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Briefing Via Satellite-Teleconference on Medical Care Being Provided to Enemy POW's

Presenters: Navy Capt. Charles Blankenship, commanding officer of the USNS Comfort
April 11, 2003 9:00 AM EDT

STAFF: Well, let's go ahead and get started. I'm sure there will be people that will join us in progress for another one of our early morning briefings here. This is our -- really, our third briefing with respect to issues regarding U.S. treatment of enemy prisoners of war. And today, we want to take you to another location, where enemy prisoners of war are being taken care of, aboard the USNS Comfort, the hospital ship.

We have Captain Charles Blankenship with us from the staff of the hospital ship. The Comfort's among -- is one of among several coalition medical facilities that have been regularly treating enemy prisoners of war. Captain Blankenship is the commanding officer of the Comfort's medical treatment facility. He's joined by his chief surgeon, Commander Ralph Jones, his head nurse, Commander Tommy Stewart, and by the ship's Arab-speaking translator, Lieutenant Ramzy Azar. They're each going to tell you a little bit about the work that they're doing.

We do have both Kuwait and Qatar on the telephone listening in. And so, we will be taking questions today from media that are aboard the Comfort as well as those that are in Qatar today, and you, of course, here in the Pentagon.

So with that, Captain Blankenship?

CAPT. BLANKENSHIP: Hello. I'm Captain Charles Blankenship. I'm the commanding officer of the medical treatment facility on Comfort. On my left is Commander Stewart, the head of nursing. On my right is Commander Jones, the head of surgery, and Lieutenant Azar is our Arabic translator on board.

To give you a little background about this ship, it's a converted super tanker. We have a 1,000-bed capacity, and we are staffed presently right now at that capacity. It's considered a tertiary care facility. If you want an idea of what that is in the United States, that's comparable to the care that you would get at the National Naval Medical Center in Bethesda, or Walter Reed Army Medical Center or Wilford Hall Air Force Medical Center. In the combat zone, we're considered a level three facility.

In the continuum of care, level one would be buddy aid, the field medic or the corpsmen in the battalion aid stations. Level two care would be the forward resuscitating surgical facilities. And for the Navy, the casualties we'd be receiving at treatment ships at that level -- patients are resuscitated, stabilized and life-saving and limb-saving surgery is done there, and then they're transported back to a level three facility, and that's what we are. At a level three facility, that's the first level at which you would get all of the sub-specialties of the surgery and medicine and very sophisticated diagnostic capabilities.

The ship has two missions. Its primary mission is combat support, and it also has a secondary mission of humanitarian relief and disaster relief. And for Operation Iraqi Freedom, we're actually performing both missions.

For the coalition forces, we take those patients who need to be stabilized, who have fairly serious injuries. We stabilize those patients and get them strong enough that they can withstand a trip back to the next level of care, which would either be in Landstuhl, Germany, or Rota, Spain, and then further transport back to continental United States.

For that second mission, the humanitarian relief, we're also taking care of Iraqi prisoners of war and civilians. We follow the Geneva Conventions. Patients who are brought to us, doesn't matter who they are; we take care of everyone who shows up and they get the same standard of care. In fact, the first casualties that we treated on board were Iraqi enemy prisoners of war.

Since the operation has started, we've had about 300 admissions. Yesterday was probably our highest admission day since we've been out, and we had about 50 admissions yesterday. We've taken care of about 120 coalition force patients and a little bit over 150 Iraqi patients; 30 of those have been Iraqi civilians.

And before I pass things off to Commander Jones, who's the head of surgery, I'd just like to make the comment that I'm a general surgeon, and I've been very impressed at the level of care that the field facilities have provided to both the coalition forces and the Iraqi casualties. They worked under very austere circumstances, and we've been very impressed with the level of care that these patients have gotten. And they've been in very good condition when they've gotten to our facility. And on that, I'll turn it over to Commander Jones.

CMDR. JONES: Good afternoon. I'm Commander Ralph Jones. I believe you have a series of slides, and while you're loading those, I will discuss the route of any patient released to this facility.

Enemy prisoners of war enter the facility in no more the same means than our own coalition forces or Iraqi civilians. When they are brought to our casualty receiving, which is equivalent to civilian emergency rooms, they are treated in like kind to our own forces. They're indoctrinated with the patient admin. department, giving us information regarding their name, their location, and we assign them a name. With the aid of interpreters, we then process them into casualty receiving and do care equivalent to any trauma facility in the United States. Once they are processed through there and receive all their last evaluation by the subspecialist, decision to admit them directly to a ward or to the surgical department for some type of definitive care or temporizing care in a stage procedure.

