Kids Shouldn't Be Collateral Damage in a Combat Zone: They Should be Treated

Last week, front line combat footage from an Apache helicopter was released to the public. After watching the clips, I sat wishing I had been surprised by what I saw. But I wasn't.
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Last week, front line combat footage from an Apache helicopter was released to the public. After watching the clips, I sat wishing I had been surprised by what I saw. But I wasn't. Having rolled outside the wire in combat myself, I have to admit that the carnage did not strike me as anything beyond the brutal reality of war. What I was struck by instead is a detail that is largely left out of the video.

At the end of the clip two line medics can be seen desperately running with wounded children in their arms. Their commander, "Bushmaster Seven", is urgently requesting a medevac (medical evacuation) to the Rustimiyah combat support hospital. His requests are denied. Which raises the critical question- who was the officer at Rustimiyah who denied the transport? And why?

Few leaders realize that our medical rules of engagement -- MEDROE -- severely restrict the treatment of local nationals in our combat support hospitals. There are some legitimate reasons for this policy. For example, what do you do with a child whose parents are killed in battle? That's just one of many questions that are not so easy to answer.

Having served as a battalion surgeon, however, I can vouch for how infuriating it is to turn away a child in desperate need of help. It ran counter to everything I stood for as an American soldier, and it is in serious conflict with the Hippocratic Oath.

Technically the MEDROE allow evacuation for cases where "life, limb, or eyesight" are threatened, but only during "acute resuscitation". Functionally, most forward medical assets are not equipped with pediatric trauma resuscitation supplies, so it makes little difference how hard you try to work around the MEDROE. Pediatric trauma resuscitation is arguably the single most complex medical scenario imaginable, with extremely difficult anatomy for invasive techniques like a thoracotomy (e.g. "cracking the chest"). In an American university hospital there are typically over fifteen experts involved in resuscitating a single child.

Yet when we have the highest imaginable responsibility to care for a child in combat, the lowest level line medics are left to fend for themselves without support from higher levels of care. A line medic is typically a junior enlisted soldier who has to convince a senior medical officer to risk assets by sending medevac help into a "hot" landing zone. The default policy is to play it safe and minimize the assets at risk. Officers are not rewarded for taking a chance - even if it costs us the opportunity to live up to our values as Americans. Tragically it is children caught in the crossfire who pay the price.

As a way to solve the problems associated with MEDROE, my fellow infantrymen and I set-up the legal infrastructure necessary to bypass the restrictions in our sector in Iraq. Since the Red Cross and major NGO's had fled the violence, we set-up a non-profit foundation to function inside the combat zone. In the process we overcame countless hurdles to evacuate stabilized children for life altering surgeries.

The hurdles, sadly, were not just the considerable tactical obstacles involved in combat. In fact, the most troublesome challenges came from our own federal regulatory officials. When we were told that we were not allowed to submit non-profit grants, we challenged the largest DoD contractors to match the funds we had raised. To date no company has matched the funds that a handful of infantrymen raised amongst their friends and families

Army Field Manual 3-24, the counter-insurgency manual, dictates that it is a leadership imperative to take the initiative to solve problems that soldiers witness in the field of battle. FM 3-24 also dictates that "logical lines of operation" among all actors - military and civilian, private and public - must be synchronized to deliver relief to local national populations. Despite incredibly difficult obstacles we embraced the Army ethos-- improvise, adapt, and overcome--to execute that mission. The Hope.MD Foundation has surgeons standing by from Dartmouth, Yale, Columbia, and numerous other universities offering to help mitigate the horrors of war.

Perhaps someday the DoD contractors will accept our challenge and help alleviate these disasters. Or perhaps someday a serious discussion of our MEDROE will help give hospital directors the resources they need to truly open their doors for care. Until then, we will continue to believe in American ideals, and the hope they can bring to mankind.

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