WAS I READY FOR THAT?

Mary Langcake FRACSSQNLDR RAAFSR

Director of TraumaSt George Hospital

Sydney NSW

NO!

READY FOR WHAT?

The Mission The training The reality Coping? The aftermath Progress report Personal balance sheet How can one be ready?

THE MISSION

AUSMTF2 – 22 July – 04 Oct 2008 Deployed to Tarin Kowt in Uruzgan, Afghanistan Tasked to:

augment the Dutch Role 2e hospital in TK provide Combat Health Support to NATO-led

International Security Force (ISAF) including Afghan Security Forces (ANSF), and eye-, life- and limb-saving health support to local nationals (LN)

THE MISSION

AUSMTF2 – the team RAAF – PAF and SR Specialist MO's – General and Orthopaedic Surgeons,

Anaesthetists Nurses – Perioperative and Intensive Care Medical Assistants – OT and ICU OIC – Perioperative Nurse with subunit command

experience

THE TRAINING

MRE

Netherlands April 2008 met and trained with 420

Hosp Cie reviewed equipment rehearsed casualty scenarios rehearsed MASCAL

THE TRAINING

Force Prep – RAAF information re culture,

conditions, welfare, support classified information about

risks etc

RSO&I – MEAO acclimatisation – 50oC, dusty briefings weapons training TCCC

THE REALITY

One of the highest rates of battlefield trauma experienced by a solitary ADF surgical and intensive care capability in recent history

THE REALITY

CASELOAD

In 75 days132 presentations to theatre – 78% emergency158 surgical procedures – 81% emergency26% ISAF – 50% AS>29% - <16yo

Casemixgeneral – 43%orthopaedic - 57%

41% penetrating trauma:GSW, Blast, Knife

THE REALITY

MASCAL

Sept 2 2008 – SOTG came under sustained , heavy enemy fire high velocity firearms, RPGs, mortars

Fire fight lasted approx 4 hours 11 casualties 9 evacuated – 7 → Role 2e

2 → FST

THE REALITY

Penetrating injuries from both GSW and blast fragmentation

One soldier critically injured with life-threatening wounds

Remainder – fragmentation injury +/- GSW Multiple procedures into the early hours of the

morning FST casualties admitted and required RTT Critically injured soldier underwent re-look

laparotomy then evacuated to Landstuhl

THE REALITYCHILDREN

COPING – RSO&I

Struggled with rapid fire exercise due to knee

520 C on day of weapons training heat exhaustion

Threatened with RTA

Confidence shaken

COPING – TARIN KOWT

• Casemix outside of civilian experience

COPING - TARIN KOWT

High operational intensity no time to“pick yourself up, dust yourself

off and start all over again”

COPING – TARIN KOWT

• No “personal space”• Environment

CHILDREN

8 yo boy

GSW (L) thigh, exit ® flank

Shocked

DCL – stabilised

Turned over for debridement of flank woundbradycardia, BP

died on the operating table – “missed” injury to IVC

CHILDREN

13 yo boy

Accidental shotgun wound (L) thigh

Shocked Leg pulseless, paralysed,

anaesthetic

HILDREN

morrhage control

Fix femur

mpt to revascularise

% of SFA missing

uccessful attempt to scularise

AKA

MOTIONAL DISTRESS

ut of my depth

ot good enough

ividly reliving failure to save child

nsomnia

norexia

E AFTERMATH

old I was “a disappointment” as an officer

Confirmed my belief “crashed and burned”

wo days later –flight out delayed by dust stormMASCAL – trauma team leaderOff duty after 0200

ome help for my self esteem

E AFTERMATH

mmunition removed from magazine

Weapon disabled without my knowledge

E AFTERMATH

fraid to go back to civilian practice in case I made mistakes

E AFTERMATH

id not initially seek help

My fault for not being up to the challenge

lanned to resign from RAAF

elt humiliated

upported by RAAF to take leave of absence fromvilian employment

E AFTERMATH

rofessional help

Diagnosed major depression and PTSD

On-going management

OGRESS REPORT

till “relive” events on occasion

OGRESS REPORT

Poster girl for how we got it wrong”

ime heals all wounds

he positives outweigh the negatives

have gained more than I lost

Would like to “get back on the horse”

RSONAL BALANCE SHEET

ROSFriendshipTeamworkAfghanisExperience in traumaAcquiring new skillsService

• CONS– Demands of casemix– Emotional challenges– PTSD

OW CAN ONE BE “READY”?

RAIN FOR CASEMIX

mprove pre-deployment training

SimulationsWork as teamsPaediatric trauma experienceVisit trauma centres with high caseload of penetrating traumaCSTARS Senior visiting surgeons program to LandstuhlEmergency War Surgery Course - Lackland Air Force Base, US

TTER PSYCHOLOGICAL SUPPORT

ORE DEPLOYMENT

More opportunity to speak with those who have been before “forewarned is forearmed”

More time off before leaving – I was making calls about

patients at the airport

Don’t deploy members with history of psychological illness? Would have precluded >50% of the team But be aware they may have greater need of

psychological support even if they continue to perform“above and beyond the call”

TTER PSYCHOLOGICAL SUPPORT

DEPLOYMENT

Only a Padre on base

Phoning home not always an option due to OPSEC

Individuals may take multiple hits with little if any down time to “pick themselves up”

Requires good team leadership but other deployment issues often a higher priority particularly during high activity

OW CAN ONE BE “READY”?

ind some space even if it is under the covers!

ell people if you are struggling, don’t expect hem to guess

ealise the “goalposts” are different and be repared to accept it (tough in reality)

orgiveness – yourself, others

ARON COOPER, WGCMDR ANNETTE HOLIAN, SQNLDR MARY LANGCAKE,

GPCAPT GREGOR BRUCE

SQNLDR BRUCE ASHFORDSQNLDR SANDY DONALD

AUSMTF2

“We have to do the best we can.This is our sacred human responsibility.”

Albert Einstein

THANK YOU