GSACEP Lecture Series: Afghanistan Evacuation Mission Panel Discussion

GSACEP emergency physicians reflect on the fall of Kabul and the evacuation of Afghanistan in the final days of the US presence.  Featuring Dr. Katrina Landa, MD; Travis Callahan, PA-C ; Andrew Chambers, RN; Dr. Roderick Fontenette, MD; Dr. Matthew Streitz, MD

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Episode Transcript

Kat Landa (00:00):
As the emergency physician and OIC in charge of

(00:03):
the Special Purpose MAGTF, whichis the Marine Corps Shock Trauma
platoon that was in directsupport of Second Battalion
first Marines. And subsequentlyit was also in support of BLT
one eight, because they were colocated with us down between
Abbey and east gate. Soindirects of we're in a forward
roll one capacity outside of thenormal North HKIA. area. And we

(00:29):
did quite a bit of evacuationcare.

Rod Fontenette (00:33):
Afternoon, again, I'm Rod Fontenette, was
the CCATT theater director outof Ramstein, Germany at the time
I was there deployed already ona regular six month deployment
and then the Afghanistanevacuation happened. The
majority of the missions we weredoing prior to that day were
mostly COVID NPC missions Pinyonpatients of downrange that had

(00:56):
COVID-19, and transporting themin NPC throughout theater in any
other thing that would happenprior to that day, and then
things like drastically changedthe days from that day for for
the rest of my deployment. Sohappy to chat about it.

Travis Callen (01:13):
I'm Travis Callen, en PA, I was at the NPA
on the trauma team at HKIA. Roletwo and I was also the triage
officer. Throughout the time,there are a couple through the
suicide attack in the daysbefore that.

Moderator (01:29):
So the first question here for the group is
what diving time into lessonslearned. What was one of the
greatest lessons learned for youduring this

Travis Callen (01:46):
so when I first got to HKIA, I started setting
up the triage system. And mywhole plan was planning for a
mass cow because the writing waskind of on the wall and we knew
we had the Intel threats thatsomething was going to happen.
So I put up trauma towersoutside to kind of have an A
through E for your marchalgorithm ATLS setup so people
could go right to a cabinet grabwhat they needed. I planned for

(02:08):
a 30 person mass cow. So thebiggest lesson I learned was
when you're in a situation likethat and you are planning with
your consumables for TCCCsupplies over over plan three
times and have things that arenecessary and get rid of things
that are unnecessary. You don'tneed size extra small gloves
outside, you should have large,you should have plenty of
tourniquets, you should haveplenty of cric kits, and combat

(02:29):
gauze, that kind of stuff was mybig takeaway from the triage
aspect of that day.

Rod Fontenette (02:36):
I think for me from the CCATT side of things,
so normally, prior to COVID,there are always three CCATT
teams that are deployed inGermany at Ramstein
when COVID happened, the AirForce increased the number of
CCATT teams that were there,there were the regular three
deployed, and then theyincreased an additional three

(02:56):
specifically in theater forCOVID transport only, right
before my teams and I got there.
They sent them with a one ofthose teams home and made all
five teams that were CCATT teamsremaining all COVID teams and
just regular operations teams.
So we got there, we all could doCOVID transports and non COVID
transports which were great.
Right? So but once Afghanistanhappened, they sent an

(03:18):
additional four teams there.
Right. So now I have nine CCATTteams that have to kind of be
over in addition to the CCATTteams that are in Qatar much
closer to the fight, right. Sojust being able to move all
those resources and making surethat everyone is on the same
page and have a good essay wasgoing on was huge. That was the
first thing. Second thing and Isay this from the very beginning

(03:41):
of this mass cow thing I waslike quite often when these
things happen is the pediatricpatients that are really, really
heavily affected, right. Butwhat's the what's one thing that
CCATT doesn't do that much ofpediatric transport, right?
Because we're that's just notwhat we do our smallest ET tube
was a six Oh, right. In case weneed to like cric somebody for
whatever reason, right? I try toput it a kid Oh, that was two

(04:02):
and a half years old, eight anda half kilos that six or 8 tube
just was not going to work. Wehad zero pediatric supplies.
Right. So that was a huge gap incoverage that we had that we
noticed very early on. Right.
And so as we go through this, wecan talk about, like how did we
work to fill those gaps. But Ithink that was a big deal. And
also the team composition.
Right? So I was the only Ibelieve em doc on the team.

(04:25):
Right? And then we had ananesthesiologist with a
pulmonary critical care doc andthis was the five teams that
were originally there and thenwe had I think it was another
general medicine critical careright so I was the out of the
group of the five of us I wasthe only one that had any
pediatric like like comfortright the other ones was like I
haven't dealt with a kid andlike forever since like

(04:46):
residency training. Right? Andso that was another thing. Even
if we had supplies Howcomfortable is my team on my
team is what even taking care ofthese really sick kiddos? Right
the team in Qatar picked up akid his kid was I want to say
five years old and intubated.
When was the last time you hadany of these pulmonary guys like
set tidal volumes and things onvents? Right? It's just it was
it was difficult. So thosethings we had to work through

(05:09):
very, very quickly. And again,as we work through this, we kind
of talk about some of thoselessons learned. Yes, sir. Let's
say the most limiting how manyfor that?
Oh, that I don't know. Not to doit. I know we're trying to wrap

(05:32):
up now. But I know we don't haveto do it. Yeah, see.

Kat Landa (05:54):
I have a lot of lessons learned from generally
the entire operation. So I'm notgoing to go into all of them
during this talk. I have a talkon Sunday. But I think the most
important lesson looking back,and especially for after that
sucker punch from Captain D in,the biggest thing I can I can
take from that experience isbeing engaged with your

(06:15):
operational leadership in theplanning in the phase zero time
piece of all of this whileyou're planning to plan, we
thought we weren't even goinginto Afghanistan, we thought we
weren't going to have to do anevacuation. I mean, from the top
down, that was the messaging wewere getting from our
operational leadership. Thatbeing said, being engaged with
them put us in a strategicposition at the time, to best

(06:37):
support the sickest marine thatthat survived the actual blast.
I had a very publicdisagreement, fine, friendly
disagreement with my CEO, morethan a month prior to the event,
about where we would be located,should we go into Afghanistan,

(06:58):
and his position was, I want youat the rule two, I want you to
the rule two, I don't want youclose to the Marines, because I
don't want you to get hurt yourteam to get hurt. And so we came
up with a compromise after alittle bit of back and forth. We
had similar personalities. Andafter a bit I said, Sir, we're
there to support your Marines.
In that case, that we they can'tmake it that 15 minutes around

(07:19):
the flightline. There may be atime that there is someone who's
so significantly injured, thatthey wouldn't be able to survive
that ride. And unfortunately, Iturned out to be right in this
situation. Not that I wanted tobe because again, this is a
horrible situation. But therewas one patient that came to us
and many of them bypassed us atour at our role one E. We're

(07:40):
calling it because they wentstraight to the roll to where
Fortunately, there were fivetrauma teams available right
there at the roll too. But thecorpsman knew we were located a
quarter a mile from them. And sowhen they had someone who was
Perrier rest and you know, theydidn't have oxygen, they don't
have any tools. And theyexpertly the corpsman expertly
recognized that this patientneeded help. And Newari were so

(08:04):
bummed the extra half an hour orwhatever it was that got him to
the operating room. And again,that's a credit to that corpsman
who recognized that that patientneeded help and that he he found
us in that in that moment. Sobeing engaged operationally is
the key, I think to take fromall of this if you aren't
engaged with your operationalleadership, and that goes across

(08:25):
the board, especially in thesejoint environments where we
don't have this like purplemodel yet. You have to know what
the operation looks like, whatyour plans are and integrate
fully with the Marine Corps forus or other operational line
leadership. Can you clarify whatdo you mean by harder sir?

Audience Member (09:00):
Given 11 hours notice, why because the person
who was supposed to gorangefinder figured out 11 hours
before deployment and BB was acurl. Right work for me. I got
substituted. As much as we'vemade headway forward. I think
it's important that weunderstand your conversations

(09:21):
where the person earlierhappened. About there's
advantages and disadvantages,but laid out. What are your
toolkit? Nobody better than you.

