Military, Civilian Medical Communities Join Forces
By Master Sgt. Bob Haskell, USA
Special to American Forces Press Service
WASHINGTON, Jun. 4, 2004 The poplar trees were barely beginning to bud in mid-May in the high ground of the Colorado Rockies, the 9,300-feet-above-sea- level setting for a high-level medical conference put on by the Air National Guard.
It explored, among other matters, the budding relationship between the civilian and military medical communities. Some 400 medical men and women, including an 11-member team from Harvard University, devoted the Readiness Frontiers Medical Conference to exploring ways in which military and civilian health professionals can join forces to help Americans deal with catastrophic disasters and attacks by terrorists.
The civilian team, led by Dr. Susan Briggs of Harvard Medical International and the Massachusetts General Hospital, introduced its brand new Harvard Advanced Disaster Medical Response course to the military physicians, nurses and emergency medical people at the conference in Keystone, Colo.
"This is an unprecedented opportunity for us, as citizen-soldiers, to strengthen a partnership with our civilian medical leadership," said Col. Randall Falk, a urologist and aerospace medicine specialist by training and the National Guard Bureau's air surgeon. "Joint training and response planning for national or international disaster or attack are our targets."
Two themes underscored the conference that featured presentations in such subjects as current challenges in bioterrorism, dealing with biological, chemical and nuclear agents in weapons of mass destruction, and caring for the dead and their families.
The military and civilian medical communities must work together, because neither has the critical care resources to handle a major disaster or terrorist attack on its own.
The Air National Guard can respond to those situations better than ever because it has modern mobile emergency medical facilities situated throughout the country. The facilities are called EMEDS - Expeditionary Medical Support systems.
Conference goers, including nine military medical people from Canada, Israel, Mexico and Slovenia, were also told of a new civilian-military medical program in Arizona where Air Guard people train during their weekend drills with civilians who care for trauma patients at Scottsdale Healthcare.
"Nine-eleven proved to us that we are a nation that comes together," said retired Maj. Gen. Paul Weaver Jr., former director of the Air National Guard and now a private consultant, who helped arrange the Scottsdale alliance. "It is not if we are going to have another attack. It is when," Weaver predicted. Neither the nation's military nor civilian medical communities have the personnel and resources to cope with a major crisis alone, he said, "but together we can."
Falk and Briggs have been nursing that notion as their friendship has blossomed since 1996, when they were colleagues at the Harvard School of Public Health. They, along with Col. Daniel Coleman, the Massachusetts Air Guard's air surgeon, were the driving forces behind the conference.
Falk, who trained at Vanderbilt University in Nashville, Tenn., and joined the Tennessee Air Guard in 1983, is in his fourth year as the NGB air surgeon.
Briggs has practiced medicine for three decades. She is a surgeon at Massachusetts General Hospital and served in Germany as an Army Reserve colonel during the 1991 Persian Gulf War. She also led the United States' surgical response team to southeastern Iran following the earthquake that killed thousands of people in late December 2003.
"The medical assets are fairly limited in this country. The military and civilian sectors need to work together in any kind of mass casualty event, particularly a terrorist attack," Briggs said. "We need our disaster response to be integrated. We need to know each other's strengths."
Civilians know how to staff medical centers, for example, and the military knows how to decontaminate victims of a biological, chemical or nuclear attack before they enter a medical facility.
Critical care specialists - emergency room doctors, anesthesiologists, orthopedic surgeons and critical care nurses - are in the greatest demand and shortest supply throughout the military's reserve components, because they are already working long hours, and earning good livings, in civilian facilities, Falk explained. Nationwide, the Air Guard is short about 50 critical care physicians and about 75 critical care nurses, he added.
The Air Guard has trained about 3,000 of 6,500 medical people to work in the EMEDS critical care facilities, and the rest will be trained as soon as possible, Falk said.
Many of those would staff the 25-bed EMEDS that the Air Guard has established in 10 Federal Emergency Management Agency regions. The system's basic package includes three Alaska shelters with an emergency room and an operating room. It is staffed by 25 people, including two surgeons, a dentist and three nurses.
Scottsdale Healthcare is pioneering the push for greater civilian-military cooperation. Arizona Air Guard medical personnel began training there in April, said Dr. Thomas Wachtel, and will be there every month beginning in September.
The first group is coming from the 161st Air Refueling Wing in Phoenix, and members of the F-16 training wing in Tucson will come on board later this year, added Wachtel, a retired Navy captain. The plan is for the Guard people to work in the emergency room and trauma center at first and then move into the intensive care center.
There will be plenty of room and plenty of work, Wachtel predicted, because the Scottsdale trauma center will expand from one unit to four, from 12,000 to 55,000 square feet, in September. He also believes that other medical professionals from the Army National Guard and active Air Force will join this effort. Guard people will be able to serve when they can during the month and when the hospital needs them - not just during their drill weekends. And it makes sense for the civilian and military people to get acquainted, he said.
"Who are you going to war with? That's the real issue here," Wachtel said. "If you work together now, you'll know who you're dealing with during an emergency."
"It's a win-win for America," Falk said.
That idea made sense to the military leaders who attended the Readiness Frontiers conference, including Maj. Gen. Gerald Harmon, the Air Guard's assistant to the Air Force's surgeon general, and Air Force Brig. Gen. Lloyd Dodd, the surgeon for the U.S. Northern Command, the nation's military homeland defense agency that is based at Colorado Springs, Colo.
"The Department of Defense can put a lot of resources into one place or some resources into a lot of places, but the National Guard can be responsive across the entire country if, for example, terrorists strike in a dozen different cities at once," Dodd said.
"Believe me," he added, "Northern Command plans to capitalize on what the Air Guard is doing."
(Army Master Sgt. Bob Haskell is assigned to the National Guard Bureau, Arlington, Va.)