Surgical teams bring care closer to front

[Woodmonkey]

More and more surgical units — doctors, nurses and corpsmen — will be deploying to the front lines in the coming months after trials showed dramatic decreases in combat deaths since the units were first fielded four years ago, according to the Navy’s top doctor.

Since the Korean War, the Navy has not normally placed doctors in front-line units. Instead, corpsmen have stabilized troops, who were then evacuated to mobile hospitals farther from the action to receive care from physicians.

That system, based on getting patients to a trauma surgeon within the “golden hour,” led to dramatic decreases in mortality within a generation. Shock-trauma platoons on the front lines are the next step in the evolution of military trauma care, said Navy Surgeon General Vice Adm. Adam Robinson.

The concept is similar in spirit to one championed by Cmdr. Richard Jadick, who deployed forward during the November 2004 Battle of Fallujah in Iraq.

Robinson said this doesn’t count as “definitive surgery,” but it’s crucial to troops’ survival.

“The key to this is you can do major resuscitative surgery very close to the front lines,” Robinson said in a May interview with Navy Times. “It is simply to go in and stop massive bleeding, and take care of massive wounds in an efficient way, and to stabilize the patient so they can be evacuated.

“What we really need to do is get close to the battlefield, have a very light capable unit that can do resuscitative surgery and that can turn over quickly, so we can be in and out very quickly.”

The platoons combine forward resuscitative surgical teams of 12 to 18 people — usually two surgeons, a scrub technician, a circulating nurse and several corpsmen — outfitted with “enough instruments and surgical disposable equipment to do 18 major operations in a 24-hour period, with a larger team of nurses and corpsmen to care for stabilized patients on the front line for several days if necessary.”

“When you marry those two groups up, you have the ability to do 18 surgeries pretty rapidly,” Robinson said, adding that shock-trauma platoon members can then care for and protect stabilized patients until they can be safely evacuated.

“So if you got caught in a bad situation where you couldn’t get anybody out, a [prolonged firefight] for instance, you could hold them there and care for them pretty well while you have them,” Robinson said.

It’s still unclear how many shock-trauma units will be established, which Marine units they will serve with, or when the push will be completed. Three spokespeople for the Navy’s Bureau of Medicine and Surgery did not return several calls by Friday for more information.

Being there
Although he wasn’t in a shock-trauma unit, Jadick saw firsthand the importance of moving doctors forward when he was in Fallujah.

There, he learned the “golden hour” was really a matter of minutes.

“That’s the goal that everybody talks about, but in combat, it doesn’t make much sense,” Jadick said. “If somebody is shot and they are bleeding out, they might have five minutes or 10 minutes. If you can get there in two minutes, you should have been there in one minute. Every second counts.”

Jadick gave up a slot in a urology fellowship to deploy with members of 1st Battalion, 8th Marines, and decided to move his battalion aid station closer to the front lines so that he could provide care to wounded Marines more rapidly.

He received a Bronze Star with a “V” device for valor for saving wounded Marines caught in an ambush; he chronicled his exploits in his memoir, “On Call in Hell.”

Jadick said corpsmen are often burdened with defending themselves and their Marines and don’t always have the time or experience to treat severe traumatic injuries properly.

Jadick, a former Marine communications officer, scoffed at the idea that it was a waste of resources to send a highly trained surgeon forward, risking death or serious injury.

“It goes with the territory,” he said. “If you pay all this money for me, sitting on the shelf doesn’t help. Plus, if I am forward, I am helping and training corpsmen.”

The source