The Trauma Hot Box

There is a very important room at Craig Joint Theater Hospital here at Bagram. It's called The Trauma Hot Box. It's located in the ER. It is equipped with 6 patient beds, 4 ventilators, racks of supplies for procedures, 2 crash carts for cardiac/respiratory arrest, and anything else you can think of that might be needed for critical patients. The most unique thing about this room is its temperture... it is kept at a toasty 95 degrees. Why you ask? Well, there is a well known fact in medicine that warm trauma patients do better than cold ones. So, here at Bagram we do eveything we can to help our patients even if it makes the staff all hot and bothered. Of course, we have rules about that too. Clearly posted on the the door of The Trauma Hot Box is a sign that says:


1. You do not speak about The Trauma Hot Box.

2. No complaining.

3. No gawking outside the window.

4. No passing of gas.

The Trauma Hot Box was used to its full capacity on Easter Sunday. As I slept off my night shift, waves of new trauma patients arrived throughout the day. We were only getting warmed up on what was dubbed "Sunday Bloody Sunday". I arrived at work at 1900 hours and at 1905 a "Level 2 Trauma" was called over the loud speaker. This is when a large bolus of patients is due to arrive which will exceed the capabilities of the in hospital staff. Most of the doctors and nurses are paged to come to the hospital. What happened next can best be described as controlled chaos. The medical evacuation teams brought in severely injured Americans one by one. Each bed in The Trauma Hot Box was manned by 2 doctors, a nurse, and 2 technicians. I happened to be teamed with our vascular surgeon on this night. We first unhooked our patient from the vast amount of equipment attached to the stretcher. Then, we moved him over to our bed. Next, we began a systematic examination of him from head to toe. I started at the head and our vascular surgeon began at his feet. We called out our findings as we progessed. The same scenario was playing out in the other 5 beds in The Trauma Hot Box. "The pupils are equal and reactive bilaterally"... "The pedal pulses are strong on the right"... "Lungs are clear. Heart is regular"... "No wounds noted on the head"... you get the picture. Simultaneously, the technicians drew blood, obtained vital signs, and placed the proper monitors onto the patient. In the corner of the room, the pharmacist was dolling out medications and the lab was busy running tests on the blood samples.

Our particular soldier had a large bandage on his right leg. We tested the blood pressure in his ankle versus his arm. It was normal. Thus, he was unlikely to have any major bleeding in the leg. He also had gaping wounds of his scrotum and his left leg. This made sense given the mechanism of the injury. The floor of his vehicle was blown upward which smashed his legs when an Improvised Explosive Device (IED) went off as they drove down the street. Luckily, our patient was completely awake and aware of the situation. His brain was spared any trauma. Next, we rolled the patient onto his side to look at his back. The spine was palpated and a finger (gloved of course) was inserted into his rectum much to his dismay. Welcome to Bagram!

Having done our head to toe exam, he was now ready for x rays. The radiology technicians rolled in their portable machine. Multiple x rays were taken of all the possible problem areas. This took several minutes as the patient needed proper positioning and such. We are able to view the X rays right then and there on the portable machine looking for obvious problems. As soon as all the X rays were done, our patient was ready for the CT Scanner. We "packaged" him up by unhooking the monitors, connecting the oxygen to a tank, replacing the bandages on his legs, and covering him with blankets. He was now ready for transport. We wheeled him down to the radiology suite, moved him onto the scanner, then sat back as the radiology technicians programmed the machine to obtain images of the patient from his skull to his pelvis. This is called a "Pan Scan" which pretty much everyone gets who is involved in an explosion. We use technology to the extreme here.

My patient that night was taken to the operating room shortly after finishing his scans. This is also pretty much a standard procedure at Bagram. Within several hours he was admitted to the hospital in stable condition. He had a full on trauma assessment, was surgerized, and now was ready to move on to his next stop in Germany. There was a happy ending for this patient. Barring any unforeseen complications, he would keep both legs and walk again someday in the not too distant future. As for the other 5 patients who came through The Trauma Hot Box that night, some did well and some not well. On this Easter Sunday, we did our best and I guess that is all you can ask. In the end, The Trauma Hot Box was in disarray with bloody bandages all over the floor and medical equipment scattered around the room. The cleaning crew quickly entered to get The Trauma Hot Box ready for the inevitable next round of casualties.