The call came into the Tactical Operations Center of the Combat Support Hospital via telephone at approximately 1320 hours.  Answering the phone and receiving a short 9-line from the brigade operations center.  I wrote down the information and passed it to the Battle Captain, the shift leader.  This call started the wheels into motion for a Level I MASCAL.

        Five Strykers, an awesome armored vehicle, monsters of authority, were on their way to the hospital from somewhere in Mosul with several critically wounded soldiers onboard.  An insurgent suicide bomber with his automobile packed with explosives attacked the soldiers by driving himself and his deadly cargo into the Stryker then detonating the vehicle in the name of Allah.  This suicide vehicle borne improvised explosive device (SVBIED) is the preferred method of attack by the insurgents.

       My usual course of action to mass casualty events is run over to the medical helicopters landing pad and check for any aircraft parked in or around where the MEDEVAC helicopters land that may pose a potential problem for speedy incoming helicopters.  Once the pad is clear, the next item on the list is to ensure we have enough litter bearers to handle the offloading of the patients.  Placing another mental checkmark on my list leads me to the Emergency Medical Treatment facility (EMT).  Poking my head into the EMT to check for any last minute changes to the status of the incoming helicopters, I noticed that we just so happened to have the MEDCOM Commander, a Brigadier General, visiting our hospital when we received the call for the MASCAL.

        Going from the EMT back to the helicopter pad and patiently waiting for the sound of incoming vehicles, the voices of confusion shouting orders and the unconscious crackling of radios.  I have waited many times on this now quiet pad and routinely take advantage of the peace before the arrival of the carnage.  It is one of my few moments of silence allowing me to collect my thoughts before engaging in the horror.  Placing head in hands and starring at the ground, there is pleasure in the temporary solitude.  Then, without notice, the sounds of Strykers rear my head.  Off in the distance are these mammoth vehicles taking a dangerous short cut racing across the airfield in my direction.

        The short cut is a potentially disastrous maneuver that could jeopardize the operations of the entire airfield and more lives. At times, there is the feeling as Northern Iraq is like the wild, Wild West.  However, to the drivers in the Strykers nothing else matters other than getting their fellow wounded soldiers to the Combat Support Hospital and fast.  I had to do some quick thinking to prevent a disaster.  This shortcut is not the usual route the vehicles take to the hospital.  The radio I carry is not capable of communicating with the Strykers. Therefore, I had to radio the TOC to relay a message to the airfield tower to advise caution to any incoming aircraft that the Strykers were crossing the landing strip.  The tower reported that a C-130, cargo airplane, was on approach to landing and request holding the Strykers.  This was an impossible feat.  The Strykers were traveling at such a high rate of speed across the field that the TOC could barely get the call into the tower fast enough to alert the incoming aircraft.  The Strykers kept rolling across the airfield and the aircraft landed behind them uneventfully. I am sure the pilots had a few choice words for the Stryker guys.

        I could see the Strykers picking up speed and head directly towards me.  A cold chill began to run through my body, like cold fishes swimming in my veins.  Realizing that a 22-ton war machine was heading directly for me and not slowing down.  I anchored myself where I wanted the Strykers to stop and placed my trust in the training of the soldiers behind the wheel and the brake manufacturer.  I raised my arms to guide them in and the first vehicle came to a screeching halt just within feet of where I was standing. I could hear the tailgate of the steel monster slam to the ground and out came the screams and cries of the severely burned and wounded soldiers.

        I quickly ran to the rear of the vehicle and started to help extract one of the wounded.  The sounds of soldiers yelling back and forth at each other to get the first soldier off the vehicle as fast as possible were barely audible in the confusion.  I could hear one of the soldiers say “First Sergeant you’ll be OK, just lay down and hang in there!”  As they were off-loading the First Sergeant, he began to thrash and scream in pain nearly falling off the litter.  I attempted to grasp the First Sergeant by the arms and noticed the sleeves of his shirt burned into his flesh and a bandage falling off his left hand with his fingers raw and mangled.  There were second and third degree burns along both arms.  I grasped the First Sergeant behind his neck and shoulder blades to avoid his burns and swung him back onto the litter very carefully.

