BCMS Medical Record Fall 2020 - 49

During a mass casualty situation, the number of emergency
patients overwhelms the medical resources, and physicians must
give priority to those patients in the last category, in order to
salvage those with the best chance of survival. During my Viet
Nam experience, the triage unit could transform from sleepy
to overwhelmed in a matter of minutes when a firefight broke
out. The helicopters would start arriving with their casualties,
an alert sounded, and it rapidly became an "all hands on deck"
situation. As a physician, being forced to make life and death
decisions is a very psychologically distressing proposition. Trying
to comfort a mortally wounded Marine, knowing the situation to
be hopeless, cuts to the core. The prevailing ethos in the Viet Nam
era was to "suck it up" and bury any psychic distress you might be
experiencing. We now know that this leads to PTSD, common
among military veterans of all generations.

The Invisible Enemy
The Viet Nam was the first conflict for the US Military in which
the enemy did not wear uniforms. We were basically fighting a
guerilla war against the Viet Cong, who blended into the civilian
population. It was impossible to determine who was an enemy and
who was a friend. Even small children were enlisted to throw hand
grenades into US military vehicles, then disappear into a crowd.
There were other unseen enemies. We had to take Dapsone and
Chloroquine tablets to prevent mosquito bite-induced Malaria, and
Typhoid fever was endemic in the area. Almost everyone at some
point battled "jungle rot," a tropical fungal skin disease.

Lack of Supplies
The US Marine Corps prides itself on doing more with less,
relying on esprit de corps, discipline, and courage of the individual
marine to complete the mission. On the medical side, however, this
presented a difficult problem, as we were often faced with shortages
of medical supplies, particularly antibiotics. We had Pen VK and
Tetracycline, and that was pretty much it. If a Marine had a serious
injury infection requiring more sophisticated antimicrobial therapy,
we would have to medevac him to an offshore US Navy hospital
ship, or to a Navy hospital in Japan.

Wartime Triage,
Viet Nam

Medevac "Chinook"
Helicopter, Viet Nam

Dangerous Working Conditions
Working at 3rd Med was relatively safe, compared with what
the front line Marines were experiencing on a daily basis. But
compared to civilian life, this was dangerous duty. We experienced
almost nightly rocket attacks, during which we had to get into
our sandbag bunkers and hunker down until the attack subsided.
There were times when, while under rocket attack, we would have
to perform surgery wearing helmets and flak jackets. There was
the always present danger that our compound could be overrun by
a massed assault, such as happened during the Tet offensive a year
earlier. I slept with a loaded M-16 at my bedside, should that occur.

My "Hootch" with
sandbag bunker for
shelter during rocket
attacks

Disruption of Personal Life
The military veterans of most wars, and certainly of mine, often
experienced the separation of the physician from his family and
personal support network. There were no "accompanied tours"
in the Viet Nam combat zone. Further, we had no cell phones
to communicate with the home front. For us, we had only snail
mail, the delivery of which was haphazard and always delayed.
There were no female nurses; their function was assumed by Navy
Hospital Corpsmen.

Psychological Trauma and Drug Use
The stresses of war, both for the soldier and for the military
physician, were both immediate and longer lasting. The Viet Nam
war introduced to the civilian US population what would become
today's "War on Drugs," primarily by way of returning Viet Nam
war veterans who used and became addicted to marijuana and
heroin. The use of these drugs was a mechanism by which those
psychologically traumatized by war could deal with that stress. The
delayed stress effects came to be known as PTSD, but that was a
term or phenomenon that we were not familiar with at the time. It
remains to be seen how the stress of dealing with the corona virus
may manifest as future addictive disorders in today's front line
healthcare workers.
continued on next page >

Operating Room following a Rocket Attack
FALL 2020

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BCMS Medical Record Fall 2020

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