’s roster included nurses and flight surgeons, an emergency room physician and specialists including a clinical psychologist, orthopedist and anesthetist.

The group was responsible for the medical care of the almost 2,000 Air Force personnel based at the camp.

Coakwell also oversaw preventative-medicine programs for more than 25,000 people at the surrounding Army camps near the airport, he said, entailing everything from food safety to pest prevention.

Patients with minor afflictions regularly shuffled into the EMEDS’ tents. Some just had the sniffles, others were dehydrated or overheated; more than a few had cuts, bruises, sprains and various infections.

But the EMEDS doctors and nurses always had to be ready for the battle wounded, who often arrived without notice and in multiples.

“We had pilots who were flying on their way to some place else and got scared,” Chang said. “We were close by. They landed without calling us. They land on our airstrip and say, ‘Help, I have an injured.’”

“Or three or four,” Coakwell said.

The Camp Sather EMEDS was designed to receive one to two critically ill patients who could be treated right away. When more arrived, it required quick thinking — triaging patients — and improvisation: The Morale, Welfare and Recreation tent was converted into a patient ward.

“We worked whenever it was necessary,” Chang said. “There was a period of about 10 days where we were just working as long as you could be awake.”

In e-mails from Baghdad that Chang wrote to co-workers at Misawa, she described those busy times: “Around midnight, someone came in with a partial left arm amputation and blast injury to the left chest. We were in the operating room all night again. We did a shoulder amputation. … We went through 10 units of blood and got him on a plane within one hour of surgery stop time. That’s 3 nights in 4 that we were operating 8-12 hours.”

The most common injuries were to extremities — arms, legs, feet and neck — areas not protected by body armor, Coakwell said.

Terracciano, who at Camp Sather was in charge of the nurses and medical technicians, told of one soldier who lost a foot when someone lobbed a grenade inside his Humvee. “He fumbled trying to throw it out the door. It fell at his feet.”

The goal in treating the seriously injured was to stabilize them so they could withstand medical air evacuation or ground transport to a safer and larger hospital, the Misawa team said. The EMEDS unit didn’t have the room or the equipment to administer more extensive care. Sometimes, soldiers — lucky in the sense, at least, that they were spared more crippling wounds — returned to the field. “Fix ’em up and send them back,” Chang said.

Adrenaline rush

While caring for patients, the EMEDS doctors and nurses had to watch out for their own safety. Flak vests were required gear, except for in the shower and while sleeping. The camp was hit multiple times by rocket-propelled grenades.

“We felt vulnerable,” Coakwell said. “It’s you and canvas … between the potential rocket or mortar.”

In one of her e-mails, Chang wrote: “Wow, what an exciting few days. First, on Sunday morning, we were attacked by rockets. Fifteen rounds hit the airport. One landed near the EMEDS tent, but luckily did not detonate. We all evacuated in a hurry. We spent a better part of 5 hours in the bunkers.”

Nobody in their camp was injured from any of the attacks, Coakwell said.

Receiving badly injured patients at a moment’s notice while mortars rained overhead was reminiscent of mass-casualty exercises the 35th Medical Group conducts at Misawa, Coakwell, Chang and Terracciano said.

While they felt the drills prepared them for the real thing, the two can’t be compared, they added.

“Exercises are great on paper. Everybody laughs and jokes, and we’re out here smoking a cigarette,” said Terracciano, who oversaw the nurses and medical technicians at Camp Sather. “But until you’re actually doing it, then it hits home that, yeah, you better be paying attention, and you got to suck it up — this is the real world.”

Chang said the biggest difference is the adrenaline rush. “In exercises, it’s very hard to muster a true adrenaline rush. When the real thing is going on, you feel good about what you’re doing, and you become more alert, and you’re faster at what you do.

“The good thing with the exercise,” she added, “is you’ve seen it. Your procedure of how you go about doing this is second nature.”

Ready to return

Chang, Coakwell and Terracciano said they left Baghdad with vivid memories, lingering questions and a desire to go back.

One of Terracciano’s fonder memories is learning how to drive an Army Abrams tank, a form of wartime recreation that helped him decompress from the intense working environment.

He gets choked up when talking about the U.S. military police killed when some Iraqis lobbed rockets into Abu Ghraib prison.

“They bring them in and they’re lifeless,” he said. “You just put them to the back, and you bring in the next group of folks that you can try to save.”

Coakwell will never forget the Baghdad morgue and writing out death certificates.

“I had done that in an exercise setting but it was all pretend,” he said.

Chang said what stood out for her was the bravery and spirit of those on whom she operated, of men who looked like kids “that I thought should be home playing football,” she said.

“They got shot down and they’re ready to go back out and do it again. That’s bravery to me.”

Chang’s and Coakwell’s EMEDS unit treated more than 1,000 patients, they said, and lost none.

Would they do it again?

“Two weeks, I’m ready to go back,” Terracciano said. “You’re doing the job you trained to do.”

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