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Combat Medicine

March 29, 2003 at 12:00 AM EDT


SPOKESPERSON: Check for breathing! Tourniquet!

SUSAN DENTZER: The action was taking place thousands of miles from Iraq, but for these trainees, some of whom may soon be on their way to the front, this exercise seemed real enough. Almost real, too, was their patient– a $30,000 high-tech mannequin called Simman. This one was programmed to simulate a severely wounded soldier whose arm and leg were blasted off and spouted imitation blood. The medics struggled to treat the dying dummy, even as they came under enemy fire.

SOLDIER: Incoming!

SUSAN DENTZER: Despite their best efforts, Simman died.

SOLDIER: Incoming!

SPOKESMAN: All clear! All clear!

SUSAN DENTZER: Despite their best efforts, Simman died. (Taps playing)

SUSAN DENTZER: Afterward, we talked with medic trainee, Daniel Schipper. He’s one of about 400 now enrolled in this 16-week course at fort Sam Houston in San Antonio, Texas.

DANIEL SCHIPPER, Medic Trainee: I’ve received more than a wealth of knowledge of how to go onto a battlefield and safely bring the injured patients off and protect them at the same time. So as far as being deployed, I’m ready to go.

SUSAN DENTZER: To care for soldiers wounded in the war in Iraq, the armed forces are using a host of new techniques and technologies. Some are derived from the same advances in trauma care seen in civilian medicine, but others are based on lessons learned from earlier military conflicts in places like Afghanistan and Somalia. All this has produced transformations in combat medicine that previously hadn’t changed much since the Vietnam War. Army Col. Alan Morgan is an emergency physician who oversees the medic training at Fort Sam. He’s led an overhaul of the program over the past two years to beef up trainees’ skills. Morgan told us that a medic is not a doctor or nurse, but rather a kind of first-responder who moves with the troops.

COL. ALAN MORGAN: In a combat situation, a medic is the first person or the first medical individual to take care of the injured soldier — whatever the injury is, from a gunshot injury to the chest to an airway problem, making sure that the soldier is given prompt medical care instantly so that he is taken care of so that he can be moved back to get more definitive care.

SUSAN DENTZER: These trainees are mostly young and often have no or minimal medical knowledge. When they arrive at Fort Sam, they must first complete the same course civilians take to become emergency medical technicians, or EMT’s. Then they undergo intensive training in the more sophisticated skills they’ll need on the battlefield. Some of the material is taught with specially-developed computer software that challenges students to make critical-care decisions, then gives them feedback about the impact on the patient.

SPOKESMAN: We can set the level of debriefing to whatever level, more detail, more detail. It tells them everything they should have done, the things they did do that they shouldn’t have and it will actually tell them — gives them general guidelines to what they could do to make it better.

SUSAN DENTZER: Reporter: Before the overhaul of the training program, medics- to-be learned only from books and never worked with real live patients. Now they’re able to learn from human stand-ins, the dummies. The mannequins’ vital signs are controlled by laptop computer; mechanized lungs allow them to breathe. By practicing on them, the students learn such skills as the all-important ABC’s of trauma care– clearing airways, then checking for breathing and circulation.

COL. ALAN MORGAN: They actually leave the course right now and their first day on the ground could be in Afghanistan or Iraq and they’re expected to take care of wounded soldiers. And as you see in the news lately, there are wounded soldiers. And so, their actions depend if they live or die.

SUSAN DENTZER: Once on the battlefield, medics will also have sophisticated new tools to save lives. These include an army-designed tourniquet that can be used with just one-hand, and this bandage made from the compressed shells of shrimp. It fuses directly to red blood cells, sealing a wound shut and halting high-pressure arterial bleeding quickly. While the medic trainees learn about medicine, other personnel already trained to provide care are learning how to do so in combat.

This group at Camp Bullis in San Antonio, includes doctors and nurses; some new to the military, others already in the armed forces or reservists. Almost none have ever seen combat, but they’re now being acclimated to such common battlefield conditions as urban warfare. One training scenario is loosely based on the 1993 incident in Somalia, portrayed in the movie “Black Hawk Down.” Somalian fighters used grenades to down an army Black Hawk helicopter in the capital city of Mogadishu. Medics who rushed to the scene struggled to treat the wounded there against a barrage of enemy fire. That’s a typical response, but the wrong one, says army Lt. Katherine Fogelberg, she helps coordinate the course at Camp Bullis.

LT. KATHERINE FOGELBERG: With medical personnel, their first instinct when they come across a casualty is to immediately start to treat them. What they have to understand in that situation is the first thing they need to do is get those patients to safety and then they need to go ahead and start treating them.

SUSAN DENTZER: So here the doctors and nurses practice returning enemy fire with dummy M-16’s, then removing the injured to a safer location for treatment. After the exercise, air force pediatrician Dr. Cathy McElveen; she told us the training hammered home the stark contrast between combat medicine and her civilian medical training.

CAPT. CATHY McELVEEN: I don’t think anyone truly wants to be in a combat situation. You know, the first and foremost, the best way to treat patients is to have a secure area and not actually be fighting and not actually being in combat with people shooting at you. But you know, I’m ready to go over if they choose to send me.

SUSAN DENTZER: And on the deadly battlefields of Iraq, McElween and her colleagues might then be able to save at least some lives.