Page 24 - Journal of Special Operations Medicine - Summer 2014

Preparedness for Resuscitation at a
Geographically Isolated Army Troop Medical Clinic:

Lessons From Camp Blanding, Florida

Nicholas M. Studer, MD, EMT-P; George W. Horsley, PA-C; Dan C. Godbee, MD

ABSTRACT
Introduction: Many Servicemembers rely on non deployed Introduction
Role 1 facilities, such as troop medical clinics, as their Many active duty personnel rely on dispersed battalion
primary source of healthcare. At geographically isolated aid stations, sick bays, and troop medical clinics (TMCs)
military installations, these facilities are the “only game for their primary source of healthcare. In the Reserve
in town” for medical care. Servicemembers may present and Guard component, healthcare available during inac-
to these facilities with emergent conditions, regardless tive duty and annual training periods may be their only
of designed intent of the facility or the wishes of staff. contact with the medical profession. Many military med-
The U.S. Army Troop Medical Clinic, Camp Blanding ical providers have noted that reservists will often pres-
is such a facility. Methods: The clinic was reorganized ent with chronic complaints because they have nowhere
with a 5S approach, streamlining supply, equipment, else to be seen. Additionally, some of these facilities—es-
and workflow processes. This was accomplished to pecially on Reserve and Guard training sites—are geo-
allow the facility to not only improve its general de- graphically isolated far from larger military treatment
livery of care but also ensure capability to handle at facilities (MTFs) or sources of civilian emergency care.
least one medical or trauma resuscitation. Equipment,
disposable supplies, documentation, and staff training Many facilities without a dedicated emergency medicine
were addressed. Results/Discussion/Conclusion: Despite service believe that emergency patients should “know
facility intention, lack of supplies/equipment, or staff in- better” than to come to their facility. The 6th Medical
experience with emergency care, an acute ill or injured Group clinic at MacDill Air Force Base goes as far as to
Servicemember must be stabilized at the nondeployed post “No Emergency Services” on its welcome signs in
Role 1 facility while awaiting transport to a higher level the parking lot. Sometimes it is difficult for healthcare
of care. This expectation is the same as that of deployed workers to identify those at risk for sudden decompensa-
Role 1 facilities. A cost-savings can also be realized when tion; it is harder still for laymen. While we may hope as
minor “emergencies” are handled in-house. hard as we can, a worried “battle buddy,” “shipmate,”
or “wingman” will seek help wherever they can find it.
Keywords: aid station, troop medical clinic, sick bay, re- The lay public—including the line personnel we sup-
suscitation, emergency medicine, primary care, National port—has an expectation that all medical personnel have
Guard, rural medicine, sick call at least some basic capacity for handling emergencies.
Army Regulation 40-3 requires that “all MTFs will, dur-
ing routine hours of operation, have the capability to de-
termine if a patient care emergency exists and to initiate
Case Presentation 1
life and limb saving measures before providing definitive
It is 1430 in the U.S. Army Troop Medical Clinic at treatment or transporting the patient for definitive treat-
1
Camp Blanding, FL. You and your staff cleared the fa- ment.” The other services have similar requirements.
cility of the morning’s sick call patients and are engaged
in administrative work. An Army captain bursts through The McWethy Troop Medical Clinic at Fort Sam Houston
the front door of the facility and shouts to the reception is located less than 2 miles from the front door of the San
desk, “I have a heat casualty in the car; can you take Antonio Military Medical Center (SAMMC) emergency
her or do we need to drive to the ER in Starke?” You department and is across the street from the post’s main
tell him to bring the patient inside and page staff to the emergency medical services (EMS) station. In this situa-
trauma bay via the intercom. tion, it is reasonable for a TMC to provide a lower level

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