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Camp Speicher, Iraq — A boy's cry for his mother comes from the intermediate care ward of the 325th Combat Support Hospital (CSH) one morning in late September. The Iraqi child, whom U.S. medical staff estimate is around 11 or 12 years old, has a broken left arm and gunshots wounds to both feet. His head rests on a colorful pillow case that might be found in any pediatric ward in the U.S.

After almost five years of war in Iraq, the presence of children in U.S. military hospitals is commonplace. But according to the U.S. military, this child was not an innocent bystander in the wrong place at the wrong time. Instead, he is being held at the hospital as an insurgent along with three men who also are wounded. They were taken into custody together after firing upon U.S. soldiers outside of this Army base located in Saddam Hussein's home town of Tikrit.

The boy and the men are tucked into the end of the long, narrow intermediate care ward where they are guarded by four armed soldiers who say they do not sympathize with the youngest of the detainees, even if he has just barely entered adolescence.

The detainees are separated from the rest of the patients in the ward by folding privacy screens. But on the other side of the screens, there are surprisingly few U.S. servicemembers. And the few soldiers who are resting on the wafer-thin military mattresses have non-combat-related complaints.

Indeed, since the 325th CSH, an Army Reserve unit from Independence, Mo., arrived in Iraq at the beginning of September, the number of U.S. combat dead and wounded per month has dropped significantly and continues to fall.

"I am pleasantly surprised we have not seen the level of casualties I expected," says Lt. Col. Christopher O'Connell, RN, chief nurse of the 325th CSH at Camp Speicher. "I'm OK with that."

O'Connell, who is a flight nurse with Dartmouth-Hitchcock Medical Center in New Hampshire, says about one-third of the hospital's census consists of U.S. servicemembers and two-thirds comprises a mix of Iraqi army and police, detainees, Iraqi civilians, or civilians from other countries.

The 325th CSH's sister hospital at Al Asad Air Base in Iraq's western Anbar Province is experiencing a drop in casualties as well. One year ago Anbar Province was one of the most violent areas in Iraq.

"I thought we would have more trauma," says Lt. Col. Peggy Hennessy, RN, chief nurse of the 325th CSH at Al Asad. "If this trend continues, we'll be fortunate."

The trend is a welcome relief from the first part of the year when the number of dead and wounded soldiers rose because of the infusion of soldiers into Iraq as part of the military's counterterrorism "surge" to quell violence around the country. The casualties from the surge already have made 2007 the deadliest year for U.S. servicemembers since the war started, even though the year has not ended.

May has been the grimmest month this year with 126 deaths. Since then the number has steadily declined to a low of 38 deaths in October, according to the website icasualties.org. The number of wounded per month has decreased as well with a peak in June of 750 wounded to a low in October of 296.

The military attributes the drop in casualties to the success of the surge and to a movement among Sunni tribal leaders to cooperate with the U.S. military instead of al-Qaida terrorists.

Lt. Col. Judy Fryover, RN, NP, charge nurse of Camp Speicher's intermediate care ward, says although she has more Iraqi patients than U.S. soldiers, even that number has decreased. In her civilian life, Fryover is a clinical nurse with Sparrow Hospital in Lansing, Mich.

The website icasualties.org shows that there are fewer Iraqi army, police, and civilians being killed or wounded but that the overall numbers are still higher than those for the U.S. This is reflected in Al Asad’s 12-bed ICU, in which most of the patients are usually Iraqi army or police, says Hennessy, who works at SSM Health Care in St. Louis, Mo.

Iraqi civilians still are frequent patients at U.S. military hospitals. Recently an 8-year-old Iraqi boy was admitted to the ICU with burns to more than 60% of his body, says Hennessy. 1st Lt. Robert Hafner, RN, a staff nurse in the ICU in the 325th CSH and, back home, a nurse at the burn unit at the University of Kansas Medical Center, helped care for the boy and taught the other nurses and medics about advanced burn care. Unfortunately, the boy died.

“Emotionally, it was hard for everyone to care for this patient because many members of the staff have children that age and, in my case, I know what I can do for him in the U.S., and what we can do here doesn’t come close,” says Hafner. “They were working really hard to find a place for him to evac to in the states.”

Despite the drop in U.S. casualties, a few soldiers have died at the 325th CSH at Camp Speicher.

“A soldier’s death is without a doubt the hardest thing anyone here has to deal with,” O’Connell wrote in a follow-up letter to Nursing Spectrum. “I knew these days would come, and I have been sharing with my staff, long before we arrived in Iraq, the need to be prepared for it.”

Fortunately, no soldiers have died at Al Asad.

The combat-related trauma being seen in U.S. troops at both hospitals includes wounds from improvised explosive devices, sniper fire, and small arms fire, report both O’Connell and Hennessy.

Non-combat related trauma involving servicemembers at both of the 325th hospitals includes military training accidents and motor vehicle rollovers.

At Al Asad, the most common non-combat complaints for which Marines or soldiers are admitted to the hospital are abdominal pain, renal stones, and mental health issues, says Hennessy.

The stress of going “outside the wire,” the military term for leaving secure U.S. bases to travel through Iraqi villages, “takes a toll on front-line soldiers,” she says.
The lower casualty rates help improve staff morale and free up time for continued training and education, say the military nurse leaders.

“It has given us a chance to refine our operations, train our less-experienced soldiers, and make the hospital ours,” says O’Connell. “Our battle rhythm has established our daily ebb and flow.”

The slower pace allowed nine soldiers to take a 40-hour class and receive certificates in field sanitation, Fryover says.

“We also are able to give more soldiers time off to participate in gym activities, such as basketball tournaments, 5K runs with prizes, and a flag football tournament, thereby increasing morale,” she says.

The staffs of the 325th CSH in Camp Speicher and Al Asad are hopeful the numbers of dead and wounded will continue to decline — or at least not rise. But if they start to climb, “we’re here and we’re ready if needed,” says Hennessy.

Says O’Connell, “We know our world can turn on a dime and what is now quiet could be anything but at any time.”

For a photo gallery documenting our time in Iraq, click here: www.nurse.com/Gallery/galleries/Iraq/

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Janet Boivin, RN, is editorial director of the Greater Chicago and New England editions. To comment, e-mail editorIL@nursingspectrum.com.

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