Hey! Hey! Look at me!
Now, the one thing I hate when they do movies
is every time you get some sort of torso injuries,
they make them spit blood, and that doesn't happen.
You don't vomit blood from getting a gut shot
or anything like that.
Hi, my name is Peter Rhee.
I served in the military for 24 years,
and I'm a trauma surgeon.
I was one of the first surgeons into Afghanistan.
Today we're going to be looking at battle-wound scenes
in movies and judging how real they are.
This is a really good scene.
When that explosion went off in slow motion,
you could see the boot flying right at the camera.
It's a little bit unusual from an injury point of view.
A shell coming in hitting the ground
would take his legs off like that.
Because seeing bilateral amputees
at the thigh has been a really recent injury
that we never saw before in previous wars.
We didn't really see bilateral amputations above the knee.
Before, in the other war movies,
they would step on Claymores and landmines.
And those were actually meant
to take off your foot and your ankle,
so the medics would come out,
and then you'd sniper the medics
and get more casualties.
So it wasn't really supposed to be a mortal wound.
His was mangled below the knee, but obviously,
his was going to be close to what we were seeing in Iraq,
where they would just build these huge bombs
and bury them into the ground.
We were seeing just legs blown sky-high.
I could do three hours on tourniquets.
Blood loss is the No. 1 preventable loss
that we want to avoid. Some of the soldiers,
they even wear tourniquets when they're going out there.
Actually, what we are recommending and what we teach
is that they put on your own tourniquets.
The tourniquets are problematic
because if you don't put it on right
and if it's not on absolutely the tightest it can be,
you'll bleed more and you'll bleed out.
When you put it on, you got to commit to it.
You got to go full bore.
And I tell you, putting a tourniquet on
will be the most painful thing you experienced
about three to four minutes.
It's like your leg is falling off.
So it is something you do as a last resort.
It will save lives, but you got to go for it.
Otherwise it will actually bleed more.
Desmond: Here comes the morphine,
here comes the morphine.
It's gonna kick in real quick, Ralph.
We're gonna get you shifted.
In the old days, morphine was good.
We got scared of it
because morphine can definitely kill you.
If you were to take a person who's low blood pressure,
not a lot of blood circulating,
and then you give it,
then it can depress your cardiac function,
and then you can die.
You would also stop breathing.
So we've actually gone away from morphine in the field.
We use a new drug called ketamine.
While it provides a lot of relief of pain,
it does not lower your blood pressure.
So that's the reason why we use it.
The medics can do a lot, and they're so vitally important,
but a lot of the movies,
I think the audience doesn't understand
that a medic is not a trauma surgeon.
Trauma surgeon obviously went to medical school,
did five years of general surgery,
then two years of training as a trauma surgeon.
So seven years of training, like a brain surgeon.
The medic's job is to get them to us.
Not to clamp things in the field.
It's pretty good.
I'd say give it a 9.
Now we know that IV bags actually hurt you.
We no longer use crystalloid solution in trauma,
even when your blood pressure falls.
The studies that we're shown is that
the people who don't get those IV bags,
they have a better chance of surviving.
If you give them that fluid,
their blood pressure goes up,
and then you bleed more.
Back then, that was the only way we did it.
We are only finally recognizing that
saltwater solution doesn't resemble blood at all.
I think he put a mosquito clamp in the mouth to do it.
That was turning me off a little bit.
I could see it
doing it with bare hands is a possibility.
We used to do a lot of this in bare hands.
And when I started my residency,
we were doing it bare hands too.
So that's not too unrealistic.
That area is called a junctional bleed,
where you can't put a tourniquet on it.
So we're still trying to invent ways to stop bleeding
when you get shot at the groin or in the armpit,
because you can't put a tourniquet into your armpit.
I got it.
It's going back in!
Hold it! Hold it!
This was not a good scene for me.
I've used it for training lots of times.
