SAN DIEGO—During his first deployment as part of Operation Desert Storm in 1991, Dana Covey, MD, noticed a gap between the injuries that were occurring on the battlefield and the ones that forward surgical teams were most equipped to handle. Namely, he recognized that most battlefield injuries occur to the extremities, but medical teams were not well-equipped for that type of surgery, being more concerned with the life-threatening injuries to the chest and torso.
As an orthopedic surgeon—one who would go on to eventually chair the Department of Orthopedic Surgery at the San Diego Naval Medical Center and serve as senior orthopedic consultant for the Navy—the disparity concerned him.
At the beginning of the wars in Iraq and Afghanistan, Covey’s concern began to be shared by all military surgeons working near the frontline. Thanks to superior body armor, soldiers were surviving their injuries in greater and greater numbers but were faced with the still-numerous extremity wounds.
“People who previously died due to wounds to their thorax and abdomen are now living, but their extremities are still mangled,” explained Covey. “So what you had is a change in the epidemiology [of war wounds] over time. That prompted me to get involved in some committees and some initiatives to improve the treatment of those injuries on the battlefield.”
Covey retired from active service in 2015, but, during his 40 years in the Navy, he helped pioneer a number of innovations in how orthopedic care is delivered in military and disaster zones that are still in use today.
During his time as consultant to the Navy surgeon general, Covey set out to address the issues he saw during his Desert Storm deployment. “What we found was that initially the surgical teams didn’t have the orthopedic expertise to treat these injures that they were seeing,” Covey explained. “We reconfigured the equipment load-out and personnel manning for Marine and Navy far-forward surgical teams so that they were able to do emergency surgery and then ship the [patient] out on a medevac.”
The major part of that reconfiguration came with changing the Authorized Medical Allowance List to include enough supplies to treat the extremity injuries they were seeing. “It was about making sure the right stuff was in those cans,” Covey said. “Once we were overseas, there wasn’t much that could be done about it.”
Because he was in regular conversation with orthopedic leaders in the other services, Covey was also able to help standardize those AMAL containers so that all the services were using the same type of equipment. A servicemember injured on the battlefield might be treated at a Marines far-forward surgical base, then be flown to the Army base at Kandahar, Afghanistan, then to the Air Force base at Landstuhl, Germany, before being shipped back stateside.
“In a short amount of time, a servicemember sees a lot of facilities and services,” Covey said. “It’s helpful to have all those places use standardized equipment.”
Not all of Covey’s contributions were given the benefit of such lengthy planning. Covey was stationed at a Marine base in Okinawa, Japan, in the early 2000s. The 7th Fleet was about to embark on a top secret mission where they would be deployed to fight a group related to al-Qaida. Demonstrating that necessity really is the mother of invention, Covey and his colleagues were tasked by their commanders to prepare a transportable suite that could a small destroyer surgical capability.
“We got the call the day before,” Covey said. “We needed to put something together to be ready to embark on the ship by midnight.”
They made the deadline, the mission was a success, and the suite of equipment was used to successfully perform surgery on a ship that, the day before, did not have surgical capability. The team eventually developed the suite formally, creating what is essentially a large box of surgical equipment that can be lifted onto a ship with a crane. A variation is available for lighter ships where the equipment is carried on in bags. This Expeditionary Medical Support System is still in use today.
While he’s retired from the Navy, Covey still teaches at the University of California, is a practicing surgeon at the San Diego VAMC and has a hand in a number of projects on war wounds and orthopedics. So he’s still thinking about how he can help soldiers wounded on the battlefield.
One of his next big challenges is figuring out how to prevent soldiers from bleeding to death before they reach help. “Troops all carry tourniquets with them that they can use to stop bleeding. The problem is the deaths are coming when the injury occurs at the junction of your shoulder or your thigh where you can’t get a tourniquet around,” Covey explained. “That’s the big challenge right now. They have to be seen very, very soon or they bleed to death.”