Friday, August 14, 2009
By Anthony Loyd, Camp Bastion, Afghanistan
Beneath the warmth of the early morning summer sky a familiar routine begins at Camp Bastion’s hospital. The bodies of three British soldiers, brought in by a Chinook medical emergency response team shortly after 6am, are already lying in the mortuary.
Two were killed in action, the third died of wounds before he could be operated on. A fourth British soldier, an additional morning arrival, lay sedated in intensive care, with a leg blown off.
A team of medics and two chaplains were waiting at the main hospital entrance for the next helicopter to touch down. “We’re in the middle of a s*** morning and it’s getting worse,” remarked Captain Cat Kemeny, the hospital’s adjutant. “We’ve got four more UK casualties coming in from three incidents. The next we’re expecting is a double amputee.”
She had barely finished speaking when a Chinook landed near by and unloaded the newest casualty. On the stretcher lay a beautiful young man in bloody uniform, his face unmarked by the terrible injuries that had ended one of his legs above the knee and stripped the second to little more than bone. “Welcome to Helmand,” Colonel Tim Hodgetts, the hospital’s medical director, murmured beside me.
It seemed incredible that this latest, war-ravaged emblem of youth was even alive. More than that, though, he was still conscious, opening his eyes briefly as Colonel Hodgetts squeezed his shoulder and told him he would be looked after, confirming his name in a quiet voice. They wheeled his stretcher past the hospital’s resuscitation bays and into the operating theatre, where a combined emergency team of British, American and Danish surgeons and nurses began their work upon his shattered frame.
“He was taking it like a trooper,” the American Chinook crewman said. “We didn’t manage to get any pain treatment on him and he was taking it.”
Bastion’s military hospital has transformed itself since British troops set up base here in 2006, developing from an ad hoc collection of tents into one of the world’s busiest trauma hospitals, treating 623 patients in the past three weeks alone. More than half of these have been British soldiers, the rest a combination of International Security Assistance Force troops, Afghan soldiers and civilians.
This figure, which includes non-combat-related injuries, is higher than any other recorded so far in Helmand province in any similar period, as the Taleban’s bombing campaign has reached new levels of ferocity.
Within an hour, more casualties had arrived: a British soldier with part of his face blown off; another with back injuries sustained in a blast from a makeshift bomb; another shot through the throat. “This guy should buy a lottery ticket,” said Captain Joe Rappold, the US Naval officer heading the emergency team. “The bullet skimmed his carotid artery by millimetres — he’s a lucky guy.”
British-run, but staffed by a trination group of 190 medical personnel, predominantly Danish, the hospital has only 28 beds. It flies its more serious casualties back to Britain as soon as possible. In times of extreme crisis, however — such as happened on Monday, when ten very serious cases arrived, some of them children — it can perform its own limited “surge”, setting up impromptu resuscitation units as required.
Colonel Hodgetts, 47, veteran of four tours of Iraq, directs the hospital’s medical practices. He arrived back at Bastion for his third Afghan tour in mid-July. Despite the appalling workload that at times has had staff working 22-hour days (“You have to make them sleep for two hours or else everyone falls over”) he is proud of the survival rate of the wounded that has been achieved by his staff.
From April 2006 to July 2008, of 296 British “major trauma” survivors to be treated in Bastion, 75 had been expected to die because of the gravity of their wounds. Colonel Hodgetts expects the rate of these “unexpected survivors” to be even higher for the more recent period.
“The speed and aggressiveness with which we resuscitate, the tools we use — it’s way beyond what most hospitals are capable of. Get them to our hospital alive. That gives us an opportunity to do what we can do, which is a paradigm so far beyond my NHS experience it is hard to explain.”
He paused on his speedy rounds of the hospital to fill out a form for the double amputee, ticking the box marked “VSI” (very seriously injured); the category that will allow the soldier’s family, who were imminently to receive the knock on the door telling them of their man’s fate, immediate transport to Birmingham to meet him off the aircraft.
“Different things affect different people,” he said afterwards. “Some of my younger medics have never seen anything like this before. Some are affected by what they see, others by what a wounded soldier may say. Myself, it’s probably ‘Rose Cottage’ — the morgue. There’s often something quite horrific about the injuries there: individuals arriving in multiple bags. Not good to deal with. I have seen over 60 bodies there this time.”
The next casualty to arrive did not survive. Weighing barely 13lb (6kg), a tiny Afghan girl a few months old, very sick — possibly with meningitis — she arrived on a Chinook, having been discovered by US troops. A team laboured for half an hour to save her, but to no avail.
“I think there is nothing more we can do,” one of the Danes finally said, above the frantic labouring of the child’s chest. “I propose we stop treatment. Is there anyone who disagrees?”
None did. Treatment stopped. The little girl died, then and there, on the table of Resus Bay 3.
For an awful second I thought I might choke; an unforgivable act of weakness in front of the calm resolve of the young medics.
“Don’t think we are immune from all this,” said one as I walked away, as humbled as I can recall.