If you will look at my slides, I will discuss some of the specific case loads that we have seen over here.

We have performed 274 procedures. Each procedure represents a patient, but the case itself may have multiple procedures and multiple providers. For instance, we may have an orthopod pinning or rodding an arm while the plastic surgeon is preparing an extremity for graft, while the vascular surgeon is working on the patient, as well. Or, there may be sequential operations on the same patient, where we stage each operation as one, but the different surgeons, the orthopods follow the general surgeons, follow the plastic surgeons, and what have you.

From the time of March 20th to April 10th, the trend of our analysis shows that we have continued to increase the number of cases. Yesterday, the caseload was approximately 35 cases. Today, it's equivalent. And tomorrow is booked equivalently.

When we see the breakout as far as our combatant versus noncombatant surgical caseload, 88 percent of the cases are via combatant injury, and 12 percent are noncombatant. A further breakdown reveals that 61 percent of our surgical caseload is enemy prisoners of war, 28 percent of our caseload is from U.S. or coalition forces, followed by 11 percent Iraqi civilians.

When we further look at our analysis, we can see that the combat- specific subspecialities are well represented, that 46 percent of cases are orthopedic, 32 percent are general surgery, and then a number of cases are divided through the other providers, with neurosurgery 4 percent, E&T 4 percent, ophthalmology 4 percent.

Our average case times run approximately 160 minutes. The longest case was 11 hours, where we essentially rebuilt a person's spine that was injured. Our shortest case may be as short as 10 minutes, for a simple washouts or debridements.

At this point in time, I'll pass the mike to Commander Tommy Stewart, the head of nursing.

CMDER. STEWART: Good morning. I'm Commander Tommy Stewart, and I'm the senior nurse executive on board the USNS Comfort.

My perspective is more on the nursing needs of the enemy prisoners of war. As was alluded to, the majority of the combat injuries that we're seeing on board here are surgical-orthopedic in nature. As a result of the surgical procedures, many of the patients will require multiple dressing changes. One of the things that that's created for us was the development of wound care teams in each of the active patient care areas.

We're fortunate to have a certified wound care nurse specialist on board, Lieutenant Commander Angela Nemo, who has actually helped to guide the formation of these teams and the employment of these teams throughout, for each of the patient areas.

The patients' basic needs are similar. All of them require nourishment, pain medication, and most cases, antibiotics. These needs are met by a staff of hospital corpsmen and nurses.

Some of the patients may in fact require care in our intensive care units. The units -- the patients will only have a nurse and a hospital corpsman assigned to provide care for them, and some of them may require assisted ventilation on a ventilator there, to help breathe.

One of the problems that we ran into with nursing was some of the issues of the dealing with enemy prisoners of war were safety in nature. Safety concerns for all staff were addressed prior to any personnel being assigned to an enemy prisoner of war ward. Each ward had several of our master at arms or security personnel assigned to those words, and our nursing personnel were given guidance on how to provide care at the bedside on each ward in general.

Examples include always having someone to observe the back and the blind side when you're providing care at the bedside; removing sharp objects, such as pencils or pens, putting them inside the pockets; removing belts, which can be used against you in a hostage situation, should it occur. Master at arms personnel are stationed at the front and the rear of each of the work areas, and as such, they have constant vigilance over the surroundings. The open ward design that we utilize onboard the ship provides easy access from any vantage point within there for security personnel.

My last comments have more to do with the personnel themselves because these personnel, the young men and women, are the next generation of nursing personnel who will provide combat casualty care. The wounds they see and treat are not comparable with anything in peacetime Navy medicine. To them, the care they provide to enemy prisoners of war is no different than that provided to any other sick or injured individual. They hold the care of al sick and injured to be a sacred trust.

With that, I'll turn the mike over to Lieutenant Azar.

LT. AZAR: Good morning. My name is Ramzy Azar, lieutenant, United States Navy. I'll just start out by sharing a little bit of my background, at least my professional background, and how I got to this position as translating.

I've been in the Navy for about two years and serve as an environmental health officer. Mainly what that involves is tracking down communicable diseases and controlling the spread of communicable diseases. My speciality and my focus is in international health with a focus on disaster public health.

Onboard the Comfort, most of my time is currently dedicated to translating for the staff as well as for the EPWs and the Iraqi civilians. Arabic is my primary language. I was born in Lebanon and moved to the United States as a child.

Onboard, we have four Arabic translators. Three were sent to augment our services. Between the four of us, we have different dialects. My dialect is a Lebanese dialect; we have a Moroccan onboard, a Palestinian dialect, and also a Kuwaiti dialect. We translate around the clock, as needed by the patients and by the staff. We translate throughout the ship. There are a total of 150 Iraqis aboard; 120 are EPWs, 30 are civilians. We translate, like I said before, throughout the ship. We translate in casualty receiving, the operating room, three intensive care units, and four hospital wards. So we have quite a bit of space to cover.