        As we were pushing the litter into the hospital, the First Sergeant screamed repeatedly in mercy. “Put me down, put me down, please put me down!”  Thinking to myself, was he referring to placing him under general anesthesia as quickly as possible or putting him out of his misery.  I kept repeating to him that he was going to be OK and hang in there! He kept painfully tossing and turning as we moved him into a treatment bay.  His medical treatment team zoomed in on him and the medical orders were popping off.  “I need a central line! Cut the rest of that uniform off! I need his vital signs!”   I picked up a central line and handed it to the crew then walked away to assess the situation and coordinate any further incoming wounded.  As I walked away, the odor of brunt flesh and feces places a very distinct and identifiable aroma that is imprinted in your brain forever.

        I made the rounds to each bay making my own assessment of each patient and checking with the Chief of Trauma to see if any soldier that had an eye or head injury required further evacuation to a higher level of care to Balad, north of Baghdad. After my quick assessment, I went back out to the CSH PAD to see if any additional patients needed admitting to our facility.  All the wounded are off loaded and the Strykers were sitting on the CSH pad.  The Strykers now needed to be move off the pad in the event of additional incoming wounded on helicopters.

        A few hundred meters in the distance, I could see the C-130 off-loading and loading pallets of supplies or equipment. The Strykers were parked and congesting the helicopter pad. I had to get these Strykers moving and off my pad before another MEDEVAC needed to land and bring wounded to hospital.  I ordered the Strykers off the pad.  They hurriedly loaded their gear, started the Strykers and rolled off the airfield.

        Minutes later, I received another radio message that we were expecting a MEDEVAC with three soldiers to land on the helicopter pad within the next few minutes. I was puzzled about seeing three soldiers offload because the radio reported two urgent patients. I thought for a second that maybe an additional helicopter was landing without notice. As the helicopter landed, three soldiers got off and I escorted them off the pad towards the hospital.  I stopped them at the triage area, asked them if they had any hand-grenades or explosives. They denied possessing any explosive ordinance. One soldier started to hand me a large knife and I told him to keep it.  It is normal for soldiers to carry knives in a combat zone and is permitted in the hospital.  Well, unannounced to me, one of the soldiers was a suicidal psychiatric patient.

        Through the organized chaos and the fast pace of the medical staff, barking orders and moving patients around, the hospital psychiatrist suddenly peered out from the crowd.  We made eye contact and gestured her in my direction, bumping into several staff members on the way.  I leaned over and asked,  “Has your patient, the one that just came in, been searched?”  “No!” she replied with a question mark.  I then asked her, “Is he homicidal?”  Again, she replied,  “No, he is suicidal.”  We made our way over to search the soldier with a sergeant.  Grabbing the first Staff Sergeant near me, we had him search the soldier.  Well, low and behold, he produced the knife.  Recalling back to the triage area, where we initially met and asked him if he had any explosives, he gave the strangest smile and said "no". It was a creepy smile.  Nevertheless, I now know why there was a guard assigned to him for his own protection.

        Dashing back into the hospital, I started to investigate the source of the trauma.  A Lieutenant from the Infantry Brigade explained the enemy is now beginning to experiment with different types of explosives.  This being said, I notice that most of the soldiers had severe burns as opposed to the usual large open wounds from blast trauma.

        I eventually made my way over to the MEDCOM Commander and asked his opinion of the MASCAL.  He had a good impression of our operation. He reminded me about the last time he was here during the Surgeon General’s visit. We had the same type of MASCAL.  So being the wise guy that I am, I tapped him on the shoulder and remarked that maybe we need to keep the Generals away from here.

        The wounded soldiers will take their turns in surgery depending on their priority.  As soon as they are stable, a medical evacuation airplane will transport them to Germany for further hospitalization and rehabilitation.

        The pain resulting from their acts of heroism and personal sacrifice will not go unnoticed to those who live this day.  Trying to reverse the roles to imagine their pain instills a feeling of guilt and shame for not doing enough to help those wounded or killed.  I have not earned the right to make the effort to feel the physical or emotional pain of losing a leg, an eye, a hand and its future consequences on them or their families.

        So there you have it. All this organized chaos occurred within a few hours for me but I will bear the scars of this day imprinted in my mind forever.  Moreover, as long as there are fellow soldiers out there under conditions worse than mine then I will do whatever it takes to do my part to win this fight. Do I look tired, yes.  Do I feel tired, yes.  When will I sleep?  I will sleep when my mission is complete.  When I am ordered to go home or when I am dead.  I will replay this day many times in my mind and pray for those soldiers who made it.

LTC John R. Gouin

228th Combat Support Hospital

FOB Diamondback, Mosul, Iraq