Kat Landa (09:31):
I had the background and strange honor and I hate
bringing this up because itfeels like every time I have a
conversation about this, thiscomes up I was the first female
battalion surgeon for FirstMarine Division back in 2012. So
I went with Third Battalion,fifth Marines at that time for a
two year tour and kind of gotused to the environment of the
division line background so thisdeployment because I was female

(09:56):
wasn't as a large deal to me,because I'm just used that back
and forth and just integratingand being myself, despite the
fact that, you know, Marineshave, especially line division
background have their ownmentality about women being in
combat. I think it was harderfor my nurses and my fellow

(10:17):
emergency physician, this washer first operational tour at
all. Understanding that they maytreat you differently. Marines,
especially, for example. So Ithink what you're getting at is
my CEO wanted me to be at therole, too. And I had a team of
five female officers, and halfof my core men are female. And

(10:37):
pushing back on that, I think,partially that may have been
because we were a group ofwomen, he didn't really want us
to be close to combat. But thatbeing said, I had this argument
with him like we are there foryour Marines, if I can't be
there for your Marines, who'sgoing to be there? And so laying
that out and just being firmabout it. I think that that kind

(10:58):
of helped quite a bit. But yeah,there are a lot of operational
challenges being when we werethe Marines. And it's just one
of those situations that you getused to, and I think eventually
the Marines will change as we'veintegrated more and more
females. Maybe, maybe not. I'veseen a difference, though, at
least seeing now. Like femaleenlisted with the infantry. I'm

(11:19):
like, Oh, wow, that's new. Butyeah, it's a different
situation. I don't know if Ianswered your question
completely, sir.

(11:43):
Yes, sir, the boldness is a bigpiece. And he's saying, he like
flippantly said, Well, you arethe subject matter expert. I
said, Yes, sir. I am the subjectmatter expert. And this is what
I said. And he, we left arguingwith each other, and I did what
I wanted to do, because at theend of the day

Moderator (12:07):
take what I'm hearing from you, as well and from you
is, by being at this operationplanning meeting, you have to be
able to speak their language. Sojust as we have to talk to each
other and communicate with eachother on, you know, when you go
into your presentations in thehospital, you have to be able to
speak a different language tothe line and you're not
communicating with words theyunderstand. And maybe simpler,

(12:30):
it's the Marines are moreintellectual with the Air Force.
The Army just kind of goes withwhatever it is. But, but I think
that's really important. And soI think that is an important
thing, that either you said,like, Hey, if you want me to
treat your Marines and yourguys, I need to be there. So
like, I think that's somethingthat we can, we should highlight

(12:51):
here, especially for some of theresidents who haven't had an
opportunity to interface withthe line, treat it like a
foreign language, and you've gotto learn the language because
you can't speak their language.
You're never gonna get anychanges. And they boy, Aqua
Hancock with policy change, ifyou can't speak their language,
you're not going to change. SoI'm kind of talking about

(13:12):
lessons learned. He mentionedsome of the challenges, what was
an unexpected, the greatestunexpected challenge that you
faced during this event?

Kat Landa (13:27):
That you guys can take the microphone.

Rod Fontenette (13:29):
Again, the two for me, were the lack of
pediatric supplies and thenmaking sure we had enough blood
available, right, because wedidn't know what we were going
into leaving Ramstein. So whatwe ended up doing was we worked
closely with the blood bankthere at lunch to at law MC. In
every Seacat team that liftedout of their heading downrange,

(13:49):
they left with a Collins boxfull of blood, right because we
just didn't know what all weneed. So it helped out
tremendously, because there'squite a few patients that ended
up getting transfused as amatter of fact, when we went and
did a tale to tell with the teamthat was at Qatar. So they went
to Cabo and then we lifted fromRamstein, and we all kind of run
the food back at Qatar. We gotthe two patients from them. I

(14:10):
got one off the plane. And thenwe actually went into the
hospital at Qatar and at thesecond patient, we ended up
having to transfuse the patientthat we got from them. So again,
just making sure you haveadequate supplies. What I did on
the pediatric side was Iremember when I was attacking
back in Africa, Djibouti, we hadlike these blue, kind of like
brazo bags, like pediatric bags,right? And so when all this

(14:33):
started to spin up, I was like,why can't we just find those PT
brazo bags? Right? And no onehad I went to the log ease. They
have even heard of these things.
Typical log e Speedos. Can yougive me an SN of that way to
have them to put it in theircentral? I don't have an
innocent just readily available.
So we went to Lorem see to getanother patient and as I'm
walking through the ICU, what doI see on the court? The blue

(14:55):
brazo bag. I was like that's thebag that that I need. Right and
so I call the folks I think is apeds floor whatever wasn't an
extra one of those bags. And sothey said we have one bag in the
SimCenter that we can just giveyou I was like perfect, right
and so the guy was like Buteverything is expired and I was
like doesn't matter just send itright now I have no supplies

(15:17):
right and so what do they do?
Before he brings the bag heempties everything out of the
bag and just bringing the bagwhich is empty purple in pink
and red in yellow empty pouchesI was like this helps a lot
so then a log he was like whatdo you have to pack out list
that goes in each pouch? I waslike again, dude, why am I gonna
get this information from so Ireached back to Leslie wood kind

(15:39):
of wood back with AMC, and I waslike Ma'am, I found the bags
that I need. Can you get methese bags and she was like I'm
on it. Within the next few days.
AMC had it like Rush shipped uslike three of those bags of
respiratory therapists and I webuilt two bags of stuff that I
just felt needed to be in eachone of those bags and then every
team that lifted to go downrangelevel one of those bags and I
made sure we had enough et tubesand in each one of those bags

(16:01):
that we had nasal cannula thatwas pediatrics. Now we're
breathers out of Pediatrics. Wehad everything that they could
possibly need. I found lmao likeour anesthesia folks over at
alarm. See, I was like, I justneed a bunch of pediatric LMH.
Right. And and so they hooked usup with everything we could
possibly need. In those bags. Ifound vent circuits that we
could put on because right ifyou're gonna put them on the
vent, I can't use an adult ventcircuit, right. So I had to go

(16:22):
find vent circuits. So we foundall those things to make sure
those teams are ready. And thenwe actually had a put together a
bunch of didactic sessions,right? Let's just get together
with our AE colleagues and say,Okay, now let's talk about vent
settings on pediatric patients.
So I was presentation inpediatric patients so that all
the teams that went to go pickthese patients up they were
ready. So that was that that wasone of the big things we did

(16:44):
another thing was so there wasthis kiddo, right. And so Lauren
see they don't have a pick youright so what they did was they
found two pediatric dogs findout which hospital they came
from downrange, but I think fromleaking he and they brought them
up to larm see to staff liketheir makeshift pick you and so

(17:04):
that was really really sickkiddo. She was I think this
little girl was I think she wasthe one that was two and a half
years old and about eight and ahalf to nine kilos, right? So a
lot of them were verymalnourished, right? She had
blast lunch, it just she wassick, right? She was intubated.
And so they called Seacat waslike, hey, when a patient needs
to be transferred, transportedback to the states to Walter

(17:27):
Reed, like, Okay, we'll comeround and see the patient. So
the C cat team goes and it wasanesthesia provider was the doc
on that team. So they get toLauren Z. They're looking at the
kiddo and the log roller, right?
And when they log roller to getan x ray has sat strapped to the
50s. And they wanted them totake one more, right and so
assess dropped into 50s. And ittook about an hour for her to re
recruit to get back to where sheneeded to be. Instead of like,

(17:48):
nope, she's not ready. She isnot safe for flight. Right? And
they were like, well, I don'tunderstand how USC cat fill, you
can deny transport. And she waslike, because this patient's not
safe. You can't even log wellthis character says dropping
into the 50s and staying there.
Altitude doesn't make that anybetter. Right? So basic
physiology, right? And so therewas like fire right? And so this

