BALAD AIR BASE, Iraq — There was a drumbeat. A battle was looming.

Negotiations with the insurgents in Fallujah were failing. Coalition troops were massing. Would the offensive kick off? If so, when? What would it be like?

The staff at the Air Force Theater Hospital watched this. They listened to this. They waited.

“Suddenly,” said Dr. (Col.) Ted Parsons, deputy commander of the hospital, “the helicopters started dropping out of the sky.”

The helicopters would come for days, day and night, ferrying wounded from the battlefield, filling the operating rooms and the beds of the hospital with human carnage — American soldiers and Marines, Iraqi National Guard and police, enemy combatants and civilians.

“War doesn’t discriminate. Everybody gets hurt,” said Dr. (Lt. Col.) Jim Quinn, hospital chief of staff.

They came in an endless chain, carried from the helicopter pad nearby, through the swinging plywood door of the emergency room and into the operating rooms. Again and again. And again.

“We pretty much did not have an operating room empty for eight days. We have three operating rooms,” said Dr. (Lt. Col.) Dan Jenkins, trauma medical director. “I stopped looking at my watch. I would say most guys had no idea what day it was.”

Doctors and surgeons catnapped when they could — an hour here, an hour there. Some medical staff would break away for four hours of uninterrupted sleep and then go back to 24 hours of uninterrupted work.

“The first day or two was a lot of adrenalin,” said Capt. Henry LeBlanc, nurse manager of the emergency room.

The patient load numbered in the hundreds. The wounds were brutal. Limbs torn away. Bodies shredded by bits of fast-flying metal and sharp shards of glass. Wounds that refused to stop bleeding.

Emergency room nurse Capt. Manuel Martinez, a neo-natal intensive care unit nurse back at Wilford Hall Air Force Medical Center in San Antonio, Texas, was shaken by what he saw two weeks ago.

“I don’t think anything can prepare you for what we do here,” he said.

But there is a method for measuring the success of the hospital staff’s efforts, a way to quantify the effectiveness of choking back emotion and focusing on the job.

People died at the hospital, but only those who arrived with mortal brain injuries perished. No medical procedure or effort could have saved them, doctors said. But they were the only ones.

“Of the other hundreds of casualties that we operated on,” Jenkins said, “not a single patient died.”

First taste of battlefield

For nearly every person on the staff — surgeon, nurse, x-ray technician, pharmacist, what-have-you — this was their first taste of combat medicine.

Most of them are from Wilford Hall at Lackland Air Force Base, the service’s largest hospital. San Antonio is a big city with its share of violent crime, auto accidents and natural disasters.

“Coming here and taking care of the (improvised explosive device), mortar, grenade blast injury patients really required a small amount of on-the-job training,” said Jenkins, who for eight years has taught surgeons to prepare for war. “We didn’t know what it was like. We knew what it was supposed to be like.”

The staff was making a bit of history just by showing up. This is the first time since the Vietnam war the Air Force has operated a hospital like this in a war zone. That’s not to say Air Force docs and nurses haven’t been near the front in the last 30 years, but they haven’t had a presence like this one.

“It’s not as groundbreaking as it might appear,” said Quinn. “Doing something of this size and scope is what’s unique.”

An Air Force Theater Hospital is defined as having 85 beds, with the ability to expand.

More than 200 people are on the staff in Balad, including 15 to 20 surgeons. Although most come from Wilford Hall, about a dozen Air Force bases are represented. The staff is augmented by Australian Air Force doctors and nurses.

Changes and concerns

The Air Force took over in September from the Army’s 31st Combat Support Hospital. Only a few changes were made, said Dr. (Col.) Greg Wickern, commander of the 332nd Expeditionary Medical Group, which runs the hospital.

For one, infection control was enhanced, he said. The place was scrubbed from top to bottom and measures increased to keep out the dust that seeps in everywhere. Hand washing is emphasized even more than usual. Dressings are to be changed only in the sterile confines of an operating room, not the ward.

“I don’t think we’ve had a single external wound develop post-operative infection,” said Wickern, a pediatrician by trade back in Texas. “That’s just amazing under these conditions.”

Also, the Air Force added a team to handle injuries to the neck and head, something that was not part of the 31st CSH. Until then, cases requiring such care were sent to the combat support hospital in Baghdad.

For the first two months, business was brisk, but manageable, nothing out of the ordinary. Wickern admitted to some concerns as the possibility of an all-out battle on his doorstep drew closer.

“I knew we had the expertise,” he said.

But, he added, “We were a little worried about the shock and awe.”

Second Lt. Aidan O’Neil, a nurse in labor and delivery back home, said she didn’t know what to expect.

She works on the post-operative ward and is modest about it, saying she doesn’t do the heroic things done in the emergency room or in surgery.

“I make sure they get their antibiotics so they don’t get infections,” she said.

Sometimes, she said, the patients weren’t in the ward more than 10 minutes before they were whisked away for evacuation.

“We had patients who begged not to be evacuated out of theater,” she said.

When the wounded troops woke up from surgery, she said, “the first they want to know is, ‘Where’s my buddy?’”

O’Neil found the time as often as she could to check for them. It was a thrill for her to report back that the patient’s buddy was doing well in a bed nearby.

“What they do is great,” O’Neil said of the wounded troops. “What I do is a privilege.” LeBlanc, recalling the frenetic days in the E.R., said,

“Considering what the guys in Fallujah were going through, what we had to do seemed reasonable.”

Quinn, an allergist and immunologist, added: “I don’t think I’ll ever get used to battlefield injuries to kids.”

Back to normal

A few days after the chaos subsided, the hospital was running along at a more normal pace. It still had a number of Iraqi patients — fighters who helped the coalition. They can’t be evacuated until their care and safety can be guaranteed.

But the emergency room was back to treating patients who had twisted ankles playing basketball or something equally mundane.

Reflecting on the effort during “the Fallujah surge,” as some called it, the staff gave itself pats on the back.

“There’s no weakness in this team,” said Jenkins.

He praised everyone, from the emergency room crew and the x-ray technicians to the supply personnel and the blood lab staff.

He had especially credited the forward medical teams, which were the first to treat the wounded and get them back.

Added Wickern said, “I knew it would go well. I expected it to go well.”

But, he said, the result was “better than I ever would have expected.”

LeBlanc said, “I think we did great. I know we did great. There’s no doubt. The criteria is, ‘Is this a place you would want to be taken if you were injured?’ The answer is, yes.”

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