Mass Casualty Exercise

I am posting some pictures of our recent MASS CASSUALTY exercise. This is performed several times while in theatre to make sure everyone that would actually be involved in a scenario like this is ready and knows their positions. This is not something that I have ever been involved with in the states so it was a learning experience. Essentially the number of patients and their ailments is decided and when the exercise begins, someone calls into the EMS saying that they have X amount of patients in this location, and they tell you what the hypothetical incident was. Our clinic is so small that when we have more than 2 critically wounded patients, we are considered to be having a "mass casualty". The incident they gave us this time was that there was a roll-over vehicle accident and there were 7 critically wounded and 2 dead on scene.
The dental officer...yeah, you would think I would be there to fix any broken teeth of people with minor injuries 3-5 days after the initial incident...NO SUCH LUCK!! The dental officer serves as the TRIAGE OFFICER during a mass casualty.
triage ( ) n. A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment.
So now I get to be the first one in the whole medical clinic to see the injured!! Not what I signed up for!
I stand outside the clinic as they bring me these people, the EMS brief me on what there injuries are and their vitals, and then somehow I dig into my brain to decide if they are:

Black (Expectant) which entails pain medication only until death
Red (Immediate) which entails life threatening injuries
Yellow (Delayed) which entails non-life threatening injuries
Green: (Minor) which entails minor injuries

It is a bit like playing god (maybe not quite that important), which I have decided I would probably be pretty good at...except everyone would live. The hardest category to decide on is black. Essentially if I decide someone is black it means that they are likely to die OR that trying to save them would take away valuble resources that would best be used to treat patients more likely to live. Talk about a tough call. I guess that is why we practice these things?

I do triage in my real job, but when the worst outcome is the removal of a tooth...it sure does make it easier to decide.

So here is the team and a few of the pics from the exercise. Overall we did pretty good... we sat around a round table with a lot of important people a couple days later and discussed where we could make improvements. I had to get the "some people are going to die LT. Downey, that is what happens in a Mass Casualty" talk. :(

As promised I am posting pictures of my so called “camel-ride”. Turns out that there was only one camel when we got there, a large line, and the camel would be called BAMBI if it were a deer…so I decided not to ride it and just get a picture with it. The proportion of large people waiting to ride the camel was disturbing, so I figured one less time around the circle may spare him some bad knees!
Since I last blogged I have gone from super dead at the clinic, to really taking off here. The turn around came when I spoke to the Army PA that shares the clinic with us. I asked him if he thought his Commander would be open to the idea of me getting his soldiers in to the clinic, updating their exams and trying to get their work done before they go home in December. I had tried this with one of the other groups here and had not gotten a very good response… the kicker is that the non responsive unit only has 65 guys, whereas the other group has 600. They were responsive, and now I have been ramping up to almost a full time dentist here. It is great. They are a reserve unit and therefore have a lot of dental needs. These guys get activated, they are required to come in get an exam, get any EMERGENT care done, and then they deploy. Most of them still have a large amount of NON-EMERGENT dental care that goes undone. By the time they get home, they get another exam and then usually are not considered ACTIVE anymore so getting their dental work is done is on their own $. They have been really appreciative, and it has boosted my morale to know that I am getting utilized here.
Last weekend the Nurse (Lilly) and I discovered our Beauty Salon here on base. We had seen it before but were still in our US state of mind ….meaning, we thought EWW gross, it is probably nasty in there. But, after 2 months now, we have constantly been reorganizing our ideas of what is gross. We walked in and found 2 soldiers laughing, rubbing their eyes and couldn’t figure out what was going on. As it turns out, they were getting their eyebrows “threaded”. The chance of 2 females walking in on this are, I would guess 1/100, at this base. We could tell they were a little embarrassed, so Lilly decided to capitalize on this and says “What are you going to do if I tell your unit you guys were in here getting your eyebrows threaded?” and one answers back “ We were where?, what are you talking about?” He had his denial statement down. So I asked if they come here often and the one says “No Ma’am, our mission was canceled today because of the dust, so we were bored.” It was hilarious….two guys, mission canceled that were in the salon crying from how bad it hurt to get their eyebrow hairs in-line.
Last week we went to an outlying camp and saw the band Filter. It was a good show but I was forced to drink 2 "Near Beers", felt too strange to be at a concert without a beverage in my hand. It tastes pretty good to me. We also have wine called “Fre”, I guess that is a fancy way of spelling FREE (as in alcohol free), that tastes really good. We don’t have it at our camp so we get people to bring it back when they come from Arifjan.
My little guy that came in to get the ring removed from his lip (I say little cause he is adorable 18 year old that can’t weigh more than 110 lbs) was sitting out in the waiting room last week with a splint on his arm. Apparently he is the gunner on their missions which means he sits high in the middle with a strap on him and head poking out of the vehicle, anyway, he said they hit a big bump and he was holding on to the gun handles (takes both hands) and the bottom broke out underneath him sending him down into the cab, but he was strapped in up top so couldn’t fall all the way down. His shoulder dislocated from holding onto the gun when he hit the bump. The guys in the vehicle all had sound proof ear protection on and couldn’t hear him yelling or see that he was stuck. He traveled over half an hour with his arm pointing strait up out of the vehicle, arm dislocated before someone noticed his legs were flailing around. Although he got his arm back into the socket, he has some nerve damage. Poor kid.
This month is punctuated with a birthday party for Rausa, 2 fun runs, a haunted house, lower temperatures, and the promise that another month will indeed pass!!! Love and miss you all!

