Winning is the science of being totally prepared

by U.S. Medicine

December 8, 2011

Editor-in-Chief, Chester ‘Trip’ Buckenmaier III, MD, COL, MC, USA

When this issue of US Medicine reaches our readers, we will be well into the holiday season and drawing 2011 to a close. Like many, I often find myself using this time of year to reflect on the previous 12 months, new directions, challenges, successes and failures. It would be hard for any federal-medicine practitioner not to pause and reflect on marking the 10-year anniversary of 9/11 this past September. So much of my life, professionally and personally, has been defined by that event.

It was no small shock when I realized the United States has been in continuous conflict for more than half of my military career. The wars in Iraq and Afghanistan have been the longest in our nation’s history. I was at the end of my professional training at Duke University as a fellow in acute-pain medicine and regional anesthesia when the planes crashed into Twin Towers, the Pentagon and the field in Stonycreek, PA. My professional activities have been molded and defined by those events ever since.

To many federal-medicine practitioners who deal routinely with the horror and tragedy that armed conflict brings on human lives, war is humanity at its worst and should be avoided with the utmost vigor of our intellect and faculties. Nonetheless, the political reality of war is real, and the role federal medicine plays, “to support and defend the Constitution of the United States against all enemies, foreign and domestic,” is honorable and vital to our nation’s freedom. War is a catalyst for change, and perhaps nowhere in the field of human endeavor is this change more apparent and positive than in the field of medicine.

I have committed the sin of pride many times within this column and will do so once again. I have been amazed at the accomplishments of federal medicine in responding to two conflicts half a world away, yet achieving an extraordinary statistic: Fewer than 10% of wounded warriors die as a result of their wounds.

All of this has been accomplished by volunteers to the federal medicine system responding to an unprecedented type of warfare – global insurgency. Advancements in our understanding of post-traumatic stress, traumatic brain injury, and pain management will revolutionize the way medicine is practiced in this country in the 21st century. The military-trauma management and evacuation system has been a tremendous success story in medical coordination of care and logistics. If anything positive can come from war, the great strides forward by federal medicine surely are on this short list.

‘Winning is the science of being totally prepared.’ Cont.

The investment made by our military in providing the best medical services possible for our warriors is inspiring. After a decade of conflict, federal medicine is not resting on its laurels but continues to refine and improve its global system of care. I recently had an opportunity to serve as a physician consultant to a medical-war gaming exercise designed to challenge the next medical-command staff being deployed to Afghanistan. The exercise involved demanding scenarios developed from real-world incidents. The deploying staff managed each scenario under the scrutiny of experts from every aspect of deploying medical care, from logistics to public affairs. What a tremendous opportunity for these leaders to meld as a medical-battle staff prior to taking control of the “real deal.”

I extend my congratulations to the military medical leaders who have developed this exercise for deploying command elements. Any leader involved in an exercise of this type will immediately see the intrinsic benefits from this type of preparedness training.

I did have one persistent, unsettling thought throughout the exercise. As a student of history, I can say with some certainty that the next war to challenge our federal system of medicine will be nothing like the current conflicts. I have always been concerned that our medical response tends usually to be based on assumptions rooted in the medical lessons of the previous war. Since the Korean conflict, we have had the technological edge and the assurance that our air and sea lanes are free of molestation as we faced our enemies. I think it is fair to say that our present, incredible wartime medical response has, at its foundation, the assumption that the American military will always have uncontested control of movement in and out of the battle space. Will that always be true? Can we assume such freedom of medical supply and evacuation capability in a true, peer-to-peer conflict? Will we be ready to medically respond and meet or exceed our “ less than 10% died of wounds” success with a sudden change in the present conditions we take for granted in battlefield medicine?

George Allen’s understanding of the need to be prepared for anything allowed him never to coach a pro football team to a losing season in 14 seasons. We can be justly proud of our medical record in the present conflict; let’s be sure to be prepared for whatever challenges are revealed in the next conflict.

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