Page 156 - Journal of Special Operations Medicine - Spring 2017

medicine. And my observation is that some do and more are solvable. But the benefit is special, the quality of care
are following. compares favorably with the best systems in the nation,
and we have the readiness capability to protect that first
Do you think that military medicine as a whole casualty.
has learned anything of value from the Special
Operations community during recent combat The military, and especially the Special Operations
operations? community, is likely to be deployed into increasingly
Certainly. The experience of combat care and healthcare austere environments that lack the robust medical
support in small isolated units has been a valuable les- care and evacuation systems that existed during
son that I believe has been applied as large field facilities the Iraq and Afghanistan wars. How should
have morphed into the small highly mobile units that in- military medicine respond to best support our
creasingly rely on frontline providers as well as the basic Servicemembers in those remote regions?
survival skills of each Operator. We would be highly un- Military medicine must hold as its first principle a high level
likely to have advanced so far so fast without the model of of medical readiness. When Warriors go out the door to
Special Operations Forces. defend our nation, capable and just as well-trained med-
ics must go out that same door to defend them. Period.
Tactical Combat Casualty Care has significantly That is the Alpha and Omega of military medicine.
contributed to reducing battlefield mortality. What,
if any, impediments do you see to TCCC principles Is there anything else that you would like to share
being used by law enforcement, fire, and emergency with our readers?
medical services (EMS) responders during tactical Yes. I am proud that I was drafted and had the good sense
incidents such as active shooter events in our nation? to ditch my antimilitary attitude and spend my entire pro-
I have always seen TCCC as an enhanced set of EMS skills fessional career caring for those who care for America. All
for the specific circumstances of prolonged care in aus- who serve in any branch of military medicine can be justly
tere environments and/or under direct kinetic conflict. proud of themselves and their organizations. And we
Most civilian EMS care lasts moments to a few hours and, should remember that each of us owes any success to the
only in the rarest of cases, under fire. That may change as giants who went before and brought us up to their stan-
the world becomes increasingly unstable. dards. There is no other healthcare organization like it.

Further, having the skills for the rare occasion adds a level And as I continue to serve in my small way as director of
of value to any emergency response system. So . . . the AMSUS, I note that even on retirement, we never take off
short answer is, yes. I see the value. Through the eyes of a the uniform entirely. . . .
cost-constrained EMS department, I expect implementa-
tion to be less than universal.

What do you see as the greatest challenge facing
military medicine now and in the future?
The biggest challenges for military medicine today are
the efforts of Congress, among others, to impose dra- “Sending Charlie Papa” are the signal flags that have
matic and drastic changes on a system that is already flown from every US naval hospital since 9/11/2001. “Char-
working very well. lie Papa” translates into “steaming to assist,” signifying a
ship running on all burners to provide relief. These flags
Through 15 years of war, the cost of the Military Health were run up the Navy Bureau of Medicine and Surgery
System/TRICARE program has grown as a grateful Con- flagpole within hours of the attacks on that fateful day and
gress added benefits and categories of benefits to the have since flown worldwide to emphasize the mission to
system. Now that the guns have (temporarily) stopped fir- every hand every day.
ing, the system they built looks too expensive to the same
Congress and even to many leaders in the Pentagon.
The opinions or assertions contained herein are the private
Military medicine now must again effectively remake its views of the author and are not to be construed as official or
case for its value proposition. Military health systems as reflecting the views of the Department of the Navy or the
have their problems and weaknesses to be sure. These Department of Defense.

132 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017