As a translator, I must say that I've had an opportunity to hear a lot of interesting stories and to see a lot of injuries, and at times it's quite overwhelming. The Iraqi people have gone through quite a bit over these past few years, and certainly more so now. And it's important to say that most of these people do not have health care, and certainly cannot afford it. And we are offering the best treatment, the best possible in the world. We're certainly able to heal their wounds and even reunite them with their family members.

On many occasions what we'll see is a child lost for a few days and will be treated here onboard, and again, without us having any idea of where her family members are. Fortunately, some of the incidents that we've run across, at least in this particular case, an aunt has come onboard and we were able to match the two. We have husbands and wives that are reunited onboard. And like I was saying, there are so many interesting stories. Many are wonderful stories, however, there are some tragic situations. For example, a 12-year-old child coming here for treatment, and certainly her expressing that she has no more family back home; civilians that are being treated on board that were forced to fight; certainly, POWs. I had one situation where an EPOW had come on board, and he was convinced that we were going to hurt him on board. As I tried to reassure him that we are here to help him, he just simply broke down and cried.

One thing I'd like to say is that it's important to note that these personal stories will speak very highly of our contributions to the Iraqi people. And the Iraqi people have expressed thankfulness and gratefulness on an every day basis, certainly to the corpsmen, to the doctors, to the nurses and even to the -- to our security forces.

CAPT. BLANKENSHIP: That concludes our briefing. And we'll be glad to take questions at this point.

STAFF: Why don't we start with two questions from the Pentagon and then go to the Comfort, if there's any questions there, and then to two questions from Qatar.

Q Captain Blankenship, this is Charlie Aldinger with Reuters at the Pentagon. You said -- I believe you said about -- you'd had about 300 admissions, 120 coalition and 150 Iraqis. Could you give us firm numbers on that, as far as the 300 are concerned, and a breakdown of the 150 Iraqis? What is the percentage as a breakdown of how many were civilians and how many were fighters? And this 11-hour surgery you spoke of, was that a civilian? And could you give us some details on that? Thanks.

CAPT. BLANKENSHIP: With the total numbers right now, I think we have a about a hundred -- 150 is correct for the Iraqis on board and about 32 of those personnel are Iraqi civilians, and the rest have been classified as EPWs.

Of the other admissions for coalition forces, we've had right at 120 coalition force admissions, and I think about 32 to 35 of those were actually people that were wounded in action. The other personnel were disease, not battle injury admissions.

What was the second question?

CMDR. JONES: Regarding the patient that took 11 hours, this was a coalition force U.S. serviceman. He had a spine injury that was unstable to transport, with a neural deficit that had to be stabilized. We have an orthopedic spine specialist and a neurosurgeon that specializes in spine care, who did a complex anterior and posterior repair to stabilize this patient for transport back to the United States.

CAPT. BLANKENSHIP: Let me clarify that a little farther. Our role out here for the coalition forces is primarily, at a level three facility, to take those personnel who cannot safely be transported home, do whatever is necessary to get them into a condition where they can be safely transported. And that was the reason for the spine surgery. It was considered unstable.

We also take those injuries that are minimal but preclude a patient returning to duty immediately. We rehab them on board the facility for a period of one to three weeks, and then we can return them to their unit, and they do not have to be medevaced out of the area.

STAFF: A question here. Go ahead. Lisa?

Q Hi. I'm Lisa Burgess with Stars and Stripes. I wanted to go back to the safety issue with POWs. It seems as though there would be a lot of potential danger involved with sharp objects, oxygen tanks, things of that nature. Can you talk a little bit more about how you protect your staff against possible hostile actions?

CAPT. BLANKENSHIP: Number one, we augmented our security forces on board, and we have a formula for how many security forces we need for every three or four EPWs.

The other thing is that all the wards in which we house the EPWs -- all of the removable equipment that could potentially be used as a weapon have been removed. We call it "sanitizing the area."

And the third thing to remember is that at a level three facility our patients are litter patients; they're not ambulatory. These people are pretty sick, and actually, because of being a litter patient, the danger to the staff is actually reduced because of that. But we've taken all the necessary precautions that we need to take to protect the staff. And again, we provide the best care possible under the circumstances.

Q I'm sorry, can I ask a follow-up clarification? So once these people are ambulatory, then what happens to them?

CAPT. BLANKENSHIP: When they have received the maximum amount of care that we require here and they can be basically self-care, we transport them from the ship to a facility ashore.

