In this age of simulated mannequins and iPhone apps to prepare for the NCLEX, James Gennari, BSN, RN, TNS, applied his "old school" nursing education to save a soldier's life in Afghanistan.
Last January, Gennari was alerted that a 22-year old with a live rocket grenade in his leg while was en route to his makeshift OR in Musa Qala, Afghanistan. Medical staff were forewarned they couldn't all rush to the helicopter because that increased the risk for sudden explosion.
Once presented with the young patient, the East Chicago, IN, nurse relied upon therapeutic touch, conscious sedation and jaw thrusts which guided him through the most dramatic episode of his career and saved a soldier's life.
"I talked to my old professor at Purdue University-Calumet and told him to tell his students old school counts," he reflected. "Everything I did was simple stuff. The first thing in the training manual is the most important: identifying myself, saying I'm here to care for you."
Day of Infamy
His approach was low-tech but Gennari's mission was anything but simple.
As department head for a mobile ED and shock trauma platoon, Gennari dealt with lost limbs on a daily basis. His mobile OR suite was attached to a resuscitative surgical system.
Much of his work consisted of stabilizing soldiers in the golden hour. If quick resuscitative surgery was necessary, Gennari would often be involved in debridement of above and below the knee amputation.
On Jan. 12, a medevac helicopter transported a patient with a live explosive device still lodged in his leg.
As policy dictated, he couldn't go inside the clinic for treatment, lest he endanger the lives of the other patients. One wrong move could trigger an explosion.
"So I went out there and stayed with him," Gennari said. "He was out there all by himself. I told him I was his nurse and I'd stay by his side until we got that thing out of his leg."
Gennari consulted with the explosive ordinance removal specialist, who advised against surgery and said they'd have to pull the mortar out manually.
Gennari performed conscious sedation and, immediately afterwards, the EOD specialist told him that was his last chance to leave the site and potentially save his own life.
"I told him, if you ain't leaving, I ain't leaving," Gennari recounted.
With that, the two discussed protective clothing options. In the end, they opted to wear only flak jackets, which is similar to a bulletproof vest and helmet.
"If we put on suits, we wouldn't be able to move around as much," he said. "We decided not to wear any protective glass equipment because we'd blow up anyway if the device exploded. Why die sweaty?"
With that said, the explosive device specialist removed a 14" rocket propelled grenade that was embedded up to the patient's buttock in three tugs.
Concurrently, Gennari administered pain medication and kept the airway open. Because of the extra narcotics, the patient had no reaction when the device was removed.
Gennari then initiated a jaw thrust until the soldier had spontaneous respirations. The hole in the patient's leg was three-quarters of an inch in diameter, so Gennari tightened the tourniquet.
The entire episode took approximately 7 minutes, Gennari estimated.
Momentarily, the stretcher bearers arrived with the shock trauma platoon. Two surgeons applied non-pneumatic pressure dressing. The patient had good circulation, so they intubated and prepared for critical transport to a Level III facility, which is the military equivalent of a Level I trauma center.
After the 65-mile trip to a hospital the British and U.S. Army personnel, the patient's leg was saved and he started rehab therapy back in the U.S. Today, he can bear weight on the leg.
Seven months later, Gennari is also back at his regular post as nursing clinical and administrative manager for general surgery, ENT, and urology at Capt. James A. Lovell Federal Health Care Center in North Chicago, IL.
He's never followed up with a former patient, but felt compelled to call when he learned the patient was recovering in Washington, D.C.
"He didn't remember much, except that someone with glasses and a moustache told him he wouldn't leave until the thing was out of his leg," Gennari said.
A few months' perspective also helped Gennari come to terms with the enormity of his actions. Given the opportunity, he said he would do everything the same, including the decision not to send a subordinate to remove the mortar, which would've been permissible because of his high rank.
"I did consider it at the time, but I knew that if someone panicked, there would be a higher risk of the device blowing up and killing everyone," he said. "I knew I wouldn't panic. I'm 52 and this isn't my first deployment. It was everyone else's. I'd never ask someone else to do something I wouldn't do myself."
Robin Hocevar is senior regional editor at ADVANCE.