The way they did the artery,
clamping the artery, and so on.
For surgeons and people who do vascular surgery,
it wasn't very realistic.
It is somewhat chaotic.
Obviously somebody had a flashlight on there.
That's the reason why we always wear headlights on our head.
For trauma out there, you don't need much.
You just need some basic retractors.
You got to have good lighting.
And then the second thing is you got to have suction.
If you don't have suction nowadays,
it's really tough just working with sponges
and ways to soak up stuff.
For what I do, you don't need a lot of stuff.
So that is a major problem.
The wounds were OK.
I'd give this about a 6.
Expectant. Routine.
Priority.
He's gone.
It's a great movie.
It's pretty well done.
Triage in the field is very different
than triage when you come to a medical company.
You're not doing so much of this
actually during the heat of the battle itself.
It's usually once the initial firefight gets done.
There's four categories when we triage.
So he went through all four of them.
Dead, expectant, they need your help,
and then they're OK.
The guy's hollering and yelling.
If they're yelling, they're OK.
So it's a routine.
And then he had one guy that's a priority.
And then that guy was already dead.
Confirming someone that's dead
in a few seconds is not easy to do.
I was in Ramadi when we had 200 people
that were bombed at one time from one bomb.
We got 70 of these casualties that came right to us.
Just coming in, and they all come in one by one.
And I was the triage officer.
The first Marine I got was expectant,
but I couldn't tell for sure
because I only had literally four, five seconds
to decide whether he was dead or not.
And there was no way we could use our resources
to work on them. So what you're doing
is trying to cherry-pick the easy saves.
So you don't want to spend too much time on it,
which is very different than what we do in civilian trauma.
In civilian trauma, we go full bore,
hardcore team of 12 on top of one person
for hours and hours.
And that's not something you can do in the military.
I'd give it a 9.
Jesus!
Bring it in! Bring it in!
I said get his guts in now!
What they're trying to show is an evisceration.
So, a guy got hit, they're taking enemy fire,
high-velocity weapons, AK-47s out there, getting hit.
And then you eviscerate your organs.
They're making an attempt to push it back in.
You can't do it. It doesn't work that way.
The ones I saw were from exit wounds of AK-47s
through a little small plum-size hole.
You will shove everything out because you got pressure
as you're grunting and moaning from the pain.
And then you can't shove it back in
because it just pops right back out.
So unless they're chemically paralyzed by intubating them,
it's a waste of time.
In penetrating injury,
when we're talking about bullet wounds and so on like that,
the main thing is just get them to me as soon as you can
and stop the bleeding.
If it's not your heart
and your major vessels, we can save you.
If you don't hit those, the rest we can repair.
Hey! Hey! Look at me!
Now, the one thing I hate when they do movies
is every time you get some sort of torso injuries
they make them spit blood. And that doesn't happen.
Unless you get shot in the mouth
or you have something going through your cheeks
and your throat, up high.
You don't vomit blood
from getting a gut shot or anything like that.
Ready, up!
Let's move!
The one thing I do like is they do show
how difficult it is to move a heavy body out there.
These are 200- to 300-pound masses that you got to drag.
And two guys pulling these things is not that easy to do.
I think that part's well done.
You'd never drop in a bird when there's fire going on.
And a bird's not going to come down
to go do a casualty evacuation
when they're going to be shooting
at a $40 million bird up in the air.
You'll only land when it's a really secure landing zone.
I'd give it about a 6.
Hawkeye: You operate on a human time bomb
while your life flashes in front of you
and you promise God anything he wants
if it will keep your patient from blowing up in your face.
He's doing a spinal anesthesia there.
I like how he put the needle in and he's injecting.
They did this in the Korean War.
Back then they used a lot of regional anesthesia.
OK. Get it out of here.
So he obviously got shot
in the buttock region, pelvis region,
and he's got a live ordnance in there.
So this is a real scenario. This happens.
I think that's a rifle grenade that they shoot.
