Deployed Military Medics Reassured Their Effort Have Positive Impact
Every week for more than seven years, the Joint Trauma System headquartered at the U.S. Army Institute of Surgical Research has held a worldwide video teleconference led by trauma surgeons and specialized trauma nurse coordinators to discuss the intricate processes of care for those injured in the wars in Iraq and Afghanistan. Recently, military medics deployed in support of Operation Enduring Freedom held a different type of VTC -- this one linking a broad range of medical staff at a deployed hospital in Afghanistan to a recovering wounded warrior, the operations officer from the Warrior in Transition Battalion, and nurses specialized in outcomes research all back at Fort Sam Houston, Texas. This first-of-its-kind VTC was designed to reassure deployed medics involved in the challenging mission of caring for devastating injuries that their efforts are worthwhile and to provide them a "fast forward" look at the results of their effort.
In most cases Airmen, Soldiers and Corpsmen at downrange surgical facilities care for troops for only a short period of time ranging from hours to a few days before patients are transported out of theater. As such, medics in the deployed setting have limited opportunity to interact with wounded troops and, in most cases, never see them after they are evacuated out of the theater of war. The challenges and stresses associated with stabilizing such severely injured patients can at times leave the medical staff questioning the effectiveness and value of their efforts. Additionally, deployed medics naturally question the eventual outcome of patients having incurred such severe injury. In an attempt to allay these concerns and to answer questions related to patient-centered outcomes, the VTC was coordinated for members of the medical staff at the Craig Joint Theater Hospital and the 455th Expeditionary Medical Group, which is a level III combat casualty care facility at Bagram Air Field, Afghanistan.
With support from the 59th Medical Wing Chief Scientist's Office at Lackland Air Force Base, Vascular Injury Research Nurse Coordinators, April Ames-Chase and Andrea Russell, teamed up with medics at CJTH to coordinate the novel exchange. The event was conducted so that deployed medics could ask specific questions of a wounded warrior recovering from severe injuries and the WTB operations officer.
"My main objective was to let the deployed medics know that what they are doing is very important," said Ames-Chase.
"Are your efforts worth it? Yes," said Staff Sgt. Daniel Fye, over the VTC link to the assembled audience at CJTH.
Fye is an Air Force explosive ordnance disposal specialist who lost his left leg below the knee and suffered severe damage to his right leg in May 2011 when he stepped on an improvised explosive device. He offered words of kindness to the audience of emergency and operating room personnel as well as medics from the ward and intensive care unit at the 455th EMDG,
"You gave me the opportunity to come back home to my family," said Fye. "Yes, it has been difficult for the past year, but I'm with my four kids and wife and that's because of what you did for me there."
Fye vividly recalls the day of his injuries. He was aware of what happened to him and what needed to happen in order to survive and make it back to his family.
"I knew that if I could just get back to the base, I'd be all right." he said.
Prior to deploying, Fye had read about the high survivability rate of wounded warriors during this conflict. It was something that he and the other EOD specialists in his unit had talked about. With that in mind, he knew that if he made it back to base after the event he would survive his injuries. After a 45-minute wait for a medical evacuation and a 10-minute ride on a helicopter, Fye made it to the level III surgical facility in Kandahar in southern Afghanistan.
"I don't remember much once I got there," said Fye. "But I do remember hearing comforting and caring voices telling me that I was going to be all right."
Vascular surgeon and USAISR Deputy Commander, Air Force Col. (Dr.) Todd Rasmussen, coordinated the event with the USAISR nurse research staff to make the VTC happen for members of the medical staff at CJTH where Fye was taken and operated on prior to aeromedical evacuation to the level IV facility in Landstuhl, Germany. Rasmussen has been involved in research at the 59th Medical Wing and the USAISR that has contributed to the high survivability of U.S. troops injured on the battlefield. As a senior surgeon who has deployed to Iraq and Afghanistan multiple times, Rasmussen understands the stresses and challenges faced by personnel deploying and the reasons that they may question the value and effectiveness of their efforts.
"The wounded warrior physically experiences the event or point of injury one time and then is often unconscious or sedated for much of the following days or weeks," said Rasmussen. "But downrange medics may be asked to focus on, and render care to, five or six of these patients at once or throughout the course of a day for several days in a row throughout an entire deployment."
"So it's very rewarding to see the positive outcomes that can be achieved in patients months and years later. Seeing this positive, longer-term recovery emphasizes to military medics that what they are doing today has tremendous value and is worth it, a fact that can often be lost amidst the grueling schedules and injuries."
According to Ames-Chase, the VTC went very well. Questions pertaining to pain management and recollection of events surrounding the point of injury were asked of Fye and Maj. Joshua P. Dailey, the WTB operations officer. Both Fye and Dailey were questioned about the quality of rehabilitation and family support following severe wartime injury as well as the eventual quality of life of single and multiple amputees.
The session was genuine enough to facilitate even complex questions and discussion related to whether or not wounded warriors ever expressed a wish that the medical staff would have "let them die or pass from their severe injuries." Fye, Dailey and Ames-Chase all emphasized an overwhelming sentiment of gratitude among wounded troops towards the medics for working hard to sustain their lives in the hours and days following seemingly irreparable injury and damage.
"No, I have never thought that or know of any wounded warrior say that," said Fye.
Dailey answered, "I have not met any of our wounded Soldiers who would have preferred to be allowed to die."
When asked what could be done to improve the care at the level III facility, Fye said, "I don't think there's much that can be done to make anything better. The care and the compassion were great. I had a very positive experience while I was being treated there."
Air Force Col. Julia G. Stoshak, Chief Nurse of the 455th EMDG who is deployed with Rasmussen, said that the VTC was well worth it.
"Our medics see and care for amputees over and over again, in the emergency room, operating rooms, and on the inpatient units," she said. "To hear and see that the extreme effort given every day of their deployment by our medics makes a positive impact on the lives of the wounded warriors coming through here, helps and lets us know that what we do matters. I think it was great to hear from a wounded warrior and to get some understanding of his experience. I highly recommend continuing this activity with other deployed members throughout the surgical facility here and possibly at other deployed facilities."
"This forum is good for them [deployed medical staff] and facilitates vital feedback confirming that what they're doing is worth it," said Rasmussen. "We can't control the severity of injuries that we are asked to care for, but we can control the care, compassion, composure, and skills that we bring to the fight. That's what we need to focus on."