Friday, July 2, 2010

Law of averages

I met a brigade commander last night who came in to see his soldier in the ICU.  He had traveled from a base over an hour away, and was anxious for a status update, and report on the progress of his care.  The answers were not what he wanted.  No pupillary reflex.  No corneal reflex.  No muscle tone.  No gag reflex.  Most likely, his trooper was brain dead.

The man was crushed, in a work-related accident, by a falling steel panel.  The piece which trapped him to the ground required a forklift to move, and 15 minutes afterwards, the man was without a pulse and in cardiac arrest.  His heart was recalibrated with eletricity, chest compressions and delivery of oxygen, but the tell-tale signs of his anoxia were present already, even by the team of EMTs providing his care.  Fifteen minutes without oxygen to your brain is not survivable.

The Commander said that support brigade suffered no battlefield deaths during his deployment of nearly a year, but two accidental work-related deaths.  This is not clumsiness - in fact, very much the contrary, as there could have been many more in the thousands of munition transfers, movements of heavy machinery, and preparation of heavy equipment for the infantry forces if not for their training and safety precautions - but instead the unavoidable, statistical reality of unpreventable accidents; and the more dangerous the job, the greater that reality.

I cannot help but think, however, of dying via an accident here as less palatable than the same thing happening at home (or a battlefield injury here).  Men fight in war, and some die there; this is an ending of honor, and a risk these men, and their families, understand from the outset.  When we leave home to fight, however, we cannot oblige (nor accept) an early departure from this world for the mundane and unworthy poor stroke of luck.  A cracked head on a waxed floor.  A wet finger and an ungrounded light switch.  Complications from a severe pneumonia.  These things happen all over the world, so they happen here too.  If there still 100,000 troops, and 100,000 contractors in Iraq, it is simply a law of averages that bad things will happen to some of these people.  Location, is everything, however, and going down in a hostile country, 8,000 miles from home in the care of strangers is not how anyone envisons their end.

[FWIW - The DoD takes pride in the manner by which family is notified, and the means by which these family are brought to see injured family members at the first possibly opportunity.  Usually, this means Germany, east coast US, or England, as family cannot be flown into the AOR.  We make every effort possible to maximize the physiology of these patients with non-survivable injury, so that they can survive long enough for family to see them at these locations, and possibly even serve as organ donors.  We cannot predict how all patients will do, but most can be supported by vasoactive pharmaceuticals long enough to get out of the AOR via emergent air evacuation.  Sometimes, we are wrong, families wait in Germany, but patients never alive, dying on the plane, or to Dover AFB, in Delaware as HR (human remains).  This is uncommon, but can happen, and is part of the risk taken in an aggressive approach to getting patients and families together.  It just makes the accidental non-battlefield death that much harder for family]. 

No comments:

Post a Comment