Monday, October 24, 2016

Army medics may face fewer resources, increased role

(ANS) -- During a visit to Afghanistan in 2009, then-Defense Secretary Robert M. Gates told troops at Camp Leatherneck of his goal to provide the same adherence to the "golden hour" in Afghanistan that was at the time being practiced in Iraq.

He was referring to a standard of care that gets Soldiers to advanced-level treatment facilities within the first critical 60 minutes of being wounded, thereby greatly increasing their odds of survival.

Maj. Gen. (Dr.) Joseph Caravalho Jr. said that the golden hour standard of care might not always be possible in future conflicts and even in current humanitarian operations in austere environments, where treatment is far away in terms of time and distance.

One such place, he said, is Africa, where Soldiers operate in small teams, sometimes with just one medic. There are not very many nongovernmental health organizations operating on that vast continent, and hospitals are few and far between, he explained.

In parts of Africa and other austere places, he said, the gold standard of one hour may come to mean "six hours" instead.

Caravalho and others spoke Sept. 22, at the Association of the United States Army's Institute of Land Warfare hot topic: "Army Medicine: Enabling Army Readiness Today and Tomorrow."


Col. Jim Czarnik, U.S. medical liaison to the United Kingdom Ministry of Defence and U.S. Army surgeon general consultant for Operational Medicine, said getting used to operating in austere environments can be challenging.

Czarnik, who served as the command surgeon of U.S. Army Africa Command on his previous assignment, said those who entered the Army medical community after the wars in Iraq and Afghanistan were already underway are experienced in operating in environments where the golden hour response time is possible.

The Army medical community, he said, has become accustomed to quick medevac flights to nearby forward operating bases, working with medical equipment left behind by previous units, and operating in advanced medical facilities.

Very little of that exists or is practical in Africa, where small, mobile teams are widely disbursed across a continent that's nearly 30 times the size of Iraq and Afghanistan combined.

"Commanders accustomed to the golden hour are being told there's nothing there," and that's quite a change for them, Czarnik said.

The new reality of medical delivery in austere environments doesn't involve the construction of new medical treatment facilities. And with the small mobile teams operating in Africa, it also doesn't include bringing along expensive and bulky medical equipment.

Instead, small medical teams will need to learn to use the existing medical infrastructure, supplies and medicines of host nations, Czarnik said.

Where certain host-nation capabilities are lacking, such as in transportation for casualties, locally contracted services will need to be used, he said. Also, the Army will probably look to nongovernmental health organizations to fill in the gaps, as they did during the Ebola crisis in West Africa.


Command Sgt. Maj. Gerald C. Ecker, who serves as the command sergeant major of Army Medical Command and the senior enlisted advisor to the Army surgeon general, said with the new reality of medical care, the importance of the medic's role within small teams will grow, and his or her training and expertise will be relied on to a greater than ever degree.

The Army will need to help Medics expand beyond the skills they currently possess, he said. Today's medics are "hungry to learn more and we're passionate about feeding their hunger."

Doing that, Ecker said, will involve providing them with more advanced medical training than they are currently receiving and getting them certifications and licenses. They will need to acquire, for instance, a better understanding of physiology and pharmacology.

"We want to allow them to work at the highest scope of practice in clinical environments and get solid pre-deployment training," he added.

Also, medics will need to be empowered with more leadership authority, Ecker said. Well-trained medics of the future should be able to advise their platoon leaders on who should and who shouldn't move forward on an assault, since they know current conditions of their Soldiers better than anyone.

Czarnik agreed with Ecker's prognosis of a better-trained medic, but said, "We're too handcuffed by policies and licensure [requirements]." Policymakers will need to make changes first, Czarnik said, so medics can get the advanced training they require.

Sgt. 1st Class Paul Loos, noncommissioned officer in charge of Surgery/Anesthesia - Special Forces Medical School Course, Special Warfare Medical Group, said Special Forces medics are already receiving advanced medical training on their own.

For instance, they are listening to podcasts about medical procedures and taking quizzes to demonstrate they've mastered the material.

"We're enabling medics to teach themselves," Loos said.

Caravalho said medics in austere environments, now and in the future, "may be doing one thing one day and on a dime be asked to do something totally different."

For instance, they may one day be on a humanitarian mission and the next, helping to perform surgery for major combat operations.