The Ladies of Camp Virginia : LTJG Rousa (PA), Me, LTJG Greenwood (Nurse)

The bain of my existence, 2 compressors+ 2 pumps = my nightmare

This sign cracks me up....

Ahhh..... HM3 Duran, my dental tech....

Our "movie theatre"

My first month in Kuwait was official on September 8th, and my first 2 months away from home is official today! Yay, we are making some progress.

I wish I could say a lot has happened since I last blogged, but on the contrary, I have not blogged because things slowed down drastically here. The Stryker Brigade that came through at the end of August only stayed about 2 weeks temporarily bringing our camp population up to 1,200-1,300 but since then we have been back to our permanant party population of aproximately 800-900 soldiers (and sailors I guess:). From my estimation that means there was about 34,000 teeth under my care for awhile :) My weekly numbers went from aproximately 30 patients down to a lonely 9! We should have another surge coming in a couple of weeks and so hopefully business will be up again.

To stay busy I have been trying to help out in medical as much as I can (we had a SHOT-X last week .... short for shot exercise) in which we vaccinated about 1,000 soldiers and sailors with the H1N1 vaccine/flu vaccine combination. We had quite a line out the door for a couple of days, and one of the corpsman was kind enough to volunteer to let me give him his vaccine. It sounds simple considering almost every patient I have to inject with a needle, but when it comes to giving a shot on the outside of the mouth... it was like my first injection all over again. I was shaking and it took me a good 20 min after I was done to stop feeling jittery inside. The docs and nurse had a pretty good time making fun of me. I was able to get back at them later when the following patient came in:

The patient was about 21 and he came in to see the doc with a complaint that he had a lip ring stuck in his lip. The kid had gone on leave, decided to pierce his lip and then unfortunately got kicked in the mouth (probably was out one night...being all that he could be: ). Instead of taking out the stud, he left it and the cut healed over the post on the inside of his mouth. When he went back on duty, he had to remove it (not allowed to have that in the military obviously) but he could not access the part to remove it since it was inside his lip and healed over. So, he cut the outside ball off (not sure how) and so all that was showing was a little shaft that poked out (almost looked like a little black hair). He still couldn't get the other part out, so he came in asking if someone could remove it.
The PA (an army CPT) asked if this was something I felt comfortable doing because he had never had to cut the inside of the lip and he wasn't about to start. This was funny because they cut things open ALL THE TIME! Including cysts, absesses, etc. So now it was my time to make fun and say "ohh, you don't want to do something on the inside of the mouth, so now you know why a shot on the outside makes me uncomfortable!"

I made a little tiny cut and pulled out the guys lip ring, sewed it up and he was good to go!

I have had shadow now for the last 2 weeks and it has been really fun for me. He is a SSGT in the Army, about 24 or so but he is a medic with a unit here that runs convoys from Kuwait to Iraq every 2 days. It really sucks for him because he sits in a Humvee and drives 5 hours up to Iraq, unloads food and gear and supplies to guys, and then drives back the next day. Anyway, he came in when he found out there was a dentist here because he really wants to go to dental school and so I have been letting him watch procedures, and talking to him about how to get into school etc. He is more serious than many of the corpsman I have come across about wanting to go to dental school as he is currently taking the online Kaplan test, already has his undergraduate degree, and has come by almost every day that he has had off (even when we don't have patients) to watch and ask questions. His dad is still in the Army and is currently deployed in Iraq about 3 hours further North from where he is bringing supplies to, I am sure his mom is a wreck right now.

We had another race this Saturday in memory of 9/11. It was a 5K and I took first in my age group, and I think I was second overall for females. The PA here is 25 and she is fast! Reminds me that I am getting pretty old :(

Tonight, we are going to ride a camel?! I will take pictures and post later.

