Navy Matters: A-10 Scrapping Justification Exposed

Please click through and read the whole thing. Something I hadn’t considered.

This is a Navy blog but I just can’t pass on the following Air Force item especially since it indirectly impacts Marine and Navy CAS.

DoD Buzz website quotes Air Force Gen. Mark Welsh as saying that scrapping the A-10 will save $4.2B over five years (1).  This apparently is the Air Force’s justification for letting the A-10 go.  Of course, the real justification is preserving the Air Force’s buy of F-35’s.  Be that as it may …

Let’s check that cost savings number out, shall we?

via Navy Matters: A-10 Scrapping Justification Exposed.

Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News

Appalling decision.

The document (from the DOD) reads in part:

“Passage of this legislation could directly and indirectly influence potential court-martial panel members, witnesses, or the chain of command, all of whom exercise a critical role under the Uniform Code of Military Justice (UCMJ). Defense counsel will argue that Major Hasan cannot receive a fair trial because a branch of government has indirectly declared that Major Hasan is a terrorist — that he is criminally culpable.”

via Defense Department says giving Purple Heart to Fort Hood survivors would hurt Hasan trial | Fox News.

But saying it’s not a terrorist attack doesn’t influence those same people? This is sophomoric at best, but bizarrely this is the Line from DoD officials.

Also, there’s a systematic robbing of the Fort Hood victims of benefits and now military awards, which is unconscionable.

For Shame.

The Worst Quackery of 2011: Battlefield Acupuncture – Forbes

So: the 2011 winner of the worst quackery award is: battlefield acupuncture. This bizarre practice, invented just 10 years ago, offers a trifecta of ills:

It offers no medical benefit and carries a real risk of harm for some patients.

The U.S. government is wasting tens of millions of dollars per year on it, and plans to increase its spending next year.

The patients are wounded combat veterans who have no choice about where to get treatment.

In battlefield acupuncture, the “doctor” (no competent doctor would do this) sticks needles into the patient’s ear to relieve pain.

via The Worst Quackery of 2011: Battlefield Acupuncture – Forbes.

Incredible. And infuriating.

(Found on Twitter, but I cannot recall who tweeted it).

Navy HPSP / GMO Query

I got a nice email form someone who stumbled across this Humble Blog, and had the following questions; my replies follow. Those who have something constructive to add, please do so in the comments.

1. I’m most interested in EM. Given that I have no prior military service/experience, am I basically going to have to do a GMO tour to get this specialty?

Well, it depends on a lot of factors. Your branch of service is probably the biggest determinant (AF is best, Navy is historically worst at going from Internship straight to residency without a GMO tour), but there are several reasons you might not want to go straight to residency.

Honestly, residency is easy compared with being a GMO, at least the first year of a GMO tour. I finished a Basic Surgery Internship, and went to the fleet as a Battalion Surgeon (honorary doc title). I could spit out the Ddx of hypersplenism but had no idea how to treat musculoskeletal back pain, an ankle sprain, or PFPS. I’ll get into the rest of this later.

2. Did you do a GMO tour? If so, how was it?

Yes, GMO for 4 years. Fortunately for me it was between conflicts. To plagarize some guy, it was the best of times, it was the worst of times. Seriously, if I could have my GMO job 1/2 time and my real job 1/2 time I’d be a very happy person, and a happy doc.

3. What made you ultimately decide to stay in military post-active duty or leave for private practice?

I wasn’t a career type, and I knew I wanted to work in the real world. At the time new EM grads were going to boats, and while they’d be very useful there were there a shooting war, it would be a punishment tour otherwise.

4. What kind of leadership opportunities did you have in military medicine that you feel would have been impossible/unlikely in civilian medicine?

I got to lead, really lead, some excellent Navy Corpsmen, I got to advocate for some Marines and Sailors who needed it, and I got to go places nobody gets to these days. (2 trips to Iwo Jima, try booking that on Kayak).