STAFF: Captain Blankenship, do you have reporters there that would like to ask a question?

Q What is the facility? Where do you send them?

CAPT. BLANKENSHIP: The question that we just received is, where is the facility that we send our EPWs? And right now we send them to a location called Camp Freddy, and that's coordinated through the 800 Military Police Brigade.

STAFF: Do you have another question from the Comfort?

Q Yes. Peter Rice (sp), NBC News. What's your operating cost per day? And do you have the total amount you have spent so far on care? And is there any kind of breakdown of between coalition and Iraqi?

CAPT. BLANKENSHIP: The question was, what is our total or our cost per day, operating cost, and do we have a breakdown between coalition forces and EPW costs. And right now I cannot answer that question.

STAFF: Let's see if we have anybody in Qatar who has a question for the Comfort and its crew.

Q Yes, please. My name is -- (inaudible) -- TV. You have mentioned some stories from those patients. Can I know some of those stories, one or two?

STAFF: Do you understand the question?

LT. AZAR: Can the Pentagon try to repeat the question for us?

STAFF: Certainly. The question has to do with -- perhaps for Lieutenant Azar, some of the stories that he might be able to relate about the EPW situation, some circumstances.

LT. AZAR: There are a few interesting situations that seem to arise. We have clear EPWs. In other words, we know that they are military and they are telling us that they are military. And then we have civilians that have been kind of forced into the field. It's been kind of interesting differentiating who's civilian and who is military. Regardless, we've been trying to treat them all the same. However, a lot of these folks are pretty desperate to get back home and to be reunited with their families. And I know that this command is certainly making every effort to reunite them and do the appropriate thing, especially with regard to whether they are civilians or not.

I hope that addresses your question.

Q Yes. I have another question, is that possible? I would like to know in which conditions they are now. And do you have any idea about their future; they are going to go back home or what they will do?

STAFF: Comfort, this is the Pentagon. The question had to do with, if I captured it correctly, what is going to happen to those once they have been treated on the Comfort, both EPWs as well as civilians.

CAPT. BLANKENSHIP: Right now, like the question we had before, once the patients have received the maximum amount of treatment here and they're stable and need no further health care, they're transferred ashore. We do have people on board that are in very critical condition right now and are going to require some longer-term care, and we will keep those people on board as long as necessary to provide that care and until facilities are available ashore that we could transfer them for that continued care.

STAFF: Okay, we're going to come back here to the Pentagon.

Q Hello. Brian Hartman with ABC News. A couple questions. First off, are most of the patients on your ship from any particular city or region of Iraq; the Iraqi patients, obviously?

CAPT. BLANKENSHIP: I think that we've gotten a mixture of patients from southern Iraq all the way up through Baghdad, and a lot of that depends upon the level of care that they need. And we do provide intensive care and burn unit care here. And we've had people shipped to us all the way from Baghdad for that care.

Q Another question. Could you give me an idea of how -- you have a thousand-bed ship and you only have a few hundred people on there. How has the tempo of what you're doing there met the expectations that you had going in? Did you expect to be getting -- you know, your heaviest day being 50 people a day, or were you expecting something much worse?

And then just one more question. Can you tell me, have you had anybody on board who you've had to check out for any chemical -- suspected chemical or biological weapons exposure? And has anything checked out on that front?

CAPT. BLANKENSHIP: I guess we'll do the second question first. We have not had to evaluate anybody for any kind of chem-bio warfare contamination.

The first question -- do you remember what that was?

Q Yeah. The first question --

CAPT. BLANKENSHIP: Could you repeat that first question?

Q I just wanted to know -- you have a thousand-bed ship there and you only have a few hundred people coming in. You said that 50 people a day was your heaviest day. Is that what you expected? Did you expect to be having a much busier day there doing much more work?

CAPT. BLANKENSHIP: We weren't expecting to have that high of a volume. We are staffed by doctors -- we're supposed to be able to take a hundred patients per 24-hour period. That 50-patient load came in about a six-hour period yesterday, so it was a pretty heavy load in a short period of time.

STAFF: Do we have anyone else there? Go ahead, Lisa.

Q Hi. This is Stripes again. I have a technical question and then a quick one on Navy patients. How do you get patients to the ship? Do they come in by helicopter? And if so, what types of helicopters?

And the second question is, I notice there are a lot of -- you've got 34 Navy patients here who came in for diseases. Can you tell me, was there a flu outbreak or something?

CAPT. BLANKENSHIP: On the first question, on transportation, all of our patients come to us by helicopter. We can land any of the helicopters in the inventory. And we've had patients come from the Army Blackhawks. We had CH-46s from the Marine Corps. We've had the CH-53s that have come from some of the amphibious ships.

