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Walter Reed Bethesda, USU Host Trauma Symposium


By Bernard S. Little

WRNMMC Public Affairs

Walter Reed National Military Medical Center, in partnership with the Uniformed Services University, hosted the 2017 Trauma Symposium in the National Intrepid Center of Excellence Auditorium March 30.

The American College of Surgeons certified WRNMMC as a Level II Trauma Center in 2013, acknowledging it capabilities to initiate definitive care for all injured patients. Elements of Level II Trauma Centers include 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. In addition, the Level II Trauma Center provides trauma prevention and continuing education programs for staff, as well as incorporates a comprehensive quality assessment program.
“We have, over the last 14 years, developed a trauma system within military medicine that is absolutely phenomenal, and [it] has had great success,” said WRNMMC Director Army Col. Michael S. Heimall. He explained it’s essential the military trauma system maintains this proficiency despite the current “lull in kinetic activity” and decline in combat casualties, “because it is going to spike again.”
“We’re going to enter a new paradigm,” Heimall continued. He said for the last 14 years, during the better part of the war in Iraq and Afghanistan, it has taken an average of 26 minutes to get a combat casualty from the point of injury to operative care. “If we got the patient [to that care] in 26 minutes to under an hour, the patient had [about] a 97 to 98 percent survival rate…the highest ever during a war.
“The next place we go fight, we’re not going to have that luxury [to evacuate casualties quickly to more advanced care],” Heimall said. He explained this will require health-care professionals to become even more innovative in order to provide exceptional trauma care in situations where the environments may be even more remote and austere, or the U.S. military and its allies do not possess the air superiority to easily evacuate casualties for higher levels of care.
Such situations will also require effective leadership, and keynote speaker at the symposium, retired Brig. Gen. (Dr.) Luis Fernandez, stressed leaders must set the example for the teams, not only by what they say, but also by how they conduct themselves, what they do and how they are perceived by others. “You need to know who your people are, and you need to be looking out for them,” said the general, who specializes in trauma surgery and surgical critical care. As commanding officer of the Texas State Medical Brigade, he was instrumental in ensuring that evacuees of hurricanes Katrina, Rita, Gustav and Ike received excellent medical care in special needs shelters manned by Texas State Guard Soldiers.
He explained two important principles of leadership are to “know your job and have a solid familiarity with your subordinates’ jobs,” and “search for ways to guide your organization to new heights.” Also, “when things go wrong, do not blame others. When you win, the team wins; when you lose, the leader takes the blame, not the team. Internally, you can critique [a team member], but to the outside world, the leader takes the blame. That’s your job.”
Maintaining a sense of calm, especially when situations may be dire, such as in the operating room if a patient crashes, is also important for leaders, Fernandez added. “If you lose it, the whole team could lose it.”
Guest speaker at the symposium, Dr. Thomas Scalea, physician-in-chief at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore, explained emergency medicine, as an independent medical specialty, is relatively young with trauma becoming a specialty during the 1990s when people were formally trained to provide that care. Prior to that, emergency departments were generally staffed by physicians of various specialties on staff at the hospital on a rotating basis.
Scalea now trains a number of residents from WRNMMC at the University of Maryland Shock Trauma Center. During the symposium, he discussed operative management of complex liver injuries, explaining “hesitation and loss of composure kills” in such trauma cases. “We are training a generation of surgeons who have done very few big liver cases, [which] is neither bad nor good. Future generations will use damage control more often than I would. This evolution may be associated with increased survival, but likely more frequent and different complications.”
Several additional topics discussed during the symposium included challenges in implementing ideal spinal cord injury treatment paradigms downrange; treating casualties of the Syrian Civil War; thoracic approaches and incisions; best practices in managing patients with an open abdomen; indications for operative rib fixation; bring precision medicine to the critically ill; the Department of Defense Trauma System; transforming surgical training with simulation; and male fertility and andrology issues with combat genitourinary trauma warriors.
Heimall said his hopes are the trauma symposium expands to include more medical facilities and institutions globally. He added this was one of the first symposium live webcast out of the medical center to other health-care facilities, and providers, including NATO partners from around the globe who signed up and took the assessments following the topics, could receive continuing education credit.