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"Bloody Boot" Ministry Prepares Chaplains for Combat

By Douglas J. Gillert
American Forces Press Service

SAN ANTONIO, Texas, Dec. 3, 1998 – Chaplains get a lot of their training in seminaries and through courses offered by their services. But how do they learn to minister to severely wounded and injured service members and the medics who care for them?

One such place is Brooke Army Medical Center here, where the Clinical Pastor Education program teaches chaplains to minister amid the blood and emotional stress of a hospital emergency room. Chaplains join trauma teams battling daily to save the lives of victims of violence, from gunshot wounds to car accidents. Because the Brooke ER is one of San Antonio's three "Code 3" trauma centers, they see the same kinds of damaged bodies and minds they would see on the fields of battle.

"The Army has what it calls the 'muddy boot' ministry for chaplains in the field with soldiers," said Chaplain (Maj.) Michael Raymo. "This is the 'bloody boot' ministry."

For a year at a time, chaplains train here under the Clinical Pastor Education program, where they spend part of the time pulling duty in the ER. Only Army chaplains currently participate, but the Air Force, which has a similar program at nearby Wilford Hall Medical Center, has expressed interest in adopting some of the Army's techniques, Raymo said.

During that year, chaplains are integral members of the trauma team of physicians, nurses and medical technicians. The chaplain always stands at the head of the gurney, talking to conscious patients, offering prayers and support to every one. After emergency surgery, the chaplains are as likely to minister to the staff and to one another, helping people deal with the carnage they've witnessed, the grief they may feel.

Although medics and nurses also are trained to communicate with and comfort patients and families, many don't handle losing a patient very well, Raymo said.

"There's never an easy night in the ER," Raymo said. He recalled a recent incident in which a woman rolled her car with her 4-year-old daughter strapped in the back seat. "The back of the car was demolished, but we couldn't verify the girl was DOA [dead on arrival]. The mother had just minor bruises and scratches but kept crying out in the trauma room, 'My baby. My baby.'

"We finally received word that the girl was dead, and the mother reacted violently. She had to be calmed, and I was the only one there to help her."

Meanwhile, the grandmother showed up, and when she learned from a nurse the girl was dead, she immediately fainted. "I caught her as she was going down," Raymo said. Another family member, a 15-year-old boy, learned of the girl's death. "You could see the imprints his knuckles left in the wall," Raymo said. "As the chaplain, I had to be there for each of these people."

Raymo and other chaplains also have to "be there" for the doctors, nurses and medics after such traumatic incidents, to debrief the trauma team and help them prepare for the next arrival. It's critical, therefore, that chaplains bond with other trauma team members, he said. "You have to have confidence and trust in each other."

On a shelf in Raymo's cluttered office sits a four-legged stool that he says represents the human needs particularly prevalent in an ER trauma room.

"The four legs on that stool represent the physical, emotional, mental and spiritual needs everyone has," he said. "If one of those legs is missing, the stool wobbles. Likewise, a person's life isn't level unless all four needs are met. That's why chaplains are a critical part of trauma care."

If chaplains aren't physically, emotionally, mentally and spiritually prepared, they may have a hard time helping people through extremely traumatic events, Raymo said. "This training will have bearing on every aspect of their ministries."

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