SUNDAY, NOVEMBER 28, 2010
KLMNO
EZ RE
A9 TRAUMA TRANSIT
‘If something goes wrong that we can’t handle, it’s a failure of the imagination’
flight from A8 shrapnel fragment nestled
against his third neck vertebra. His eyelids were heavy with mor- phine, which he delivered to him- self with an orange controller in his hand. “The secret to these flights is
preparation,” said Gonzalez, whose regular job is heading the emergency room at Landstuhl. This is his third deployment.
He’s been runningCCATmissions for seven years. “We try to imagine what could
go wrong,” he said. “We do that with every single patient every single flight. If something goes wrong that we can’t handle, it’s a failure of the imagination.” As a practical matter, that
means drawing up drugs in sy- ringes and IV bags, ready to use if a patient spikes a fever, throws a blood clot, starts to bleed, has an allergic reaction, or can’t breathe and needs to be put on a ventila- tor.
On this flight, all the patients
were stable except Solorzano. Damaged by shock and the
molecular trauma of repeated resuscitation, the cells lining his miles of blood vessels were al- ready starting to leak before the soldier was put on the airplane. As water moved out of the blood- stream into surrounding tissue, his blood pressure fell. His arter- ies clamped down to compensate but couldn’t keep his systolic (or top) blood pressure from dwin- dling down below 100. As it did, the amount of urine made by his kidneys — a gauge of healthy “perfusion” of his organs — fell, too. Two and a half hours into the
flight, Gonzalez conferred with Capt. Julia Kiss, the nurse giving one-on-one care to Solorzano. Normally a CCAT team has one nurse; Kiss was an extra lent by the Bagram ICU because the un- conscious soldier needed so much attention. The two talked through a closed-circuit headset, the only way to converse easily over the engine noise. They decided to give him a
“bolus” of IV fluid to see if that would boost his urine output. It did. But not for long. Elsewhere in the plane, Maj.
Marilyn E. Thomas, the regular ICU nurse on the team, and Master Sgt. Alfonso L. Betiong, the respiratory therapist, tended to the other patients, testing their blood, monitoring the machines and logging data in tiny boxes on record sheets. Provorse asked for drink, and Thomas watched him hawklike as he sipped from a 6-ounce can. As morning came, the patients
on the bunks stirred. Three got down and hobbled to the bath- rooms, a member of the aircrew on each arm. Many produced iPods from under their quilts. On one top bunk, a soldier read a
PHOTOS BY LINDA DAVIDSON/THE WASHINGTON POST Jennifer Provorse helps her husband, Army Sgt.HiramProvorse, stretch his calf muscles before he is taken off to surgery at Landstuhl RegionalMedical Center inGermany.
ambulance pulled up to the low- ered ramp. Members of the ground crewin brown flight suits helped unclip Solorzono’s litter and carry him to a waiting ambu- lance. His blood pressure was 60/30,
and his urine output was zero. The ambulance had room for a half-dozen patients, but it left for the 12-minute trip to Landstuhl with only Solorzano aboard, si- rens blaring as soon as it hit the highway. Afterward, Gonzalez said it was the first time he’d ever seen that happen.
HiramProvorse was the only one of the four most-critically injured patients on his flight who was able to communicate with those around him. Once inGermany, wife Jennifer kept a watchful eye.
paperback, “Hitler’s Lair.” Four hours out, Solorzano’s
blood pressure had dropped be- low 90. The IV bag with norepi- nephrine, a neurotransmitter used to treat shock, was set up, and Gonzalez ordered it started. “He’s basically in multi-organ failure now,” the doctor said.
Six hours out, as the airplane
passed over Budapest, Gonzalez addedphenylephrine, a last-ditch drug to raise blood pressure. The plane landed at Ramstein
Air Base at 10:19 a.m. German time, six hours and 42 minutes after leaving Afghanistan. The day was cloudless and cool. An
In Landstuhl Landstuhl Regional Medical
Center, built in the early 1950s, has three miles of corridors and 3,000 employees. About 65,000 soldiers from the Iraq and Af- ghanistan wars have passed through it since October 2001. Its peacetime allotment of chaplains is two. After the wars started, that increased to four. Since 2005, there have been six. The average battlefield casual-
ty stays in the hospital for 31/2 days before being discharged to outpatient care or, more likely, sent on to Walter Reed Army Medical Center in Washington, the National Naval Medical Cen- ter in Bethesda or Brooke Army Medical Center in San Antonio. Many of the most seriously
injured patients — those who have lost multiple limbs or suf- fered serious head trauma — are not aware of their injuries until they are back in the United States. A few are never aware, and
never make it home. Diego Solorzano died at 9:45
p.m. German time the day he arrived, never regaining con- sciousness. His parents arrived the next morning at 5:15. It was a Sunday. They had
spent most of the morning with a chaplain. They had not yet seen their son’s body. They agreed to speak briefly about him. They were brought to the pediatric clinic, which was quiet except for a doctor catching up on paper- work with his daughter, in pig-
tails, who was exploring the emp- ty rooms. Solorzano’s mother, Patricia
Valdovinos, is a 41-year-old cloth- ing designer. She was originally from Mexico. His stepfather, Ce- sar Muralles, is a 53-year-old truck driver from Guatemala. Theirs is a blended family of six children, ranging from age 12 to 30. Diego was the second-oldest. Valdovinos held a framed pic-
ture of them. She was composed, but her lower eyelids were swol- len. Her husband sat next to her, holding her hand. She said: “The last time I talk-
ed to him on the phone, he said, ‘I’m a sheepdog, protecting the sheeps.’He didn’t care for hisown safety if he had to protect some- body else.” His stepfather said: “We were
proud of him. I want to say that he never got into trouble with the kids who want to become gang members. He chooses to be an Army guy. His platoon called to say he was a hero. And we believe so.”
browndm@washpost.com
CAREER FAIR
December 7, 2010 11 am to 5 pm The Washington Post
1150 15th St NW, Washington DC 20071
Engineering, Technology and Security Clearance Career Fair
Candidates must have US citizenship and at least 2 yrs of Engineering, Technology or Defense industry experience on top of related degree (or
comparable military background). Some employers will require an active security clearance.
Watch for updates on employers attending the event and available job opportunities
QUESTIONS? Employers contact: 1-877-842-3976 x18 or
admin@expoexpertsllc.com Job seekers contact: 1-877-842-3976 x17 or
resume@expoexpertsllc.com
www.washingtonpost.com/careerfairs J647 3x7
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140 |
Page 141 |
Page 142 |
Page 143 |
Page 144 |
Page 145 |
Page 146 |
Page 147 |
Page 148 |
Page 149 |
Page 150 |
Page 151 |
Page 152 |
Page 153 |
Page 154 |
Page 155 |
Page 156 |
Page 157 |
Page 158