1. Groves, John T. Jr. RN, BSN, MSN, CEN

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Emergency departments are usually reserved for the eyes of crusty old veterans in the nursing and medical profession. Not so in the Army. While maintaining a level of care unprecedented in any previous conflict (less than 10% casualty rate) what may have gone unnoticed is not only how we train but who we train to go to war. Surgeon General Kevin Kiley stated, "other armies have brave people, they have smart people but the difference between how we fight and how other countries fight is how we train." Even having had some unique teaching assignments ranging from Special Forces medicine to the Army Trauma Training Center in Miami, I am still surprised. We are currently deployed in Iraq with a staff so inexperienced that most hospitals would not consider hiring them for their least challenging areas without special training, let alone their emergency and critical care units. We train and take medical specialists of all ages, but most are very young. Just like the 18-year-old rifleman, the Army Medical Department takes 18-year-old medics and 22-year-old nurses fresh out of school and puts them in some of the bloodiest emergency departments in Iraq. As a senior officer with 19 years of experience, it has become the pinnacle of my career to serve with such special young people (Figure 1).

Figure 1 - Click to enlarge in new windowFigure 1. Members of the 10th CSH EMT in Baghdad, Iraq, holding a flag sent from a civilian ED stateside.

It is often said of our "greatest generation" that they were unique young people who answered the call during World War II. Hearing those veterans speak, they have no doubt that our current generation will rise to the same level if needed. I can certainly attest to that without hesitation. Our Generation-Xer's and younger men and women are more than up to the task.


In just 4 months here in Iraq, examples of their heroics in saving lives are countless. Three days after arrival in country, this young team received four U.S. fatalities simultaneously, a larger group of fatalities than the previously deployed Combat Support Hospital received during their entire tour. It was unnerving, shocking, sad, and heartbreaking. And, it all happened within a matter of minutes. Watching inexperienced nurses and medics challenged with the horror of death of young Americans their own age is something that touches even the most seasoned professionals. One of the most memorable moments of this tragedy came after lifesaving efforts were ceased on one young soldier. A colonel from the 2nd Brigade, 502nd Infantry Regiment, stepped up to the desk to offer his comfort to one of our youngest nurses. His words were extremely touching, "Thank you for what you do and all your efforts; he was a good man and is deserving of your tears." Witnessing a colonel personally thanking a young lieutenant was something very special.


Now fast-forward to 4 months later and you couldn't pick out the two seasoned nurses and three seasoned medics who were deployed among the 31 rookies. Events occurred daily that hardened the young soldiers. More important, skills have been forged at breakneck pace. Not only do these young heroes resuscitate patients, but they also risk their lives by jumping into helicopters with patients who have severe brain injuries and must be flown to another hospital. Treating an unstable, severely injured patient in-flight is a task reserved for the most seasoned of nurses and medics in the civilian community. Out of necessity, this is not always possible in Iraq.


Even with events from home overwhelming them, they hunker down and drive on, not wanting to let their teammates down. One nurse and medic had to be evacuated due to personal injuries, yet both pleaded to be brought back. This is the value of selfless service. It reflects one of our main Army values: placing the needs of others ahead of your own.


Here are some special moments from our time here: friendly competition to get the most helicopter flights in, a successful thoracotomy by a young physician who had only trained on animals prior to deploying, and, after saving a pulseless soldier, a young lieutenant remarked, "I learned today that when you do CPR that doesn't always mean they die."


I now understand why we are here. It is for the combat soldier. But also it is for these young heroes. They will carry the torch and caduceus for all of those who have come before and all of those who will come after.