17 April 2012

Pentagon issues guidelines on live explosives in battlefield surgery

USA Today reports that the Pentagon has recently issued guidelines for performing the delicate battlefield surgery of removing live ordnance from a servicemember's body.

The guidelines provide information on bomb triggers, recommend body armor for surgeons, and warn against shifting the patient because of fear of detonation. They also recommend the presence of a bomb disposal expert, and that the surgery should be isolated to guard against killing other patients and destroying equipment. Hand saws should be used for cutting bone, because electronic tools could set off the bomb.

Such procedures are rare.

In March of 2010, an Air Force trauma team at the Craig Joint Theater Hospital at Bagram Airfield, Afghanistan removed a live incendiary round from a patient's head.

And in 2006, PFC Channing Moss was impaled by an RPG. MAJ John Oh, a surgeon at the 759th Forward Surgical Team at Orgun-E, Sgt. John Collier, CW3 Jorge Correa, SFC Daniel Brown, and many others all risked their lives to fly PFC Moss to the FST, surgically remove, and then dispose of the ordnance.

The most recent case occurred in January of this year.

As wounded Marine Cpl. Winder Perez, fresh from the battlefield, lay on a gurney at a remote medical station in Afghanistan in January — a rocket-propelled grenade inside his body — Navy nurse James Gennari approached.

"I took his hand. Held it in mine. And said… 'I promise you I won't leave you until that thing is out of your leg,' " Lt. Cmdr. Gennari recalls.

"I really did know that thing could have blown up," Gennari says. "But I figured I would leave that up to God."

Army Staff Sgt. Ben Summerfield, left, removes an unexploded ordnance from Marine Cpl. Winder Perez, while Lt. Cmdr. James Gennari treats Perez on Jan. 12 in Afghanistan. Photo: U.S. Navy.

The nearly 2-foot-long rocket that had struck Perez on Jan. 12 in Helmand province, lay along the length of his thigh muscles with its tip thrust inside his left buttock, says Navy Capt. H. Donel Elshire, a doctor on duty.

As Gennari administered pain medication and kept Perez's airway open, the Army explosive ordnance disposal expert, or EOD, pulled out the explosive.

During all that, Gennari noticed that Perez's dog tag said he was Catholic. "I'm Catholic," the nurse says. "So I said a prayer… for (Perez), for me and for the EOD guy."

In the photo above, you'll note that the procedure was performed outside the OR, surrounded by blast barriers, and involved a minimum number of personnel. The patient was undoubtedly brought into the OR for further care immediately after the ordnance was removed.

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