Page 28 - Journal of Special Operations Medicine - Summer 2014

Advanced Cardiac Life Support (ACLS) and Prehospi- “prolonged field care,” these skills would be especially
tal Trauma Life Support (PHTLS) courses were offered valuable. All military midlevel providers and physicians,
to the unit primarily responsible for providing staff to regardless of specialty, should have both the competence
the TMC. However, a particular challenge in the Reserve and confidence to handle critical patients, at least at the
and Guard setting is that physicians and medics only level of a paramedic. With this backdrop of war readi-
drill monthly. Medics may work daily in a field com- ness, the greatest military in the world should not rely on
pletely unrelated to medicine, and even on Active Duty, local civilian EMS to be its primary safety net.
the physicians and mid-level personnel who often staff
these facilities do not have emergency medicine training If the raison d’être for military medicine is summed
or experience. A study of endotracheal intubation in de- up as “To Conserve Fighting Strength,” taking care of
ployed Role 1 facilities—typically staffed with primary our Servicemembers in their hour of greatest need is a
care physicians and mid-level providers as well—found part of that. Not only can we provide initial stabiliza-
a significantly decreased success rate compared with tion until proper transport is possible, the authors assert
Role 3 facilities (TD Anderson, RL Mabry, P Allen, SL that handling relatively minor “emergencies” in a calm
Love, unpublished information). Taking an entire drill and collected manner within the geographically isolated
weekend away from staff with the myriad of administra- TMC presents a major cost savings versus civilian emer-
tive pressures and requirements on them to complete an gency care paid for by TRICARE.
ACLS course is difficult, to say the least. These person-
nel are often unlikely to obtain this training at their own
expense when they believe it does not relate to their daily Case Presentation 1 Conclusion
life as an automotive mechanic or family medicine PA. A 25-year-old female second lieutenant is assisted into
the trauma bay by clinic staff and her Soldiers. Her re-
This may be less of a challenge in the active duty setting, sponses to questions are slowed and she appears lethar-
where ACLS and PHTLS/TCCC training as a minimum gic. Her skin is moist and flushed. Your team quickly
should be mandatory for all medics and providers. Mid- disrobes the patient and places her in a gown. They ap-
level providers and physicians should take advantage of ply the cardiac monitor and pulse oximeter and obtain
the weeklong Tactical Combat Medical Care (TCMC) vital signs. Cardiac rhythm strip shows sinus tachy-
course offered at Fort Sam Houston. This course is spe- cardia: heart rate, 104; blood pressure, 128/78mmHg,
cifically intended for providers in the deployed Role 1 respirations, 24; Spo , 98% room air; and temperature,
2
setting and focuses on applying Advanced Trauma Life 99.8°F orally. An 18-gauge peripheral intravenous cath-
Support (ATLS) principles in a resource restricted envi- eter is placed in the right antecubital fossa on a second
ronment. Scenario-based training where the clinic staff attempt. Lungs and heart tones are clear, abdomen is be-
6
must function as a team during a mock resuscitation nign, and rapid neurological exam reveals no focal defi-
should be a matter of clinic routine. Refresher training cits. A 500mL bolus of lactated Ringer’s is given with
on procedures should be executed frequently. dramatic improvement in the patient’s mental status. A
12-lead electrocardiogram and urinalysis to include hu-
man chorionic gonadotropin is negative. The patient is
Discussion
observed for 2 hours of oral rehydration until urinating
While work remains to be done, the Camp Blanding clear and is discharged to her unit with light duty re-
TMC is now far better prepared for the regular stream striction. As your patient departs, the staff are bringing
of urgent and emergency patients who present to the fa- a Soldier with a bandaged hand into Exam Room 1…
cility. These lessons could and should be applied to other
geographically isolated Role 1 type facilities. The equip- This single case—often repeated—illustrated not only
ment and supplies to accomplish these tasks are rather achieving the patient-focused care military medicine es-
minimal when the scale is only indeed just one “emer- pouses but also supported the overall mission of the unit
gency room.” Similar points could be made for even while saving TRICARE the substantial sum potentially
those facilities that are close to major MTFs, where the incurred with a civilian emergency department visit. Key
equipment could take the form of a single “emergency points from this article are summarized in Table 2.
cart.” Even at major installations, EMS response may be
delayed in certain instances and clinic staff must be pre-
pared to manage a critical patient for up to 20 minutes. Acknowledgments
Mass casualty situations may require any medical facil- The authors would like to acknowledge SGT Kristopher
ity—regardless of location—to perform outside its com- Stone for his longstanding and unwavering labor to
fort zone. Training investment in emergency care is never provide quality medical care to the personnel at Camp
a waste, keeping providers and medics sharp for their Blanding. CPT Gregory Horn, 2LT Seth Grubb, 2d Lt
“war mission” role during deployments. In the setting of Benjamin Fedeles, 2LT Keith Groshans, 2LT Richard

18 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014