Military Trauma Clinicians Struggle to Stay Sharp
By Sandra Basu
WASHINGTON — In an effort to maintain medical readiness after the Iraq and Afghanistan conflicts, DoD officials are developing a list of joint essential medical capabilities that would be required in operational settings and could be regularly assessed.
Once the list is approved, the services will then collaborate to define individual skillsets that would be required across the spectrum of joint military operations, a House subcommittee was told.
“I’m hoping whether they ask for Army, Navy or Air Force, whatever the chairman [of the joint chiefs of staff] is looking for, it won’t matter because we are using the same codified skillsets,” said Joint Staff Surgeon Army Maj. Gen. Joseph Caravalho Jr, MD. “If we are truly interchangeable and one service is short a surgeon, for instance, using EMCs, we can look to another service and say, ‘You have met the standard, can you come in and fill it?’
In describing how the EMCs will be helpful, Caravalho gave an example of a general surgeon who goes on to become a plastic surgeon but will be needed as a general surgeon when deployed, although she might not have practiced in that capacity for many years.
“We track her as a competent board-certified credentialed privileged plastic surgeon and lose sight of the general surgery part,” he explained. “EMCs will say, ‘No matter where you are, when you deploy, have you met the skills and attributes we are looking for in a deployed setting?’” he explained.
The development of EMCs was recommended in last year’s Military Compensation and Retirement Modernization Commission report. It suggested that DoD clearly identify EMCs needed for its operational mission “taking into account the experiences during the last 13 years of war,” adding that “the military medical lessons learned during war must be preserved and improved upon whenever possible.”
The discussion of the EMCs took place during a hearing held by the House Armed Services Subcommittee on Military Personnel on the medical readiness of military medical providers. Lawmakers expressed concern about how military medical personnel are currently maintaining their skills, particularly trauma specialists.
“During periods of limited deployment, trauma skills can quickly degrade, which is why we must do everything possible to maintain proficiency in both trauma and emergency medicine,” said Subcommittee Chairman Rep. Joe Heck (R-NV). “It is crucial that military trauma teams have the proper patient volume and case complexity during times of limited deployment, so that they can maintain the skills needed in combat.”
Lt. Col. Jean-Claude D’Alleyrand, MD, chief of Orthopaedic Trauma Surgery at Walter Reed National Military Medical Center, Bethesda, MD, told lawmakers, meanwhile, of the challenges he faces in maintaining his trauma skills.
“It’s a problem that I have been struggling with for a number of years now,” D’Alleyrand recounted. “I do a number of things in order to maintain what I consider to be an acceptable level of proficiency. I spend two of the weekends of the month moonlighting at local trauma centers. I pay my own way to go to trauma courses, I teach trauma courses. I basically do everything I can just to maintain a certain level.”
Civilian Trauma at Walter Reed?
Heck asked whether it would help trauma physicians, such as himself, if Walter Reed National Military Medical Center were integrated into a civilian EMS system as a receiving facility for trauma patients, in a similar fashion to Madigan Army Medical Center and Brooke Army Medical Center.
D’Alleyrand told Heck that “without question” it would.
“If you look at any job, any skill you can think of — musician, professional athlete — you would never consider being excellent in a field by dabbling in a field,” D’Alleyrand responded. “The weekend athlete is, by definition, the weakened athlete,”
Opening Walter Reed to civilian cases, D’Alleyrand suggested, “at least gets the whole hospital ready for some level of trauma.”
Also testifying was Brig. Gen. Robert Tenhet, Army Deputy Surgeon General, who explained that the Army has already taken steps at a few smaller medical facilities to move military surgeons to locations with more higher-acuity cases.
“We are going to have to see more of that as we go forward to ensure that we have the training capability and … it’s even a challenge at some of the places we are moving them to,” Tenhet said.
Col. Linda Lawrence, MD, Air Force Special Assistant to the Surgeon General for Trusted Care Transformation, told legislators of the importance of Graduation Education Programs for the military.
“We have to maintain GME hospitals … if we ever consider removing GME, I believe that will be the death knell to our robust hospitals maintaining those lessons learned,” she told lawmakers.
Tenhet also emphasized the importance of GME programs and said. Army GME is the largest such platform in the DoD, supplying more than 90% of all military physicians for the Army.
“These programs are vital to our ability to recruit and retain highly skilled medical providers,” he said. “Most importantly, these programs are the primary means of transferring knowledge from this generation of military providers to the next.”