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Readiness Training Institute Preps Medical Pros for Battlefield

By Donna Miles
American Forces Press Service

FORT SAM HOUSTON, Texas, Oct. 1, 2004 – The best medical skills, honed at the most renowned medical schools, won't do much good in combat if the provider doesn't survive to use them.

That's what drives Army Col. Alan Moloff, director of the Defense Medical Readiness Training Institute here, to ensure that military health-care providers have battlefield survival skills as well as top-notch medical skills.

The institute offers training to help doctors, nurses, physician assistants, and other medical-service-corps professionals from all military services prepare for the rigors of combat and the challenges of providing patient care on the front lines.

"The challenge is realizing that you're much more limited in terms of equipment and resources" than at traditional treatment facilities, Moloff said. "You have fewer people, no MRI and no CT-scan lab that can give you results within 30 seconds."

Without ready access to these technologies that have become so much a part of traditional patient care, military health-care providers must focus on the basic principles of trauma care, Moloff said.

"At the forward edge of the battle, the challenges have remained relatively constant for the last 100 years," he said. "The first two minutes of health care have been the same since the Civil War: establish an airway and stop arterial bleeding. If you can do that, you are going to save the person."

But even that simple prescription takes on a multitude of challenges in wartime. "You have to look at what care you can provide while under fire and what has to wait until the firing stops," said Moloff.

Providers must triage patients when faced with multiple casualties and determine how and where to evacuate them, if necessary. "The closest medical facility may not be the best for your patient," Moloff said. "You need to determine how to safely evacuate the patient and how far you need to go to get the appropriate level of care."

In addition, health-care providers must master basic military and combat survival skills so they can provide life-saving trauma care under the most difficult conditions imaginable.

Training at nearby Fort Bullis incorporates includes scenarios that replicate the pressures of the battlefield, providing a setting for medical professionals to treat patients while protecting themselves from enemy action. Beginning this month, for example, the institute began training medical professionals how to react if their convoys come under attack.

"The first thing you have to do to provide care on the battlefield is to survive," Moloff said. "So teaching those skills is central to what we do."

Moloff said the students play close attention to the training. Many are scheduled to deploy to Southwest Asia within months, even days, of completing their Defense Medical Readiness Training Institute training. "They know they're going to be using this training, so there is a lot of motivation to learn," he said.

While focusing their curriculum on age-old trauma care principles, the institute's staff is also looking to new developments they say will improve battlefield medical care. New, high-tech bandages help hasten the blood- clotting process, and, Moloff said, another promising concept on the horizon is a substance that will stop a wound from bleeding much the way "flat fix" material closes up leaking tires.

Also on the drawing board is an artificial blood able to carry oxygen and promote coagulation and a fluid that slows down the patient's metabolism, which in turn, slows down the loss of blood and oxygen from the body.

Moloff said he expects these developments to have long-lasting impact on combat medicine as well as traditional health care. "Everyone stands to gain -- military as well as civilians," he said.

In the meantime, Moloff said, he's pleased with the quality of battlefield medicine and is optimistic that the training the Defense Medical Readiness Institute provides is making a difference.

"We're having fantastic successes on the battlefield in saving livesbetter than we ever have," Moloff said. "It's a trend we expect to continue into the future, and we're committed to being a part of that success."

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Defense Medical Readiness Training Institute

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