Combat Nurses: a special 5-part feature from Balad Published Jan. 30, 2008 By Tech. Sgt. D. Clare BALAD AIR BASE, Iraq -- It's 4 a.m. at one of the busiest trauma centers in the world and Capt. Shelly Garceau, an emergency room nurse, is finally taking a breather. Moments earlier, she'd dropped two Marines off in the Intensive Care Unit of the Air Force theater hospital here. They'd suffered partial thickness burns over their faces and hands as a result of an explosion. Captain Garceau consoles herself knowing she did everything she could for the men. She's able to rest certain they weren't in pain when she left them. "That guy couldn't even see me. He wouldn't be able to show you who I am if he saw me. But he'd recognize my voice. And when he said thank you to me, it was like nothing else," she says. "There's nothing like the 'thank yous' that you get here -- nothing at all." The Air Force theater hospital may be the busiest trauma hospital in the world and is the only facility that provides a full spectrum of medical services in Iraq. The emergency room takes in 23 patients a day on average, 11 of which are trauma cases. In that same 24 hour cycle, the facility's operating room typically handles more than a dozen cases, performing more than 60 procedures. In the past year, nurses were behind the treatment of more than 10,000 injuries. In a four month period, the facility's statistics match or exceed activities at the R. Adams Cowley Shock Trauma Center in Baltimore, where many of the staff nurses were trained, said Col. Norman Forbes, 332nd Expeditionary Medical Group chief nurse. Behind every case and helping every patient are the nurses of the 332nd EMDG. From the moment a wounded troop lands at the hospital to the time he or she lands in Germany or is medically evacuated to the United States, a combat nurse is there to assist physicians, administer medication and care for the wounded. The hospital boasts a 98 percent survivability rate for wounded Americans who arrive here with a pulse, many of whom see the very worst of war. The success of the medical team here, according to Captain Garceau, is known among the servicemembers who fight in Iraq. On a past deployment to Landstuhl Regional Medical Center, Germany, she received patients who had been treated at the hospital. "The troops would tell us that they were really scared until they got to Balad because they knew if they made it this far, they'd be alright. That's the reason why I came here. I wanted to be a part of that," she says. Beyond the prolific number of patients treated at the facility, nurses say combat trauma creates challenges for care providers who may be treating several different types of injuries simultaneously. "We're dealing with high-ballistic, penetrating trauma. It's not the same sort of thing that you see on the streets of Detroit or Chicago or Baltimore. It's in a league of its own," said Colonel Forbes. "Most of the trauma you see in the states is blunt trauma from steering wheels and auto accidents. You get gang shootings and occasional single point entry gunshot wounds. You don't tend to see the multi-systems trauma that you see during wartime with the blast injuries." The closest comparison the colonel could make to civilian trauma came from footage he'd seen of people injured in grain elevator explosions. Despite the extensive and continuing training staff members receive to become military nurses, nothing can fully prepare them to see the level or quantity of trauma prevalent in Iraq. The training does, however, give nurses an edge. Despite the hospital's location in the center of the war zone, nurses say they are able to offer care that meets and often exceeds the level of trauma treatment available elsewhere throughout the world. The nurses aren't encumbered by health insurance limitations or concerned with co-pays. Their sole focus is on saving lives. "Our patients get top notch care here. It doesn't matter how many supplies you use on a patient or how many times they come back to surgery. The cost is nothing," says Lt. Col. Jan With, flight commander of operating room nurses. "Military medicine is further ahead than civilian medicine. I've even heard my counterparts in my civilian life say that," says the colonel, a member of the Air Force Reserve who is deployed from Offutt Air Force Base, Neb. In her civilian life, she is a coordinator for more than 20 specialty clinics in Norfolk, Neb. "The military is able to get the technology quicker," she says. Beyond technology, the nurses learn to work fast and make critical decisions. Every day, lives are on the line, and they provide the critical link to the care patients need. They work seamlessly with doctors and technicians and quickly develop the synergy needed to keep war's wounded alive. Note: Tech. Sgt. D. Clare takes an in-depth and personal look at how five nurses from different specialties are caring for the war wounded at one of the busiest trauma centers in the world in a five part series called "Combat Nurses." Part I - Emergency Room Part II - Operating Room Part III - Certified Registered Nurse Anesthetists Part IV - Intensive Care Unit Part V - Intermediate Care Ward