Award-Winning Army PA Seeks to Improve Battlefield Emergency Care

By Stephen Spotswood

Maj. Jonathan Monti was named the Emergency Medicine Physician Assistant of the Year by the Society of Emergency Physician Assistants in April. Army photo by Kelly Burell

JOINT BASE LEWIS-MCCHORD, WA — Maj. Jonathan Monti, DSc, PA-C, says he does not believe in haphazardly adding new technology to the already-overwhelming amount of gear carried by those providing medical care on the battlefield. He spent several years downrange in Iraq as one of three physician assistants (PA) to join the 82nd Airborne Division in the initial hours of Operation Iraqi Freedom.

“Having cared for soldiers on the battlefield, I’ve been reluctant to adopt new technology for use on the battlefield,” Monti explained. “Those providing care on the battlefield are often constrained. When they’re saddled with a clunky device—that can become cumbersome.”

So, if he recommends a piece of technology be incorporated into battlefield care, it is not done lightly. In fact, it’s backed up by mountains of data and years of research.

Nearly 14 years after his first deployment to Iraq, Monti serves as director of Madigan Army Medical Center’s Emergency Medicine Physician Assistant (EMPA) residency program—one of the few residency programs that incorporates prospective clinical research into EMPA training. The focus of that research has been on battlefield medicine procedures and how new technology and improved training can improve outcomes for injured servicemembers.

“We’re specifically focused on technology that can have a profound impact on the care and disposition of patients, but also keeping in mind the constraints those providing care on the battlefield are facing,” he explained. “And, as Pas, we’re acutely aware that we as medical officers can’t be everywhere on the battlefield. For that reason, we’ve focused on technology that can be used by [whoever] is providing the care at the point of injury—PAs or combat medics.”

Ultrasound is one technology that Monti and his fellow researchers suggest could have great potential to change battlefield outcomes. Monti’s doctoral research examined the use of ultrasound to detect hemothorax. He had recognized the benefits of ultrasound years prior in Afghanistan where he taught himself how to use one of the machines.

“Using it, I’m able to detect a life-threatening condition on somebody that I might otherwise have missed,” he said. “It spoke to me about the value of ultrasound, about the ease of its utility and how it can be used without a significant amount of training.”

His initial research has grown and expanded since coming to the EMPA residency program. Results indicate that medics can successfully use ultrasound to improve the diagnosis of infections, and can help locate foreign objects in the body of a patient. Having demonstrated that ultrasound is usable and valuable to PAs and medics, the goal now is to work to implement it Army-wide and to create ultrasound training for nonphysicians, which isn’t currently offered.

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