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Bringing calm to the storm.

Disbelief. Shock. A distinct fear of the unknown. All are accurate descriptions of the emotions that filled my heart when I was told that early August morning that I needed to be sure my mobility bag was ready. I was on my way to the Middle East as the Forward Command Surgeon for U.S. Central Command Air Forces.

Despite the inner turmoil, I knew that I was ready. I had been assigned as the Deputy Command Surgeon for Tactical Air Commander for a mere three months, but I had just completed a tour of duty as the hospital commander at George Air Force Base in the California desert. The hot, sandy conditions in the Persian Gulf region would not be strange to me.

George Air Force Base and the 831st Medical Group had prepared me for duty in the Middle East in yet another way. The hospital participated fully in all base exercises and training programs. So, I was accustomed to the chemical warfare ensemble, the gas mask, the weapons of war, and the ever present heat.

I was ready, and scared. Just before midnight on Aug. 8, 1990, I boarded the huge C-5 Galaxy aircraft that would ferry me and 70 other souls from Langley Air Force Base, Va., to a destination we could not be told. All of us knew the end of the line was Saudi Arabia, but none had any idea of the exact location. I remember it as though it was yesterday. A driving rain punctuated the otherwise still night air. I looked back for my family one last time, but couldn't make them out in the dark.

Then I entered the behemoth, not to emerge again until we touched down in Rhein Main Air Base, Germany.

The stop in Germany was brief, but we were permitted to spend several hours enjoying a beautiful European day before we boarded our trusty steed once again. This time there would be no stops until we reached our final destination, which we now knew was Dhahran, Saudi Arabia.

During the last leg of the flight, I seriously practice the use of my gas mask for the first time. I changed the filters, practiced quickly donning the mask, and learned to drink water through a special device inside the mask. Everything about the region were about to enter became of paramount importance to me, and I read anything I could find that described the unique culture we were to experience.

What I wasn't prepared for was the scene that greeted us when we landed in Saudi. We were confronted with the busiest flight line I'd ever seen. It was 3:30 in the morning, and in the darkness I could see lights moving quickly in many directions. Jeeps. Fuel trucks. Staff cars. Despite the activity, our aircraft sat idle on the runway for nearly 10 minutes. When I stuck my head into the crew cabin, I was immdiately impressed with what appeared to be anxiety on the part of the crew. Then I saw the reason for the anxiety through the front windscreen. There were small groups of people--shadows in the darkness--who had automatic weapons aimed in our direction. That marked the instant I realized we had truly entered a combat zone.

Finally we were able to taxi to our ramp. The great C-5 rolled to a stop, and the passenger door swung open. We were nearly wilted by a strong gust of extremely hot air as we deplaned onto the steamy tarmac. We were in Dhahran, Saudi Arabia, in the middle of the night, in the hottest weather I had ever experienced. In the distance I saw live Hawk and Patriot missiles pointed north.

Soon day began to break, and the blistering sun rose from the ground. The barrenness of the land was matched only by the confusion of those around me. I had processed through a personnel line, and I found a medical technician who had deployed with the first fighter jet squadron to arrive in Saudi. Together we toured the area quickly, as I attempted to find what turned out to be the only other American military physician in the country at that time! He was a permanently assigned physician, and, after finding him, I discovered that he knew the area very well.

The two of us secured transportation from Dhahran to Riyadh, Saudi Arabia, where I was to report to duty. Once in Riyadh, I began to settle down quite a bit, and I found the U.S. Central Command Headquarters. Major General Kaufman, the acting Deputy Commander-in-Chief U.S. Central Command in Riyadh welcomed me into his office. He smiled broadly, stuck out his hand to grasp mine, and led me to a large map on one of the walls of his office. He pointed to Kuwait and the border between Saudi Arabia and Kuwait. He said, "Randy, I'm really glad you're here. Right now you represent one hundred percent of the United States military medical capability in this theater, and Saddam Hussein has a million battle hardened troops with three to five thousand tanks poised just above that border. If he were to come across the border right now, he would capture Dhahran and the eastern oil fields in eight hours. Then, in another two to three hours, he would be in Riyadh, and you and I would be prisoners of war."

From that point, we both went about the formidable task of obtaining more resources in the Persian Gulf quickly. Thanks to the Air Force readiness program, in fewer than 30 days all 10 of the Air Transportable Hospitals (ATH) in Tactical Air Command were on the ground in the Persian Gulf, and the delivery of Air Force-deployed health care was fully under way. Additional ATHs were being built, and several in Europe were made ready for shipment in the event we needed them. Indeed, 36 hours after my initial conversation with General Kaufman, our first ATH was set up in Dhahran with 150 medical personnel and the ability to treat up to 50 inpatients. Operating capability, dental care, pharmacy operations, and laboratory resources--all a part of the ATH--were available for the first airmen dispatched as a show of force and intent toward a ruthless enemy in the deserts of the Arab world.

The Air Force Medical Service was the first U.S. combat medical capability on Arabian soil for the operations, and it constituted the only U.S. military inpatient care facilities for the first 30 days. In the spirit of inter-operability, all service members, regardless of the color of their uniforms, were treated when they presented themselves at one of our facilities.

