Thursday, April 3, 2003

Docs put skills to test in battle


University Hospital trains medics for combat care

By Tim Bonfield
The Cincinnati Enquirer

[photo] Capt. Ralph Cosme (right), a registered nurse and Air Force reservist, trains at University Hospital in a course designed to refresh caregivers in the critical care of military personnel. He is assisted by Maj. Jorge Cisneros, a doctor and reservist.
(Michael E. Keating photo)
| ZOOM |
When the trauma work pauses at University Hospital, Maj. Brad Davis often takes a few minutes to scan the war news from Iraq.

Like many Americans, he wants to keep up on how things are going. But unlike many Americans, he's also looking for a glimpse of his students in action.

As battle casualties mount, Davis knows his trainees have work to do. And when he wishes he could be there to help, he reminds himself that the training conducted over here is helping save lives over there.

"Early on, I happened to glance at the TV and I saw one of my guys," Davis said. "In fact, about half of our people are working there right now."

Since September, University Hospital has been one of four civilian medical centers nationwide providing refresher courses in trauma care for Air Force reserve physicians, nurses and technicians.

Of 45 students trained so far, most have been sent overseas, some to support action in Afghanistan, most to support the war in Iraq. Things have gotten so busy that five of the 12 students who were registered to start their courses this week have already been called up for service.

The training courses, which involve cooperation between University Hospital and Wright-Patterson Air Force Base near Dayton, prepare medical staff to serve on Critical Care Air Transport Teams and Mobile Field Surgical Teams.

A new approach

The surgical teams are trained to provide rapid, damage-control surgery to wounded troops so that they can be moved safely to more sophisticated military hospitals.

The Air Force's five-member teams are equipped with backpacks that carry everything they need to set up a field operating tent in 30 minutes.

CCAT teams - which comprise the bulk of the trainees at University Hospital - are used primarily to move injured and wounded troops by air from rear-area medical stations to more fully-equipped military hospitals.

For example, CCAT teams usually are involved when wounded troops are flown to Landstuhl Regional Medical Center in Germany.

Each branch of military service provides medical teams organized in slightly different ways. Combined, they reflect a dramatically different approach to treating battlefield casualties compared to any past conflict involving American troops.

"The military has changed its entire concept of how to provide medical care in the course of the past 10 years," said Dr. Jay Johannigman, a leading trauma surgeon at University Hospital who also serves as a lieutenant colonel in the Air Force medical corps. He spearheaded the effort to launch the local training program.

During the first Gulf War, the modern version of a MASH unit was a complex facility that required as many as eight cargo planes worth of equipment and a month to set up.

"Those things don't move. The whole emphasis since then has been to make things much more flexible," Johannigman said.

The new teams are being trained to move a blend of basic-but-modern medical care as close to the troops as possible.

Life as a battlefield

At University Hospital, the trainees work in the emergency department, the operating rooms and the intensive care units. They keep their battlefield skills sharp by treating the casualties of urban life - the shootings, the stabbings, even the car wrecks.

As the public has been reminded from the latest Iraq conflict, battlefield injuries aren't limited to bullet and shrapnel wounds.

Helicopters crash. Supply vehicles have accidents. The enemy has even run into troops with trucks.

Soldiers also get sick. Allergies flare up. Heart attacks happen.

"When you're talking about a force of about 300,000 people, almost any kind of medical problem that happens in the general public can happen in theater," Davis said.

The public may benefit from the new-generation medical technology that the military medics are using in the field.

Civilian benefits

For example, many more military medics are using medicine-coated bandages that help speed up the blood clotting process, which can help prevent a soldier from bleeding to death.

Miniature versions are emerging for ultrasound equipment, blood pressure monitors and heart monitors that can take up much of a civilian hospital room.

"We have a laptop that does all three of those things," Johannigman said.

Many of these innovations are likely to find their way into civilian medicine, where they will improve the abilities of paramedics in the field and trauma teams at the bedside.

"One of the exciting things about this position is seeing some of the directions that medicine will be going," Johannigman said.

E-mail tbonfield@enquirer.com




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