And usually that would not go into him,
because this doesn't have a sharp point
or anything like that.
But rocket-propelled, RPGs, as they call it,
we did actually have that during Freedom War.
There's a complete protocol about this.
You usually take them far away from the hospital
in an area that's fortified.
You take one volunteer.
You say, "Who volunteers to get this medal?"
Because if you come out of it alive, you get a medal.
And then you try to minimize
the number of people that go out there.
The chances of it going off
if it hasn't gone off at that point are small,
but you want to minimize the risks
of doing things like that.
There was a story, I think, in,
it was 2006 in Afghanistan, Maj. John Oh,
a West Point grad doctor
who had a guy got a RPG in his pelvis.
I think the grenade portion wasn't there,
but the tail end of it was sticking out of him.
They took a six-man team and extracted it out.
So that does happen.
My experience in the military,
in the war, was exactly like "M*A*S*H."
The mud, the dirt, the people,
the stories were exactly like "M*A*S*H."
And it was just a ton of fun
being out there helping out the troops.
You get to help out people who were injured out there.
So that's the fun part.
The clothes that they wear,
all that stuff is pretty realistic.
I give this one a 9 1/2.
Yeah, I hate this part.
If a guy at that close range
shoots you with an AK-47 with a 7.6 round,
that's going to destroy you.
But, I mean, it was really peripheral.
So it somehow just got the most minor of wounds.
But then they show that picture
of the very disproportion of the right lower lobe
with a little air.
And what they're trying to show is
this thing called a tension pneumothorax.
The lung collapses to a little small thing.
And then if the air continues to do it,
then you get so much pressure
that it pushes on the heart and the heart doesn't fill.
Then your blood pressure falls,
and you could die from that.
That's what they're trying to mimic here.
And this is really rare.
Usually if you have a hole in a lung, it bubbles out.
So it's usually always full of blood
and blood is coming out.
In a situation like that,
you would have no breath sounds on one side,
and you would have breath sounds on the other side.
But we know that even with stethoscopes when we do this,
it's very misleading.
Because when you put it on the side
that does have the tension,
you can still hear the other side of the lung.
So we have learned that that physical exam is not very good.
At that time during that war,
they would not have this Veress needle,
that special needle that he were using in this scene.
There's a lot of problems with that approach.
It is a sharp needle.
It can cause a lot of injury to the lungs.
And the way he turns it,
he doesn't really relieve it.
And it wasn't the greatest.
He had a three-way stopcock.
So that's a way that has a valve.
It's not an automatic valve.
It's something that you have to open and close
in one direction or another.
To sit around with this hardcore needle in your chest,
and you're walking around completely awake
and alert and doing tension on it every few minutes,
it's way far-fetched.
From a medical perspective,
the way they did the wounds and everything like that,
I'd give it a 2 1/2.
Stay with me.
Talk to me, guys, talk to me. What happened?
Oh, s---, is that Kirk?
There's some realism in there.
This is an outpost.
This looks like Army.
So Army Italian base station.
Army will usually have a medic,
or they'll have a physician's assistant.
Usually with as much webbing and stuff,
the unit that they're in,
the housing unit they're in, is just paper thin.
So the bullets would go right through there.
They should be a little bit more fortified
with the Hesco barriers of dirt.
You notice that the guy's bagging a guy
'cause he's not breathing well,
and they're about to do CPR.
We don't do that out there.
If they need CPR, that's wasting time,
because they need blood.
Medevac won't be here for a few hours,
which means he needs fresh blood if he wants to live.
This is the only thing we can do.
We're not sterile, and we can't test for disease.
Our fresh blood is all we can do to save him.
Gloves again, with the bloody hands.
That's not really realistic.
They have gloves at this point.
When I went out there,
we started doing this for the first time.
We actually started to really use warm, fresh whole blood,
which is miraculous.
It's unbelievably miraculous.
