Big City ER Medicine Preps Military Docs for Combat
By Douglas J. Gillert
American Forces Press Service
SAN ANTONIO, Texas, Dec. 9, 1998 [Note to editors: This is a corrected copy. Corrections include rank and spelling of primary source. The copy should read "Dr. (Col.) Cass Conaway. Also, last sentence
of paragraph 2 is changed to read "...1.5 trauma surgeries per physician for 24 hours."]
Military medics in Vietnam called it the "golden hour" -- that precious 60-minute countdown when they scrambled to stabilize wounded soldiers -- to save their lives and limbs. Sometimes at field hospitals, the golden hour extended to 12, 18 or 24 hours, the emergency medical teams working without break or sleep to treat hundreds of wounded soldiers.
Since Vietnam, military medics have deployed to other lands and skirmishes, but they haven't experienced the intensity of Vietnam emergency rooms. Even during Desert Storm in 1991, the single largest trauma event yielded an average of only 1.5 trauma surgeries per physician for 24 hours.
The Army, Navy and Air Force surgeons general insist military surgeons must receive more hands-on training in trauma care. They want each surgeon to know what it's like in a trauma center -- and that knowledge, they said, will better prepare military doctors for combat medicine.
Except at a handful of military emergency departments that provide trauma care to their civilian neighbors, military doctors today have little opportunity to train hands-on for combat care. Many Army, Navy and Air Force medics just can't get the training they need in-house. Now, a pilot program promises a new resource -- big, inner-city hospitals. The first to offer such training is Ben Taub General in Houston.
In September, the forward surgical team from the 41st Combat Support Hospital, Fort Sam Houston, Texas, trained at Ben Taub. The nurses and medics came from Brooke Army Medical Center, also at Fort Sam Houston, while the surgeons came from throughout the Army's Great Plains Regional Medical Command. They received the training under an experimental Army program called Combat Trauma Surgical Training.
The medics trained individually and collectively alongside their civilian counterparts. When the training was completed, a senior military physician spent time helping them relate their experiences to what they would see in actual combat. To a person, the medics said they came away from the training with renewed appreciation for military medicine and greater confidence in their own capabilities.
Based on the medics' experiences at Ben Taub, defense health officials are looking at expanding the program to other civilian hospitals and providing the training to trauma teams DoD-wide, said Army Dr. (Col.) Cass Conaway, 41st Combat Support Hospital commander.
"We want to train 12 teams a year, one per month," Conaway said. Fort Bliss, Texas, will send a team to Houston in February, and teams from Fort Hood and the Air Force's Wilford Hall Medical Center, Lackland Air Force Base, Texas, are slated for later classes. Conaway has recommended DoD supplement the clinical training with field exercises at the Army's Fort Polk training center in Louisiana. The entire program, he said, will cost about $240,000 a year.
Ben Taub helped reduce costs for the pilot session by paying for housing (a local college dormitory) and food for the military trauma team. The Army spent just $4,700 to train 20 military medics for one month. Future costs will include housing and per diem and will vary from location to location, Conaway said, but they'll still be manageable. He said the Army plans to place its own instructors in the participating hospitals and also will seek some reimbursement for services rendered.
"Two and a half years from now," Conaway said, "we could finish training every trauma team in DoD."
The training will enable DoD to deliver better medical care to wounded soldiers and provide a better medical response to natural disasters and terrorist events, he said. And the civilian communities will benefit from the increased trauma care. "It's a win-win situation for civilians and soldiers," he concluded.