Train­ing com­bat doc­tors

Los Angeles Times - - Late Extra - Tony Perry re­port­ing from san diego

The im­ages are hor­ri­fy­ingly graphic: gap­ing, blood-gush­ing war wounds.

The faces and voices of the mil­i­tary doc­tors dis­play the strain of daily ef­forts at “dam­age con­trol” surgery as the doc­tors speak di­rectly to the cam­era.

“There are a lot of limbs lost,” Air Force Maj. Mark Gunst says qui­etly. “The wounds are al­ways dirty. They’re al­ways more ex­ten­sive than you think they’re go­ing to be.... What it looks like on the out­side may be only be the tip of the ice­berg.”

The im­ages and in­ter­views are con­tained in ed­u­ca­tional videos pro­duced un­der a first-of-its-kind ef­fort in­volv­ing a dozen doc­tors from UCLA’s med­i­cal school in co­op­er­a­tion with the Depart­ment of De­fense.

The goal is to pre­pare mil­i­tary doc­tors for the wounds they will see when they de­ploy to Afghanistan

and Iraq — par­tic­u­larly blast-in­jury wounds from road­side bombs, the en­emy’s weapon of choice.

Blast in­juries, the videos show, are sig­nif­i­cantly more com­plex and de­struc­tive than the gun­shot and knife wounds that the doc­tors have en­coun­tered dur­ing their pre-de­ploy­ment train­ing at ur­ban trauma cen­ters such as Los An­ge­les County-USC Med­i­cal Cen­ter.

“What blast in­juries do is com­bine four or five ways of killing and fo­cus them all on one per­son,” said Dr. Eric Sav­it­sky, the lead UCLA doc­tor on the two-year, $850,000 project funded by the Army.

A blast in­jury can in­clude mas­sive blood loss, or­gan and tis­sue de­struc­tion, se­vere burns and scald­ing dam­age to the throat and lungs through in­hala­tion of su­per­heated air — fol­lowed quickly by ag­gres­sive in­fec­tion caused by the shards of metal, dirt and other de­bris embed­ded at high ve­loc­ity into the body.

More than 80% of bat­tle­field wounds in­flicted on U.S. per­son­nel are blast in­juries.

Al­though the mil­i­tary has com­piled other “lessons learned” ma­te­rial — in­clud­ing a com­put­er­ized trauma registry track­ing more than 40,000 bat­tle­field in­jury cases — the videos and ac­com­pa­ny­ing text from the UCLA project are seen as a no­table ad­vance­ment in get­ting doc­tors ready for both the num­ber of ca­su­al­ties and the grav­ity of their wounds.

“Even for the most ex­pe­ri­enced physi­cians, there is a steep learn­ing curve once they get here,” said Army Col. Brian Eastridge, the joint theater trauma sys­tem di­rec­tor in Afghanistan. “They have so much to learn about how to re­sus­ci­tate ca­su­al­ties, how to op­er­ate on ca­su­al­ties, how to pri­or­i­tize ca­su­al­ties, how to treat ca­su­al­ties.”

The videos “are go­ing to make that learn­ing curve much eas­ier to pick up on,” Eastridge, a sur­geon on his fifth de­ploy­ment, said in a tele­phone in­ter­view from

‘What blast in­juries do is com­bine four or five ways of killing and fo­cus them all on one per­son.’

— Dr. Eric Sav­it­sky, lead UCLA doc­tor on the two-year, $850,000 project funded by the Army

the mil­i­tary hos­pi­tal in Ba­gram, Afghanistan.

The film footage comes from the work of a Los An­ge­les-based vet­eran cin­e­matog­ra­pher who was given to­tal ac­cess to the emer­gency room at the Air Force hos­pi­tal in Balad, Iraq, for six weeks.

Stephen Sheri­dan filmed night and day while wounded mil­i­tary per­son­nel were rushed into surgery, as well as Iraqi civil­ians, se­cu­rity per­son­nel and chil­dren, and even some in­sur­gents who, just min­utes ear­lier, had at­tempted to kill Amer­i­cans.

