339th Combat Support Hospital: The Army’s New “MASH” in Afghanistan
By Janet Boivin, RN
IF HOTLIPS HOULIHAN, Hawkeye, and Col. Potter were to step into the American Hospital Compound in Bagram, Afghanistan, they would find little resembling their infamous MASH hospital set in the Korean War during the 1950s.
The heat, the dirt, and the distant mountains of Afghanistan might be all that parallels the Korean environment in which the characters from the quintessential Army medical movie and television show saved soldiers lives while saving their own sanity.
True, the 339th Combat Support Hospital that set up camp at the compound in Afghanistan in June is essentially a tent hospital. But the maze of tents are of better quality and construction, augmented by expandable, hard-wall boxes that house, for example, the OR, laboratory, and x-ray department.
The MASH characters would be awed by the technological level of the supplies and equipment that can be transported into a wartime environment. For example, the 339th is the first Army medical unit to use a Vamos gas analyzer used to measure anesthetic gases in the OR in a field environment. There is even a CT scanner to help accurately diagnose patients conditions.
Hot showers, a gym, air conditioning, and computers can also be found at the American Hospital Compound. Even these comforts cannot overcome Afghanistans dust, but that still doesnt prevent the staff of the 339th from providing the best care they can in unfamiliar territory. You can give excellent care in a dusty, dirty environment, says Lt. Col. Donna Hershey, RN, MS, CRNP, chief nurse of the 339th.
The commander of the 339th, Lt. Col. James B. Post, MD, says there are many obstacles to providing good healthcare in Afghanistan where the environment is harsh and the living conditions are austere.
The extremes of heat and cold, the sandstorms, and the endemic diseases all provide challenges, he says. However, we have state-of-the-art equipment, great soldiers, and we believe in what we are doing.
To Houlihans and Potters delight, and Hawkeyes dismay, they would not find the 339ths surgeons flouting the militarys strict adherence to discipline and regimentation for a few laughs, as MASHs top surgeons so often did. Theres much more military discipline here, says Maj. Garth Elias, MD, a general surgeon for the combat support hospital, who as a civilian surgeon works at the UPMC-Passavant Hospital outside Pittsburgh. Theres less rebellion against the Army system.
But there is one characteristic Army nurses and physicians from any recent war would recognize: the full attention, devotion, and top-notch medical care given to wounded soldiers brought to the 339th by air or land transport from throughout Afghanistan.
Thanks to 339th, Fewer Soldiers Need Care in Germany
The 339th is an Army reserve hospital based in Pittsburgh. The hospitals approximately 100 reserve members, made up of nurses, physicians, medics, lab techs, and support staff, were called to duty this spring and arrived in Afghanistan at the end of June.
The 339th is different from other Army medical units in Afghanistan because it is larger in size, has more personnel, and can care for patients for longer periods of time. It is a level III unit, capable of treating the most serious of injuries, illness, or trauma.
Until recently, the Army deployed to Afghanistan its forward surgical teams (FSTs) capable of operating on and treating a variety of traumatic wounds. But the FSTs are not designed to treat patients for extended periods of time. Instead, patients requiring further care have been transported to the Armys Landstuhl Regional Medical Center in Germany a journey taking thousands of miles and often requiring more than one stop along the way.
The 339th was sent to Afghanistan so fewer soldiers injured or wounded in Afghanistan would need to be sent to Germany. The presence of the 339th is reducing the number of patients returning to Landstuhl, says Maj. Gary Tallman, a spokesperson for the Combined Joint Task Force 180. Two of five soldiers wounded by shrapnel [in Afghanistan] several weeks ago are a case in point, he says. The two 82nd Airborne Division soldiers spent about a week receiving care at the 339th at Bagram, as opposed to being transferred to Germany.
FSTs do the initial resuscitative surgery, but they dont have hospital beds to hold patients, says Hershey. We are here to conserve the fighting strength, to treat fellow soldiers so they can return to duty, or to get them to definitive care.
However, Tallman points out the 339th is not a long-term holding facility. After a certain threshold, or depending on the severity of illness or wounds, soldiers will go to Landstuhl to ensure the hospital here is able to give the appropriate level of care for other patients.
