Mary Langcake, director of trauma at St. George Hospital in Sydney, discusses her experiences deploying to Afghanistan as part of AUSMTF2 from July to October 2008. She describes the high-intensity trauma experienced, including treating over 130 casualties and performing 158 surgical procedures. She struggled with the emotional challenges of treating many penetrating injuries and casualties, including children. After returning, she was diagnosed with major depression and PTSD. While the deployment had both positive and negative impacts, she believes more pre-deployment training and psychological support could help trauma teams be "ready" for such high-intensity missions.
3. READY FOR WHAT?
The Mission
The training
The reality
Coping?
The aftermath
Progress report
Personal balance sheet
How can one be ready?
4. 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)
5. 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
6. THE TRAINING
MRE
Netherlands April 2008
met and trained with 420
Hosp Cie
reviewed equipment
rehearsed casualty scenarios
rehearsed MASCAL
7. THE TRAINING
Force Prep – RAAF
information re culture,
conditions, welfare, support
classified information about
risks etc
RSO&I – MEAO
acclimatisation – 50o
C, dusty
briefings
weapons training
TCCC
8. THE REALITY
One of the highest rates of battlefield trauma
experienced by a solitary ADF surgical and
intensive care capability in recent history
9. THE REALITY
CASELOAD
In 75 days
132 presentations to theatre – 78% emergency
158 surgical procedures – 81% emergency
26% ISAF – 50% AS
>29% - <16yo
Casemix
general – 43%
orthopaedic - 57%
41% penetrating trauma:
GSW, Blast, Knife
10. 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
11. 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
13. 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
17. CHILDREN
8 yo boy
GSW (L) thigh, exit ® flank
Shocked
DCL – stabilised
Turned over for debridement
of flank wound
bradycardia, BP
died on the operating table
– “missed” injury to IVC
18. CHILDREN
13 yo boy
Accidental shotgun
wound (L) thigh
Shocked
Leg pulseless, paralysed,
anaesthetic
21. MOTIONAL DISTRESS
ut of my depth
ot good enough
ividly reliving failure to save child
nsomnia
norexia
22. E AFTERMATH
old I was “a disappointment” as an officer
Confirmed my belief
“crashed and burned”
wo days later –
flight out delayed by dust storm
MASCAL – trauma team leader
Off duty after 0200
25. 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 from
vilian employment
28. 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”
30. OW CAN ONE BE “READY”?
RAIN FOR CASEMIX
mprove pre-deployment training
Simulations
Work as teams
Paediatric trauma experience
Visit trauma centres with high caseload of penetrating trauma
CSTARS
Senior visiting surgeons program to Landstuhl
Emergency War Surgery Course - Lackland Air Force Base, US
31. 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”
32. 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
33. 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
34.
35. ARON COOPER, WGCMDR ANNETTE HOLIAN, SQNLDR MARY LANGCAKE,
GPCAPT GREGOR BRUCE
SQNLDR BRUCE ASHFORD
SQNLDR SANDY DONALD
AUSMTF2
36. “We have to do the best we can.
This is our sacred human responsibility.”
Albert Einstein