(18:10):
thing blew up. Right? This onestar got involved. I mean, it
was just so there was ahorrible, right and there was
like finally it was like okay,fine. MC got involved. And it
was like if see can't see thekid Oh, can't go, kid. Oh, can't
go. So then they transfer thekid off base to Humber to their
actual pick you. So thefollowing week, my team's up
now. Right? And I was like shit.
So my team is up now. Andthey're like, hey, skiers ready

(18:32):
for transport? I was like, Oh,you fell for that once I said I
want to go see this kid. Right.
So my RT my whole team and I weget in the car. We drive 20
miles. It's about a 20 mile 30minute drive to Humber go to the
pick you we see the kid right?
Kids on clonidine drip medazepamdrip on ketamine drip. And
something else they had this kidon, right. I was like, well, he

(18:55):
she sedated. Right? And so like,there's that. Right. And so I
was like, she looks good, butthey always look good on the
hospital van. Right? I don'ttransport with the hospital. So
I was like, Alright, we're gonnago back to the base, get our 731
Come back, connect the kiddo andsee how she does on our vent.
Right. And so again, none ofthem speak English. So trying to
like communicate this back andforth. It was like I was like,

(19:17):
We'll be back right? So we leavego get the vent. We come back we
get the kid on our vent. We geta blood gas. She looks great.
Look at the team. I was like, Ithink we can do this. I gotta
think she's ready. So it waslike, alright, we'll be back
tomorrow the flight because wealso had patients at alarm z. So
it's just working out the timingpiece right to get those
patients from alarm z to theplane while we're working on
getting this young girltransport on an ambulance back

(19:40):
to the base. So we get to thehospital in Hamburg that
morning. Right? We put her onthe vet on the settings that she
had just did great on the daybefore. Right? We get on the
vet. We wait 20 minutes, we gota blog airs. Her pH was I want
to say 7.1 and a Ph co2 is like127 Don't think. And I was like,
I don't understand whathappened, right? And so if all

(20:02):
things were still the same, it'sjust like less than 24 hours ago
how she gets so much worse.
Right? And so this were kind ofus as the IDI dogs, right? This
is what I tell the residentslike, we have to be comfortable
with that vent, right? Becauseon the Air Force side of things,
our respiratory therapists orrespiratory therapist by name,
right, we call themcardiopulmonary technicians,

(20:23):
right? Not all of them arecreated equal, because not all
of them are dealing with vetsevery single day. Right? And so
we have to be comfortableManning managing that vent,
because they want to turn to usif they don't know what to do
next. Right. And so we get onthe vet, it looks at me, and he
was like, I don't I don'tunderstand what happened. Like,
I remember the exact samesettings I had yesterday, and
she is significantly worse,right? And so I was like,
Alright, so let's kind of startdo so we start when I started

(20:46):
adjusting event. And right as wewere adjusting the event, the
Homebrew position pops her offthe vent squeezes like a whole
thing of saline down the tubeand just starts bagging, right?
Some Artis like looking becausethe vents alarming, and he's
like, What the hell is like, andhe looks at the kiddo and notice
that she's not on the ventanymore. And he looks at me like
she just de recruited everythingthat she had, like, why would
he? Why would he do that? Right?
And I was like, just let it go.

(21:08):
And we'll deal with it right.
And so you get back on the vet,and I'm still confused as to
what happened. So then my nursewalks over. And as he's now
trying to get the dripstransferred over, he's like, you
know, this little girl is like,eight and a half kilos. He looks
at me and he says, Hey, Doc, doyou want to keep this LR going
at 100 miles an hour, you wantto change that? And I was like,
I think I know what happened. Ithink I know what just happened.
And I like you guys to bekidding me. Right? And so as the

(21:30):
doc on the team, now I have tomake a decision. Because if we
package this girl up and put inthe back of that ambulance,
she's ours now. Right? And shewasn't safe for transport
before. But I know that once weleave Hamburg Vamsi has made it
extremely clear. We do not wanther back here. Right. So once we
leave, we can't go to RMC and soI jokingly said we would just

(21:53):
turn around and come back. Andthat Homburg nurse was like, no.
Oh, you do speak English.
You do speak berming English. Hewas like He ain't coming back
here. Oh, no way. You're gonnaknow where you go from here. But
no, he ain't going ain't comingback here. So he and I continue
to adjust the vent. And we goteverything to kind of turn
around, right? So I startedlasix started racing, I adjusted
the vent. And finally we lookedat each other and I was like, I

(22:15):
think I think we're ready. Ithink it's gonna be a good
flight. But I think we will beready. And she did great all the
way back to Walter Reed. I evencalled to check on it and all
went well. Right. So I think oneof the biggest takeaways as we
have to be current and competentwith pediatric stuff, right?
Because pediatric Seacat teamsdon't exist anymore. Right? It's
just it's us now, right? It'sthe regular adult Seacat teams.

(22:36):
And in these contingencies whenthese things spin up as quick as
they do, quite often is thekiddos that kind of get roped
into this. Right? There wasanother kid that we transported
that she was just one of theregular evacuees. It wasn't even
a medical evacuation, right. Andso she got loaded up on a C
seven T with all the otherevacuees and then they had to
get screened and have screeningvitals as they went through the

(22:57):
day in processing tent atRamstein. Well when they put the
postdocs on her her SATs were50. Right. And so there was
like, well, that's that'susually not good. So they got
over the alarm, see, and she hada uni ventricle. Right. And so
we also would see cat had totransport her back to the
States. When I went in the room.
She wasn't even an ICU, she wasjust in a regular room and I
went to pick her up her SATswhile she was chilling in bed

(23:17):
with 60. And we were there topick her up to put on the back
of C 17 and fly to the states.
And I was like, well that's shehas to she has to go. I mean,
there's nothing that we can dofor her here. She has to go back
to the States. Her mom took off,took off oxygen and walked into
the restroom, we were flying andshe can like put on a poster
SATs with 32 like Eagle just peeon the letter from this point
forward because you're notyou're not coming off this

(23:39):
oxygen anymore. I mean so theseare the things that you just you
don't think about because wethink combat I'm like I'm
deploying for sea cat so I'mgoing to transport a lot of sick
adults. And in thesecontingencies especially like
when you think about the thingsearly on which trying to get
people moving. These kids getaffected by this stuff quite
heavily. So I would definitelymake sure you read up on your
power so what I did was to PDstat right until all the ducks

(24:02):
put PD stat on your phone rightat the end of the day when you
started if you already fumblingthrough things you already
nervous just refer back to PDstat and put the weight in and
spit out everything you need andgo from their right and that's
exactly what they did. They alldownloaded PD study we're good
to go so Yes, sir.

(24:28):
You want to give it to us on ourown?

Travis Callen (24:31):
Right. I think the biggest challenge I had was
going from but over mydeployment I was inside of a
hospital and that's where Itrained at I did fellowship out
at UMC and Nellis Air ForceBase. So I trained in trauma
Bay's and emergency departmentson the 26th. We had our first
marine come in and he's verysick and unfortunately despite

(24:53):
our efforts, he was a casualty.
At that point, I went outside toassume my role in the triage Bay
And I kind of went from being anindoor cat to an outdoor cat.
And I had to practice medicineoutside on the ground, without
oxygen without suction, withoutnurses to help. So it was my
first time really just workingwith corpsman with stuff that
was laying on the ground next tome. I remember that challenge

(25:15):
being like, Well, this guy,because we had one Marine that
was on his side in the recoveryposition that was going to lose
his airway soon. So we, I wasimmediately like, This guy needs
suction, and he had terriblewounds to his face and jaw. But
suction wasn't an option. So weput them on the side, and we
started spilling the blood outof his mouth. And I tried to

(25:36):
take a 60 cc syringe with a 18gauge Kathrada to suction out
his mouth and quickly learnedthat doesn't work. But luckily,
I was able to wave down ourDCCs, the colonel Bruce Lynch,
who got the marine inside and hewas taken care of inside, we
avoid doing a crike outside. ButI immediately went from that
scenario to re evaluating theother other patients we have,