Sheri­dan doc­u­mented a 14-hour op­er­a­tion in which a golf-ball-size piece of shrap­nel was re­moved from a sol­dier’s skull.

He recorded the im­prove­ment over sev­eral weeks of a 6-year-old child wounded by an in­sur­gent’s bomb. And Sheri­dan was there when a dozen vic­tims from a heli­copter crash were brought in.

“It’s amaz­ing: You see guys come in so in­jured and bloody you fig­ure they can never sur­vive,” he said. “But these doc­tors are rock stars — their en­durance is in­cred­i­ble.”

The amount of blood shown and the close-up views of sev­ered limbs and trau­matic wounds — in one scene, a doc­tor pushes a sol­dier’s in­testines back into his body — are far more graphic and ex­ten­sive than news agen­cies will show.

The videos in­clude de­tailed, writ­ten ex­pla­na­tions by mil­i­tary doc­tors and other ex­perts, in­clud­ing the UCLA doc­tors, about emer­gency surg­eries done to sta­bi­lize wounded sol­diers, air­men, sailors and Marines so they can be air­lifted in a spe­cially equipped Air Force cargo plane to the mil­i­tary’s Land­stuhl Re­gional Med­i­cal Cen­ter in Ger­many.

The videos will be used at med­i­cal train­ing sites in the United States and at mil­i­tary hos­pi­tals in Afghanistan and Iraq.

Sep­a­rated into 13 chap­ters deal­ing with a med­i­cal spe­cialty — such as am­pu­ta­tions, brain in­juries, burns, eye dam­age, burns and spinal in­juries — and a dozen chap­ters show­ing spe­cific op­er­a­tions, the videos are con­tained on a sin­gle DVD. There is a chap­ter on pe­di­atric trauma, based on the many chil­dren wounded by ex­plo­sions and stray gun­fire.

Bor­den In­sti­tute, a mil­i­tary pub­lish­ing com­pany, plans to dis­trib­ute 5,000 copies of the 712-page book por­tion of the over­all project, which is ti­tled “Com­bat Ca­su­alty Care: Lessons Learned from Op­er­a­tion En­dur­ing Free­dom and Op­er­a­tion Iraqi Free­dom.”

The DVD was in­tro­duced in Au­gust for view­ing by sev­eral hun­dred mil­i­tary med­i­cal pro­fes­sion­als at the Ad­vanced Technology Ap­pli­ca­tions for Com­bat Ca­su­alty Care Con­fer­ence held in Florida.

The idea for a multimedia ed­u­ca­tional pre­sen­ta­tion was cham­pi­oned by Robert Fos­ter, who, un­til his re­cent re­tire­ment, was a high-rank­ing of­fi­cial re­spon­si­ble for re­search projects for the of­fice of the sec­re­tary of De­fense.

When doc­tors be­gan to re­port back to him about the med­i­cal chal­lenges faced by the wounds in­flicted by so­called im­pro­vised ex­plo­sive de­vices, Fos­ter gath­ered the bureau­cratic sup­port needed to de­velop a com­pet­i­tive grant to be of­fered through a pro­gram to en­cour­age re­search by small busi­nesses.

Af­ter the bid­ding process, UCLA and Pe­lag­ique LLC, a spinoff of the UCLA Cen­ter for Ad­vanced Sur­gi­cal and In­ter­na­tional Technology, were cho­sen first for a $100,000 con­tract to de­velop the project, and then a $750,000 con­tract to de­velop the videos, book and an ul­tra­sound sim­u­la­tor train­ing video.

Sav­it­sky has shown parts of the videos to his stu­dents at UCLA to help them gain ad­mi­ra­tion for their med­i­cal col­leagues in the mil­i­tary.

“When I show it to my res­i­dents, their jaws drop open,” he said.

LIFE­SAV­ING:

A new train­ing video aims to pre­pare mil­i­tary doc­tors for the trau­matic wounds suf­fered by troops from road­side bombs.

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