Program boosts troops' health care

Civilian doctors teach treatment of severe injuries

By Bill Scanlon, Rocky Mountain News (Contact)

Friday, December 28, 2007

Moore spent two weeks at hospital in Germany.

When the conflicts in Iraq and Afghanistan began, trauma doctors in cities like Denver were years ahead of military surgeons in knowing the best way to treat severe injuries.

But now, thanks to a program that brought civilian soldiers to an overseas military hospital, the military surgeons are doing work on a par with the best U.S. trauma centers, says a Denver chief of surgery.

"The military surgeons learned incredibly advanced techniques from the civilian surgeons," said Dr. Ernest Gene Moore, chief of surgery and trauma services for Denver Health Medical Center, who spent two weeks last year in the trauma center and intensive- care units at the Landstuhl Regional Medical Center in Germany. Landstuhl is where badly injured U.S. soldiers are flown, before they are returned to the United States.

Moore is the lead author of an article, "Military-Civilian Collaboration in Trauma Care and the Senior Visiting Surgeons Program," in this week's issue of the New England Journal of Medicine.

"What I saw was truly outstanding care for injured soldiers," added Moore, who helped inaugurate the Senior Visiting Surgeons Program. "Families should be reassured that their sons and daughters are provided the best care available."

That certainly wasn't the case 41/2 years ago, when the U.S. launched its attack on Iraq, Moore said.

Back then, military surgeons worked mostly on retirees or their spouses at Veterans Affairs hospitals - a car accident here, a chest wound there.

The real action was in urban trauma centers, where gang shootings and traffic accidents made ERs standing-room-only affairs on Saturday nights.

Suddenly, in 2003, the military doctors were dealing with soldiers who were blown up by improvised explosive devices, then burned, then perhaps shot at by snipers before they could reach safety.

Urban trauma centers had been using a concept called damage-control surgery for more than a decade, but it was foreign to the military hospitals, Moore said.

The idea, with a severely injured patient, is not to try to stitch every artery, valve and wound back in place in one giant surgical intrusion.

Instead, they do the surgeries that are urgent, but then use vacuum packs, clips or other devices to stabilize the patient until he or she is strong enough to undergo follow-up surgery.

For example, plastic tubes can be used as temporary replacements for arteries "instead of taking the time to harvest veins," Moore said. "Instead of spending time in the operating room finding every place where an abdomen is bleeding, place (vacuum) packs on the abdomen" to temporarily stop the bleeding, then close the abdominal wall later.

"It's absolutely saving lives," Moore said. "The injuries resulting from these IEDs are astounding."

Civilian doctors also taught their military counterparts how to safely use a blood-clotting agent, originally developed for hemophiliacs, to stop multiple bleeds.

Moore last year taught military doctors how to vacuum-pack a massively bleeding pelvis, instead of using time-consuming measures to control bleeding.

Military doctors had plenty to teach the civilians as well.

"The military has really developed some incredibly efficient triage and transport systems" for when dozens of soldiers are injured at once, Moore said.

"They would be highly appropriate for us in the event of terrorist events or other mass casualties," Moore said.

"At Denver Health, we're always preparing for the possibility of a terrorist attack. By combining trauma systems - military and civilian - and learning from each other, we can improve outcomes for all injured trauma patients."

scanlon@RockyMountainNews.com or 303-954-2897