(25:57):
they're already categorized. Andwe use the NATO system. So
there's your T one that goinside right away, T two, that
would be like our delay, and Tthree would be minimal. So I was
making my way through the T twosand T threes because the T ones
had special operators and otherforeign surgical teams taking
care of them outside. So I feltI was best utilizing
readdressing tourniquets goingback through primary and

(26:18):
secondary surveys. And while Iwas doing that, it was
incredible to me what was in ourT three and minimal areas. Like
there was a young girl probablylike she looked like an like an
American 12 year old. So she wasprobably like an Afghan 16 or 18
year old but very medium sizewith penetrating trauma to her
abdomen. And I pushed on herabdomen, it was really hard as a

(26:40):
rock, obviously paramagnetic andshe yelled at me screamed at me.
And this young girl didn't go tothe O R for six more hours to
say so you can understand themechanism injury that day that
our people went through. She wasback in the T three area, which
would be walking wounded ifwe're at an airshow and

(27:00):
something happened, right. Sothe biggest challenge for me was
saying, okay, Travis, she's shewould be a T one back in the
States right now she's a Tthree. So reassess Do you can
eventually she'll get the careshe needed. Same thing with the
the airway patient that waslosing his airway quickly, he
was T two, and there was peoplein front of him, they were T

(27:23):
one, because of the panic I had,and probably not enough field
experience, honestly, because ifI was a field trained medical
probably just would have crackedhim and maybe saved a bed inside
for someone else. We got himinside. So the challenge I've
dealt with since then, is kindof accepting what I failed at as
far as not acting sooner withhim. And realizing where I can

(27:47):
improve as a provider. Your mostunexpected challenge?

Kat Landa (28:06):
Yes, there was a major one, again, that this is
reflected kind of the biggerpicture of the entire process,
because we were already multipledays into the evacuation at this
point, and actually move peoplepretty quickly by the 26th, from
where I was, as opposed toearlier in the operation. But

(28:28):
when we were doing our plan toplan again, we had a bunch of
medical equipment that we had onthe flight line along with the
rest of the marine stuff thatwas going to fly into Cabo from
Saudi Arabia, where we were forthe deployment. And fortunately,
one of my nurses as we'regetting ready to go because they
said okay, don't worry about it,your equipment will fly. And

(28:48):
right after you, one of mynurses, like let's grab all of
our scalable stuff out of thatquad con, which was fortunate
was Bella, who Christina Polkand I deployed with at our prior
deployment. And fortunately forher foresight, and again, just
being anxious because I just Idon't have a good feeling about
this. Let's just grab our stuff.
And because we had beenpracticing being scalable, and

(29:09):
utilizing smaller teams, we hadvery limited but some medical
equipment when we showed up. Andin a true Navy fashion as the
admiral had pointed out, we didbeg borrow and steal, highlight
steal from the rural to and alsofrom the 24th Mu who was located
and in North H kya. At theterminal, some of their

(29:30):
equipment. Unfortunately, it24th Mu came on the morning of
the 26th and said we want ourstuff back that you stole from
us because we're about to packup and go home. So on the day of
the mass casualty in thatevening was around 530 at night.
We only had one canister ofoxygen, one monitor, One vent,

(29:52):
one suction and we've got fourPretty sick casualties right off
the bat. I mean, two are airwaysthat were able to, if you just
position them they'd be okay.
Kind of like the one you hadmentioned initially at least one
that was it like a penetratinginjury to the arm. And then the

(30:15):
the fourth one, which is thisvery sick gentleman. So, again,
resources that we didn't have Imean, the pediatric stuff was
huge earlier on in the missionand we had kind of made up some
field type care for babies andchildren, for the evacuees,
because there was a lot ofmedical care that happened prior
to the mass casualty that wetried to keep her in the role

(30:38):
too, you guys were gettinginundated. So that's actually
one of the requests they had forus was can we start seeing those
patients, but the lack of care,lack of supplies that we had
available, like available to usat our site. For the mass
casualty, we were working on ourbackpacks, which fortunately, I
had phenomenal faculty andmentors, some of which that are

(30:58):
in this room, during myresidency about you know, making
sure that you're able to bescalable and make sure your
backpack has your, you know,otusa and all these other things
that you that you need, and weended up working out of those.
The additional piece was thehuman resources. So to one had
asked us to push our ambulancewhich again, we were only a
quarter mile, but push one ofour ambulance was some enroute

(31:20):
care resources down to the gatein response to increased threat
level, the night before the masscasualty so I actually split my
team. And our teams were kind ofdoing cute 24 hour shifts with
one nurse on each team. Myself,the other ER doctor, we actually
just lived at the roll. One, wedidn't really go back. And the

(31:43):
team that was off was actuallyhelping out with the ambulance
triage at the time. But I onlyhad three corpsman and one other
ER doc myself at our role oneduring the actual mass casualty
my team that was at abrogate wasa nurse and three corpsman. And
they were actually triaging atthe gate doing that mass
casualty at point of injury. Butagain, not having a nurse.

(32:07):
Again, there's been there's somefaculty that are here that told
me as a resident, you may nothave a nurse, get used to, you
know, doing your own vitals andbeing comfortable just doing the
nursing procedures. And that wasdefinitely the case. So those
were two huge things, resourceswere incredibly limited for this
particular region and the typeof teams that I had for such a

(32:32):
large number of casualties.

Moderator (32:37):
I'd like to take this opportunity. I have some more
questions. I'm sure you hadenough facility time questions
with me. But once I open it upto the group here any questions
or comments from the audience?

Audience Member (32:57):
Just assaulted myself. I'm I'm Andy. I'm one of
the third year residents at modagain. First, I wanted to thank
you, sir, for kind of askingthat question before as like one
of the more junior physicianshere. And like someone who's
just about to graduate, it'sreally encouraging to have male
leadership actually acknowledgedthe fact that women do have, you

(33:21):
know, oh, obstacles, althoughthey might be like unseen, but
it's just an additional burdenthat we carry. So I appreciate
that, but kind of along thatline, I'm going operational next
year. And, uh, kind of wanted tosee if you guys had any advice
for not just as a female, but asjust like a junior medical

(33:44):
officer, when you're havingconflict with your chain of
command that may not be medical,and kind of how you stand up for
yourself, how you stand up foryour medical team, the needs of
the mission of yourself and yourmedics in line with, you know,
the rest of the unit that's notmedical, because it kind of you
sounded, it sounded like Dr.
Lander that you alluded to thatthere was, you know, disparities

(34:05):
in your vision of movingforward. So

Kat Landa (34:12):
I think the key piece is coming back to being able to
speak that operational language.
But even if you can't do that,if you can put your potential
patients if you can put thosepeople first, if you can say I
think this is a risk because ofXY and Z, or I recommend this
because I'm concerned about ifyou can phrase it in the way
that you are concerned abouttheir soldiers, Marines,

(34:35):
sailors, airmen, if you canphrase it in that way, even if
you can't speak the languagethat should come across. Now
that being said, I have lots ofother things we could talk
offline about, which is alsoabout you know, decreasing
emotionality of things. So youcan state your concerns without
actually getting emotional aboutit because at the end of the
day, the operational commandingofficer, the line person, what

(34:58):
they say goes, right? So you canhave these conversations, but
no, at the end of the day, theirdecision is their decision. So I
did have this kind of like backand forth. But I also
acknowledged that, sir, if youwant me to be there, and this
was an AAR, it's an after actionreport for exercise we had done
that this came up, said if youif we do this, and you say, you

(35:21):
need to be at the role to I willgo there. But if you don't tell
me that, I'm going to do what Iwhat I think is right, and he
was like, well, whatever youthink, Doc, and that was that.
But again, taking theemotionality out of it, and
putting your future patientsfirst is probably the best way
that I've learned to deal withany type of leadership

(35:42):
challenges, and that's on theline. And that's also even in
the MTF, as a department head.
Same thing, if I could explainit in a way that I was concerned
about future patients, andactually describe why and what
risks I was seeing that alwaysseems to at least help you in

(36:02):
your mission to be the bestphysician you can to these
people. Did that answer yourquestion?

Unknown (36:08):
Yeah, thank you.

