News & Information - The Mercury - April 2009 Mercury

Camp Bucca is located on the southern edge of Iraq, and is host to the single largest Theater Internment Facility (TIF) in the world. Camp Bucca is temporary home to the 115th Combat Support Hospital (CSH) from Fort Polk, La., responsible for providing world-class medical care for nearly 15,000 detainees and 8,000 Coalition forces and civilians.

Detainees are screened by medics and seen daily by Army nurses and primary-care providers, either through sick call or scheduled appointments. The primary-care facilities, known as compound treatment rooms (CTRs), offer services such as medication administration, immunizations, minor surgical procedures and treatments, and specialty consultations ranging from cardiology to orthopedic surgery.

Medics are the backbone of what the military police call "wire medicine," — algorithm-derived detainee medical care provided by trained medics, certified as emergency medical technicians (EMTs) and prepositioned at all compounds. All medics assigned to 115th CSH must receive a week of training dedicated to wire medicine operations. A team leader and preceptor then coach and mentor the "wire medic" for up to four weeks before permitting a wire medic to work with a team of providers and nurses. Since most physicians and nurses are "rotators" (less than 180 days in Iraq), the wire medic provides the continuity of medicine on the wire.

The addition of nurse case managers to manage complex patients in accordance with standards set forth in Department of Defense-based clinical practice guidelines (CPGs), and the addition of licensed practical nurses for medication administration helped maintain the same standards of care for detainees as for Coalition forces.

Improvements in detainee health care include changing sick call from once every four days to daily, improved medication administration, inprocessing and release medical screenings, redesigning the wire medicine force structure, implementation of specialty care at the wire and nurse case management of chronic medical problems.

A big initiative during the 115th's tour has been electronic medical records. This continuity of patient documentation is easily retrievable and provides the attending physician a quick and convenient medical history of the patient, whether at Camp Bucca or Camp Cropper.

"It was extremely challenging for our young army nurse officers and NCOs, especially those coming from Army medical centers such as Walter Reed or Madigan, to leave an environment that used inpatient EMRs and arrive to Camp Bucca where hardcopy was routine. However, the Medical Communications for Combat Casualty Care (MC4) team was on board and we went from a hardcopy record to EMRs within weeks," said MAJ Melaina Sharpe, head nurse of the intermediate care ward.

"We take our mission of providing safe health care quite seriously," said Sharpe. "Although the mission is challenging at times, it is extremely rewarding and knowing that we are here doing the job we are trained to do and watching our patients smile again, makes the tough times easier to bare."

The 115's operating room team has performed more than 500 surgeries. Procedures include fracture reductions, hernia repairs, gallbladder removals, pilonidal cysts, hydrocelectomies, excision of granulomas, lipomas, orthopedic hardware removals, creation of rotational flaps and skin grafts, and emergency appendectomies.

Occasionally Iraqi citizens with very severe injuries present for treatment. Women and children, most with terrible burns, have come to the gates of Camp Bucca in hopes of survival.

"Our hearts truly go out to these people who are injured so badly," said COL Kathleen Ryan, officer in charge of the hospital at Camp Bucca and chief nurse for the overall medical task force in charge of detainee health care. "It seems fuel for cooking and heating is a leading cause. While our colleagues in civil affairs go out and teach safer ways to store and handle fuel, we do everything possible to give them the best chance to return to their Families. We have been remarkably successful doing just that. It's a great boost to our hospital morale and really shows the local population how caring and committed we really are in building a future Iraq."

Monitoring the number of detainees presenting with complaints of low back pain, the physical and occupational therapy team initiated a back class for detainees, which is an Arabic power point presentation that is presented with a translator. The detainees seemed to like it and asked a lot of good questions. Encouraged by the number of questions that were asked and the interest generated by the detainees, the P&OT team began to visit the compounds to administer physical and occupational therapy, as well as monitor progress. They have cared for thousands of detainees, outfitting hundreds with prosthetic devices and reducing the backlog of several months to days.

(Compiled from articles submitted by the 115th CSH)

From the April 2009 Mercury, an Army Medical Department publication.