The Sandbox

GWOT hot wash, straight from the wire

Welcome to The Sandbox, a forum for service members who have served or are currently serving in Iraq and Afghanistan, returned vets, spouses and caregivers. The Sandbox's focus is not on policy and partisanship (go to our Blowback page for that), but on the unclassified details of deployment -- the everyday, the extraordinary, the wonderful, the messed-up, the absurd. All correspondence is read, and as much as possible is posted, lightly edited. If you know someone who is deployed who might have something to say, please tell them about us. To submit a post click here.


June 19, 2007

: LT Carl Goforth
Posting date: 6/18/07
Stationed in: Anbar Province, Iraq
Milblog url:

I sit down to dinner with Tim, D-squared, and Eric. Chaplain is a few tables down and comes over with his radio: "Guess what, guys? GSW* to the chest 15 mikes out."

Five minutes later "Chaps" is leaving. "Sorry guys, but the patient just rolled up." Eric is up and gone in a flash. Deja vu. This seems to be the recurring chow routine; not even a sip of coffee before we check out. Tim and I collect the leftover trays and make our way.


Entrance wound to his left chest, but no time to look for an exit wound yet. First up, starting some big IV's, a central line, and several Army personnel on the left placing a chest tube. Eric is at the head of the bed and gets the patient intubated. Chest tube in place, and we get an initial flood of blood: hemothorax.

"Can we re-infuse it?" someone asks.

"No, we don't have the autotransfuser connected. We'll have to connect one as soon as we can," I say as the patient continues to slide downhill.

"That's it, we need to open his chest," says Eric with a sense of urgency. Clammy patina and color is quickly turning ashen, the color of cold gravy.

Our surgeon: "Grab the lines, grab the chest tube. We are going to the OR now." I'm somehow grabbing IV's, pulling off trauma bay monitors, and balancing the chest tube collection chamber while on the move.


Anesthesia machine on, hot line powered up, barely-controlled chaos as everyone flies around the room. Grab sterile instrument sets, hang the fluids on pressure bags and crank up the fluid rates. Eric says, "I want four units of packed blood cells now. Who is the runner? And I need you to move now," as the patient looks, well, blank. "Someone feel again for a pulse."

No pulse. Chest compressions started, our two surgeons throwing on sterile garb while simultaneously starting the thoracotomy. No time. Every second is more precious than the last. Eric and I are pushing fluids and now blood as fast as our hands can move. Extra hands are recruited to help us pump blood and fluids even faster.

The temperature outside: 110. For the first time, the OR temp is climbing beyond comfort. We just have to turn the AC on for relief. V and D-squared walk over to turn it on, and...nothing. We know the heat works; been using it for months. We know the fan works; been using it for a few weeks. We now know the AC units are down. Both of them.

In no time, everyone is drenched in sweat. On call for this flight, I'm stuck with the flight suit on.
As soon as the patient is stabilized, we will be en route to Al Asad. The suit is soaked before the case is over, and my night has just begun.

I have it easy compared to the guys who are scrubbed in. They are wearing sterile gowns/masks/gloves on top of uniforms. No chance to step out of the room for relief or to hydrate, they are on the verge of heat exhaustion after an hour. Eric becomes the offical Gatorade representative.

Framed_goforth_gatorade2Blood arrives. Eric and I each grab one along with blood tubing. "Just keep the blood coming, and we are activating the blood bank as of now. Make it happen." The Army moves lightning fast, the Big Voice is calling out basewide for donors, and we have lifesaving whole blood in what seems like minutes.

The whole blood is a huge score for the patient: we are now giving him warm oxygen-carrying hemoglobin along with replacing the clotting factors he is losing to his injuries. Martin resects the patient's left lung: the round went right through it. Arterial line placed, Martin finishes damage control and is satisfied he stopped all of the thorasic bleeding. He starts closing the chest back up, and places two new chest tubes to drain any residual blood.

Blood chemistry and hematocrit counts are almost perfect, despite the significant losses of the patient's own volume. Another save.


It's nightfall. Around 10:00 pm and the temperature is still 100 degrees. So much for the idea that desert temperatures drop precipitously at night.

Patient does well. I'm giving blood in flight, groping for IV lines, changing out the oxygen tank, tweaking the ventilator settings to prevent high airway pressures, writing down vital signs and medications-given on a piece of tape on my flight suit, and searching for the drug access port so I can give some sedation and paralytics.

We touch down on the medical helo pad, and I run ahead to give report to the accepting physician.

The Blackhawk is in no hurry to go back to Ramadi. It's their bird, and my priority status has just been downgraded to "passenger". They go to the "dust off", and we sit there for 30 minutes before going to the fuel farm for more JP-5. The helo is blacked out, and the rotor spin drowns out any chance at hearing anything. The adrenaline crash is winding down, now that I safely passed my patient off to the Army CSH, so I close my eyes and shut down mentally.

Sensory-deprived moments. Strapped into my jump seat, sandwiched between the crew chief and flight medic as the turning rotors rock me into a rhythmic trance after hours of trauma, surgery, and flying. The cabin feels like a miniature furnace late into the night. I smell hot engine exhaust, hydraulic fluid, and a dozen other lubricants, propellents, etc. But this is a dedicated patient evacuation helicopter, so take the normal industrial smells and add a mixture of flight suits soaked in sweat, the patient, and the faint metallic smell of blood, old and fresh. An aroma I will not soon forget.

* GSW: gunshot wound


Nice clear account, but, yes, you are right - deja vu all over again. Some of us are old enough to remember other sweltering OR's and helo evacs. The more things change....

Thank you for your hard work. Remember this save; you did good.

LT Goforth,
Wow, you guys are amazing! Thankyou for taking care of our injured. I love reading your posts.
Take care of yourself too!

Thank you for being there, for being fast, for being hot and sweaty and overworked. Thank you for every one you save....and for trying so hard on the ones that can't be saved.

How highly we do value the individual lives of our soldiers!

This has always set the US military apart from our opponents. I am glad to see that you and your team continue to express this core value of our military.

You are doing the work that I value highest - healing.

Be well,

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