August 1998 Bulletin

Military hones trauma skills

Hospitals help DOD keep doctors combat ready

Next month, Ben Taub Hospital in Houston will begin providing about 20 military medical personnel with much needed trauma training to keep them at combat-level readiness.

It's a one-month rotation that will give general surgeons, orthopaedists, nurses, medics and others the experience of a Level I trauma center that handles 150,000 emergency cases a year

Keeping military surgeons and other medical personnel combat-sharp in peacetime is difficult when the most common procedures in military hospitals are delivering babies and treating digestive disorders

A General Accounting Office report in April found that many medical personnel in Operation Desert Storm in the Persian Gulf had little or no experience in taking care of severely injured patients. Of the 16 surgeons on the Navy hospital ship USNS Mercy, only two had recent trauma surgical experience. Also, none of the more than 100 corpsmen at a surgical support company had ever seen actual advanced trauma life support given to a trauma patient.

Army surgical teams identified to complement the rapid movement of troops and provide emergency surgical services included obstetricians/gynecologists.

Kenneth Mattox, MD, Ben Taub's chief of medical staff and chief of surgery, said the emergency cases at his hospital will provide a lot of experience in dealing with blunt trauma and penetrating wounds. The military personnel will be integrated with the civilian staff in the crucial triage and decision-making experience.

There is no Department of Defense (DOD) or service hands-on training program for sustaining trauma care skills. In 1996, Congress ordered DOD to implement a demonstration program that would provide trauma training for military medical personnel.

DOD selected Naval Medical Center at Portsmouth, Va., to lead the program. The naval center signed an agreement with Eastern Virginia Medical School to provide training at Sentara Norfolk General Hospital, Norfolk, Va.

Earlier this year, Sentara provided a three-week rotation in trauma for six general surgeons in the hospital's Level I trauma center, which handles about 2,100 patients a year, said Frederic Cole, MD. Six more surgeons will be trained in November.

The DOD also provides limited trauma care training at its two trauma centers at Brooke Army and Wilford Hall medical centers, San Antonio.

The DOD has not determined how many medical personnel need to be trained. Not all of the 480 general surgeons or 73,000 medics would be assigned to combat units.

Top wartime injuries

Lower leg open penetrating wound with fracture

Thigh open penetrating wound with fracture

Multiple, nonperforating fragment wounds of skin and soft tissue

Upper arm open wound with fracture and nerve injury

Lower leg open penetrating wound without fracture.

Top peacetime care at military hospitals

Single infant born without caesarean delivery

Single infant born by caesarean section

Uterine and ovarian procedures for nonmalignancy

Knee procedure

Esophagus, gastrointestinal and other digestive disorders.

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