Guidelines issued on live explosives in battlefield surgeries
Primer aims to prevent detonation
As wounded Marine Cpl. Winder Perez, fresh from the battlefield, lay on a gurney at a remote medical station in Afghanistan in January — a rocket-propelled grenade inside his body — Navy nurse James Gennari approached.
“I took his hand. Held it in mine. And said . . . ‘I promise you I won’t leave you until that thing is out of your leg,’ ” Lt. Cmdr. Gennari recalls.
“I really did know that thing could have blown up,” Gennari says. “But I figured I would leave that up to God.”
Operations to remove an explosive device from a servicemember’s body are rare. Military medical officers officially report three cases from the current wars, though some doctors say there have been more. Even so, it’s a big enough concern that in recent weeks guidelines on how to perform the delicate surgery have been issued for doctors in Afghanistan.
“It’s a very unusual event,” says Army Col. Jeffrey Bailey, director of the Pentagon’s program for improving battlefield care. “When it occurs, it’s nice to have some kind of road map.”
The guidelines — at times gruesome — offer a primer on bomb triggers, recommend body armor for surgeons and warn against shifting the patient because of fear of detonation. A bomb disposal expert should be there, and the surgery should be isolated to guard against killing other patients and destroying equipment. Use only hand saws for cutting bone, because electronic tools could set off the bomb.
Research published in 1999 documented 36 such operations since the beginning of World War II. None of the explosives have gone off.
The same was true in January. The nearly 2-foot-long rocket that had struck Perez on Jan. 12 in Helmand province, lay along the length of his thigh muscles with its tip thrust inside his left buttock, says Navy Capt. H. Donel Elshire, a doctor on duty.
As Gennari administered pain medication and kept Perez’s airway open, the Army explosive ordnance disposal expert, or EOD, pulled out the explosive.
During all that, Gennari noticed that Perez’s dog tag said he was Catholic. “I’m Catholic,” the nurse says. “So I said a prayer . . . for (Perez), for me and for the EOD guy.”