A Tribute to Medical Task Force 46: Their Story During The Battle of Mogadishu

In mid-April, The Veterans Site published a well-intended tribute to the amazing work that Dr. John Uhorchak did during the Battle of Mogadishu in Somalia. Dr. Uhorchak kindly responded with both corrections to the article and his own tribute to the personnel of the 46th Combat Hospital, to whom he credits the stellar work done during the traumatic 34 hours featured in the movie Black Hawk Down. We are humbled by his service, and the service of all who were a part of healing and saving lives during that terrible 34 hours.Below is Dr. Uhorchak’s statement in full.

While it is nice to be recognized for doing well, failing to recognize those who actually did the work is a disservice. The members of Task Force Ranger, and the 10th Mountain Division who went to rescue them, are the true heroes. Among them were recipients of two Medals of Honor, two Distinguished Service Crosses, several Silver Stars, and several Bronze Stars for Valor.

I am not a hero. I am but one of scores of Army physicians and surgeons who have traveled in harm’s way, taking care of America’s best over the last 200 years of our Army’s existence. The survival of the wounded of Black Hawk Down was due to the skill of the 46th Combat Support Hospital, known as Medical Task Force 46. It is the team at this hospital that are the medical heroes of October 3rd and 4th, 1993.

Black Hawk helicopters continue to be used by the U.S. military today.
Black Hawk helicopters are still in military service today, in the U.S. and around the world.

There were 3 surgeons at the 46th that day, myself and two general surgeons. I did not operate on a liver or fix a carotid. I’m an orthopedic surgeon. I did do 22 surgeries in 34 hours. There were 36 surgical patients, of which many were operated on by both a general surgeon and myself. I have since lectured to cadets at USMA, residents, other surgeons, and medical professionals on the medical events of Black Hawk Down. Vignettes such as these are used as teaching points.

About a third of the way into the battle (on the hospital time line), I had finished one of the many orthopedic cases. As each of the three surgeons did, I was making the rounds of the ER/pre-op, and the ward where delayed surgical cases were waiting. Our surgically trained eyes may recognize injury that looks benign, but is a disaster waiting to strike. I saw a soldier who had been given a sandwich to eat, but he had a bandage around his neck. He said he hadn’t been seen by a surgeon, but it was a superficial neck wound without much bleeding.

I told him not to eat, and removed part of the dressing to get a peek at the wound. At the bottom of the wound, I could see the pulsing of the carotid artery – intact, but apparently bruised. That artery could have developed a weakness, clotted, and caused a stroke, or worse. It needed surgical exploration. Major Tony Canfield, one of the general surgeons, was just finishing his OR and immediately took the soldier for an exploration and repair. In a bad situation, triage is an ever ongoing process by everyone involved.

Field training, as depicted here by U.S. Army medics in South Korea, is an essential part of being prepared in the event of a mass casualty incident.
Field training, depicted here by U.S. Army medics in South Korea, is an essential part of being prepared in the event of a mass casualty incident.

I continued to try to get an appreciation of our workload, and help DEP Commander Col. Denver Perkins to prioritize the surgeries. Colonel Perkins’ training in the hospital in the four weeks prior to the battle was key to the superb performance of the 46th during the incident. At this time, we had already been operating for more than 12 hours, while the Task Force Ranger forces were still fighting for their lives on the streets of Mogadishu.

I stuck my head into the room of Major (now Col., ret.) John Holcomb, who was elbow-deep in a young soldier’s abdomen. John asked if Tony was available to help. I told him that he was exploring a carotid and asked if I could help. Having exposure to general surgery during training, I could be more than just a retractor holder. A systematic search revealed the source of the bleeding, a trans-hepatic/retro-hepatic vena-caval gunshot wound, requiring a formal laparotomy and thoracotomy as well as taking down the diaphragm. I had to hold the liver and lungs out of the way so that John could repair the vena cava. The situation was very tense, the anesthetist pumping in blood and fluids trying to keep this young soldier alive until John could get the bleeding under control. At one point, to break the tension, I commented that “we must be in really deep s***, if an orthopedic surgeon is holding the liver and lungs.”