We can't do that in the civilian world,
but we did walking blood bank.
In my unit in the Ramadi Charlie Med, two-surgeon shop,
we had about 60, 70 medics with us as well.
The base was about 600 people.
So we'd go to the chow hall,
and there would be a guy that screams out,
"Walking blood bank."
Everybody would spit out their food,
go line up at my medical company,
check their dog tags.
They lay down on the floor.
They would poke them, get a bag of blood.
We would do a little test to see
if they were compatible when we used it.
So from that perspective, it's true.
There's a lot of little mistakes that they made
through here in order to dramatize it,
and they can get away with it for most people.
But you wouldn't be walking up to them
and giving them your blood standing up and things like that.
At least they're wearing the right uniform.
So I give them 7.
Take the plasma.
Hey! Hey, give us a hand!
He happens to have miraculously
one bottle of plasma and rubber tubings.
That's what they use.
Bottle of plasma. It wasn't clear,
it was usually a little yellow.
You take your blood,
and then if you put it into a machine and spin it,
all the red cells are heavy.
They go out to the outside,
and that's your, what we call, your packed red blood cells;
a thin layer of white cells;
and the rest of the water,
which has proteins in it, is called plasma.
And it has all these proteins in it called factors,
which help stop bleeding as well.
And it's a very, very good resuscitative tool,
much, much better than using the bags of IV,
the saline and the lactated Ringer's,
that we used in Vietnam.
I like the idea that they brought the plasma into it.
I'd give this a 6, 7.
Medic: BP 80 over 60, pulse 112, severe burns,
dyspnea, signs of shock.
We got to take care of enemy combatants.
We'd get soldier A and the guy who shot soldier A.
We'd get to take care of both of them.
We'd get to take care of civilians.
I took care of 6-year-olds
with big hunk of metal sticking out of her neck.
Fortunately, missed her spinal cord.
Burn wounds from explosions are common.
When you get civilians, they get burned.
Military people we didn't see a lot of burns
because, again, you're always in the vehicles.
The setting is pretty realistic
for depending on where you are.
You know, they come in by stretchers like that.
Field hospital, they have, you know,
lots and lots of doctors and areas of triage
and care versus a very small area forward.
Two units Ringer's in the field,
5 milligrams morphine administered.
Where is she burned?
Total body surface burned,
I estimate 45%.
The acting, the shaking, the convulsing.
I don't know what that was all about.
He would see a person that's moulaged
with thoracic and frontal extremity burns,
which is quite severe, probably closer to 80%, 90%.
But then he's asking the other guy where he's burned.
He's looking at the person, and the guy says "legs."
Well, it's obvious to the viewer
that's he's burned, you know, everywhere.
The dialogue was not really realistic
and not fun for me.
And everything was very scripted.
I just didn't enjoy this part of it at all.
If there was a way to mess it up,
they messed it up for some reason.
So I give it about a 5.
Just stay with me, Smurf.
Keep talking. Keep making noises for me, yeah?
I see it.
The medical care was good.
It's exactly what she should have done.
I was happy with that.
She packed it. She dressed it.
She tried a tourniquet.
And sometimes they still bleed out.
So that was believable.
Come on, Smurf.
Normally you want to put tourniquet time on the face
and say when you put the tourniquet on.
Usually we'll do black markers for that, Sharpies.
I want to know whether that tourniquet's been on
for five minutes or 45 minutes.
If it's been on for two hours,
you're going to have a dead leg you got to cut off.
Vietnam War, Huey helicopter from the United States shows up
and cranks her to the top of that place.
And her coming up there with the pressure on it,
that's feasible and doable,
strategically just didn't make a lot of sense.
I'm going to say, because, you know,
the medical part was pretty decent,
I'd give it a 5, 6.
You know what I thought was more accurate?
The top three, I would say, were "Saving Private Ryan,
"Hacksaw Ridge," and "M*A*S*H."
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