An Italian woman was in a severe car collision in Niger and staff at the local hospital realized they couldn't treat the woman properly with the equipment they had on hand. What followed was an 18-hour odyssey that relied on medical staff from six countries and U.S. Special Operations Command Forward, a pop-up blood bank, and a doctor translating medical jargon between four languages.
It all started when an Italian woman and her male passenger were driving near Nigerien Air Base 101 in Niamey, capital of Niger. The ensuing wreck injured them both. Nigerien ambulance services moved them to the local hospital where doctors made the call that the woman needed to go to a more advanced facility.
The hospital said the woman had a liver bleed, a life-threatening condition that requires surgery. The case was referred to Italian military doctors nearby who asked the American surgeons of SOCFWD — North And West Africa for help. The ground surgical team quickly discovered that the liver bleed wasn't the only problem.
Three doctors, U.S. Air Force Capts. Melanie Gates, left, Nick McKenzie, and Richard Thorsted, all with Special Operations Command Forward — Northwest Africa ground surgical team, gather for a photo at Nigerien Air Base 101, Niamey, Niger, on June 21, 2018. The doctors were all involved in an emergency surgery which successfully saved the life of an injured Italian woman.
(U.S. Air Force)
"Upon reviewing the CT scans, there was also evidence of free air in the abdomen, concerning for a small bowel injury," U.S. Air Force Capt. Melanie Gates, GST emergency medical physician, told an Air Force journalist. "When the patient arrived, her skin was white and she was in serious pain with minimal responsiveness. Her vitals were much worse than previously reported."
"First thoughts upon seeing patient … she wasn't doing well," said U.S. Air Force Capt. Richard Thorsted, GST anesthesiologist. "She arrived to us in critical condition with a high fever."
Italian military members, left (sand-colored uniforms), Special Operations Command Forward Northwest Africa ground surgical team members, middle (in civilian clothes), and members from the 768th EABS, right (in multi camo-patterned uniforms) gather for a photo at Nigerien Air Base 101, Niamey, Niger, on June 4, 2018. A multinational team of medical practitioners on the base saved the life of an Italian civilian injured outside by patching together a team of doctors and other medical personnel from six nations and multiple military branches.
(U.S. Air Force)
The doctors initiated two important actions as they prepared to conduct the surgery; coordination for an airlift to take the patient to Senegal once the surgery was finished, and the collection of A-positive blood to keep the patient going during surgery and airlift.
Both requests would require more work and luck than expected.
First, the major stakeholders needed to ensure the aeromedical evacuation took place included French personnel who controlled a lot of the coordination in the area, Senegalese personnel who would receive the patient into their care, Germans who would conduct the evacuation if civilian personnel could not, Americans who were performing the first surgery, and Nigerians who had originally secured the patient and whose country was hosting her first surgery.
Luckily, Italian military doctor Valantina Di Nitto spoke at least three languages and was able to pass critical patient information and medical plans of action between all the stakeholders. She created a road map for medical care, from the surgery in Niger to Senegal and, eventually, to Italy.
At the same time, base personnel needed to immediately procure five units of A-positive blood. Unfortunately, the medical personnel who knew how to draw the blood weren't yet familiar with the equipment available on the base.
Lt. Col. Justin Tingey, 768th Expeditionary Air Base Squadron flight doctor, and Master Sgt. Melissa Cessna, 768th EABS independent duty medical technician, pose for a photo at Nigerien Air Base 101, Niamey, Niger, on June 21, 2018. The team recently set up a walking blood bank to enable life-saving surgery to an Italian woman who nearly died in a car accident outside the base. The patient is now in good condition and recovering in Italy.
(U.S. Air Force)
In a weird coincidence, U.S. Navy Hospital Corpsman 2nd Class Bryan Killings did know how to use the equipment, and he was passing through the base en route to another destination. He got a text message from his bosses while at dinner.
"My leadership told me they had a patient coming through and they needed me to assist them," Killings said. "They said they needed A-positive blood."
Killings rushed to the walking blood bank and trained Army and Air Force personnel on how to use the equipment, then assisted in the collection of blood from five donors.
In the operating theater, a team of Air Force doctors took the blood and got to work. The three doctors, Air Force Capts. Melanie Gates, Nick McKenzie, and Richard Thorsted, were all recent graduates of medical school.
Luckily, after completing their residency programs, all three had undergone special military training before heading to Africa that included clinical scenarios in austere conditions.
"Our training kicked in. We all knew our roles and worked well together," Gates told Tech Sgt. Nick Wilson. "I believe our training was crucial for our development as a team and ability to handle situations like this."
In the end, the amalgamation of civilian and military medical personnel pulled it off, and the patient is recovering Naples, Italy. She is currently in good condition.