Week 3

On Wednesday my OIC (officer in charge) went to a command meeting and let Camp Virginia know that they now have a dentist. It may have not been related, but on Thursday I saw 8 patients. It was a really busy day. Many of the Stryker teams are coming through and when they come to me, they have such limited time before they leave again that my hands are tied as far as what I can do for them. In fact just last night I had a guy come with an absessed tooth (said it had been bothering him the entire deployment!) and I couldn't do a root canal on him because his plane was leaving in 2 hours. I just gave him antibiotics and percocet, hopefully the change in altitude won't be too bad on him.

Last night we had some friends from our detachment come up and have a barbeque with us at Camp Virginia. It was a great turnout, was curious why anyone would want to leave their camp to come here, but as it turns out there are things to be desired about a small camp away from the mother-ship.

I got talked into doing a 5K run at 7 pm. I wasn't plannig on doing it because I thought it would be too hot, but the people from the other camp twisted my arm and I went ahead and did it. Glad that I did as I won and got a $25 gift certificate. It reminds me of Yuma because there are about 35 guys running the race and only 7 girls.... makes it much easier to take home a prize.

Not much else went on this last week. Now I am just in my office trying to wrap up my applications to University of Iowa and University of Michigan.

Week 2

LTJG Greenwood and I standing outside the clinic (TMC) Troop Medical Clinic
My House (second door on the end)

Single Operatory (I have 4 in the clinic)

Dental Wing

This week I did more organizing, throwing away, cleaning off dust etc. I saw a total of 13 patients some with legit dental issues, and then some that were definitely something that we needed to call the WAAAmbulance for, including my 8:30 Dental Emergency that happened today!Twice now since I have arrived I have had someone come running after me on my way back from the gym to tell me we had a dental emergency, and "where was I?"... of course I don't have a duty phone like the docs,(we are working on that) so nobody can get ahold of me unless I am in my room.

Where was I? I will give you a hint: Eating, Sleeping, Working Out, Doing Laundry or In the Shower/Bathroom....that is where I will be for the next 7 months :)

It seems I frequently go from being "Oh, she is just a dentist" to " Thank god we have a dentist" which I am okay with.... unlike The Hangover, you will not get me to extract my own tooth by telling me I'm not a real doctor!

In fact... the PA, and Nurse have had to see so many rectums lately, I am very proud to not be a real doctor:)

On with my story.... so one was a root canal at 9:30 pm last Sunday, but the one worthy of the Waaambulance was today. I got the message on my way back from the shower that a girl at a nearby base knocked her tooth out. So I asked them to get ahold of her again and tell her to put the tooth in milk (yes, that is not just urban myth) and come on down. 2 hours later, the pt shows up with her partial denture in hand, and a plastic tooth submerged in about 10 oz of milk! Are you kidding.... the tooth was not even real, it had broken off her denture as she was devouring crab legs last night! ARRRG

#1. WTF

#2. We didn't get crab legs last night!

I am posting a bunch of pics for you guys to see the lay of the land and the clinic.

1 Week Down 26 to go !?

Made it through the first week! My god, the clinic is a wreck. Not only have I had to go through and remove about $4,500 worth of expired items, the dust on the shelves and boxes of supplies makes me SICK! I knew there would be dust, but when it comes to items that will be used in a health care setting, I just cannot accept things being visibly dirty! I saw only 2 patients this week but it is a good thing! I have had trouble with just about everything that I could have:
- No phone, internet, or printer in my office
- Lack of supplies, tons of expired items
- No access to program to input patients in dental system (all my medical collegues use a similar system, the dentists however use the Army's program while in theatrer to input dental encounters)
- My Tech, bless him, is having just about as much trouble as me and so I have to stop my projects to help him with things... which by the way...I have no idea how to either, so I have to read about it, then show him!
The big wigs came up from Camp AJ and I believe they are going to send me someone else who knows something about Dentistry (thank god). In the "real world" there would be a senior enlisted person who would guide my tech on what he needs to do, how to do it etc, and there would be little interaction between my tech and me (except when we started treating patients), but since there are no senior enlisted people that have ever worked in dental, they cannot guide him.... which leaves me. All the time spent helping him, is time less time that I have to do the stuff I need to get up and running. Wow, am I ranting or what?
Anyway, before I bore you all into never reading my blog I will point out some highlights
1. We have a starbucks!
2. The gym is nice and is not busy much
3. I saw a cat and I gave him water (Violation of a general order!)
4. My room is my own, even if it does not have a bathroom and the shower facility is located about .2 miles away
5. The DFAC (dining facility) has OK food....at least it has a salad bar
I am going to post some pictures really soon! Love you all.

Finally Arrived

There is really so much that has gone on in the past 4 weeks and I was unable to get internet access so I will fill you in...bullet style.

