Janice Weixelman is a family physician who has practiced for years in both Wellington and Red Feather Lakes. She is also a member of the National Guard and a month ago she was called up to serve in Afghanistan. She is a part of Miramont Family Medicine and her partners were very willing to support her during this time. Kudos to Dr. Bender and the other physicians and staff at Miramont for helping out.
I have asked Dr. Weixelman to give me an update on her experience in Afghanistan, and she was kind enough to send me an update. It is long, so I’ll break this up into two posts. Here is the first one:
On Wednesday, I had a very full day. I started out with signing the paperwork to work in the ER at the Heath Craig Joint Theatre Hospital at Bagram Air Base. I had orientation in the ER that morning. We received one med evac flight in that morning with 4 people on Board. The injuries included a 22-year-old involved in an IED incident and he had a below the knee amputation (he lost his foot) on one side, a broken leg on the other and several other injuries; a 22-year old who was in a roll-over of a Rhino (an armored vehicle) and his lower leg was trapped in the window during the roll-over so he sustained a fracture; a 46-year-old gunshot wound in the arm and a 23-year-old with a gunshot wound that entered above his hip and exited by his thigh – no internal organ damage, thankfully. So the war is real.
Bagram Air Base receives the casualties from “downrange” that need more surgery, need re-evaluation and evacuation out of the country or need to be re-evaluated for possible rehab in a closer place. Some injuries/illnesses may only need a short recuperation period – a minor fracture, a burn that encompasses a small area, a person recovering from having their appendix out, etc. The short stay people are often returned to their base for recuperation or sent to a CASF which is a “staging facility” that is set up to rehab them.
Bagram sits at the north area of Afghanistan. The medical evacuation flights have a route called “the bandage run.” This is an area on the map to which they may run to for picking up patients. If you draw out the area on the map, it is a fan-shaped area with the “handle” of the fan being at Bagram and the areas with hospitals and bases being in a spreading triangular pattern over the middle and southern part of Afghanistan.
There are, essentially, 3 types of flights that may come into the ER – the most serious medical evacuation can be significant trauma patients and the fixed-wing aircraft (our C-130′s) can bring in up to 17 patients at a time. Which means the ER can suddenly be flooded with casualties. All of these patients are “used trauma” patients meaning they have already been evaluated and stabilized to the best ability possible. Some have even had surgeries and significant treatment, but need to be re-evaluated before being placed on a flight to Germany.
Landstuhl, Germany, is the first stop on the way back to the US for our military personnel who have injuries that will not allow them to Return to Duty (RTD). Those who have already had surgery may go back to the Operating Room (OR) for additional debridement (cleaning) of their wound before they are shipped out. The military is keeping tight tabs on our head injuries now.
We have learned that IED and mortar blasts can cause significant concussive injuries that may not be apparent immediately, but will begin to show signs in a few days. Thus, there are a list of questions that are asked of all patients that are involved in these types of injuries – how far from the blast were you? (50 feet or less mandates another set of criteria), were you wearing protective gear? Did you lose consciousness?, etc. There have been over 135,000 Traumatic Brain Injuries (TBIs) in Iraq and Afghanistan since 9/11, most of them minor. 5,000 of these have been serious. Anyone who has had a 2nd TBI is out of the game permanently. The Craig Heath hospital is named after a person who was killed in one of the Afghan conflicts.
The words “Joint Theatre” refer to the fact that the hospital treats all military branches of which there are five – Air Force, Army, Navy, Coast Guard and Marines. The Marines are actually a branch of the Navy. The hospital will also see the contractors, but there can be a glitch. The contractor is an employee of a company, and it is up to the individual companies to determine what level of care/workman’s comp they will cover. Some contracting companies have a “resuscitate only” contract, so the hospital can treat only if the patient is in a life-threatening situation. Other companies have given Craig authorization to treat all injuries.
There are 3 hospitals on this base, the other 2 hospitals are a Korean and an Egyptian hospital. The Egyptian hospital has a 24 hour Urgent Care/ER, and many of the contractors are supposed to go there, but won’t. The Egyptian hospital is still in its infancy and still working on funding, so although they have excellent physicians, they may not have adequate equipment for things like simple wound care, and are making decisions based on materials at hand and inpatient census as to whether they can take care of a laceration in the appropriate manner. The Korean hospital does not have 24 hour availability to urgent matters, and apparently can be very picky about who they want to treat.
END PART I