Page 122 - JSOM Winter 2019

An Ongoing Series

“There I Was”

A Cup of Improvisation

Ben Hubbard, Pararescueman; Chris Freeman, Pararescueman;
Kelly (Rock) McKay, 18D/Z (R)*

learance Team 1 was well into their day, conducting anteriorly and only found the one bleeder from the small frag-
building clearance operations in order to exploit mate- mentation wound over CTM-B’s right tibia. Completing full
Crial left behind by key enemy personnel. While another exposure, PJ2 cut off CTMB’s underwear and removed the as-
team was assessing the next target, the three-man clearance sault belt to find a larger, nickel-size, inguinal fragmentation
team was inside a masonry, one-story residence. While clear- wound with a fist-size hematoma actively bleeding.
ing the structure, an improvised explosive device (IED) was
triggered three rooms deep into the building. The blast caused PJ2 attempted to pack it with a hemostatic gauze but was un-
a massive fire in the room with a trapped individual, fallen able to get contact with any large vessels due to the relatively
debris was everywhere, smoke filled much of the space. small size of the open wound. While still conscious and mostly
lucid, CMT-B was able to offer help. While grabbing at his
Clearance Team member A (CTM-A) closest to the IED and inguinal wound, he said, “Place a junctional on it, like we did
most critically injured was trapped in the building under de- in the class,” referring to the medical training that the team
bris, clearance team member B (CTM-B), and the subject of conducted before deployment.
this article, was severely wounded in the adjoining room, and
clearance team member C (CTM-C) was wounded with tem- For a junctional tourniquet (JTQ), PJ2 knew he needed a pres-
porary loss of consciousness and a shrapnel wound to the pos- sure point device. With his medical ruck in the rear of the con-
terior thigh while two rooms from the blast. voy approximately 75 m away, too far considering the severity
of the wound, PJ2 ran to the nearest medical vehicle to search
The primary medic immediately entered the building, con- for a JTQ and found a Skedco litter strap with a cobra buckle.
ducted triage, and directed CTM-C to assist CTM-B to the He needed a pressure point device and found a stainless-steel
breach point, a window. The primary medic and CTM-C coffee cup sitting in the center console that would work in this
would remain inside the structure to provide care and extrica- situation. PJ2 returned to CTM-B and applied the improvised
tion to CTM-A, who was trapped inside the burning building. junctional tourniquet. With the coffee cup directly on the skin
over the wound, PJ2 slipped the strap around CTM-B’s waist
[For purposes of clarity, “other team members” refers to team and placed the cup on the bleeder, connected the buckle, and
members not inside the structure where the clearance team with assistance from a team member, tightened the strap un-
members were at the time when the IED exploded.] til the bleeding stopped. PJ2 then reassessed for other major
bleeds and saw oozing still coming from the tibia and applied
CTM-B, covered in blood on his face, uniform, and kit, made hemostatic gauze and a quick pressure dressing. A team mem-
it to the breach point and was met by the alternate medic ber (an 18D) gave CTM-B a fentanyl transmucosal lozenge to
(PJ2). PJ2 and another team member dragged CTM-B from assist with pain (Figure 1).
the window and placed him on a litter directly outside the
building. PJ2 applied a C·A·T tourniquet (TQ) high on CTM- PJ2 then examined the upper body and noticed multiple frag-
B’s right leg over his pants, followed by incomplete upper and mentation wounds (approximately eight in total) on the upper
lower body exposure using trauma sheers. torso and neck, placed halo chest seals over the chest, and then
cut small portions from a chest seal and covered the penetrat-
PJ2 noticed a considerable amount of blood had already been ing wounds on the neck. PJ2 examined CTM-B’s face, eyes,
lost. The right and left legs had small fragmentation wounds ears, and head to find extensive glass, shrapnel, and dried
with blood still seeping from the right. PJ2 readjusted and blood on CTM-B’s entire face, left ear, and forehead. CTM-B’s
secured the TQ and continued to search posteriorly and eyes remained intact because of the use of eye protection.
*Correspondence to rock.wie.stein@gmail.com
The authors are affiliated with part of a joint Special Operations team in the OIR theater of operations.

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