Marine surgical companies counter terrorist brutality with medical care

7 Oct 2004 | Sgt. Luis R. Agostini 1st Marine Logistics Group

Since the beginning of the war on terror, the world has witnessed terrorists employ a number of ruthless tactics on hostages, including torture, executions and beheadings.

Receiving less attention is the unwavering moral compass of their counterparts -- the Navy surgeons, nurses and corpsmen who treat captured anti-Iraqi forces.

First Force Service Support Group’s two surgical companies, designated Alpha and Bravo, and the Surgical Shock Trauma Platoon save lives daily, both friendly and enemy.  The 1st FSSG, headquartered here, provides all logistical support, including supply, transportation and medical services, for the all Marine forces in Iraq. 

Since April 2004, Marine surgical units throughout Iraq have operated on 53 anti-Iraqi forces injured in hostilities against U.S. and Iraqi forces.

“We treat them like anyone else,” said Navy Chief Petty Officer David M. Ruhlman, 41.

Ruhlman, Alpha Surgical Co.’s leading chief petty officer, has seen four anti-Iraqi forces admitted to the company’s surgical room in the last month.

Treating friendly and enemy forces presents a unique challenge to the providers and staff, said Navy Capt. Eric R. Lovell, assistant chief of professional services and senior emergency medicine physician for Bravo Surgical Co.

“At first, it’s upsetting to know you are helping the enemy live after they just tried to kill us,” said Navy Lt. Cdr. Patricia C. Hasen, a critical care nurse with Alpha Surgical Co. “But when we’re taking care of someone, they are just another patient we are trying to save.”

Emotions can run strong when doctors treat enemy patients.  But the status of an admitted patient is insignificant when the crew is trying to save a life.

“We’re just trying to save lives first,” said Ruhlman, a native of Boonville, Mo. “We have to put our emotions to the side and just treat them like a patient.”

Surgical units throughout Iraq, such as Alpha and Bravo Co., train their personnel to keep up with the fast-paced environment of these medical facilities through mass casualty exercises.

A mass casualty is defined as treating multiple shock trauma patients who require multiple medical resources, such as resuscitation and surgery. 

The exercises incorporate simulated, and sometimes real, captured insurgents. During training scenarios, injured insurgents are ‘assigned’ the worst wounds, testing the medical team’s prioritizing skills.

The training helps with the decision making process, and keeps the companies’ staff prepared for any situation, said Ruhlman.

“We fight a different enemy than the Marines do,” said Navy Chief Petty Officer Mark W. Goldschmidt, leading chief petty officer for 1st FSSG’s Surgical/Shock Trauma Platoon.  “Our enemy is time, regardless of who comes through our tents, and our training helps prepare us for when it really happens.”

“It’s our responsibility to ensure we give the best care we can for anyone that comes through the company,” said Hasen, a 36-year-old Rochester, N.Y., native.

Like any seriously wounded patients, enemy casualties are sent to a higher echelon medical facility to recover following surgery.

Hasen often accompanies them on the flights, when compared to a stateside medical evacuation, would cost nearly $115,000.

“It’s a sobering feeling to fly them, knowing we can get shot down while in the process of saving one of their own,” said Hasen, who, since her arrival in mid-August, has accompanied anti-Iraqi forces on three flights to a higher echelon medical facility.

In addition to fighting against the clock when trying to save critically wounded patients, the doctors are also faced with a language barrier when treating anti-Iraqi forces. When a captured insurgent is admitted to a surgical unit, an Arabic translator is brought in to gather lifesaving information.

“There’s certain things we need to know, like ‘what happened,’ and ‘where does it hurt,’” said Goldschmidt. “That’s where the translator comes into play, and when the Iraqi patient sees the translator, he becomes very eager to tell someone what happened in his own language.”

On any given day, surgical units can use about $1,000 worth of medical supplies to treat an individual patient, not to mention the amount of time and number of staff members needed in more serious cases.

For example, if an enemy casualty was brought into a surgical unit for a shotgun wound, it would take at least two corpsmen, a nurse and a doctor during the initial stages of treatment in the emergency room. 

If the captured insurgent required surgery, he would get sent to the operating room, where an anesthesiologist, a surgeon, an operating room nurse, a recovery nurse, a ward, a scrub specialist and a ward corpsman would handle the surgery.

If a Marine and an enemy casualty were admitted at the same time, the medical staff, based on established guidelines, would have to determine which patient requires the most immediate attention. 

Since all patients are treated equally, the wounded enemy possibly may be prioritized over the Marine, said Goldschmidt, a 37-year-old Pueblo, Colo., native.

If the wounds are minor, enemy casualties are detained following their medical treatment for further processing.

Marines are often upset with medical personnel at first because they are treating those who may have just killed their fellow Marine, said Seaman Anthony B. Arthur, a corpsman with the 1st Medical Battalion, 1st FSSG, and 22-year-old El Paso, Texas, native.

Marines later understand the importance of providing humane medical treatment to anti-Iraqi forces, Arthur said.

Bravo Surgical Co., which supports Combat Service Support Battalion 1 in Fallujah, recently saved the lives of two insurgents setting up an improvised explosive device on a road. The intent was to disrupt any passing U.S. convoys. While setting up the explosive, the two insurgents were severely wounded by their own blast, sustaining severe burns and internal injuries. 

Rescued from the side of the road by patrolling Marines, the insurgents were evacuated to Bravo Surgical Co., where they were treated for their wounds.

“Doctors and nurses must look beyond the fog of war and compassionately treat all victims involved,” said Lovell.

Both casualties suffered severe wounds – a severed artery in the arm of one, a ruptured bowel, metal shrapnel and skin burns in the other.

Due to the severity of the injuries, the patients required blood transfusions. Blood used in the treatment of casualties are provided through donations by U.S. servicemembers – the same people the two patients may have been targeting in the first place. 

The operation took two surgical teams working simultaneously four hours to complete.
All together, the casualties underwent 12 hours of intensive resuscitation and life-saving surgery.

After upgraded to stable condition, the insurgents were sent to a higher echelon for intensive care and reconstructive procedures.

As anti-Iraqi forces continue to attack U.S. servicemembers operating in Iraq – through terrorist acts, hostage taking, or conventional warfare – the men and women who treat the wounded will continue to do so, no matter who is placed on their operating table. 

The surgeons, nurses, and corpsmen understand they’re held to standards higher, and more personal, than any treaty or international agreement can dictate.

“Understanding that our purpose is just, and that all humans deserve treatment with dignity and respect, are the guidelines we… choose to pursue,” said Lovell.       

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