Audience Member (36:17):
Good afternoon, everybody. My name is Dane
Davidson with Zolo medical. I'ma former Navy guy, but I
converted Coast Guard and endedup retiring Coast Guard, do work
with Zoll medical and a coupleof things that have hit me, I've
been in this role. I'm aparamedic by train. And the
first thing I want to say isthat as a paramedic, we strongly
believe that everything startsand ends with physicians, we

(36:38):
can't practice without yoursignature. And at the end of the
day, when we have a criticalpatient, we're bringing them to
you. So to us, it's all aboutyou. And as the Admiral said,
Who better than you. And I saythat to bring up two other
points that the captain in hispresentation a while ago talked
about the devices where themonitors failed, the batteries
failed. Other kinds ofsignificant equipment, issue

(36:58):
failures, as well as with Dr.
Fontan net talking about theoptions of you know, folks
weren't exactly comfortable withthe possibly with some of the
settings on doing ventilation,whether that's pediatric adult,
whatever the case may be. I sayall this because I want to bring
to you a resource that we'rehere for you. Zoll medical right
now our ventilators areaspirators, or monitors, or

(37:18):
defibrillator is there, four offive very critical things that
you all carry in field medicine,roll one all the way through to
the to the MTF. There's seven ofus on our team, that our whole
goal and role is we're verypassionate about coming out in
ensuring your readiness and yourtraining. It doesn't cost you a
dime, all you have to do isreach out to us. We will come to

(37:39):
you we go everywhere we couldsee you in Korea, we can see you
in Japan, we can see you here inthe States anywhere. And I know
some of you were here to hearthat earlier. But I know we
didn't have all the room afterhearing some of these other
stories and I want to say thatwe do get calls a lot with
people in the field that havehad what could be a catastrophic
failure on their equipment, butwas actually very preventable

(38:01):
and very simple. If they wouldhave looked at it on the
forefront and I say that to youas the physicians use us as a
resource to come help you andyour teams all you got to do is
call us we're here to help thankyou

Moderator (38:19):
hospital, every hospital every ICU every er
every aid station, so projectnature camps dirty with
equipments, right so a lot ofthat's the magical uniforms of
the nurses and medics andforming that we work with but
you as a physician thatguidance. You're already trying
to figure out how to turn it on.

Unknown (38:50):
makes everybody walk into a room you think about
things you didn't do or you dothis long enough. You're who you
are. As long as you'reabsolutely going to be able to

(39:10):
pretty good look at it.

Audience Member (39:16):
Nobody says especially with extreme
circumstances. Last Name,questioners. This is where we
don't talk about. We'll talkabout we'll talk about we'll
talk about configuration. So Iwalk around with a dog it's

(39:46):
pretty nice to do my job. Butwithout a doubt, there are
things I like to say. If you godo what I did because African
British there All right I wantyou all to take a collection
from the old man and ever knowhow are they not us we were in

(40:21):
the field when you look at thosemy class though they have
different inside of giveaway thebiggest thing that grabs these
packets that are actuallywatching and once it's out there

(40:45):
I was thinking the same thingall said oh my god you can share
your goals that are normal eachother in time we had a lot of my
PTs in the backgroundkeep up with three year old

(41:07):
cigarettes or car accident thosethings Travis stood up here I
apologize we're not going to getrid of genders Yes, you are some

(41:39):
disadvantages. Oh my god did youactually manage? On top of what

Laura Tilley (42:17):
we're offering to our clients we have go through
trauma and trauma and so theneeded mental health
professionals revered were thatit acceptable. Growing our

(42:44):
bandwidth and being able to vote

Unknown (42:48):
yes, something dramatic happens. But there are new
things. And we can get to theother side. You don't have to
get smarter about how we get andthere's so many new they're
coming for the free plugin isEMDR therapy that is very one of

(43:15):
them. You don't have to benervous. Yo Yo

Audience Member (43:39):
you talk to them. They're saying it's going
to change the person. But PTSDfor sure. But I'm like

Laura Tilley (43:48):
everyone for everything. You had a question?

Audience Member (43:56):
To follow those two comments. First, thank you
for sharing your personalexperiences, because it's less
than a year ago and so weappreciate that. So there's a
lot of discussion on pediatricor lack thereof interventions
and training in you know, wereall in charge of resuscitation.
My question is more in theoperative management that damage
control surgery. Did you all seeany barriers to treating

(44:19):
pediatric surgical patients atyour location or even post op
surgical patients during theactual, you know, intervention
during the operativeintervention, whether orthopedic
or general surgical and thenhave a follow up.

Rod Fontenette (44:36):
So by the time you made it to us in Ramstein,
larm see if there were likethere was one kiddo that he was
like five years old, prettysevere traumatic brain injury
intubated. Like literally whenthat kid landed at Ramstein, he
was airlifted in the Hilo ofbase to Hamburg. So I mean, they
will move in those cases prettyquick out of there if they
needed something moredefinitive, because we obviously

(44:57):
we didn't have like a pediatricneurosurgeon and all that stuff
at Lorenzi So as soon as thatkid landed me within like an
hour or so he was on a helogoing. So they moved him pretty
quickly. And that was the onlysevere trauma when then I had
the rest of the world medicalstuff.

Travis Callen (45:11):
So we had, I think there's at least three
pediatric X labs that were doneat the role too. And I mean, our
surgeons, I didn't hear of anycomplications, and all those
kiddos end up gettingtransferred out without any big
issue. And in the recess Bay,we're really we're really
blessed to have em physiciansthat also moonlight and do like

(45:32):
the teaching agreements betweencivilian hospitals. So they see
pediatric patients outside thebase. So when it came to
resuscitation of a pediatricchild and hemorrhagic shock, it
wasn't something new or theyweren't on their back foot, they
were able to do it. My doc, Ericmolesky, put in a pediatric
central line, like in 30 secondslike, and I think that that's a
really a big testament for theactive duty folks, like if

(45:54):
you're at Bamse, or if you're atlike Tripler or the other bases
that are seeing a big patientpopulation, you probably don't
need as much, but the smallerinstitutions, I think you can't
beat the training agreementswith local hospitals and getting
your Doc's and hopefully,someday the mid levels, the PAs
can also get out and do some ofthat stuff as well. But to
answer your question, sir, thedamage resuscitation surgery,

(46:17):
and the recess in the traumaareas for pediatric patients, as
far as I know, went well.

Unknown (46:24):
Great, and were there any army F RSDs or fsts? At your
locations?

Travis Callen (46:30):
Yeah. So um, so we closed Bagram 20, June went
to H kya. And we joined a armyFRS table, either the 9/75, or
ninth 23rd, which was a half oftheir team, the other half was
in Kuwait or, or Bering, andthen the other half joined them.
And then, after the 15th ofAugust, when stuff started, go

(46:51):
belly up, half that teamretrograde, and the other half
stayed there. So there was halfan frst with us, as well as a
bunch of other specialoperations, conventional and
partner nation surgical teams. Ithink the final number was
around eight or nine.

Audience Member (47:11):
Just a quick question. So if I understand
this correctly, and I think I doso we had Marine combat
lifesavers, who handed offpatients to a navy role, one who
handed off patients to an armyrole two, that were evacuated
out of country by an Air ForceSeacat team. So my question for
the group is, had you met eachother beforehand? Had you ever
had a training opportunitybetween the services and if not

(47:34):
where our gaps in our blindspots?

