News>Pacific Angel med team gets real-life trauma care education
Lt. Col. David Worley, a critical care transport nurse, removes the dressing from Neng Yong Ya's head, April 27, 2012, at the Lao-Mongolian Friendship Hospital in Phonsavahn, Xieng Khouang Province, Laos. Mr. Ya, a 30-year old farmer, was critically injured April 24 when a Vietnam-era unexploded ordnance blew up as he attempted to remove a stump from a field. Worley is working with Operation PACIFIC ANGEL 12-2, a joint and combined humanitarian mission, and is normally assigned to the 123rd Medical Group of the Kentucky Air National Guard. (U.S. Air Force photo/Master Sgt. Mike Hammond)
Tech. Sgt. Christain Simpson, Lao nurse Syam Pone Ponsavah, and Lt. Col. David Worley apply antibiotic ointment to the wounds of Neng Yong Ya, April 27, 2012, at the Lao-Mongolian Friendship Hospital in Phonsavahn, Laos. Mr. Ya was wounded when a Vietnam-era unexploded ordnance blew up as he worked to remove a stump from his farm. The U.S. and Lao medical professionals were working together as part of the humanitarian mission Operation PACIFIC ANGEL 12-2 when Mr. Ya was brought to the hospital in critical condition. (U.S. Air Force photo/Master Sgt. Mike Hammond)
by Master Sgt. Mike Hammond
Operation Pacific Angel 12-2 Public Affairs
5/1/2012 - PHONSAVAHN, Laos (AFNS) -- With a swing of the axe, Neng Yong Ya's life took a dramatic turn for the worse. The 30-year old Lao farmer was at work, April 24, trying to remove a tree stump from a field when a Vietnam-era unexploded ordnance blew up. The force of the blast threw him, and caused trauma to his chest and stomach. The right side of his face was shredded and badly burned. One moment, it had been a normal day's work, and the next, Neng was clinging to life.
It was obvious that Neng needed medical attention, but the farmer and his family lived a five-hour drive from a real hospital. Concerned family members loaded Neng into a vehicle and made the long trip to the Lao-Mongolian Friendship Hospital in the city of Phonsavahn, in the Xieng Khouang Province of Laos. Meanwhile, the bleeding inside Neng's torso became like sand in an hourglass - time was ticking, and without critical care, he would surely die.
Classroom to Emergency Room
In what was surely the only spot of luck for the farmer that day, a number of U.S. military and Lao military and civilian medical professionals were at the Friendship hospital, as part of Operation Pacific Angel 12. The combined team was working on providing health services and learning from one another through various seminars and training sessions and seeing patients. Just the previous day, topics had included Burn Management and Trauma Care. About the time Neng's family arrived, the PAC ANGEL doctors, nurses, and medics were tackling a busy afternoon agenda and tending to patients.
Then, the phone rang.
"I was working with the Nursing SMEE (Subject Matter Expert Exchange) and one of the nurses there got a call," said Lt. Col. David Worley, a critical care transport nurse with the 123rd Medical Group of the Kentucky Air National Guard. "When this patient arrived ... the ER was short staffed and they wanted to know if (the nurse) could come over to help. We basically just followed him over there."
The nurses, along with visiting Swiss doctor Manfred Mueller and nurse Sarah Wasecha, began assessing Neng and trying to relieve some of his pain. Meanwhile, Col. (Dr.) Frances McCabe was working patient care in the clinic next door with Dr. Ming Tommanya, a Lao doctor assigned to cover the emergency department at the hospital. When word of the badly injured patient came, McCabe and Ming rushed over to help.
"By the time we headed that direction, they had removed the patient from the emergency department in order to get an X-ray," McCabe said. "I saw the patient had what appeared to be some bad, some very significant, facial injuries. Clinically, we assessed that he had no function in the left side of his chest. The lung was either collapsed or surrounded by blood ... you can't leave it like that. He needed a tube to be placed in that side of his chest."
Outside the comfort zone
At that critical moment, the U.S. medical team began to see the challenge of working an urgent trauma case in a location without many of the standard equipment items they took for granted back home.
"I see patients this badly injured and worse all the time," said McCabe, who works as a flight surgeon with the Pentagon flight medicine unit of the 79th Medical Group at Andrews Air Force Base, Md., in her Air Force Reserve capacity. McCabe also serves as the Emergency Department medical director at the St. Charles Bend Level 2 trauma center in Bend, Ore., as a civilian doctor.
"It's not that difficult for me to manage these patients at home - with all my toys, and all my consultants, and all my highly trained nurses," the colonel said. "What makes you sweat is looking around and you are not in your normal work environment and you don't speak the same language as the patient or anyone else who's there to help you. So, you have some extra things to overcome. That makes it more challenging."
The U.S. and Lao doctors and nurses all agreed that Neng needed a chest tube, but the hospital didn't have one. Other supplies, like ventilators, suction systems to pull the blood out, and properly sized IV tubes were also lacking, said Tech. Sgt. Christain Simpson, a critical care and aeromedical evacuation technician from the 18th Aeromedical Evacuation Squadron, Kadena Air Base, Japan, who is here with the PAC ANGEL team.
"It was very, very difficult to find items. We made three chest tubes, just from supplies that were available," Simpson said. "It was completely unorthodox, but these were things we had to do to save the patient's life. We took the concepts of Self Aid-Buddy Care and turned it into field medicine... in a hospital environment."
The team pressed on with efforts to save Neng's life. They created the chest tubes, and it worked! A liter of blood came rushing out of Neng as soon as the tube was in, and more followed. They used a plastic water bottle to help create a pneumatic pressure suction system to assist the flow from his chest.
Meanwhile, since Neng was losing so much blood, the farmer's family stepped up to give him a chance as well. They donated all the whole blood they could, which Neng received when he needed it most.
"His family really saved his life," McCabe said.
ICU room becomes the classroom
Despite the best efforts of the U.S. and Lao medical team, no one held high hopes that Neng would still be alive when the medical team arrived at the hospital the next day. But it turned out that he began to stabilize. And so it happened the following afternoon that Worley and Simpson got the opportunity to teach a few more concepts to the hospital staff... right at Neng's bedside.
As two men skilled and experienced in critical care, they used their expertise to demonstrate changing Neng's bandages that day (and those that followed), and fielded questions from the staff on his care going forward after the Pacific Angel team would leave.
"I have never seen that many staff members huddled around a bed just to see what was going on," Worley said. "And we were teaching the entire time. Vocalizing to the doctors and nurses what we were doing, what medication we were using, why we did it this way, and locating potential secondary or additional injuries. So from the day of the incident, to today, to tomorrow when the next dressing change happens, it will be a continued learning opportunity. For us as well," Worley continued. "We had to seriously step outside our comfort zone in working without the equipment and supplies we were used to."
No one knows what will become of Neng as the days go by. He is far from being out of the danger zone, medically speaking. His family wonders how they will make it without him, if it comes to that. The force of the blast exploded both of his eyes; he will likely never see again. The accident the farmer suffered was, from any angle, a devastating tragedy to his family.
Even as the team hopes for Neng's continued recovery, they also hope some permanent value to the local community can come out of this terrible injury.
"We are hoping that some standardization - some process improvement - can come from this here at the hospital," Simpson said. "And for us, getting hands on a patient and providing care in more austere conditions was a benefit."
By working side-by-side, the Lao medical team saw Western medicine techniques in practice. The U.S. team learned to make do without the luxury of all the supplies and equipment they were used to having on hand. Together, the combined Pacific Angel team ensured that, at least for the moment, Neng the farmer still has a chance at life.