The other three soldiers injured in the attack needed care beyond the 339ths capability, not in terms of immediate treatment, but long-term care. They were stabilized at Bagram and then sent to Germany, says Tallman. Unfortunately, one soldier eventually died from his injuries.
Skirmishes between Taliban fighters and US and Afghan soldiers have recently intensified and kept members of the 339th busier than they were in the first few weeks after arriving in Afghanistan, says Hershey.
Civilian Skills Suited to War
In the civilian world, the 339ths nurses, physicians, medics, and lab workers have jobs similar to their military positions with the 339th. It is the patients for whom they care that may represent the biggest difference.
Although casualties have been extremely few in number compared to those of other wars, a soldiers injury or death from combat is always a soul-searching event for military caregivers.
There is little that can prepare you for the sights and sounds of combat injury, says Post. The emotional impact of young, healthy people being grievously injured can be difficult.
Post, an ear, nose, and throat surgeon at Allegheny General Hospital in Pittsburgh, says he has used his skills on patients with wounds to the head and neck and those with sinus problems brought on by the dust and heat. His most challenging case has been a soldier with a severe head injury who the team thought would not survive. Says Post, Fortunately, the patient not only survived but is now doing great.
Lt. Regina Long, RN, FNP, is the officer in charge of urgent care, the main triage area of the 339ths ED. Soldiers with anything from splinters to headaches to fractures first arrive at her department, where she decides what level of care they require. Long is assisted by a physicians assistant, four medics, and clerical personnel. She knows most of her patients, although ill or injured, are young men and women in peak physical condition.
At home in Cranberry Township, Long, 47, is clinical coordinator of the geriatric department at Mercy Hospital Pittsburgh. I work with Alzheimers patients, so this work is a refreshing change. Im learning a lot, she says.
Hershey, too, works with older individuals back in Pennsylvania. She is director of care and outcomes for Masonic Homes, a continuing care retirement community in eastern Elizabethtown. Most of the skills she uses at the retirement community transfer to what she is doing in Afghanistan. At home, I oversee the ancillary clinics and supervise the lab and pharmacy, just as I do here, says Hershey, 46. I am using my skills honed during the last 20 years of my nursing career.
But her role as an Army chief nurse extends further than in her civilian capacity. As chief nurse, I want to make sure people are taking care of themselves, she says. I try to get team members days off, but that is a challenge. Weve had a good, steady census. We all pray for a little boredom so we know our servicemembers are safe.
For the most part, the 339ths supplies are adequate and equipment is up-to-date; but there are times when the staff needs to use some Yankee ingenuity, says Hershey. For example, nurses have used paper clips and sheets to create privacy screens for patients. The 339th also doesnt come supplied with wheelchairs, so staff members have converted special stretchers that bend in the middle into makeshift wheelchairs.
As a nurse anesthetist for the VA Medical Center in Pittsburgh, Maj. Eric Schroeder knows how to punt in the military system. Schroeder, chief nurse anesthetist for the 339th, says he and other OR personnel gathered a cache of medications before leaving for Afghanistan because they anticipated resupplies might be slow in arriving. Were used to shortages in the VA. Ive been at this for more than 20 years, says Schroeder, 51. We adjust our practice [in Afghanistan] to what we have. We give a good anesthetic here, even though it may not be exactly like what we would give in the States.
Far, Far from Home
There is one other sentiment MASHs Houlihan, Hawkeye, and Potter would recognize homesickness. Every member of the 339th has left behind family, friends, and colleagues. Elias has become obsessive about e-mail, a habit he says he does not have in the States. He has three little girls, ages 8, 5, and 3. His oldest is facing the hardest adjustment to his absence. My wife taught her how to e-mail, and that has helped, he says.
Longs two sons are older than Elias daughters and better understand why their mother has been sent far from home. They think its a job that needs to be done and their mom can do it, she says.
The nurses and physicians of the 339th wont be in Afghanistan for long periods of time. Elias assignment will probably be only three months duration, while for Hershey and Long it could be as many as six months. Whatever the length of the stays in Afghanistan, none of the members of the 339th would give up the opportunity to serve. Says Hershey, I think were all proud to be here to do our part for our fellow soldiers and for maintaining the freedoms we hold so dearly. The Army could have picked any hospital on active duty or reserve, and they picked us.
Janet Boivin, RN, is editorial director of Nursing Spectrum.