Military Medicine

     Col. Patricia R. Hastings has had a long and diverse career as a healthcare provider. After graduating Iowa Methodist School of Nursing and Drake University in Des Moines, she worked as a paramedic and registered nurse, then entered the Army in 1983 after completing medical school at the University of Osteopathic Medicine and Health Science in Des Moines. Dr. Hastings completed her residency in emergency medicine at Fort Hood, TX, in 1986 and completed follow-on assignments as chief of the emergency departments at the 98th General Hospital at Nuremberg, West Germany, and Darnell Army Hospital. She was selected for a disaster medicine fellowship at Madigan Army Medical Center, Fort Lewis, WA, and received an MPH degree at the University of Washington. Upon completion of the fellowship, Col. Hastings served as chief of Madigan's Disaster Assistance Response Team (DART). She responded with the FEMA Puget Sound Urban Search and Rescue Team to the Northridge, CA, earthquake, Oklahoma City bombing and the 1996 Olympic bombing in Atlanta. While on this assignment, Colonel Hastings was also medical director for the Pierce County (WA) American Red Cross and Tacoma Community College's paramedic program.

     Colonel Hastings was deputy commander of clinical services at Irwin Army Hospital, Fort Riley, KS, where she was responsible for medical services at the Army's first Warfighting Training Center. She served as director of the Department of Combat Medic Training, which trains more than 8,000 soldier medics a year.

     She is currently director of the U.S. Army's Emergency Medical Services division, which is responsible for more than 59,000 medics on Army posts throughout the world.

     What is "military medicine"?

     Military medicine is a special brand of medicine that encompasses humanitarian and disaster response, austere medical and trauma care in conjunction with the routine care of the soldier "athlete" and his or her family. All specialties are represented in military medicine, but there is a special need for those who understand emergency and prehospital care. A huge part of military medicine is the combat medic (aka 68W). Most of their time is spent providing care directly to soldiers and at the point of wounding. Their skills and special talents bring back patients (both soldiers and civilians) instead of victims. There are 39,000 68Ws in the Army (active, Guard and Reserve).

     In the past, you responded with the military to "civilian" disasters and experienced some degree of interaction between civilian and military EMS units. Was this interaction positive, and what lessons can be learned for future responses?

     In a disaster, the uniform makes little difference. Communication is the critical "center of gravity." The interaction is very positive. Lessons learned are:

• Prior planning (and introductions, i.e., knowing your colleagues/trust) makes the response much easier.
• Don't have only a "paper plan." (In the words of Gen. Dwight Eisenhower, "It's not the plan; it's the planning.")
• Have a basic understanding of agencies' (your agency and all other agencies that may potentially respond) abilities, and understand that disasters have unique needs/requirements.
• Support each other (e.g., the military provides evacuation for ill civilian responders).
• Share information about the situation (e.g., how many and where are the injured; what is needed...food, shelter).
• Understand jurisdictional issues (Who is in charge? Fire? Police? Federal?). The military is a support element in most disasters (foreign and domestic).
• Be able to practice modular expansion and contraction of response.
• Train together.

     There are certain necessary skills needed to turn the above from theoretical into reality. These include: systemic thinking or the ability to consider alternatives to what may have been the original plan; the ability to think and plan strategically; having communications skills and capability to clarify issues; the ability to identify problems in advance.

     Everyone must also understand resource management and have command of the incident command system and triage.

     Can you give us some idea of treatment modalities or equipment the military is currently utilizing that may find their way to civilian EMS units in the next few years ?

     Some of the treatment modalities and equipment I mention have been on the Army's "drawing board" for a while, and some have been pushed to the forefront of our collective thinking by actions overseas. They include the resurgence of tourniquet use for severe bleeding; overall use of hemorrhage control agents; development of austere medical protocols for use by civilian agencies; advancement in both prosthetics and rehabilitation medicine; new understanding of how to train in simulated environments; and more interagency training.

     Raphael M. Barishansky, MPH, EMT-B, is program chief of Public Health Preparedness for the Prince George's County (MD) Health Department, and a member of EMS Magazine's editorial advisory board. Reach him at rbarishansky@gmail.com.