In anticipation of significant events, it is customary for organizations to plan ahead. Should an event occur, it becomes simple to employ the plan and manage the event. In the case of Operations Desert Shield and Desert Storm, there was no plan! Central Command Air Forces (CENTAF) medical planners had only recently initiated plans for a possible conflict in the Middle East when Saddam Hussein bullied his way into the heart of his small neighbor, Kuwait. Medical plans were notional, at best, and no final product existed in early August 1990.

Despite such an inauspicious beginning, the efforts of Air Force medical personnel were nothing short of inspiring. There were so many historical firsts that to attempt a complete listing would become tedious. Instead, a few highlights are presented.

The backbone of Air Force deployable medical units is the ATH. It is possible to deploy this package in increments that provide the ability to care for 14 to 100 inpatients. Housed in air-conditioned tents, the facility is very light, relatively small, and therefore highly mobile. A two-table operating suite, a laboratory, and an x-ray suite are contained in separate International Standardization Organization (ISO) units, which are connected to the tent-age and function as part of the ATH. A team of 48 to 128 medical personnel complete this highly flexible field medical facility.

Operation Desert Storm provided the first opportunity to use the ATH, as it is presently configured, in a combat environment. The results were extremely gratifying. Casualties were significantly fewer than expected, so the total ATH concept was not tested under full stress. Still, in an eight-month deployment, the ability of the ATH to maintain the health of troops so that they could fly, fight, and win was thoroughly explored. During Operations Desert Shield and Desert Storm, nearly 9,000 patients were treated in the 15 ATHs that were ultimately deployed, and another 130,000 were seen in outpatient clinics. Air Transportable Clinics (ATC) contributed heavily to the outpatient productivity. These clinics were staffed by flight surgeons and aeromedical technicians. As integral parts of the flying squeadrons, they went where the squadrons went.

An additional first was the erection of a 250-bed contingency hospital using air-conditioned tentage and an existing warehouse. Every medical specialty was represented on the staff of this hospital, and it was theoretically possible to treat a wide array of casualties within the combat zone. The result would be fewer patients with a need to be air-evacuated out of the theater of operations and quicker return of the ill and injured to combat units.

A portion of the patient air evacuation system provided yet another original opportunity. Five Aeromedical Staging Facilities (ASF) were designed, constructed, and employed in several regions of the Middle East. This concept had never been attempted. It worked like a charm, providing brief transient stabilization for patients en route out of the theater to European hospitals. Able to house up to 200 patients at a time, and staffed almost entirely by Air Reserve and Air National Guard personnel, the ASFs, combined with the more traditional Mobile Aero-medical Staging Facilities (smaller, mobile units), expertly transported more than 13,000 patients (8,000 ambulatory and 5,500 litter) during the deployment. Indeed, the aeromedical evacuation system flew 430 tactical missions on C-130 aircraft and 270 strategic missions using the C-141. Incredibly, this was accomplished without a single untoward patient-related incident on the ground or in the air.

In retrospect, perhaps the real medical heros of the Gulf War were the preventive medicine specialists in the combat theater. There were only 12 significant food-borne illness outbreaks among Air Force personnel during the entire deployment, and each was analyzed, managed, and resolved in a matter of days. The Disease Non-Battle Injury (DNBI) rate was only one-half to one-third the predicted level, thanks to the efforts of environmental health and bioenvironmental engineer professionals. These experts constantly monitored food and water sources, sanitation conditions, insect control, and other vital areas that had a potential to cripple our fighting force.

From the initial Air Force medical deployment of a single individual, and a paucity of prior planning, a system of combat casualty care that eventually eclipsed 5,000 medical personnel in theater was constructed. That happened because we enjoyed enormous creativity and innovation. It was the fastest and largest and most successful Air Force medical mobility effort in the history of our country. The success was a direct result of the highest quality people, outstanding and realistic training, unselfish cooperation, and sterling leadership.

U.S. Army Brigadier General Neal, addressing General Westmoreland in May 1968 in Saigon, South Vietnam, said, "General, the hospitals and preventive medicine assets that we need to bring into I Corps won't win the war for you, but their absence will surely be a key factor in losing the war for you." In the final analysis, the true measure of the effectiveness of the Air Force in deploying and employing the medical system in a combat environment is embodied in this final truth: Of the more than 135,000 Air Force sorties flown during Operations Desert Shield and Desert Storm, not one was canceled or altered in any way because of a medical concern. The mission in CENTAF was to fly, flight, and win. Air Force medics supported that mission in superb fashion and joined so many other military units in writing a proud page in our country's history of the defense of freedom and our national interests.

COL Leonard M. RanDolph Jr., MD, is Command Surgeon, United States Central Command, MacDill Air Force Base, Tampa, Fla.
COPYRIGHT 1992 American College of Physician Executives
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Author:Randolph, Leonard M., Jr.
Publication:Physician Executive
Date:Jan 1, 1992
Previous Article:Matching family and career goals.
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