5. Would you have decided to still do HPSP if the scholarship amount was significantly smaller? (ie, <50% what it is).

It was that then, I did it because I wanted to serve and it served by desires and interests. In general, if you’re considering HPSP just to pay the bills you won’t be a happy camper, and you’re signing on the line for a lot of years.

6. Is it possible to find out how many GMOs the Navy needs? (Currently, there are rumors that the Navy is going to change the GMO program).

No idea. But, don’t consider GMO time punishment, or time lost, it’s just something different, and I still think of (parts of it) fondly. The bonus of being a GMO and re-applying to a military residency? Time in Service is weighted on your app. So, if you want to be a brain surgeon but were bottom of your class, after a few GMO tours you’d most likely be in (YMMV).

Best of luck with your decision, and please let me know how it goes!

Army seeking troops bitten by stray animals following rabies death – Army – Stripes

Wow, that is awful beyond belief.

Army seeking troops bitten by stray animals following rabies death – Army – Stripes.

SEOUL – The Army is redoubling its search for anyone who might have been bitten by a wild animal in Iraq or Afghanistan following the Aug. 31 death of a soldier from rabies, the service’s public health command stated Wednesday.

“The death of this soldier is very tragic, and we are taking actions to ensure something like this does not happen again,” Lt. Col. Steven Cersovsky, director of epidemiology and disease surveillance at the Army’s Public Health Command, said in the release.

Spc. Kevin Shumaker, 24, became the first soldier to die from rabies since 1967 after he was bitten by a stray dog in Afghanistan.

Shumaker told his parents that he received three of six necessary rabies shots in Afghanistan, but did not receive the final shots because they were expired, according to a Contra Costa Times report. Shumaker, a 10th Mountain Division soldier, died at Fort Drum, N.Y., eight months after the bite.

“I would not be without my son if the proper treatment was given to Kevin,” his mother, Elaine Taylor, told the newspaper in September.

Prayers for his family.

World’s first malaria vaccine works in major trial | Reuters

Okay, like all of us I want an effective and safe malaria vaccine, and the tone of the article is hopeful. But…

The trial is still going on, but researchers who analyzed data from the first 6,000 children found that after 12 months of follow-up, three doses of RTS,S reduced the risk of children experiencing clinical malaria and severe malaria by 56 percent and 47 percent, respectively.

Loucq said widespread use of insecticide-treated bednets in the trial — by 75 percent of people taking part — showed that RTS,S can provide significant protection on top of other existing malaria control methods.

via World’s first malaria vaccine works in major trial | Reuters.

We’ll have to read the study, but if you’re mixing a change in bednet use AND a new vaccine, well, let’s hope they were measuring what they thought they were.

Wife of slain doctor pleads not guilty – SignOnSanDiego.com

A woman suspected of stabbing her husband, a respected Navy surgeon, to death before stabbing herself several times at their North Park home pleaded not guilty to murder Wednesday in an arraignment at her Scripps Mercy Hospital bed. She was then ordered held on $2 million bail.

Jennifer Trayers, 42, a bank employee, is accused of killing Lt. Cmdr. Frederick John Trayers III, 41. San Diego police homicide Lt. Kevin Rooney would not say when the attack likely occurred, but he said neighbors did not report hearing any disturbances at the couple’s home.

via Wife of slain doctor pleads not guilty – SignOnSanDiego.com.

LCDR Trayers was reportedly the Chief Resident in Emergency Medicine at Naval Medical Center San Diego.

RIP.

How to make Oral Rehydration Therapy fluid

Doc Gurley (who’s been going to Haiti since at least the first earthquake relief started) wrote a post today about cholera (currently hitting Haiti hard).

She found there were very few YouTube videos about how to make Oral Rehydration Therapy (ORT) fluid, which is the mainstay of cholera treatment.  Simply put, if you can replace orally what you’re losing from the far end, you get to live.  It’s cheap, it’s easy, but you have to know what to do for it to work.

ORT is super cheap and amazingly easy to make.  Thanks to Doc Gurley, there is now an illiterate (as in language independent) how to video: Recipe for Life!

While it seems graphic, I think it makes perfect sense.  Here’s hoping it helps!

