Refugee Relief International After Action Reports

Free Syrian Army (FSA), March 8-20, 2013, Syrian Border

Two days of travel brought the Refugee Relief International, Inc. team to a border town in Turkey, a few hundred meters from Syria. We linked up with the Social Association Lien e. V., a German NGO looking out for Syrian refugees. On our way to the site, we viewed a refugee camp for thousands of former Syrian Army officers and soldiers, and their families, who refused to shoot their own people. Seventeen students and several facilitators and translators were waiting for us. The students for the RRII Combat Medic Course were hand-selected and all were serving as dedicated combat medics with Free Syrian Army forces across northern Syria. Some students traveled over 600 kilometers to reach the training site. The training team consisted of David Mohler, MD, trauma surgeon and orthopedic oncologist (USA), John Padgett, PA-C, PhD, medical school faculty and former US Special Forces medical specialist (USA), Florian Schmitzberger, medical student and paramedic (Austria), and Abdul Aziz, trauma instructor and paramedic (Lebanon).

Our classroom facilities consisted of an upper level room in hotel, with white board and flat screen for display of PowerPoint's.

The following is a review of what was taught in the course:

10 March: Sunday:
Student brief to us about their problems and what they need to know; ABCs; Rapid Assessment; Cervical spine stabilization; spinal fractures

Monday:
Evacuation under fire; suturing; fractures & sprains; splinting; head trauma;
Suturing practical exercise using tissue simulants

Tuesday:
Chest and abdominal trauma; sniper considerations; practical application of suturing & chest tubes; casualty evacuation & rapid assessment practical application

Wednesday:
Practical spine trauma stabilization methods and considerations; patient transport methods, solo and in teams; battlefield tactical considerations for care and extraction of casualties under fire. Field Training Exercise with care and extraction under fire.

Thursday:
Wound ballistics; burns; fluid replacement; chemical & biological warfare considerations; tactical combat casualty care guidelines; field anesthesia

Friday:
Triage; medical considerations in a guerilla warfare environment; course review and brief-back. Graduation Exercise/Ceremony

While in the border town, we were contacted by the Union of Syrian Medical Relief Organizations, UOSSM, and were asked to give some training to the staff of the nearby recovery hospital. This hospital cares for the injured from Northern Syria who require rehabilitation and long term wound care. The ages ran from the very young to elders, from all walks of life. The vast majority of wounds were caused by bomb blast injury and crush injuries from collapsing buildings. Gunshot wounds were a small minority of the injuries. Paramedic Schmitzberger, an experienced Basic Life Support (BLS) instructor, gave two BLS courses over two days, while the other members of the team saw patients or assisted with the training.

The student make-up was varied. We had three medical students, a pharmacist and others of mixed backgrounds; all were very attentive and applied what we taught them in practical exercise scenarios. They were, in our opinion, educated and intelligent Syrian patriots, sincerely struggling for freedom. They were keen to let us know that they were not jihadists or terrorists, but Syrians whose lives had been interrupted by the civil war. We also came to believe that if the US and NATO countries are serious about regime change in Syria, and avoiding thousands of more casualties, a no-fly zone needs to be implemented.

During a class on chest trauma, John Padgett demonstrates how fluid seeks its own level, using Florian Schmitzberger as a training aid.
David Mohler and Abdul Aziz demonstrate proper suturing and tendon repair on high-tech tissue simulators
Abdul Aziz explains principles of the management of a below-knee amputation, while David Mohler illustrates.
Flowers or bombs? This piece of graffiti on a wall in northern Syria says it all.
Graduation certificates for the combat medic course were produced by long-time RRII supporter Victor Vinson.
At the clandestine hospital, Mohler and Padgett remove a stabilizing pin from a femur fracture. The sophisticated orthopedic equipment was obtained from a local hardware store.