Says Poor Communication With Civilian Counterparts Is Everyone’s Loss
In Nov. 2020, U.S. Air Force 1st Lt. Mary Elizabeth Frederick, a clinical nurse assigned to the 96th Medical Group, stationed at Eglin Air Force Base, Fla., disinfects personal protective equipment after providing care to COVID-19 patients at Sanford Health Bismarck in Bismarck, N.D. She, along with approximately 60 servicemembers, is worked jointly with the U.S. Army and civilian hospitals to assist in the mitigation of COVID-19. U.S. Army photo by Maj. Chad Brink
ATLANTA — A new Special Communication in JAMA Network Open decried that military medicine’s contribution to healthcare advances often are overlooked and that not enough communication occurs between civilian and military clinicians.
“Although innovations developed by military medicine regularly inform and improve civilian health care and public health, the architects of these advances and the methods they use are often overlooked,” wrote Arthur L. Kellerman, MD, MPH, of Emory University and colleagues Ross S. Kotwal, MD, MPH, of the Defense Health Agency’s Joint Trauma System at Joint Base San Antonio-Fort Sam, Houston, TX, and Todd E. Rasmussen, MD, of the Mayo Clinic in Rochester, MN. “Enhanced communication and cooperation between our nation’s military and civilian health systems would promote reciprocal learning, accelerate collaborative research, and strengthen our nation’s capacity to meet a growing array of health and geopolitical threats.”1
The commentators described how military medicine in the United States was “established to treat wounded and ill servicemembers and to protect the health and well-being of our military forces at home and abroad.” Accomplishing those tasks has led to the capacity “to rapidly adapt to the changing nature of war and emerging health threats; throughout our nation’s history, innovations developed by military health professionals have been quickly adopted by civilian medicine and public health for the benefit of patients in the U.S. and around the world.”
The articles included examples of how military medicine has advanced civilian healthcare and public health, even though its research and development differs. “During the conflicts in Afghanistan and Iraq, military medicine’s focused approach to performance improvement and requirements-driven research cut the case fatality rate from severe battlefield wounds in half, to the lowest level in the history of warfare,” the authors pointed out.
The impact of military medicine has been notable since the founding of the republic, according to the article, which advised that, within months of the founding of the United States, in January 1777, Gen. George Washington directed that the Continental Army be inoculated against smallpox. “It was the first time in history that an army was immunized by command order. Shortly afterward, in a letter to William Shippen, MD, Washington offered the following explanation for his decision: ‘Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army in the natural way and rage with its usual virulence, we have more to dread from it than from the sword of the enemy.’ Washington also instituted policies on camp cleanliness and other preventive medicine measures to preserve his army’s health. These principles still guide military medicine today,” the authors wrote.
Significant contributions from military medicine have continued until the present time, according to the articles. “Less than a month after China first reported a cluster of flulike illnesses in Wuhan, the USS Theodore Roosevelt, a nuclear-powered aircraft carrier, was hit with a large-scale outbreak of the COVID-19 infection,” according to the commentators. “The Navy’s swift response, and the epidemiologic investigation that followed, produced early insights about disease symptomatology and transmission among young adults.”
In addition, when the pandemic hit the United States, many military doctors, nurses, medics and other healthcare professionals were repeatedly deployed to come to the rescue of overwhelmed civilian hospitals—some did that five or six times over a 2-year period.
“Most notably, in May of 2020, the DoD contributed a 140-person military team of vaccine, logistics, and contracting experts to augment those assembled by the US Department of Health and Human Services (HHS) Assistant Secretary of Preparedness and Response to launch Operation Warp Speed,” the authors explained. “Under the leadership of Gustave F. Perna, a 4-star Army general, this joint DoD/HHS team ensured that safe and effective vaccines, diagnostics, and therapeutics reached the public in record time, potentially saving more than 1 million lives.”
The article also cited “vital contributions to the basic sciences as well. Military laboratories, including the Walter Reed Army Institute for Research, the Naval Medical Research Center, the U.S. Army Medical Research Institute of Infectious Diseases, and a network of military laboratories around the world have long been global leaders in the fight against high-impact infectious diseases, including malaria, dengue fever, Ebola, and HIV/AIDS. While on active duty in the medical corps of the U.S. Navy, Carl June, MD, made important discoveries that paved the way for his later development of chimeric antigen receptor T-cell therapy.”
Yet, the authors argued that military medicine and its practitioners have failed to receive the credit they deserve, noting, “Despite this remarkable track record, military medicine’s value to civilian health care is often overlooked. For example, election to the National Academy of Medicine is supposed to recognize individuals for outstanding achievements and commitment to service. Of the more than 1,800 members inducted into the Academy since 2000, only 7 (less than 0.4%) are former military health professionals.”
They suggested that a difference in culture accounts for the disparity.
“Civilian institutions tout the achievements of their stars to garner prestige, research grants, and patients,” the authors noted. “The military prioritizes teamwork and service above self. Military promotions are tied to demonstrated leadership, not numbers of research grants or publications. When military authors submit manuscripts to civilian journals, they are often told that their work is too specialized for the journal’s readers. The resulting lack of visibility hinders the exchange of knowledge and may discourage some students from considering a military health career.”
They also pointed out the political consequences of limited visibility, writing, “In contrast to marked growth of spending on veterans’ health and US health care overall, funding for military health has been flat for 10 years.”
One solution, according to the special communication, is the military-civilian partnerships that have been established to help sustain the clinical skills of military physicians, nurses and other health care professionals. “Expanding such partnerships would strengthen readiness, increase academic output, and promote reciprocal learning.”
Calling the Mission Zero program, which embeds military trauma professionals in civilian trauma centers and was recently launched by the Department of Health & Human Services, “promising,” the authors urged state governments to ease licensure requirements for military healthcare professionals assigned to civilian hospitals and allow more military hospitals to participate in civilian trauma systems.
“Specialty societies can play an important role. The American College of Surgeons has led the way by forging a formal alliance with the military health system,” they emphasized. “Others should follow its lead. Journal editors should publish high-quality military health research. In July 2023, the National Academy of Medicine informed its members that it is adding veteran status to the descriptors it monitors to measure diversity. It should do the same for nominees. This would increase the likelihood that outstanding service members, past and present, are fairly considered for membership.”
The authors cited a paper about Mission Zero stating that military and civilian trauma care and learning will be optimized together, or not at all, and added, “The same can be said for civilian medicine and public health.”
- Kellermann AL, Kotwal RS, Rasmussen TE. Military Medicine’s Value to US Health Care and Public Health: Bringing Battlefield Lessons Home. JAMA Netw Open. 2023;6(9):e2335125. doi:10.1001/jamanetworkopen.2023.35125