Per Doc Gurley, swipe the video!  Repost it everywhere!  She says Haitians have cell phones, and the more universal this knowledge is the more likely it is to help.

SanDiegoNavyDoc

They call me “Doc…”

Tuesday, August 18, 2015 Posted by admin at 9:06 PM |

It is difficult sometimes to describe to people just what it is that I’ve done for a living in the Navy. It is especially difficult to talk to civilians about my job because they have no concept of even my basic skills, but even to people in military medical occupations it is hard to explain.

via SanDiegoNavyDoc.

In case y’all aren’t reading him, you need to.  Add him to your daily reads, please.

iowahawk: Help a Brother Out

Longtime Iowahawk readers will recall my old Ozark hotrodding medico friend Darren “Doc” Lee from Operation Dumb-Vee, where we successfully conspired to plaster Doc’s Army unit’s vehicles with morale-boosting refridgerator magnets from home, during his stint in Iraq. You also may recall that Doc is my go-to supplier of, um, “Ozark hair tonic.”I am sad to report that Doc was recently the victim of a terrible garage accident…

via iowahawk: Help a Brother Out.

Read, and if you wish, give.  Your money could go to worse uses.

NATO Hospital Offers Top Notch Care in Taliban Heartland | Asia | English

Whether a soldier needs a cure for the common cold or brain surgery, the NATO hospital on Kandahar Airfield can handle it. This is one of Afghanistan’s most sophisticated hospitals, and it provides top medical care on the front line. Just minutes by helicopter from most conflict spots in the country’s south, the hospital saves the lives of 98 percent of the injured who come here.

Does it work?

Yes:

…being so close to the battlefield means if a patient makes it to Kandahar alive, chances are he will stay that way. The hospital has a 98 percent survival rate.

via NATO Hospital Offers Top Notch Care in Taliban Heartland | Asia | English.

I have no idea on this, perhaps one of you knows: is there a NATO hospital and a US facility at Kandahar Airfield, is the US one also called a NATO hospital, or what?

A Letter from Afghanistan

Forwarded by a friend of his, and I have the authors’ express permission to run it.

Hey Gang,

Another amazing and emotional day yesterday. I try to write about things that impress me professionally, emotionally, and spiritually. Yesterday I was again impressed.

At 5:00 a.m., the Giant Voice (the base PA system) announced two incoming casualties. I reluctantly roused from my slumber and made my way to the E.R. On arrival, I found two victims of an accidental grenade explosion, one critically injured and one more stable. The critical patient had third degree burns to his face, neck and upper chest and severe penetrating abdominal injuries. He was in shock and was taken directly to the O.R. by the surgical team. The other had multiple burns, but fairly superficial. He also had eye injuries and he was essentially deaf from the blast, but he was stable. While the unstable patient was in surgery, my team and I evaluated and treated the stable patient, managed his eye injury (severe ocular contusion with corneal burns), CT’d him, cleaned and dressed his burns and expedited his helicopter evacuation to the ophthalmologist at the larger Bagram hospital (we don’t have one here).

The story of how the accident happened was initially unclear, but, when things settled a bit, my patient told me the following: He and the other soldier (both trained weapons specialists) had returned from a mission and were in the ammunition bunker, returning unused grenades and other weapons to the stock. One of the weapons they were handling was a “flash bang” grenade. These are the ones that they use as their team is initially entering a building by force. They toss it in and it explodes with a very bright light and very loud sound, designed to temporarily blind and deafen the people inside so that the soldiers can enter the building with the element of surprise. SWAT teams use these a lot. They’re not designed to kill.

He states that, as they were working, he heard a “click” noise, looked back and immediately saw that the pin had somehow popped out of one of the “flash bang” grenades that his buddy was holding. He looked up and saw a look of terror on his teammate’s face. My patient just had time to turn away as the grenade exploded. He was stunned and isn’t clear exactly what happened next, but somehow they were both loaded into vehicles and rushed to the hospital. From the pattern of the explosion on the severely injured patient who was holding the grenade, it appears that, in the brief instant he had to decide what to do, he made the decision to pull the explosive into his gut and take the force into his body. By doing so, he minimized the blast effect to the other soldier and to the stored ammunition inside the shed, preventing a possible catastrophic chain reaction of explosions. Faced with the split second decision to either toss the grenade into a corner and run, or take the blast himself to save the life of his friend and possibly others in the immediate area of the ammo shed, he chose to sacrifice himself.

