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Taste of Combat at County-USC

A training program at the hospital exposes Navy medical personnel to the kind of trauma they might encounter on the battlefield.

March 08, 2003|Hector Becerra | Times Staff Writer

The trauma team worked frantically, intubating him, giving him IVs to stay ahead of the bleeding, clamping his aorta to route blood to his ravaged upper body. Within five minutes, they got a pulse and rushed him to the operating room.

There, corpsmen who had worked on the patient in the emergency room lingered, wanting to see the outcome, Newman recalled. Hours after surgery, the patient died. But Newman said the experience offered valuable lessons.

"The way I see it, this was the first time in history that this fleet surgical team worked together to help a combat casualty -- just on the eve of going to the Persian Gulf for war," he said. "I'd never seen my team work under pressure -- and someone dying on you is pretty big pressure. I learned a lot. They're a lot tougher than I thought."

After the Gulf War, the federal government's General Accounting Office issued a report citing inadequate preparedness for wartime among the military's medical corps. Most of their training, the report said, consisted of classroom instruction, drills and other field exercises.

A subsequent GAO report noted a case in which "a slot for an Army thoracic surgeon was filled by a gynecologist who admitted that he was not qualified for the position because he had never opened a human chest cavity."

In 1996, Congress passed a law requiring the Defense Department to create programs that would provide appropriate training at civilian hospitals.

The Army partnered with Jackson Memorial Hospital in Miami. Last year, the Air Force began training at R.A. Crowley Shock Trauma Center in Baltimore. Although doctors have trained sporadically at civilian hospitals before, these were the first permanent programs.

The Navy selected County-USC from among 64 trauma hospitals that expressed interest.

The Navy chose the hospital primarily for the reputation of its trauma staff and the sheer volume of patients. But the fact that County-USC doesn't deal exclusively with trauma is also an advantage in training, Navy officials say.

Every day, workers confront rowdy or mentally ill patients; police and deputies ferry prisoners from the ER to the hospital's jail ward; the poorest of the poor arrive seeking treatment for ailments; and a variety of foreign languages is heard.

"In war, you have to treat prisoners of war, refugees, injured civilians -- not just your own soldiers," said Theresa Gee, an ER nursing coordinator for the program. "We got the best deal when we got County-USC. War is not all trauma. You have to help the indigent. Sometimes you embark on humanitarian operations. You get the whole experience here."

The program works to the hospital's benefit too.

"We get a permanent team of 12 Navy people for free, as well as a lot of other free personnel," said Dr. Demetrios Demetriades, trauma chief at County-USC. "It's extremely helpful for us. For instance, we can run extra operating rooms.

"For somebody who hasn't seen a lot of trauma before, the emergency room, especially on a Friday or Saturday night, is simply overwhelming," Demetriades said. "But it's something you need to learn. You can't simulate this. You really need to see the blood. They need to become accustomed to people dying. They need to become accustomed to people with multiple injuries, with a lot of confusion -- a real war situation."

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