Combat Casualty Care Course

C4….Combat Casualty Care Course….and…Military Treasure

Today is Veterans Day. A lot of guys,and women, have some military stories to share, war stories that is. I did some time in the military uniform, but don’t have any exciting war srories to share. I don’t march in Veterans parades because I think other guys who were in the line of fire deserve to be there marching. I will share what I did try to contribute. It still means a lot to me personally, but like I said, it pales in comparison to the sacrifices of others.

The other day I was cleaning out my file cabinet and came across my, “I love me book.”  The one where you put all your certificates of completion for courses you have completed, letters of appreciation from supervisors, promotion notices and so forth.  If you live long enough, as I have, it will look pretty impressive.  Trouble is, no one is ever going to see them.  After all, mine are stuck in a file cabinet as are everyone else’s.  Besides, to some degree they have little to with the personhood of someone, if you know what I mean.  I think that is basically why I tuck them away rather than hang them all over the office walls.  By law you have to hang certain diplomas.  I think those are the only ones I hang.  I like pictures of the family, oil paintings, and maps.  I love looking at maps, so I like hanging those in my office.

As I shuffled through the pages one popped out at me.  C4 training.  The Combat Casualty Care Course.  That was no weekend training seminar or review course in an air conditioned hotel.  I had heard it was very challenging.  I knew it would be extremely challenging for me.

I was in the reserves for the military in the spring of 1990 and received some correspondence encouraging all health care providers to attend a training camp for casualty management.  There were a number of dates to choose from.  My two week time was scheduled for August of that year.  Early that summer I received some material to be reviewed before arriving.  I was intimidated to say the least.  It was basically a book on how to triage and manage casualties in a combat setting.  I am a dentist by training, not a physician, not an emergency room nurse, not an orderly.  I don’t work in a hospital.  I took a deep breath and collected myself.  I had extensive training casual management in the early 80’s while stationed in Germany as an Air Force Dental Officer.  Those training sessions were not easy but this sounded a bit out of my realm.  I had heard not everyone passes the examination, in fact a number do not.  Frankly, I had my doubts I could either.  Nevertheless, I committed myself to doing my best.

I studied the book every day for over a month.  I figured I wouldn’t have much of a chance passing a written test but consoled myself by remembering that any knowledge gained could perhaps someday save a life.  While studying I reminded myself to remember what you learn may actually apply in a real life situation.  That helped provide some motivation in what was a long month of study.

Upon arrival I was assigned to a tent full of surgeons and emergency room nurse corpsmen from all branches of the military.  Twelve to a tent, about six tents in all.  I was out of place and it showed.  I think one of the quieter individuals was a mental health care practitioner and I assumed he didn’t do a lot of emergency medical stuff either, at least not the blood and guts.  I knew in real life his skills would be quite invaluable in a war setting. The mental health professionals are unsung heroes.  I did not exactly enhance my military look when it came time to prepared our bunks.  In the early 1980’s while I was on active duty I had done this tent thing many dozens of times and had realized I just do not sleep well in a sleeping bag.  I chose instead to bring some sheets to put over my cot.  The only small sheets I could find were some of my sons that had dinosaurs all over them.  When I rolled those out I collected a number of giggles.  When the commander came through he pretended he didn’t see them but I could see the amused look in his eyes.  I didn’t care, I needed what little sleep I expected to get.

The physical part of the course was not challenging to me.  I’ve always been in good shape.  On our hikes I choose to carry the radio.  I have never felt comfortable with how you are supposed to do the Roger, over and out, Charlie, Delta, etc.  I figured this was as good as a time as any to learn.  It was also a good time to brush up my compass reading skills.  Going out at night on patrol was no big deal either.  The  obstacle courses were quite doable, even when carrying patients .  Heights can bother me some and I was a little uneasy with repealing and crossing ravines with rope ladders or swinging across on a pulley.  The training was in Texas so the August heat bothered a number of the people.  I was living in Texas at the time so I was expecting that, although I admit I do not sleep well in the heat, especially with insects buzzing around.

In the time slots between doing some physical training such as hiking or casualty retrieval in the woods with your compass and radio we listened to many a lecture on how to manage trauma.  The physical part may have been easy for me but this part was hard, as I expected it would.  A number of the physicians looked tired upon arrival and when we sat still for any length of time they would doze off.  I’m sure they were more familiar with the material than I would ever be, and besides I’m sure their regular jobs were demanding and they could use any I rest they could get.  As I said before, I was challenged by the amount and content of the material, so I had to keep close attention.

