There's emergency medicine, and there's emergency medicine in a war zone. Dr. Todd Baker spent 15 months as chief of emergency medicine at the Army support hospital in Baghdad, Iraq. He describes his experiences in detail in his book, "Baghdad ER: Fifteen Minutes." Dr. Baker graduated from the University of Arkansas for Medical Sciences with a medical doctorate in May 2001. He trained in emergency medicine at Fort Hood, Tex., from 2001 to 2004. After completing his residency in July 2004, he was assigned to the 2nd Armored Cavalry Regiment, Fort Polk, La. He later transitioned to Fort Lewis and joined the emergency medicine residency program at Madigan Army Medical Center, both in Tacoma, Wash., in 2006.
Shortly after being chosen as "Teaching Staff of the Year" by the emergency medicine residents, he was assigned to deploy to Iraq with the 86th Combat Support Hospital, Fort Campbell, Ky., in October 2007.
Dr. Baker earned the Bronze Star Medal and Combat Action Badge for his service in Iraq. After almost 8 years on active duty, he separated from the U.S. Army at the rank of major and now serves as comedical director of the emergency department at Skaggs Regional Medical Center in Branson, Mo.
What, if any, additional training did you do before deployment?
I worked as a teaching faculty in the EM residency program until August 2007, when I moved my wife and infant daughter closer to home in Arkansas. I reported to Fort Campbell on Sept. 30, and medical personnel from more than 30 different Army installations gathered to begin a 3-week preparation for deployment to Iraq. We got to know each other, but actually had minimal time for medical training. Most of our time was spent performing necessary administrative tasks prior to deployment.
Could you describe your clinic and operating room setup?
I was the chief of emergency medicine, spending 99% of my time in the ER, or EMT as the Army called it. We had 10 beds split between two rooms: three in our main trauma room and seven more in a larger room. Each bed was surrounded by endotracheal tubes, tube thoracostomy kits, central line introducers, oxygen, monitors, and tourniquets.
In our main trauma room, each bed was surrounded by preloaded endotracheal tubes and multiple tourniquets ready to go. Chest tube and central line kits were opened and covered with a blue towel. We did not have time to open these kits once patients arrived - we had to be able to perform these procedures within seconds. The SonoSite and GlideScope corporations allowed me to hand-carry $30,000 ultrasound and intubating equipment with me to Iraq, and both machines saved lives on several occasions. Belmont transfusers performed amazingly. We had state-of-the-art equipment, and we had many specialists from surgeons to orthopedists ready to help, but we did have a paucity of emergency medicine providers. We had three ER docs, myself included, to run 24/7 operations in the busiest combat hospital in the Army. We had nine nurses, four of whom had never worked in an ER. Sixteen medics rounded out our crew, but only a handful had any trauma experience. Radiology and the blood bank provided essential support. More personnel worked in the ICU, wards, and other areas of the hospital, but that was the essential crew of "Baghdad ER."
What were some of the greatest challenges of operating in a combat zone? How did you deal with challenges such as managing infection?
Fatigue was a huge issue. We dealt with death on a daily basis for 15 months, all the while rotating days and nights covering the ER. We routinely had to place expectant patients on morphine drips and wait for them to die, which is not what we were used to in the United States. For a 6-week period in the spring of 2008, we were under rocket fire multiple times per day, and our troops in the field were being hit very hard. We worked 18-20 hours at a time, slept for a few hours, and came back for more at a moment's notice. The ER docs essentially could not leave the building and go to the dining facility or anywhere else, because the rocket fire would "lock down" the facilities, and we had to be in the ER ready to go. We all missed home and longed for our families, friends, and "normal lives." However, we became like a family, and many of us are still very close to this day. We did not have time to deal with infection. Many of my central lines were done without sterile gloves, because we needed to get access within moments or the patients were dead. Of course we gave antibiotics, and patients received infection-control measures once they were stabilized, but we did not have time to deal with sterile technique on many occasions.