July 12-17: Left Groton, CT and said goodbye to my favorite boys Sparky and Brad. I arrived in Port Hueneme California for inprocessing. This place really tested my patience as each day I was there we had about an hour of things to do stretched into a whole day. This sight is to make sure the women aren't pregnant, that everyone is fit for the deployment and take care of any administrative things before going to training. The great news was we stayed in an awesome hotel for 5 nights.... not a good way to prepare us for what was to come.

July 17-22: Took a 2 hour bus trip up to Camp Pendleton to a sight called NEMTI. Naval Expiditionary Medicine Training Institute. The first week we broke our group of 160 sailors into platoons, decided the leadership organization for the next 3 weeks, and adjusted to our berthing (living quarters). The place we slept was called a sea hut and it was open bay with 10-20 other people. We slept on cots with sleeping bags, and kept our sea bags under the cot and a footlocker at the base. It took some adjustment but I was sleeping well in about 3 nights. I celebrated Brad's 31st birthday on July 19th. It was very sad to be so far apart during this time.

July 23-July 30 : This was a busy week. We had classes, figured out how to get 160 peoples laundry done, and had some lab portions of training to do. It was starting to get sort of fun as we got to know eachother, after all, we were comprised of endocrinologist, gastroenterologist, surgeons, nurses, dentists, PA's, optomotrists, internists, family practice doctors, health care administrators, etc.... so our dinner conversations were, well...... usually pretty gross! I have a whole new appreciation for Nurses, I can say that for sure. Our classes consisted of:

- Land Navigation

-Use of the SINGARS radio (single channel ground to air radio system)

-Basic Dari Language

-General Orders : no alcohol, no pornography, no feeding or trying to domesticate/capture wildlife, no buying foreign currency, no taking of weapons, uniforms etc as "prizes"...and some others I can't really remember.

- What to do if captured as a POW

- IED detection

For the "hands on portion" we did the following

-we took a 5 vehicle convoy through a fake town and simulated mortor fire, and IED explosion (real sound effects here)

-Identified 10 IED's on a pathway

- Gas chamber exercise (went into a room with CS gas and put on our masks and made sure we knew how to work them) Of course you get some gas on you and it burns your eyes, throat and makes you salivate and your nose runs.

-HUMVEE roll-over (almost like a fair ride, except you are wearing 35 pounds of protective gear and you are holding a M16 that you have to make sure stays squeezed between your legs as the vehicle rolls....not so easy)

-Weapons Qualification on the M9, some people also had to qualify on the M16. I did not, however I did get to shoot about 30 rounds on the M16 which was fun.

- MOPP gear training ( Mission Oriented Protective Posture). Shows us how to put on boots, gloves, pants, gas mask and top that you would have to have if you had a biological contaminant.

July 22- Aug 6 : Basically had some more training (some of the above hands on portion was done during the beginning of this week) and then we just cleaned up camp and got ready for our long plane ride. I had found out late last week that I would not be going to Camp Arifjan which is the main base in Kuwait, in fact, I would be serving as the sole dental provider in a Camp about 2 hours away called Camp Virginia. I was not too happy about this as the clinic had not had a full time dentist for 2 years and I knew that meant I would either be walking into a wreck, or their may not be enought patients to keep the time going by fast.

Aug 6,7 : It took us about 24 hours until we touched down in Kuwait. Had 3 layovers in between and got into Camp AJ at about 4 am on Saturday August 7. We did not go to bed, we put our gear in tents and waited for our CO to come and brief us about what was to come.

Aug 7 5:00 pm: After the CO's brief, they waisted no time. I took a bus with about 10 other up to Camp Virginia. You can imagine by now I was exhausted. Almost 36 hours of traveling. We traveled in buses with the curtains closed so I couldn't see much of anything. I arrived at about 9 pm in Camp and was shown to my little hut..... I laid my head down but had a lot of trouble sleeping despite my exhaustion... thoughts: " WHERE THE HELL AM I"!!!

The Gas Chamber Day

Leaving NEMTI

I can't believe it is only 2 days until I leave. I have got myself halfway packed... bringing a Colorado State shirt of Brad's in case I get home-sick (in case:). Brad and I are hanging out with our dog, and have scheduled a hot stone massage at the Norwich Spa. We are unsure how to spend the last couple days because it is so hot outside, we can't do anything with Sparky, but I want to get in some QT with Sparky too....

3 Weeks to Go

Today marks the 3 week point. I will be leaving Providence on the 10th of July to go to Camp Pendelton CA. I should be issued uniforms there and go through 3-4 weeks of training before leaving for Kuwait. From what I am told, the time at Camp Pendelton goes by pretty slowly because we will be sleeping in tents? Three weeks of desert camping...ehhh! Brad and I will be seeing Dylan and Candise next weekend, also celebrating our 1 year anniversary, and then off to Boston for the 4th of July weekend.