Or maybe not.  Just about as half-time was ending, my radio suddenly broke its peaceful silence, and blurted out the dreaded "EMT, TOC."  "You have an inbound MEDEVAC with an ambulatory 9 month old patient, approximately one minute out."  What?  This I've got to see...  I am not sure where they get this stuff.  Two days ago they called us for a stable, ambulatory, cardiac patient...  So I threw on a pair of sneakers and headed over to the hospital.

In our world, you never know what is going to come through those ER doors.  No one would have ever guessed this one...  The helicopter landed and in rolled a very small infant who appeared very flaccid.  The infant was in a car with his mother and father and they were involved in an accident with a Stryker vehicle.  They are lucky to be alive.  We have seen some messed up people as a result of vehicle accidents with Strykers to include an Iraqi soldier who was completely decapitated (AND, they brought the body to the CSH without the head!  Not sure how that happened or where the head went...  Maybe dinner for some stray dogs).  There are no drivers licenses here or driving tests or traffic cops so the locals do not drive so well to say the least.  Most of the accidents that we have heard about have involved people pulling in front of Strykers when they should be getting out of the way.  Anyway, back to the flaccid infant.  The only history we could get was that the mother was holding the infant when the accident occurred.  Approximately, 15 to 20 minutes after the accident the infant started seizing.  He arrived about 30 minutes after that.  He appeared to be post-ictal (a state of decreased neurologic function that follows seizures).  His eyes were open but he was not tracking anything.  He was not moving his right arm or leg at all, they were completely flaccid.  On his right side he was not responsive to pain, and he withdrew only slightly from painful stimuli on his left.  Not a good sign.  He was also having some difficulty breathing.  Fortunately the Battalion Surgeon that saw the infant after the accident was able to get an IV in his ankle; strong work.  We gave the infant some iv fluids and oxygen.  A chest x-ray was normal.  We got a CT scan of his head, also normal.  Then he started seizing again.  We gave the baby some dilantin (anti-seizure medicine).  Shortly after the dilantin, he started to move around more and he started to cry.  A good sign.  We are not really equipped to take care of infants here, so we started to make arrangements to transfer him downtown.  There are apparently two children's hospitals in downtown Mosul.  We call the Stryker Brigade Surgeon who arranges for an ambulance to come pick up the patient.  While we were waiting for the ambulance, the infant's heart rate increased and his oxygenation decreased.  I noted that the right side of his face and his right arm were moving abnormally which developed into right sided tonic-clonic seizures.  Oh great.  We decided to add some valium; shortly after receiving the valium his seizure activity ceased and his vitals improved. 

I am not sure this kid did not have some underlying seizure disorder or other medical problems.  The father said that up until now he was a perfectly healthy baby, however he was very small.  According to the father the infant was 14 months old.  However, he was very small; we estimated his weight at about 12 to 13 pounds (we do not have a scale).  This is quite small; my son is a little over 5 months old and is around 19 pounds (although some might argue that my son is a bit bigger than the norm as can be seen in some of the latest pictures).  He was also very dirty with a terrible case of cradle cap.  It was quite sad.  Could he have had an underlying seizure disorder or medical problem that interfered with proper growth and development?  Or could his poor overall nutrition predispose him to medical problems?  His father mentioned that his diet consisted solely of breast milk which would support the latter question.  You frequently hear about the sad overall health conditions of children in third world countries, but it affects you more when you actually see it first hand.

The ambulance arrived several minutes later.  A paramedic came in to get the infant and we tried to explain to him through our interpreter what was going on.  We all got the impression that he did not understand.  We had a transfer note written (most of the Iraqi doctors speak English quite well, in fact most of their medical training is in English), and the paramedic asked if it was in English...  On his way out, he asked us if we wanted the baby taken to the Children's Hospital...  We did not have a good feeling about this one...