Rod Fontenette (47:40):
Because I hadn't, I hadn't personally I
had met, had met anyone that wecame into contact with, for many
of the other services. That wasall just kind of melding kind of
went from there. But I had nevermet any of the other folks that
handed patients off to us. So

Kat Landa (47:58):
now, there were no joint joint trainings, even the
planning for it, a lot of theplanning that was involved prior
to going in was very COVIDfocused rather than actually
mass casualty. I kept asking formass casualty planners, just
north each kya. And I was like,well, that's the whole base. I
don't think we're gonna be thereif we go there. So there's none
and actually is going into mytalk. So thank you, Kevin Dean

(48:20):
for bringing that piece up. Butyes, more to fall, it's a huge
lesson learned is that we doneed to do a lot more joint
integrated, big picture pictureplanning, from the top down
would be helpful so that we'renot just throwing things
together. Now, that being said,I think the teams worked well
together, for the most part,especially for you guys over at

(48:41):
the World Tour was phenomenal.
Obviously, there's always somefriction when you've got new
forces coming in, and we'retrying to move people over
there. And who was this? And whyis this? It was It was chaotic.
I mean, there was clear on thenews, I'm sure. And on the
ground, it was certainly exactlythat. But yes, it would be a
great place to start, especiallywhen we're at committee for

(49:01):
teacher we'll see, for example,the mass casualty piece for
that, building that out. Andagain, that's kind of alluding
to my talk on Sunday, which iswe need to target how we
actually work as a purple forceon mass casualty planning and
prolonged casualty care, allthese other pieces that are
huge.

Moderator (49:23):
So I think I think part of this and I think this is
what GSA said was one way to dothis. There are certainly other
organizations and other ways tobring people together. You've
got to show up and step up andpass with the table. Because if
you're not at the table, you'renot making the decision. So now,
he can't have any impact. Wecan't you certainly can't
complain if you've never eventried to sit at the table. But

(49:45):
use these opportunities to sitdown, meet the Meet the Air
Force meet the army people likeRob are smart, right? And so
make these connections startworking through these things.
There's no reason to reinventthem. feel. And so, again, we're
here is GSAs that but likewhatever my capacity is, and
wherever I work, if I ever canhelp in any way, if there's a

(50:08):
problem has probably alreadybeen dealt with, maybe the army
hasn't dealt with it maybe justwas two years ago. So this is
why this is the value of themilitary, right? It's a huge
real, even people that havenever met together with one
another never worked before. Andit happens, right you I've heard
you were talking about this, youjust brought up with like,
individuals you never meet untiltwo seconds before you're now

(50:30):
running past counseling foryears, and that is the military
to use these opportunities toget to know each other. And then
also use GSA staffer use,whoever your friends are at
reach back and say, Hey, I needhelp. I'm more having this
problem. How can we solve it andget smart people in the room and
come together with we will addanything I'll just say to plug

(50:54):
here about the table is withAdam Hancock, it talks about
leadership and being that personand being that doctor that's
going to make the change, you'vegot to take those roles, because
if you don't take them, otherpeople will and then do policies
that if you don't like or arenot the best people to make
those policies. So just gonnaput a plug in to kind of

(51:16):
maximize your time this weekend,take advantage of the fact that
we're finally not behind a zoomscreen and get to know each
other because you never knowwhen you're going to end up on a
flight line or a fob or a ship.
You're very afraid. I think Ineed to become a better swimmer
after this morning's talk. Butyou just never know where you're
gonna run these people. So

Rod Fontenette (51:39):
I think and one of the things that I think
frustrated a few of us is thatonce we noticed that we were
moving a lot of sick kids. Wehad a an Airforce pediatric
intensivist that was deployed.
And she was at Djibouti, right?
And she's ck, right? With thespecial ops folks. Right. And I
was like, what she's not, Imean, she's not going to be used

(51:59):
there, we could definitely use ahere right to transport some of
these really sick kids back tothe states for these long
flights. And so I mean, we triedand try it and try it and they
would not let her go. LikeAlicia would not release it. I'm
like what that doesn't like sheliterally there has not been a
secret mission at that spot. And18 months, it ain't gonna happen
this week. And I can promise youso I'm gonna let her go and let

(52:21):
us use the way she can actuallybe used there without her
leadership specifically told herDon't ask again. We're not
letting you go. Yep, I was likethis, just this makes zero sense
to me. Zero sells to me. So it'sjust those things that are just
so frustrating. I mean, we kepttrying to push it up higher and
higher. Even the AE folks gotinvolved because it was like
this makes sense. Just bring ithere. We could obviously use it.
They will not they will not letit go. Actually, finally, just

(52:44):
the redeploy the whole team backhome because their deployment
had ended. And she was like,I'll extend and it was like now
it's time for you to go home.
And they will not release it.
That was just so frustrated. Sofrustrating. Like we have these
amazing resources all over theworld. And she works. She worked
in a unit and Bamse so she waslike I see kids all the time.
Like this is what we do. Likewhy why do we have to jump
through so many hurdles when wehave this resource that's

(53:06):
readily available already intheater in just one release?
Like that's just that's crazy tome.

Moderator (53:12):
There was no layover and H KY on her way back. How I
got to this plane and I ended upstopping here my way back to
Texas. I think this question.

Audience Member (53:24):
And this kind of goes back to more of the
joint question. Captain youalluded to there were some
special medics and stuffavailable to you. When you're
going if you're Moscow planningDid you know what resources you
had available in the local areaboth internationally as well as
nationally for like jointmedical 18 Delta's as well as
what those resources areactually capable of?

Travis Callen (53:43):
Yes, ma'am.
That's a great question. Iactually, I present on the
triage system quite a bit. Andthe one on my lessons learned
for challenges. It's interservice communication and
planning. So when you like whenwe have a mass cow, and it's
announced the way it goes outover the loud voice, right, have
a camp and all your medicalpersonnel show up. And when
stuff started going crazy at HQ,we start getting a lot of units

(54:05):
showing up. And so we had alittle mass cow practice one
night where there was fivepeople that were shot outside
the wall. So we stood up off fortrauma team. So we technically
just activated our mass Calplan. And a bunch of bearded
medics showed up and corpsmanshowed up that you know, we
hadn't interacted with yet and abunch of army medics showed up.
So we kind of started to getadjusted. And you know, we've
laid the groundwork, hey, we'dlike to talk to you guys. So we

(54:26):
can talk about planning. Well,that didn't happen because we
were seeing so many traumasevery day leading up to the 26th
and the 26th happened andobviously you hear a big kaboom
and mass Cal goes out. Everymedic on that base is gonna go
and help out at the role too.
And so what that turned into wasat least at least 40 to 50

(54:47):
medics and I say medics, but itwas paramedics 18 Delta's soccer
moms corpsman and then beardedphysicians. I'm assuming people
that were wearing hiking clothesand had ultrasound strapped to
their arm. Oh, So, yeah, so

Laura Tilley (55:02):
I didn't matter who they were because you don't
need me. You are just

Travis Callen (55:06):
very appreciative. They were there.
But to answer your question,there wasn't a lot of planning
for the 26, just because theunits weren't there yet. So
before the 15th of Augusthappened, everyone started
going, we started to figure outwhat our medical assets were in
there were planning for, like,the Alamo and like where the
fallback was going to be andwhere other teams could go. But

(55:27):
ultimately, we I personallydidn't have oversight over every
medical asset that was there. Sowhen I was doing my planning for
triage, the whole plan was totriage was with what we had in
the facility. Because when wehad practice, initially, at the
role to before stuff went crazy,we were told you're going to
have what you have. Our medicsare going to stay with the line
side. And that didn't happenwhen when push came to shove the

(55:47):
medics once their job was done,the line came and helped us so.
Yeah, so if that answers yourquestion,

Audience Member (55:56):
no, it does.
And it just goes to anybody elsein the room that might find
themselves in those specialtyunits or in charge of medics in
the specialty units, makefriends with your frst make
friends with your muse andeverything, make sure that they
know what resources are there.
Say hi beforehand and thatcredentialing is who cares about
that? It's just making sure thatyou know what resources you
actually may actually have.

Laura Tilley (56:18):
wander around and make friends.

