Baltimore Hospital Provides Pre-deployment Trauma Training

By Donna Miles
American Forces Press Service

BALTIMORE, Feb. 1, 2012 – Air Force Master Sgt. Charles Halcome stood at a hospital bed, laying out vials and pointing out medical instruments to be used to treat an incoming patient.

A 63-year-old woman had been walking her dog when, in a freak accident, she got run into a tree and was basically scalped in the process. Her injuries were so severe that she was immediately transported to the R. Adams Cowley Shock Trauma Center here.The first and highest-volume trauma center in the United States, it’s a training ground for Air Force medical professionals deploying to Afghanistan.

It’s one of three civilian hospitals nationwide participating in the Centers for Sustainment of Trauma and Readiness Skills program, known as C-STARS, which helps to prepare airmen to treat the kind of casualties they’re likely to encounter in the combat theater.

Air Force Tech Sgt. Josh Vest and Staff Sgt. Catalina Meissner, both aerospace medical technicians scheduled for upcoming deployments, listened as Halcome, a C-STARS instructor, talked them through the procedures to be followed when the patient arrived.

Vest and Meissner were midway through the three-week C-STARS program, getting exposure to trauma cases like nothing they had seen at their home stations. Meissner has spent most of her six years in the Air Force providing pediatric and women’s health care, most recently at Joint Base Langley-Eustis, Va. After 15 years in the Air Force, Vest rose through the ranks from providing hands-on patient care to a supervisory job at the U.S. Air Force Academy in Colorado Springs, Colo.

Both welcomed the opportunity to get trauma-care experience at C-STARS before deploying.

The Baltimore C-STARS program, which is affiliated with the University of Maryland School of Medicine and Medical Center, offers plenty of opportunity — more than any other trauma hospital in the country. It admits more than 7,000 trauma patients and performs more than 8,000 surgeries per year.

Most patients arrive with severe and often life-threatening injuries that range from gunshot and stabbing wounds to injuries from motor-vehicle accidents. Although none suffer the kind of traumatic blast injuries medical care teams treat regularly in Afghanistan, Air Force Lt. Col. (Dr.) Raymond Fang, the C-STARS director, said the training here comes as close as possible in a peacetime environment to what one would get in the combat theater.

Most of the students, like Meissner and Vest, come from military community hospitals or large clinics where they rarely experience the operational tempo or see the severity of wounds they’ll face in the combat theater, Fang said. So the staff goes out of its way to make the experience here as realistic and applicable as possible.

Halcome, dressed in the characteristic pink hospital scrubs that identify shock trauma center staff, compared the incoming dog-walker’s injuries to those of a vehicle gunner whose head slammed against a gun turret.

“When I can, I like to relate my patients to combat injuries,” he said. “It makes what we do here more beneficial to them. When these [C-STARS students] deploy, they may not see a 63-year-old woman who’s been struck in the head. But they may see a 40-year-old master sergeant or tank commander who has had his head banged against a turret.”

One of the most important lessons reinforced during C-STARS students’ 90 to 100 hours of clinical work is the importance of the “golden hour” concept, said Air Force Maj. David Whitehorn, a critical care trauma nurse on the C-STARS staff.

Dr. R. Adams Cowley, for whom the Baltimore shock-trauma center is named, recognized while serving in Europe during World War II that trauma patients who got care quickly had the best chance of survival. The first 60 minutes — the so-called “golden hour” — were the most critical.

So Cowley applied that principle when he established the nation’s first trauma lab here in the basement of the University of Maryland Hospital, and it has become a universally recognized standard.

The military medical system goes to great lengths to enforce it, striving to get wounded warriors even in the most remote parts of Afghanistan to advanced-level care within 60 minutes.

As instructors here draw comparisons between the civilian and military ways of providing care, Fang said, they also pass on some of the differences.

The military, for example, has a strict “by the book” approach to trauma care. It’s critical, Fang said, to maintaining consistency of care as patients are moved from Afghanistan to Landstuhl Regional Medical Center in Germany and, ultimately, to stateside military medical centers.

“I can have all my idiosyncrasies about how I like to take care of a patient, and that is fine if the patient is going to stay with me for their whole care,” he explained. “But if I am going to be sending a patient through four or five levels of care with four or five teams [caring for them], then we need to make sure that things are done not my way, but our ‘corporate’ way.”

That corporate way of doing business is reinforced throughout the C-STARS training, in classroom sessions and on the hospital floor during clinical training. It’s also tested in a mock combat environment during a field training exercise at Fort Detrick, Md., where students tend to simulated combat casualties while responding to “enemy fire” — actually paintballs inflicted by their instructors.

The goal, Fang said, is to take students out of their comfort zones and expose them to austere and the often-chaotic conditions in which they may have to operate.

“We try to make the scenarios as realistic as possible,” based on real cases in Afghanistan, Fang said. “We put people through these experiences so they know what they might expect.”

Whitehorn said he has seen the initial shock register on students’ faces when they go to treat their first trauma patient. “I’ve had nurses pause there and back away, and I just push them right back in there,” he said. “But that’s what C-STARS is all about. This is where we would rather have them shell-shocked, not after they arrive in the theater.”

“At first, it’s a little intimidating,” Vest admitted. “But you just take a deep breath and make sure you’re providing the case care for your patient.”

“It’s overwhelming. It tugs at your heart,” agreed Meissner.

Air Force Master Sgt. Bruce Graybill, an operating technician who oversees all C-STARS programs for enlisted members, said he sees students develop an air of confidence when they realize during C-STARS that they’re up to the task.

“We’re not only refreshing our skills, we’re also getting the confidence to apply those skills,” Vest said. “And being able to do that gives you that warm, fuzzy feeling. You know that you did everything in your realm to help that patient, regardless of the outcome.”

Fang said there’s no way civilian trauma-care experience can totally prepare airmen for the devastation they will see in war.
But he said the exposure they get at C-STARS will help them become more effective more quickly when they arrive in Afghanistan.

Experience shows that providers who deploy without trauma-care training take about 30 days to adjust to the professional and emotional rigors of the job. But Fang said subjecting them to a month of adjustment isn’t fair to the providers — and certainly not to their patients.

“We want to make people as prepared as they can be on Day One,” he said. “We may not get them all the way to their Day 30 level, but the closer we can get to that level, that is why we are here.”

Meissner she said she knows the training she is receiving here will pay off when she arrives in Afghanistan. “You want to make sure you will be able to help that soldier and save that life,” she said. “And when I look around at what is happening here, this is saving lives.”

Air Force Capt. (Dr.) Morgan Gettle, a flight surgeon from Cannon Air Force Base, N.M., attending C-STARS, said he gets personal satisfaction in providing patient care. “There’s a lot of gratification in the work here,” he said. “You get to see the effects of what you have done in terms of saving someone’s life.”