LT. AZAR: I might be able to answer some of the other questions, regarding the Navy patients. Service to the fleet is arduous, but they have the same illnesses and conditions that everyone else has in the United States. We've treated a variety of disorders, from -- eye injuries, hand injuries are very common things on ships, that require orthopedic and hand specialists; and then common diseases -- appendicitis, gall bladder attacks, the evaluation for gastrointestinal illness, GI bleeds; and the entire gamut of sub- specialties, to include, you know, complex care for GYN, or ear, nose and throat.

Q Captain, again Charlie Aldinger with Reuters. I just wanted to clear up one thing. You said you've treated about 300 people or you have about 300 people on board. Now, is this the total number of people you've treated, or the number you just happen to have on board now?

And the second question, are any of these civilians you've treated -- are any of them government leaders that they might want to hold for possible trial?

CAPT. BLANKENSHIP: The total number of people that we've treated since the operation began is about 300. We currently have about 200 people on the ship. And it's from war injuries and disease, non- battle injuries, combined.

The third question -- second question was? I didn't even -- I didn't understand the question.

Q The second question, have you received any government leaders or senior Saddam supporters who might have been injured in raids, that the United States might be interested in questioning and holding for possible trial?

CAPT. BLANKENSHIP: We have none that we're aware of. And we do have an enemy prisoner of war processing team from the Army who questions each person who comes onboard, through a translator. And we're not aware of any high-ranking officials like that.

STAFF: Let's go back to the press that might be on the Comfort, if they have questions.

Q (Name and affiliation off mike) -- for Lieutenant Azar. Based on your conversations with Iraqi prisoners of war -- (off mike) -- kind of a two-part question -- can you share with us their general impression of the care they're getting, whether they're grateful for it, their attitudes about our government and coalition forces and -- (off mike).

LT. AZAR: Well, just to at least directly answer your question, I know that they are very grateful. They express that every day. Every time I meet a new EPW, I get the same reaction, which is a gesture of kindness, a gesture of warmth, friendliness, and expressions of gratitude, verbal expressions of gratitude.

As far as anything more than that, we do not go into any discussions about the politics, whether they dislike America or not. All I am aware of is that they express thankfulness for what we are providing them. They are very appreciative.

The care they're getting I think sometimes is overwhelming to them, mainly because of the sophistication that we are able to provide for them, and they're not really accustom to that. So there are a lot of questions that I have to answer regarding the types of treatment that we do provide them.

STAFF: Another one from the Comfort? One more? Do you have --

Q I'm sorry, yes, for Captain Blankenship. Your team has trained to treat their military colleagues, for the most part, and yet they are treating lots of Iraqi patients. Can you talk about the reaction of your medical personnel to what they're doing versus what they may have expected when they came out here?

CAPT. BLANKENSHIP: Okay. The question was, we trained to treat our military colleagues, and yet the majority of what we're doing out here is treating the Iraqi EPWs and civilians, and what is the reaction from the crew? The crew is a health professional crew. We're trained to take care of anybody who's sick and injured, and there really hasn't been any distinction between force -- coalition forces and Iraqi personnel, as far as the care that's rendered. And I think the crew has really stepped to the plate, done an outstanding job with the care that they've given.

STAFF: Let's go to Qatar for one more question, and then maybe one last one at the Pentagon.

STAFF: No questions from Qatar.

STAFF: Do we have any -- we have one more here at the Pentagon.

Q Commander, this is Meredith Buel from Voice of America. Just two questions, please. First of all, what are your expectations in terms of receiving more patients in the future, in that there's been some pretty heavy fighting in Baghdad? But things also seem to be settling down somewhat.

And secondly -- this may be a bit out of your realm of responsibility, but we've heard a number of stories about extraordinarily difficult conditions in Iraqi civilian hospitals, especially in Baghdad, with the overwhelming number of patients and a big shortage of medicine. Can you tell us of any efforts to try to alleviate that crisis?

CAPT. BLANKENSHIP: On the first question, we're continuing to receive patients today, and I would expect that we would continue to do that until there are enough medical facilities ashore that can handle the load.

I don't have any visibility of the infrastructure of the medical system in Iraq and what's being done to bolster that, other than what we're doing right now.

STAFF: All right. Captain, we'd like to thank you for taking the time to be with us today and for your colleagues that have joined us. And thank you for all the work that you're doing for the health of our soldiers, sailors and troops over there, as well as taking care of the EPWs. Thank you very much.

CAPT. BLANKENSHIP: Okay. It's our pleasure.

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