With chaos one mortar away, Balad drills for mass casualties
BALAD AIR BASE, Iraq — They don’t call it Mortaritaville for nothing.
Somewhere inside the wire, a mortar generally hits a couple of times a week, making Balad among the most heavily mortared bases in Iraq.
One of them about a month ago cost a sergeant his eyesight. But all in all, soldiers and airmen here have been lucky. No one at Balad has been killed by a mortar in two years.
But Lt. Col. Sharon Duffy, deputy commander of the 3rd Corps Support Command, which is responsible for the operation of Logistics Support Area Anaconda, the largest Army supply center in Iraq, said, “Complacency is the worst enemy of anybody on an FOB.”
That was where the command’s medical adviser, Dr. (Col.) Martin Christenson, came in. A family practice doctor in South Dakota before he was called to active duty, Christenson has had a longtime interest in trauma care.
“It’s the leading cause of death from the ages of 1 to 40,” he said. For soldiers in a combat zone, it’s almost the only cause of death.
When severe trauma injuries occur, “the key is getting to the operating table,” Christenson said.
Quicker evacuations to surgery and a push for more sophisticated lifesaving techniques out to the field have been credited with saving many lives in Iraq. But there’s always room for improvement, Christenson said.
Last week, as the Iraq “outside the wire” was convulsed by a wave of sectarian killings that left some 200 Iraqis dead, Christenson oversaw a drill for another kind of mass casualty.
Christenson and others involved in the planning decided to practice a quick response to a catastrophe inside the base — in particular, a mortar hitting a dining hall, killing and injuring a score of people.
There was already one easy part.
“We have a Level 1 trauma center four blocks away,” Christenson said.
But Air Force Maj. John Mammano, chief of the hospital’s medical control center, said, “Just seconds and minutes save lives. Chaos — you’re going to have that. But the more you can minimize that, the more lives you can save.”
The drill was the first time all “first responders” on the base — fire, police, medics and even combat lifesavers — had practiced a coordinated response. It was also the first time the Army and the Air Force — which runs the “best trauma hospital on the continent,” Christenson said — had drilled together.
A similar scenario was all too real in a dining hall near Mosul in December 2004, although it was a suicide bomber, not a mortar, who killed 22 people.
And Balad’s hospital has had experience in dealing with real mass casualties. Last August, more than 30 Iraqis arrived after an explosion.
“We had a lot of lessons learned,” Mammano said. “We could not communicate. We had bottlenecks. We had an overwhelming amount of people at the beginning.”
Last month, 17 Iraqi army soldiers were taken all at once to the hospital for treatment, and Christenson said, “the hospital did very well with that.”
With mass casualties, confusion can mean that critical patients are overlooked while those who can wait and those for whom it’s already too late are treated, said Air Force Maj. Steve Resnick, who approves patients for flights out of Balad to Germany and Kuwait.
Critical patients usually make up about 40 percent of the total in a mass casualty situation, he said, and triage — sorting out who needs treatment first — is primary.
So the hospital, already proficient at saving lives on the operating table, was enthusiastic about participating in the drill.
“If you get 20 people standing in your ER, you’re never going to get [critical patients] in the door,” Resnick said. “So we organize to give the greatest good to the greatest amount of people.”
On the day of the drill, Spc. Christopher Taylor lay comfortably on his back on the mess tent floor, with his left leg draped over an overturned chair and his right shoulder smeared with fake blood to simulate his minor wound. Taylor had volunteered to play a victim in the exercise, he said, for “something to do. Something different.”
But also he said, “I love this stuff. It actually helps a lot of people do their jobs.”
The exercise had been in the planning stages for months and gave Christenson a chance to check not only on coordinating a rapid, effective response, but also a number of his initiatives, such as combat lifesaver class and a new, more sophisticated first-aid kit he hopes to make widely available.
If more people knew first aid and had better kits to stop bleeding and keep people breathing, Christenson said, 15 percent of people who die from trauma could be saved.