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Military Medics Move Combat Care to Front Lines

By Donna Miles
American Forces Press Service

FORT SAM HOUSTON, Texas, Oct. 12, 2004 – From surgical care to physical therapy to blood supplies, the military medical system is moving its assets closer to the front lines to be more responsive to patient needs and, when possible, to return wounded troops to duty faster.

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Army Cpl. Robert Bosley, a reservist with the 2290th U.S. Army Hospital in Washington, D.C., learns how to operate a field respirator at Fort Sam Houston, Texas, from his instructor, Army Staff Sgt. Rachel Marchbanks. Photo by Donna Miles
  

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At the same time, the military is boosting know-how about treating combat casualties so everyone on the battlefield, regardless of job specialty, knows the most basic steps to take to help save a life.

Operations in Iraq and Afghanistan represent the first time these concepts, which the Army started introducing about eight years ago, are being applied in combat.

Army Maj. Gen. George W. Weightman, commander of the U.S. Army Medical Department Center and School here, said the trend reflects research about injuries, particularly trauma injuries. "What we have found is that the sooner you get to people after they have been wounded, the better your chances of saving them," he said.

Weightman said that's particularly true of injuries involving extensive blood loss, "because that's what kills people on the battlefield if they don't die instantly," he said. "So the sooner we can get the medical people to them, the better the outcome."

Recognizing the importance of quick care for wounded troops, the Army started beefing up its training programs introducing a three-day combat lifesaver course taught to all soldiers in their units and creating a whole new job description for combat medics, who receive their training here, Weightman explained.

In addition, the Defense Medical Readiness Training Institute here prepares doctors, nurses, physician assistants and other medical service corps professionals from all military services for the rigors of combat and the challenges of providing patient care on the front lines.

But just as important as increasing expertise about combat lifesaving, Weightman said, is getting it as close as possible to the patient.

In response, each Army company typically includes four to five combat medics, who operate "right there where the action is happening," he said.

In addition, forward surgical teams, 20-person units that include three surgeons and an orthopedic surgeon are being assigned at the battalion or brigade level. Weightman said these teams moved alongside the combat forces during the early, "manuever" phase of operations in Iraq, cutting medical evacuations, when necessary, to less than 20 minutes.

Weightman said these teams offer not just trauma care, but also a full spectrum of services ranging from physical therapy to preventive medicine. "We've pushed a lot of resources down to the brigade level and the division level," he said. "So not only can we treat them far forward, we can prevent them from getting sick and needing to get evacuated."

When necessary, air evacuations to higher-echeleon care facilities are far shorter than in the past, Weightman said, thanks to the positioning of medical helicopters closer to the units. "We're able to get down and get to the soldiers after they'll been wounded and get them back to definitive care in under an hour in many cases, in 20 or 30 minutes," he said.

Four Army combat support hospitals throughout Iraq offer the most advanced patient treatment available in the country, "the best care short of a medical center," Weightman said.

For medical service troops, the trend toward offering care closer to the front offers unique challenges and opportunities.

Army Sgt. 1st Class Quentin "Shane" Thompson experienced the trend firsthand during the opening days of Operation Iraqi Freedom. While coalition troops were moving north toward Baghdad, Thompson traveled directly alongside them with the blood supply used to treat casualties.

"We were constantly moving," said Thompson, who quickly set up operations each time the unit stopped, drawing packed red blood cells from the back of a refrigerated 5-ton truck.

"Blood management has usually been done in the rear echelon," said Thompson, now a microbiology instructor at the U.S. Army Medical Department Center and School's laboratory technician course. "But now the idea is to get the blood to the person as close as possible to the front lines. We're trying to provide the best care possible as far forward as possible."

Maj. Tracy Smith, director of the school's physical therapy specialty program, said she's witnessed the same phenomenon in her field. Although physical therapists and their assistants once rarely deployed to the battlefield, today they're in Southwest Asia, providing sports medicine and other related care so troops can more quickly recover from their injuries and return to the battle.

"In the past, people with minor injuries would normally be sent way back to the rear," she said. "But with technicians and therapists now forward-deployed, we've become force multipliers. We truly enhance the numbers of warfighters (available for duty)."

Maj. Mary Adams-Challenger was among just two physical therapists in Iraq during the first rotation of Operation Iraqi Freedom, although that number has since increased exponentially.

By providing physical therapy care at the 21st Combat Support Hospital in Balad rather than farther to the rear, she said she was able to help return troops to duty faster, and with better long-term results. "Early intervention is the key with these acute injuries," she said. "It's all about timing. If you're able to provide sufficient treatment early on, it's far better for the patient."

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U.S. Army Medical Department Center and School

Click photo for screen-resolution imageArmy Sgt. Samuel Adegbilero from the 130th Engineering Brigade, left, receives physical therapy care at the 21st Combat Support Hospital in Badal, Iraq, from Army Sgt. Erick Cedeno, an occupational therapist assigned to the 10th Combat Support Hospital, and Army Staff Sgt. Wendy Hansen, a physical therapy technician from the 21st Combat Support Hospital. Photo by Maj. Mary Adams-Challenger, USA  
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Click photo for screen-resolution imageArmy Sgt. 1st Class Quentin "Shane" Thompson takes a break at Logistics Base Dogwood in Iraq, sitting amidst blood supplies he transported while assigned to Unit Medical Logistics Battalion (Forward). Photo by Sgt. Erine Oats, USA  
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