47th CSH stayed agile, busy in Iraq

While in Iraq, members of the 47th Combat Support Hospital excelled in a complex environment

Don Kramer/Northwest Guardian

The Soldiers of the 47th Combat Support Hospital returned to Joint Base Lewis-McChord two weeks ago with the collective satisfaction of a job well done.

They deployed to Iraq in early 2009 at a time integral to the development of a democracy; its Soldiers found themselves in a complex environment that required them to also be trainers, diplomats, resource managers and partners to other services — host-nation medical personnel and Iraqi Security Forces.

The classic duality of purpose of deploying medical units, requiring preparation for medical and operational missions, was only the beginning for 47th CSH. Medical and warrior tasks dominated the training schedule before its Soldiers departed for their third tour to Operation Iraqi Freedom. Even before deployment, the leaders of “America’s CSH” began to demonstrate the agility crucial to planning their complex, evolving missions.

Two months before the Feb. 12, 2009, casing ceremony, the commander, Col. Bryant E. Harp, was notified that unlike its previous mission from October 2005 to October 2006, the hospital would set up in three locations instead of two, adding al-Asad in Western Iraq’s al-Anbar Province to locations in Tikrit and Mosul.

Though he lacked the allocations, Harp and his staff organized the CSH as a task force, creating a deputy commander at each site with the authority to locally manage assets, assure Soldier support, maintain property accountability and administer the Uniform Code of Military Justice. The operations officer immediately began firing requests to higher headquarters for authorizations to accommodate the modified organization into a large hospital and two surgical centers.

“You combine Col. Harp’s vision with (S-3 Maj. Kevin Hamilton’s) ability to go back to U.S. Army Medical Command to secure the resources to do that,” said executive officer, Lt. Col. Daniel McGill, “because we had to request an extra company commander, and an extra hospital administrator, a trained medical service guy. The work those two officers did getting the leadership structure in place was hugely critical.”

Complex challenges

Each of the three sites had solid leadership and clean lines of command, enabling Harp and the headquarters to train their sights across the entire battlespace — a daunting expanse. The area encompassed more than 105,000 square miles, the largest ever managed by a combat support hospital in Operation Iraqi Freedom.

The mission was to provide Level III surgical, traumatic and intensive care, the highest available in a combat zone, in support of all Soldiers, Sailors, Airmen, Marines and coalition partners in Multi-National Division-North and MND-West.

Upon arrival in theater, the 240-Soldier strength of 47th CSH doubled with doctors, nurses, physicians assistants and medical specialists provided by the Professional Filler System, starting the personnel and operations sections on a continuous process of managing, accounting for and requisitioning replacements for professionals on 90-day, six-month and yearlong rotations. At the mid-point of the tour, 180 doctors, nurses and other medical professionals were replaced.

“We were dealing with 90-day rotators, that is personnel coming in and out, 180-day rotators, which is half your force, and a forward surgical team attached to us,” Hamilton said. “Redeployments and integration into theater. And you’ve got your operational stuff because you’re getting missions. So it’s not like you’re a static hospital where you set up and that’s all you do.”

Meanwhile, the I Corps Headquarters arrived in Baghdad and took the reins of Multi-National Corps-Iraq, with its emphasis on overseeing the orderly draw-down of personnel and equipment throughout the theater. The 47th CSH logistics officer, Maj. Dean Rassmussen, fell in on 12 property books with a total value of $45 million in theater and organic property. By the time materiel draw-down directives arrived from MNC-I, Rassmussen had already coordinated with company commanders to begin turning in excesses. The cooperative efforts resulted in finding more than $6 million in excess property and turning in $11.5 million. During the first quarter, the hospital cut its rolling stock almost in half, by 48 percent, and reduced its container fleet by 31 percent — turning in 19 containers during the first month in-country and 61 in all.

Busy operations tempo

The CSH opened for business with its large hospital in Tikrit. Bravo Company took responsibility for the site and noted security concerns. The Bulldog Company leadership under Capt. Gerald Kellar formulated a new force-protection plan that was so well received, it was later adopted by most tenant units on Contingency Operating Base Speicher.

During the year, the Tikrit hospital recorded more than 28,000 patient encounters, including 535 behavioral health cases and evacuated 850 patients, 50 requiring urgent or intensive care. The facility admitted 1,250 patients and performed 180 surgeries with no adverse outcomes.

Charlie Company set up its facility at al-Asad, the western-most surgical hospital in the country, serving the largest and most diverse population of 25,000 coalition forces and Iraqi Security Forces. The Cobras met the challenge of integrating the Navy and Marine assets that predominated in Anbar Province into the 47th team. The TF al-Asad Hospital received high marks in four staff-assistance visits that evaluated the facility across the board and gained special recognition for its infection-control program, which earned Best Business Practice finding from the Office of the Surgeon General. It recorded more than 17,000 patient encounters and performed 250 surgical procedures.

Task Force Mosul coordinated medical capabilities in its area of responsibility, including a maneuver brigade, a combat engineer brigade and a variety of mobile training teams and provisional reconstruction teams. The TF Mosul Hospital provided training to all local forward-operating-base physicians while conducting more than 12,000 patient encounters and admitting 400. Alpha Company sent seven Soldiers from Mosul to a large detention center to study the principles for administering detainee health care. The Silverbacks also set up situational training lanes to teach combat lifesaving techniques under hostile conditions.

Ground-breaking medicine

One of the most innovative programs involving telemedicine took place in Mosul, in which surgeons conducted consults during surgery — a first, according to McGill.

“That’s the first time that’s been done,” McGill said. “In the past, we’ve established T-med linkages that were from a T-med system over satellite to a T-med system. But actually to stream pictures and video with enough granularity over the Internet hadn’t been done before.”

The idea occurred to a cardio-thoracic surgeon in Mosul during a previous deployment in Afghanistan, where he was forced to perform neurosurgery because he was the only surgeon available.

“He ends up in surgery in an area he’s not familiar with,” McGill said. “He calls back to Brooke Army Medical Center (at Fort Sam Houston, Texas). He has a camera on his head. A guy at Brooke is looking at a screen, seeing what he’s seeing and is able to provide consultation forward to Mosul in a specific subspecialty. (It) not only gives a boost of confidence to the surgeon, but it dramatically improves clinical outcomes.”

Leadership clinic

Though all elements of the 47th CSH worked to keep up with the punishing operations tempo, enemy fighters reminded its Soldiers of why they were there. Six weeks from redeployment, insurgents fired rockets into COB Speicher, injuring three Soldiers.

“All did great, minor shrapnel injuries,” McGill said. “When you’re in a CSH, you expect to see Purple Hearts issued, but you don’t expect it to be your own guys.”

The incident also brought home for the executive officer the strength of the organization — NCOs who took charge during the chaos. Bravo Company’s first sergeant was instantly at the scene, assessing, prioritizing, directing first aid, demonstrating the leadership required in a crisis.

“First Sgt. (Rachelle) Gattenby seized control of the situation,” McGill said. “Not only do you have senior officers who are doctors and nurses in Tikrit, but you have all the senior officers from the headquarters. Everybody looks and says ‘First sergeant’s got control of this.’”

McGill said the experienced team of Harp and Command Sgt. Maj. Michael Mullaney set the tone for an exceptional leadership climate throughout America’s CSH.

“That was like a daily seminar in leadership, watching those two work together,” McGill said. “The strength of our NCOs was unbelievable, in particular the 7s and 8s. I’ve been doing this for 18 years and I’ve never seen a collection of NCOs like this.”