Photo by Janet Boivin, RN
Chief Nurse Lt. Col. Laurie Hall, RN, never expected to serve in a combat zone.

But after 17 years in the Air Force, Hall finds herself in an Air Force hospital in Iraq in charge of a team of nurses and medics that cares for almost every combat casualty being evacuated from the violence-prone country.

“I have been a critical care, ED, and flight nurse for 23 years,” says Hall, who is in charge of training courses at the Air Force’s Wilford Hall Medical Center in San Antonio. “If anyone had told me the day I graduated from nursing school that I would serve as a chief nurse at a forward-deployed hospital in a combat zone, let alone be in the military, I would have questioned that person’s sanity.”

The Air Force took control of the hospital at the Army’s request last year. It is the largest Air Force hospital to be deployed since the Vietnam War, says Col. Russ Turner, MD, hospital commander, who is also from Wilford Hall.

The Air Force Theater Hospital in Balad is one of the two biggest U.S. military medical facilities in Iraq. Baghdad hosts the Army’s combat support hospital; but only the Air Force hospital has the dual role of treating fresh combat casualties and serving as a clearinghouse for wounded, ill, and injured service members returning to the U.S.

The Air Force’s 332nd Expeditionary Force from Wilford Hall is primarily responsible for staffing the hospital. But physicians, nurses, and medics from Air Force Reserve and Guard units throughout the U.S. and from Army active duty units also provide staff.

Air Force medical service members are in Iraq only four months; they are replaced by other airmen from across the country. Although this system would seem to disrupt continuity of care, Turner says it’s akin to a relay race, with each group passing the mission off to a fresh team without dropping the baton. In the process, the Air Force churns out a new group of combat-experienced medical personnel every four months — military medicine’s gold standard.

About 20 nurses and physicians from Australia also help to staff the hospital.

“We’re here supporting the coalition,” says Lt. Col. David Collins, deputy commander for the Australian nurses. “Most of my nurses are experienced; but we’re learning about IEDs (improvised explosive devices), which cause multiple system injuries.”

The hospital’s daily rhythm is set by the frequency of insurgency attacks and any ongoing U.S. military operations throughout Iraq. Mornings tend to be the quietest part of the day. Hall, physicians, and the nurse in charge of the OR meet to review the status of the facility and plan the day’s OR cases. The physicians then proceed on rounds while Hall visits alternate units, provided there is nothing urgent going on.

Like Hall, Maj. Diane Walcutt, RN, another experienced military nurse from Wilford Hall, expected to be deployed during Operation Iraqi Freedom, but not in a combat zone.
Walcutt had seen her share of bloodied and battered bodies as a Reserve staff nurse in Wilford Hall’s ED, which draws trauma victims from the San Antonio area. But she’d seen nothing as horrific as the wounds sustained in this new war against terrorism.

Photo by Janet Boivin, RN  Air Force Maj. Diane Walcutt, RN, is the ED consultant for the entire Iraq and Afghanistan war zones.

“You need to be very skilled to handle these patients,” she says. “It’s no place for new grads.”

Walcutt described one patient who had a tourniquet on one leg, a severe injury to the other, lungs injured by the force of an explosive device, and a gunshot wound that had gone up through his pelvis and was initially undetected by the medical team.
“He was incredibly sick,” says Walcutt.

Unfortunately, she says, the patient died.

As chief nurse of the ED, Walcutt had to become weapons-qualified before leaving for Iraq. Now she carries an unloaded M9 pistol in a holster on her leg.

“I feel like Barney Fife; it’s just for show,” says Walcutt, who earned an expert ribbon in marksmanship.

Also to her credit, Walcutt was selected as the ED consultant for the entire theater of war by the Army’s 44th Medical Command in Baghdad. In that role. she advises the command regarding ED policies and training.

The hospital’s pace usually picks up in the afternoon and accelerates as evening approaches. Surgical teams often work late into the night, depending on the number of arriving combat-wounded soldiers and the nature of their injuries.

Just as in the television series “MASH,” set during the Korean War, the sound of helicopters signals incoming patients. The hospital has had 5,000 admissions since Hall arrived in Balad.

Because the Air Force hospital has the only military neurosurgeons in Iraq, neurosurgery is common.

“We do craniotomies like gallbladders here,” says Hall.

For U.S.service members,the stay in Balad is usually only two or three days at most and many times less than 24 hours, even if they are in critical condition. The goal is to transfer them to the Army’s Landstuhl Regional Medical Center in Germany for care and then on to the U.S., if necessary.

“The secret to this hospital is throughput,” says Turner. “If an aeromedical evacuation doesn’t take place, then the hospital starts filling up quickly.”

And if the hospital is full, there are no empty beds for incoming combat-wounded soldiers and Marines.

Most of the hospital’s current staff will return to the U.S. at the end of the summer. They will pass on to a fresh group of nurses, physicians, and medics the things they’ve learned in this war zone, a place many of them never expected to be.

Says Hall, “It is the greatest experience of my life and my nursing career. It calls upon every ounce of our hearts, our strength, our skills, and our endurance. The rewards are indescribable, and the sadness sometimes overwhelming. But through it all, we know in our hearts it is nursing that makes a difference.”