Back in 1991, the declaration of war in the Middle East affected people and organizations across the country, and HUP was no exception. At least a dozen employees who were military reservists were placed on active duty. One of them was Jim Armstrong, RN, the trauma coordinator for PennSTAR. He was in the U.S. Navy Reserve. With three other nurses, he reported for duty soon after the January 15 deadline the United Nations had set for the invading Iraqi army to withdraw from Kuwait. The HUP group’s assignment: helping to staff Navy Fleet Hospital 15, a 500-bed facility with critical care and operating room facilities. But things were not so simple. Even before they could see and treat patients as part of Operation Desert Storm, they had to construct the facility in Saudi Arabia using tents and equipment. Twenty-five years later, it is an experience that Armstrong vividly remembers. “We built it from the ground up,” he says today. “We had it up and running in 10 days.”
The hospital saw the largest amount of casualties during the Desert Storm. The work was not very different from what a trauma department would do at a stateside hospital, but at times the facility received more than 30 to 40 patients at a time. As Armstrong points out, however, “it was a pretty quick war.” The hospital was in use for about three months, and its performance was noted: the hospital earned a Presidential Unit Citation, the highest award for a wartime unit. Then for Armstrong, it was back to PennSTAR.
The service of the reservists on the HUP staff was noted in HUPdate, then a monthly magazine. Armstrong and Paula Crawford-Gamble, RN, then a perioperative nurse, appeared on the cover of the September 1991 issue. “I still have it,” Armstrong says today.
Operation Desert Storm was not Armstrong’s first military service. He was a U.S. Marine from 1969 to 1974 and had served a year in Vietnam. Once out of service, he enrolled in Gloucester County College, planning to be a teacher. His future wife, however, persuaded him to try nursing. Indeed, it suited him, and he found he was interested in emergency medicine and hematology/oncology. It was while Armstrong was working at Cooper Hospital in Camden that he met C. William Schwab, MD, who was the hospital’s head of trauma and emergency medical services. Schwab had done his internship and surgical residency at the Naval Regional Medical Center in Portsmouth, Virginia, and was still in active service at the time. When Schwab joined HUP in 1987 and established a Level I Regional Resource Trauma Center and the PennSTAR Flight Program, Armstrong came along as the outreach coordinator. Schwab then asked him whether he was interested in transitioning to the helicopter. “I said yes,” Armstrong recalls, “and never looked back.” That was his role for the next 26 years.
Armstrong also remembers that it was Schwab who asked him if he was interested in joining the Navy Reserve. “I wasn’t sure I wanted to be a ‘squid’ or not,” Armstrong says with a laugh. But he did join after two recruiters came around. He was assigned to a combat fleet hospital in Philadelphia. That was his standing when Operation Desert Storm began.
Today, Armstrong, a nurse for 39 years, is retired, but he continues to fly on a per diem basis twice a month. He is now based with PennSTAR2 at the Atlantic City Airport. Although the situation is not as intense as wartime, it’s trauma nonetheless. “You have to be at the top of your game,” Armstrong says, and the patients range from neonates to the elderly, with everyone in between. The typical patient in the military, he notes, is between 18 and 30 years old.
Paula Crawford-Gamble, RN, and Jim Armstrong, RN
Armstrong’s duties as a reservist included two stints overseas after his experience with Operations Desert Storm. He was in Iraq in 2005 for a year and later in Afghanistan for eight months in 2010. “In Afghanistan, it was probably the worst trauma in magnitude -- and there were so many injuries.” In particular, the improvised explosive devices (IEDs) wreaked terrible damage. Some of the patients Armstrong saw had both legs blown off. During his later service, Armstrong noted the growing awareness of the damage caused by blasts. “We realized the TBI [traumatic brain injury] impact,” he says. The old thinking was the soldiers would get over the concussion in a short time, but they didn’t. Today, trauma units are learning to recognize and treat blast injuries more effectively.
Over his years of military service, Armstrong was promoted. While serving in Afghanistan, he had reached the rank of captain. (For the uninformed people like me, he explained that a Navy captain is the equivalent of an Army colonel.) When people have asked about his time in Afghanistan, he would say, “You just can’t imagine the injuries.” The closest comparison in the United States, he explains, might be the scene at the Boston Marathon bombing and, more recently, at the massacre in the Orlando nightclub, where the assailant used a high-velocity weapon.
Since patient flights began in 1988, PennSTAR has added helicopters. There are now six, as well as a critical care ambulance. The program operates 24 hours a day, seven days a week. Armstrong admires the two helipads Penn Presbyterian Medical Center has added in recent years -- one for trauma cases, the other for cardiac care. He has nothing but praise for his PennSTAR colleagues, describing the nurses and paramedics as exceptionally well trained. “We can actually start treating a patient while in flight,” Armstrong says. Looking back, he credits Schwab’s military background for helping to make the program so strong. “The people I fly with,” Armstrong says, “are the best of the best.”