After several weeks you get to know your tent buddies.  Directly across from me was a doctor named Jerry.  He had an Army Ranger patch on his uniform.  He slept as if we were going to be attacked, prepared to move in an instant.  He knew I was out of place but always treated me with respect.  On my left was a Navy corpsman who knew more about saving lives than I ever would.  He was also more military than I would ever be. I don’t think he liked me much.  Probably wondering what I was doing there.  I didn’t blame him.  He was chosen as one of our tent leaders along with another doc who had a good military presence.  In the corners of the tent were some quieter individuals like me.  And then there was the witty one.  I can’t recall what kind of doc he was in real life but he was sharp.  He could tell a joke and be off to the next before I even got the first one.  My anxiety level heightened as to how out of place I felt.  In a room full of doc’s you had better have a good sense of humor which I don’t have.  To my right was a young Air Force emergency room nurse who sensed my unease.  When the jokes were told he would blurt out laughing, nodding and  looking towards me as if to give a queue.

One evening the clever doc heard someone talking to me about chess, something I have been good at since a child.  Across the tent he yelled , “pawn to king 4.”  I replied, “since you moved first, your white (white always moves first in chess), “pawn to king 4.”  He then said, “king knight to king bishop 3.”  I reacted with, “queen knight to queen bishop 3.”  The tent got awfully silent as we played a game in our heads.  I had learned to do so while on the chess team way back in high school.  The next day some of the docs told me they were damn impressed with anyone who could play a game of chess in their heads. I would have gladly traded my chess skills for their knowledge on how to treat wounded personnel.

That same day our instructors pitted the Army, Navy and Air Force all against each in a timed exercise as to where to station a mash unit in an emergency field setting.  Each team was given maps and scenarios.  The Air Force had the smallest team and for some reason they quickly selected me team leader.  I don’t act like a leader, so i assume no one else wanted to take charge at the moment. I used what training I had learned in Europe and was pleased our team won.  That night the doc’s were gracious in their compliments.  I knew the important thing was the real testing to follow.

They bused us to a military installation and had us take a written test in the morning.  It took all morning.  After lunch we broke into groups and lined up for the mock training.  We each would be called in individually to a room full of dummy casualties. The physician that exited the room just before I entered had a concerned look on his face.  The room was full of surgeons.  One of the surgeons handed me a card specifying the type of wounds this soldier has and what should I do to keep him alive.  The surgeon could challenge you at any time.  I had studied hard, I had had some training in Europe, but I wondered if I could apply my knowledge correctly.  I reminded myself to do just do the best I could and I was hopeful the surgeon was not out to make me look silly.

How would you stabilize this one?  How about this head wound? If you cannot get a breathing tube in, what would you do?  Why is the blood pressure dropping on this patient who seemed stabilized?  The oral examination was quite intimidating to me as you can imagine. I also endured a series of questions explaining which patients I would triage to be treated first.  Would this patient be immediate or delayed? Chopper or ground transport?  What are the chances of this burn victim surviving?  Only 2 of these 4 patients can be air-evaced, pick the two. I had worked hard and tried to pass, but wasn’t sure.  The important thing was I done all I could to prepare myself in the event of ever being called up during war.  The chances of that were remote but if I ever were, and if I ever was able to help even one wounded soldier, then my efforts were worth it.  I think most health care providers feel the same whether in uniform or not.

The next day we were lined up in formation and received sealed letters.  My document read:     written exam: pass       oral exam: pass      C4 training: graduate.

had pretty much been isolated for two weeks.  When I got home in late August 1990 the news was talking about Iraq invading Kuwait.  In January 1991, on a Sunday, my wife had a look of concern as she handed me the phone, “it is the military and they will only talk to you.”  The next day I began to close down my practice and send letters to my patients.  Eight days later I reported to duty at a hospital unit.  The Gulf War started a few weeks later. I never did make it overseas and instead was assigned to a dental unit stateside. I was extremely busy doing dentistry,getting reserve personnel dentally qualified to travel overseas. No hero stories for me, just a lot of hard work. I returned and had to rebuild my practice. By the way, the oak tree in my front yard did not have a bunch of yellow ribbons, but it did have one huge yellow ribbon. At the the front door was my pretty wife with her endearing smile. I will always treasure that remebrance. I’ll call it my military treasure.