Wednesday, November 02, 2011
Before going overseas to treat wounded troops, U.S. Air Force physicians, nurses and medical technicians complete a three-week immersion course to refresh their training in trauma care at the world-renowned R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center.
Thomas M. Scalea, MD, physician-in-chief of the R Adams Cowley Shock Trauma Center and the Francis X. Kelly Professor in Trauma Surgery at the University of Maryland School of Medicine, traveled to Afghanistan in October 2011 at the invitation of the U.S. military. He observed the “Wounded Warrior” care system in the field, during transport and in military hospitals. In 2008, he visited U.S. Air Force medics and troops in Iraq. He said trips to war zones help fine-tune the pre-deployment medical training Shock Trauma provides.
Dr. Scalea’s mission in the war zone was to provide unbiased recommendations on how to improve the system, as well as to better determine how to continually refine the trauma training he and his staff provide for the U.S. Air Force C-STARS (Center for Sustainment of Trauma and Readiness Skills) program. This program began at the Shock Trauma Center shortly after Sept. 11, 2001.
While in Afghanistan, Dr. Scalea visited U.S. military medical staff bases in Bagram and Kandahar, as well as at Camp Bastion, a multi-national military base where the U.S. Army provides medical care. Throughout his travels, he spoke with physicians, nurses and technicians who trained in the C-STARS program.
More than 3,500 Air Force medics have trained in the program over the last 10 years, and they have cared for at least 35,000 troops during that time by conservative estimates, although the actual number is likely to be far higher, said Air Force Lt. Col. Raymond Fang, MD, director of the C-STARS program in Baltimore.
While in Afghanistan, Dr. Scalea operated on wounded troops, traveled aboard a C-130 cargo plane, wore 150 pounds of equipment, and experienced daily dust storms and scorching 100-degree temperatures.
“It is a testament to technology and commitment from the military to equip a cargo plane to be a flying hospital,” Dr. Scalea said. “Care being administered by the military is not only being done safely, it is being done superbly. Even while 30,000 feet in the air in one of these cargo planes, everyone focused on the delivery of an extraordinary level of care.”
For the troops injured last month in Afghanistan, he said, the survival rate was 96 percent. Most injuries are caused by improvised explosive devices (IEDs), which most often injure the lower extremities when a soldier or Marine unwittingly steps onto one.
“We don’t think [the survival rate] is going to get any better than that,” Dr. Scalea said. The focus is on continuing to refine and adapt care so that troops recover a high quality of life and function.
“How do we not lose the lessons that we learn in Afghanistan?” Dr. Scalea said. “It sure would be nice to have all of that knowledge packaged. We can pack these lessons in a digestible form so that the next time there’s a war, we can open the box.”
But he said it’s likely the weapons and injuries will be different in a future war, requiring changes in treatment, and therefore changes in training.
“That’s why I think programs like C-STARS are so important,” Dr. Scalea said.
The Medical Center, School of Medicine and UM School of Nursing are committed to training. Expanded facilities are under construction now in the planned state-of-the-art National Trauma and Emergency Training Center. The center is part of UMMC’s new Shock Trauma Critical Care Tower, which will open in 2013. The new center will enhance the training and education of both civilian and military health care professionals.
“This is who we are, what we do and why we are here, to save lives,” Dr. Scalea said. “Training is one of the core missions of Shock Trauma.”