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DJP Update: 3- 12-2007AMNews: March 19, 2007.
Military medical care and lessons for the home front
Don't miss this outstanding article by Dr. Bill Plested, AMA President. The
link and the article are pasted below.
I can't add anything better to his wonderful tribute at the end of his
article:
"Regardless of the political posturing that has accompanied this war, the
young men and women who have voluntarily answered the call to duty by their
country are all true heroes.
In addition, so, too, are the physicians, medical personnel, pilots and all
others who volunteer their efforts to support and care for our soldiers.
Some have found it convenient to belittle our military and those who serve
in our National Guard. I find that to be repulsive. I am embarrassed by them
and for them. I have nothing but the utmost respect for those who serve in
all branches of our military and our reserve forces.
They bring honor to all of us and to our country. To them I say, "Thank you.
I salute you." "
-------------------------
Thank you, Dr. Plested.
Donald J. Palmisano, MD, JD
Intrepid Resources / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
504-455-4895 office
504-455-9392 fax
312-560-0180 cell
DJP@intrepidresources.com
www.intrepidresources.com
http://www.ama-assn.org/amednews/2007/03/19/edca0319.htm
AMNews: March 19, 2007. Military medical care and lessons for the home front
... American Medical News
From the AMA. By William G. Plested III, MD, March 19, 2007.
A message to all physicians from AMA President William G. Plested III, MD.
I have just returned from an outstanding trip and am anxious to share my
experiences with you. Gerald Harmon, MD, soon to be installed as the
president of the South Carolina Medical Assn. in addition to running a busy
private practice, is also a major general in the U.S. Air National Guard. He
serves as assistant to the surgeon general of the Air Force and is his
principal adviser on Air National Guard medical service matters.
One of the critical assignments of the guard is aeromedical evacuation of
injured patients. Improved combat casualty treatment represents a remarkable
achievement for today's Army, Navy and Air Force medical services. Because
of planning, training and outstanding coordination, today's service
physicians and medical teams have recorded the lowest lethality rates in the
history of armed conflict. In World War II the lethality rate was 30%; in
Viet Nam, 24%. But in the Iraq war, the rate is currently 9%.
This dramatic reduction in lethality rates is a combination of a number of
factors that J. Edward Hill, MD, immediate past president of the AMA, and I
had the opportunity to review on a visit to Ramstein Air Base, Landstuhl
Regional Medical Center and Spangdahlem Air Base, all located in Germany. At
each facility, we had thorough presentations about their specific mission
and contribution to the continuity of care that is given to our sick and
wounded soldiers.
That care begins with first aid measures that are self-administered or
administered by a buddy or medic. Airway maintenance and control of
hemorrhage are the immediate goals. First aid is followed by immediate
transfer by ground or helicopter to a forward surgical facility. Here, as
throughout, the speed of intervention is paramount.
The forward surgical facility is mobile and usually located in tents. The
initial surgical intervention is aimed at controlling hemorrhage, debridement,
irrigation and immediate stabilization of fractures, etc. The average
elapsed time from injury to this initial surgery currently is an incredible
20 to 75 minutes.
The patient is next transferred to a forward expeditionary hospital, which
also is located in temporary quarters (tents) but ones that are much larger
and usually on concrete slabs. These facilities have much more sophisticated
diagnostic capabilities such as computerized tomography. There wounds are
reopened (as necessary) for continued control of hemorrhage, cleansing and
debridement. Postoperatively, fully equipped recovery and critical care
units are available.
The expeditionary hospitals are located in areas that have the capacity to
land such large transport aircraft as the C-130 and C-17. The planes arrive
loaded with cargo and are immediately reconfigured to transport wounded
troops back to a regional medical center hospital. For the Iraq war, this
hospital is located in Landstuhl. From the time of injury to arrival in
Landstuhl is 24 to 48 hours.
A source of great pride is the critical care air transport team, or CCATT,
available during the evacuation of patients to the regional medical center.
These teams are composed of physicians, nurses, respiratory therapists,
physician assistants and medics.
The CCATT provides critical care including monitoring, IV therapy
and ventilator support from the transferring intensive care unit to that of
the receiving facility. The CCATT literally transforms the air transport
aircraft into a "flying ICU."
The Landstuhl Regional Medical Center is a fully equipped tertiary hospital
with extensive diagnostics, emergency, multispecialty surgical and critical
care capabilities. Hemodialysis is a recent addition. Specialty care in at
least 40 specialties is available there. The surgical and medical care is
again aggressive and very high quality. Stabilization and transport is still
the order of the day, with the next stop being Andrews Air Force Base in
Maryland. Currently, the average elapsed time from the battlefield to
the hospital in the United States is two to four days. This is accomplished
by an incredible combination of logistics and teamwork.
From the time of injury to arrival back in the U.S., every patient's course
is carefully recorded, compulsively planned and painstakingly tracked. The
outstanding results of this emergency medical care is the result of
teamwork, professionalism and meticulous attention to every detail.
I can see many lessons that offer possibilities for future application in
medical care here at home. The most impressive thing I witnessed was the
incredibly high level of "esprit" and morale of every single individual I
encountered. Teamwork was not just a platitude but a palpable combination of
camaraderie and pride. Everyone was proud of and content with their own
contribution and respectful of the contributions of others to the care of
the patient. This is sorely needed in our everyday practices.
The compulsive attention to immediate care at a level commensurate with
local capabilities and prompt transfer to centers with greater capabilities
and capacities also should be reproducible as we design more efficient
delivery systems for our future. Such carefully planned and executed
evaluation, stabilization and transfer facilities seem to be a reasonable
answer for areas of low population density such as rural areas.
As we loaded our patients for the trip home, I noticed that they
all appeared to be ill at ease. Even those able to walk were quiet
and subdued. Most of those on stretchers appeared to be in varying degrees
of discomfort. Throughout the flight the teams of medical personnel were
constantly attentive and busy. Pain relief was always an imperative.
The visages of the patients throughout the trip were grim and withdrawn.
There was an almost palpable aura of gloom. However, the minute that we
touched down on the runway at Andrews, it was as if the sun had instantly
appeared from behind a dark cloud. Every face relaxed and broad smiles
replaced grimaces and frowns. Nothing was said, but it was crystal clear
that truly -- there's no place like home.
Regardless of the political posturing that has accompanied this war, the
young men and women who have voluntarily answered the call to duty by their
country are all true heroes.
In addition, so, too, are the physicians, medical personnel, pilots and all
others who volunteer their efforts to support and care for our soldiers.
Some have found it convenient to belittle our military and those who serve
in our National Guard. I find that to be repulsive. I am embarrassed by them
and for them. I have nothing but the utmost respect for those who serve in
all branches of our military and our reserve forces.
They bring honor to all of us and to our country. To them I say, "Thank
you. I salute you."
Dr. Plested, a thoracic and cardiovascular surgeon from Brentwood, Calif.,
was chair of the AMA Board of Trustees during 2003-04.
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