Kat Landa (56:20):
That's the key piece there. So I that's basically we
did we sent someone in becausewe weren't in the role to we
weren't working out of the roleto but literally sent someone in
my other cohort. Nikki cook, Isent her ahead of time to go
make friends go say hi, this isus. We don't know we're gonna be
we're around we'll be sendingyou people. Despite that, even

(56:42):
when we're communicating in thedays leading up to 26. With them
to send them patients, Afghanevacuees, there was still some
friction, like who are you guys,and there were just so many
different teams there thatdepending on who you're talking
to, it was never Travis he wasactually very kind every time we
spoke with them on the phone.
But there was a lot of there wassome push and shove with that
for those of us that weren'tactually at the role to because

(57:04):
they had their huddles,everything like that the rest of
us were kind of spread out therewas a special ops team or
Alvarado. the flightline is big,and we were kind of the south
part. And then there was theNorth H kya. Group, which is
where the roll two was. So itwas a little different. And then
you brought up communications. Ijust wanted to highlight that a
little bit too. So within therole two, there were good comps,

(57:24):
and I know the Air Force and theArmy, and then everything for
Seacat. I'm sure that's greatcomps, but for those of us that
were not there. comps was reallydifficult. So comps between
medical units that are notattached, and especially because
these aren't the same service atall, was incredibly difficult.
So we went from the days leadingup to we didn't have cell

(57:47):
service where I was located. Iwas in an old security building
that was abandoned that I tookfrom the Turkish military and
converted into a clinic flashrecess area. And yeah, it was
jammers right outside because ofsecurity building. So there's no
cell no Wi Fi, which is what youguys were on signal. And most
operations even for theoperational side was on

(58:10):
WhatsApp, and signal, right, sowe have no comms with that.
Fortunately, I had grabbed acouple Marines they had given me
from to one to have green gearbetween ourselves and to ones
who had comms always with them,fortunately. But as it went on
my Camarines jerry rigged aprinter router into Wi Fi to

(58:32):
give us Wi Fi to actuallycommunicate with the roll to and
that is the only way that weactually announce to you guys
that there was a mass cow, itwas actually text message that
we did on signal. My first onewas like, same time that the
mass cow actually happenedbecause we got it right on the
green gear. There's an attack onabbeygate casualties pending,
and then Nikki put one out masscow and she got when we're done

(58:56):
with our patients, you know, twohours later, she's got these
nasty grams from one of theirtrauma surgeons like you can't
announce mass cattle like, Well,we did. You had 58 People coming
to you, you know, like, sothat's kind of the friction to
that you see, between units thataren't actually attached are
actually in the same structureor working together on a daily
basis. And then also thecommunication piece. So there

(59:19):
was I mean, we went through a,there was a time that a landline
was working, we were able tocall with just the evacuees,
hey, we're sending a patientblah, blah, blah, nothing about
the patient or the time or thelocation or anything like that.
But yes, signal and WhatsApp wasthe main source of communication
if you don't have access to thatbecause you don't have Wi Fi
because you're not on North. Ahkya that was an issue. So I was
very fortunate to have thesejunior Marines that just

(59:43):
seriously were heroes in theirown realm

Audience Member (59:52):
talked about the fact that you know, you had
all these people show up whenit's wonderful to have all these
people show up. You know, Italked a little earlier about,
you know, blood use and makingsure it was great they showed
up, but particularly in thatregion at the time, the TTPs

(01:00:14):
that were out there, you guysweren't expected to get one you
were expected there is going tobe at least three. So there's a
lot of danger in that emotionalreaction, right to people
flooding to a problem. Andthat's where that discipline,
and that's where theserelationships and understanding
where I applaud your work free.
But really, there's got to be alot of discipline there. Because

(01:00:34):
you get hit, you get hit again.
And early in the war inAfghanistan, one of the best
TTPs they had was putting IEDsunder dead bodies and shipping
them in is an all of our medicswould rather flip them over. And
now we had a big problem. Butagain, it's just one of those
things where talk him through, Iwill say at the last time, and

(01:00:57):
then I'm probably going to beleaving here. But nobody better
to do this today. Right in thisconference. But more
importantly, when you go back, Imean, how many people that are
currently in Fort Bragg havebeen diligent. How many people
in Louisiana been to Fort Bragg?
It's an hour drive hour and ahalf. And I think the beer is
cold in both places.

(01:01:24):
Thank you, I did want to askabout security. And so asking
just in the resources that wereavailable, and how that was
handled. And if that was one ofthose things that you could
offload have somebody addressedor whether you need to interject
yourself in ensuring that thatwas taken care of which
location? I think that will lookdifferent in each of your

(01:01:47):
components. And so if you couldeach address it, that would be
helpful to us. Thank you.

Kat Landa (01:01:51):
I'll start out point of injury for my team that was
there. The Marines themselveshad security. So they were kind
of taking care of that at mylocation. It was just the
corpsman myself. That was it andour Camarines, which, actually
when my calm Marine, LanceCorporal showed up, I said, and
we were riding outside, we weregetting gassed, there's all
kinds of stuff. This is beforethe 26th. I was like you are the

(01:02:12):
most senior marine here. So whenit comes to tactical things, you
are the man and he was like,Yes, ma'am. And he went to town,
making sure that building wassecure along with my corpsman
too, but he took his job veryseriously as a Marine. And I
appreciated that a lot abouthim. And so at the time of the
actual mass casualty, we alsoknew that there was there was

(01:02:34):
Intel for multiple blasts. Andthat was a little concerning.
And so we weren't trying to gooutside. But that being said,
we're also trying to helpoffload patients that are coming
to us to help out so it waslimited the day of the mass cow
prior to that we had Marinesthat were actually securing our
building because we had a lot ofevacuees trying to get in, which
was a different situationcompletely.

Rod Fontenette (01:02:54):
But us for security. The big issue was
whenever we will fly, like toHKIA, or even hit Qatar to
replace the CCATT Team. We wouldobviously the Ravens with us,
right? So the Ravens will flythere with us get on the plane
with the Qatar team, and thenthey would then go forward to
the sky. So they always hadsecurity on the plane if they

(01:03:16):
were going kind of into theactual area in and of itself.
One of the other issues that wehad early on was just it was so
many evacuees that even we likewe would have like a few
patients on the plane. And thenthe rest of the pain plane would
be filled with evacuees, right.
So you just just making someonehad done their sweeps and that
everyone was safe as possiblewas always a threat. But if we
knew we were going actually intoh Ky, then the Ravens would just

(01:03:39):
get on the sea 70 with us andjust fly with us for security.
So then we were landing and theywould go out and kind of spread
out and do their thing on theflightline and then before we
burned out they would all comejump back on the plane and then
we'll go back home so we alwayshad security's.

Travis Callen (01:03:55):
Pre 15th August, there was a International
Military Police on the base itwas a NATO base. Luckily 310
from the 10th Mountain Divisionfrom the army provided a lot of
security for us from the periodin between there and the the
mass cow once the perimeterstarted getting breached H kya
all army resources from the82nd. In that time, I think most

(01:04:16):
of 110 had ripped out except forJoey Griggs and Sloane Kelly,
which were two medical officersthat stayed and helped us a lot
during the that two week period.
So it was the 82nd and theMarines that provided for base
security for the hospitalitself. We have the Norwegian
Defence Force medical folks andthey send people with personal
defense weapons like little 5.7submachine guns, so it with them

(01:04:38):
that guarded the door and alsoescorted Norwegian civilians to
the flightline and thenourselves so the Day of the Day
of the perimeter breach. Asergeant major from the from the
army came to us and basicallylooked at me and two army medics
and said prepare to defend thehostile but all our guys are

(01:04:59):
busy. So which was veryunderstandable, because the
flightline, if you haven't seena picture of H kya has no fence
between civilian side and amilitary side, it's a run. And
if you can do that 400 meterdash and you're from Kabul, that
might mean you can get on aplane. And obviously the news
showed that. So the SAR majortold us that we grabbed them

(01:05:20):
fours and M nines, we put anambulance in front of the door
of the ER, which we then discussthis but bad idea if somebody's
getting side that gets shot. Sowe moved it. And we defended the
hospital. Luckily, no one camebut we we were essentially our
security. Later on before the26th there is an increased

(01:05:40):
threat of suicide vest IEDsstandard protocol prior to the
fall of Qubool was to call GodTurkish God and IMP God would
search the patient after that itwas on our staff so myself, I
remember these these guys wereburning stuff they weren't they
didn't have any bad intentions.

