Saturday is Armed Forces Day, a day when the nation honors the contributions that military service members make toward ensuring its security.
One such contributor is Maj. Ed Gyukeri Jr. of Oneonta, who recently returned from a four-month tour at a forward surgical unit in Logar Province, Afghanistan, close to the Pakistani border. It was not his first deployment in the post-9/11 world.
“I was in Iraq during the surge in 2006,” the longtime reservist said this week. “That was my first deployment. The second was in 2008, but by 2008 things has calmed down a lot.”
The Afghan tour — with the 624th Forward Surgical Team, which was attached to the 173rd Airborne Brigade at Forward Operating Base Shank, north of the city of Gardez — produced some remarkable moments, he said.
“The most memorable one that’s sort of local interest is the night that we got victims from an … engineer battalion,” he said.
The 444th Battalion is a reserve unit based in Oswego, and the soldiers had struck an improvised explosive device, or IED, on a night in early November.
“We’re a reserve unit, but we were basically the medical element for an active-duty provincial reconstruction team,” he said. “Other than the medical people, I wasn’t expecting to run into any other reservists, and certainly not to be taking care of the wounded from a reserve unit.”
What made it worse, he said was “the severity of the injuries and the number of people wounded in one incident.”
“When they arrived, four out of the six were critical,” he said. “They were pretty much dead. There really was not much life left. And, of course, we did what we always do, which is perform CPR and try to save them.
“But they quickly died,” he said in a low voice after a long pause.
“So then that left two, and one of them was unconscious. … He obviously suffered a pretty traumatic brain injury. So there was only one out of the six who could speak. And why he was lucky, I don’t know.
“Where he was in the vehicle may have had something to do with it. But, at any rate, there’s this one guy, and he’s a kid. He’s a kid to me, because I have a son who’s maybe two, three years younger than him.”
“He wasn’t in great shape either — he had a lot of things going on,” Gyukeri continued. “He had a lot of problems. … So he had all of his own problems to worry about, and there he was, laying on a stretcher, and all he cared about was what had happened to his friends.
“If I had been him, and I had bothered to look down, the last thing on my mind probably would have been how other people were doing. And that’s all he cared about. … I put that kid to sleep, and he was still asking about his friends, how they were, what had happened to them.”
Ultimately, the young man was the only survivor, Gyukeri said.
Forward surgical teams are the product of doctrinal changes in the past two decades, Gyukeri said.
“Military medicine, in general, has moved to splitting to much smaller elements and spreading them around more,” he said.
The idea is to reduce the time between injury and treatment, a period sometimes called the golden hour.
“Desert Storm-Desert Shield was the beginning of the concept of the forward surgical team, which is tiny team, which is what I was on,” he said.
“There’s two general surgeons, one orthopedic surgeon. There’s two nurse anesthetists, which is what I do. There’s one triage nurse, there’s two ICU nurses, one is an ICU RN, and one is an ICU LPN. And then we have two medics, and that’s it.”
Wounded soldiers are assessed on arrival at a triage area by the doctors, and the less-severely injured are quickly handed off to medics from a medical support unit commonly referred to as Charlie Med.
“At that choke point, the decision point, we have medics from Charlie Med, from the non-critical medical unit, and we say, ‘OK, you take this one.’ … And basically, we kind of get them out of the way so it’s not choking up the whole flow of patients.”
But the triage also involves making some difficult choices.
“You don’t just pick the most critical, but you also pick the most critical who has the highest likelihood of surviving,” he said. “If somebody is extremely critical, but they’ve lost two much blood or whatever it might be, sometimes they’re not necessarily the guy that goes to the front of the line. It’s hard to describe it. There are limited resources and limited assets.”
The strain of such work can be difficult for some, Gyukeri acknowledged.
“I think all medical people, whether they’re in the military or not, that’s either in you or it’s not,” he said. “You figure early on in your medical training you’re either the guy or gal who freezes when somebody comes into the ER with a few bullets in their chest, or you’re the person who says, ‘Wow, this is awful, what am I going to do about it?’ And you’re motivated to act as opposed to being paralyzed by fear.”
“It’s awful to see that over and over again, but, I just kept saying to myself, ‘I’m glad I’m not having to go out on patrols,’” he added.
There are other risks to working so close to a combat zone, Gyukeri said.
“They rocketed us almost every day,” he said of the insurgents.
But IEDs, are the biggest threat in Afghanistan, he said.
“It is the threat,” he said. “It is the capital T threat. IEDs, by in large, represent the majority of injuries. They’re (insurgents) very reluctant to meet American forces toe to toe, they really are. It does happen, but it’s pretty rare.”
Nobody in his unit was injured, Gyukeri said, but a medic from the nearby Charlie Med unit was killed.
“He went outside the gate on a patrol to be the medical support for a bunch of guys who were going out to patrol the road,” he said. “And they hit an IED.”