For the record, this injury has a 95% mortality rate in major trauma centers in the U.S. John got this soldier off of the operating table alive – in a Combat Support Hospital! Unfortunately, the young soldier died during a second surgery, after being air evacuated to the army hospital in Germany. (John is currently Director for the Center for Translational Injury Research, and Vice Chair for the Department of Surgery The University of Texas Medical School at Houston.)

A Marine base showing conditions in Somalia, photo circa 1993
A Marine base showing conditions in Somalia, photo circa 1993

The events of October 3rd and 4th comprised the largest mass casualty event since the Vietnam war. A hospital with 52 beds treated nearly 90 casualties. It performed 36 surgeries in a 34-hour period, staffed by two general surgeons, one orthopedic surgeon, one anesthesiologist (also the deputy Commander), three CRNAs, an ER physician (Mike Szkrybalo, who did all the triage), two family practice physicians, one internal medicine physician, and one preventive medicine physician. The battle lasted from the afternoon of the 3 Oct until the morning of 4 Oct. The hospital’s “battle” started early on 3 Oct with an unrelated casualty event that merged into the Battle of Mogadishu. Though the initial surgeries ended late on the evening of 4 Oct, on the morning of 5 Oct the work began to re-explore the many severely contaminated wounds, and the hospital was at maximum work effort for nearly 60 hours before the wounded were evacuated to Germany.

The work the operating room circulating nurses – there were only three of them – did to care for the soldiers has never been recognized. The surgical technicians scrubbed cases, passed, cleaned, and sterilized instruments, and then headed straight to the next surgery room to do more. The laboratory technicians analyzed blood samples, and when we ran out of banked red blood cells early in the battle, they collected nearly 100 units of whole blood for transfusion to the critically wounded from soldiers not actively engaged in combat. There were countless other soldiers who kept the generators running, provided security, opened large containers (conexes) to break out emergency supplies, brought sandwiches and coffee – and the list goes on.

Sir Winston Churchill said, “To every man, there comes in his lifetime that special moment when he is tapped on the shoulder and offered the chance to do a very special thing; unique, and fitted to his talents. What a tragedy, if the moment finds him unprepared and unqualified for the work, that would be his finest hour.”

If you looked around the camp at MTF 46, in some regards, it resembled MASH more than an elite military unit. Many senior officers were dismissive of the 46th, based on that appearance. But on October 3rd and 4th in 1993, its efforts were in the highest traditions of excellence of the U.S. Army Medical Corps, and the U.S. Army. This was their finest hour.

Medical Task Force 46 was never recognized for its efforts during Operation Restore Hope. In a small way, this is a tribute to their effort in returning many wounded soldiers back to their families.

The blog post goes on to tell of my and our children’s other accomplishments. Before attending the U.S. Military Academy at West Point, our children were taught hard work and perseverance. They were on numerous sports teams, did well academically, and were Eagle Scouts and Gold Award Girl Scouts respectively.

The renowned United States Military Academy at West Point (USMA) is located in Orange County, New York.
The renowned United States Military Academy at West Point (USMA) is located in Orange County, New York.

My job in the army frequently took me away from home. Thus, another unsung champion is my wife of 40 years, Cindee. She supported me in all I did, allowing me to be successful. She traveled to all the games and events, and monitored our children’s progress through adolescence. Service spouses like Cindee are the ones who reassure their children that Dad or Mom is going to be ok, and come home safely. Cindee teaches 2nd grade at the elementary school at West Point. She uses her experience to teach army children and well as help them during the difficult time when their Mom or Dad is deployed. This is a small recognition of all the military families, and what they do and endure to support those who are deployed in service to our Nation.

John M. Uhorchak

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