(01:06:01):
But these Afghans civilians wereburning some cans, cans explode
and pop and they got somepenetrating shrapnel to their
bodies. So the lights are out atthis point, the concrete
overhang of the roll too. So youcan't really see out there we
see cameras we see guys comingup there Afghan locals, I step
outside with one of my Norwegiannurses and ask like what are you

(01:06:21):
guys doing? We're hurt. We wantto come inside get looked at.
Okay, so myself and Kim AmericanCamp we've I can't remember her
name. But we went over and stripsearched a guy in a blast bunker
with Sergeant Smith who was areservists from the army. I
asked him to stand by with themfor away from us. But looking at

(01:06:42):
his buddies while we weresearching him before he came
into the hospital, we did havethose metal ones, but they just
beep all the time, no matterwhat you're scanning. So it
didn't really help. Luckily,that was the only time I had to
Pat someone down. But at thatpoint as like the triage person
after after Sloan Kelly had leftwho is a another PA, that was

(01:07:04):
the main triage person duringthe actual Mezcal itself. I did
search people before they cameinto the hospital and a handful
of times. Luckily, nothinghappened. But the security for
the most part was self providedoutside of the Marines and the
soldiers that were our primarysecurity for the base, if that
makes sense. So structuresecurity.

Moderator (01:07:24):
So we've got about 10 minutes left in this discussion,
I wanted to give you all anopportunity, if you have any. I
know you have a talk on Sundaythat you can get some more
details, but there's anythingelse that you would like to say,
to our group?

Travis Callen (01:07:43):
Yeah, um, earlier today, when Captain Deaton
talked about, we're here for theservice members, that's our job.
Really, just remember that ourjob is take care of service
members when they get shot, orblown up.

Rod Fontenette (01:08:02):
Nothing the other patient demographic that
we saw quite a bit of was OBpatients. So much so that the
Air Force actually deployed OBteams to be on all those
flights. I mean, there were alot of pregnant patients that we
transported. And that was Imean, they were like, very
pregnant, right? I mean, onethat we transported, she was
like G nine P whatever, at 40weeks with twins. I was I mean,

(01:08:26):
we had turbulence, we'rescrewed, right? So I'm like,
this is not gonna be good. It'sgonna be horrible, actually. And
she was probably like one oflike, five pregnant patients on
Wednesday. What are we gonna doit all he's like, this is a lot
of people. And so that wasanother issue right? As I do
have OB kits, like I know, wehave a big procedure bag, but
Oh, no, there's OB kits in thisthing. So now we have two
patients, right? And so it's soall that we need more blood,

(01:08:49):
right? And so then when OB Doc'sgot there, they were like, Hey,
do you guys carry Pitocin? I waslike, see cat, bro. Okay. It
says, like, you don't get outmuch do you? Like is like, you
know, you don't have that? No.
Right? So he might, he mightwant to go to alarm, see and see
if they have some of that stuff.
Right. So again, just talking tothese folks that we've never
deployed with, right? They don'tknow what we have. I did not

(01:09:10):
know what was in the backpacksthey had. So we had to come
together and just kind of dolike a sharing session of like,
okay, what do you guys actuallyflying on the back of the plane
with? And then how can we fromsee can better assist you?
Right? And if mom does deliver,right, I'll take the baby and
you make sure mom's okay. Andthen once you make sure mom's
okay, if mom has any airwayissues, and I'll step in and
help with the airway issues. Andthen we'll all make sure the

(01:09:32):
baby's okay. Right. But yet wehad to plan before it was time
to actually go out and do themission. Right. And so again, if
all these teams have never everworked before, and is this a
leader of the two he had neverflown before, they never
deployed before. So this was thedeployment in and of itself was
new, right? That experience wasnew. And then now they throw all
of these pregnant patients outthere, they have no idea what
their, like prenatal historywas, right? And so now they're

(01:09:54):
trying to find all thisinformation out and it was just
so the pregnancy in the OB piecewas was pretty robust. as well
as as well. So flexibility.

Kat Landa (01:10:04):
Evacuation. Yeah, I'll say most of my other
comments from my talk, but kindof piggybacking off this because
we're not really talking aboutthe evacuation piece, which in
itself was huge before the masscow. A lot of pregnant patients
and I just want to put a largevalue on making sure you have
your ultrasound. I love that yousaid there was bearded guys with
ultrasounds start soon becausemine was in my grenade pouch. I

(01:10:27):
had a butterfly ultrasound thatI had purchased myself prior to
deployment. And that wasphenomenal, especially because
we had just so many pre patientpieces that were pregnant, they
would come to us in the daysleading up to the mass casualty.
In fact, there was a day thatthere were no kidding 11
pregnant ladies waiting outsideto be seen by us. And these are
women that never had prenatalcare. These are women that

(01:10:48):
didn't know how pregnant theywere. And one of them had a
placental abruption. And there'sno OBGYN there. Fortunately,
there was an Afghan OBGYN behindme with her father who needed
insulin, which again, we didn'thave, but we borrowed from
someone else who had it. That'sanother story of the cowboy
medicine that went down. But,yes, so anyways, we were able to

(01:11:11):
kind of source some of thesethings from the Afghans
themselves. And this lovely,lovely Afghan OBGYN, agreed to
go to the role to to kind ofhelp facilitate planning or
delivery if it needed to happenfor this 27 week, or with a
potential eruption that I'mlike, that doesn't look right on
my ultrasound. So that wassomething else before even

(01:11:36):
beforehand that we kind of raninto. But again, a lot of
incredible, just trying to makethings work in the days leading
up to it was just something thatno one could have been prepared
for, unless we had all theequipment that we could ever
desire at the time, but thepediatric stuff, the OB stuff,
that was all stuff that doesn'tcome in your STP kit, right, it

(01:11:58):
doesn't come in combat trauma,it's all stuff I was like the
first day like, and I make an IOout of an 18 gauge for a baby
because they were throwingbabies over the fence. And in
fact, the location I was at, Iwanted that location one because
it was told I needed to be inthat proximity, but to a
corpsman from one eight,basically had a dead baby had a

(01:12:21):
baby that died in his arms atthat location at east gate the
night before. So if no otherreason I said if there's nothing
happens in the Marines, thankgoodness, that's amazing. But I
want to be here for the corpsmanbecause in this situation,
they're not trained to care,pediatrics, or non trauma. And a
lot of these, a lot of theseAfghans had, like dehydration,

(01:12:43):
seizures, hyperglycemia, justcomplete exhaustion, they have
been trampled on their way intothe gates, they've been
assaulted on their way into thegates. And then there was, you
know, the infectious issuearound us with diarrhea and
human feces everywhere. It wasbeyond anything you can imagine
at those gates. And so justknowing that you may need to

(01:13:03):
care for these things andkeeping all those, you know,
DNDi skills like Admiral Hancockand Kevin Deaton both mentioned,
those are huge issues that weneed to not only know how to do
ourselves, but the captainDeaton had said is passed on to
our nurses pass on to ourcorpsman because now a lot of
these corpsman and even steel,US Marines were taking care of a
lot of the patients before theyever even came to us or to you
guys. Thank you.

Moderator (01:13:27):
Great. I you know, listening to you all over the
past hour and a half has beenvery enlightening and very much
an honor to hear what you allhave done. I think what is
amazing to me listening to thisis all of you are emergency
medicine trained. And I thinkthat willingness and ability to
kind of think outside the boxand think in your feet is

(01:13:48):
something that we prideourselves in our specialty,
along with being militarymedical officers. And so I want
to applaud your efforts of youknow, making work where you have
reacquiring objects from otherplaces, supply sergeants are the
best friends you can find tomake things appear when there
are none. So really, you know,thinking on your feet beat

(01:14:10):
saving lives. And also what elseI heard throughout this
conversation was that takingcare of yourselves but also
taking care of your otherslooking out for your your
colleagues, your medics, yourcorpsman, you know is really
inspiring to hear. So again,thank you all for talking about
this topic. And thank youeveryone here for your
thoughtful questions.

(01:14:38):
So our next lecture is going tostart at 1520 which is in 15
minutes, so I'll see everyoneback here at 1520. pay it off

(01:15:00):
Do I still do all like forseparate