In surgery, the severely injured troop had multiple severe abdominal, chest, and head injuries and burns. He required massive amounts of blood. Our little hospital keeps around 30-50 units of blood products available at any one time, but we were a bit low because of a lot of recent trauma activity. It was clear that if this soldier were to have any chance of survival, he would likely need more blood than we had in stock. In addition, we always have to be prepared for the next trauma activation (which, incidentally, came about four hours later, four patients from a Taliban attack on a civilian minivan, including a 14 year old boy, but that’s another story). After discussing this with the surgeons, the hospital commander made the decision to activate the “walking blood bank”.

The walking blood bank is something unique to the military. In the civilian medical world, blood is collected at donation sites and very carefully screened for infectious diseases such as HIV, hepatitis, and others. Then it is broken down into its various parts: red blood cells, platelets, and plasma. These are then separately packaged and stored for later use. The military does the same thing for routine blood use. However, in a combat emergency, we have the ability to short cut the process when we need blood immediately. Essentially, everyone in the military is “pre-screened” because we are all checked for HIV, hepatitis, etc. and given a million immunizations prior to deployment. We also have our blood typed and that information is printed on our dog tags and our military ID. We’re ready to donate and receive blood at any time.

The Giant Voice broadcast across to the base: “All O-positive soldiers report to the hospital immediately!” Our Utah medics, and others in the hospital, mobilized and immediately established impromtu “donation centers” in the outpatient clinic and the dental clinic. Within 10 minutes, they were taking blood from the first volunteers. Within 30 minutes nearly one hundred soldiers were lined up to donate for their fallen comrade. The line filled the clinic, the hallway, and went outside the door of the hospital, down around the corner of the building.  All of these troops lined up look like they were waiting to get in a concert or a movie theater. As each precious, life-giving unit of blood was drawn from a troop, it was immediately taken around the corner to the operating room where it was infused, still warm, into the critically injured soldier on the table.  Over the 4 hours of his surgery and attempted resuscitation, he received nearly forty units of whole blood taken directly from these donors, as well as banked blood and platelets, plasma, and other blood products. Tragically, the surgeons, despite herculean efforts, were unable to save him and the soldier was finally pronounced dead. The news hit everyone very hard. This incredible soldier, the accidental victim of a grenade malfunction, had died trying to prevent further injury to his fellow troops. He gave his life to protect them. In turn, those donating blood gave a very real part of themselves to try and save him. That is what soldiers do for each other.

Later, I witnessed the solemn and emotional completion to this story. The Army has a battlefield tradition called the “Hero Flight”. When a soldier dies, his body is flown home for a funeral with his (or her) family. The first step of this flight for this Hero was a helicopter ride from our base to the main air base at Bagram. A special ceremony was held as his body was moved from our morgue to the helicopter to begin his journey home.

At about 11:00 pm last night, Soldiers from the fallen soldier’s unit, the hospital, and from all over the base lined up in formation along the hundred yard route from the hospital to the helicopter pad. Everyone was dressed in full uniform; no shorts or tennis shoes.

I don’t know if I’ve ever mentioned it before, but we’re a “black out” base, which means no lights are allowed at night. This is to minimize us as a target at night. We all walk around with little tactical (very dim red or green) flashlights. It’s really dark here.  So there we stood, silently and reverently in the darkness, two long columns of soldiers lining the route to the landing area, lit only by the stars in the brilliantly clear and quiet sky and a couple of glow sticks placed along the way. It occurred to me that many of the people standing in silent tribute last night had also given their blood to try and save the life of this soldier. Then, in complete darkness, two helicopters roared out of the night and landed, pulling up to the loading area, the wind from their rotors whipping the hair and faces of the silent line of troops. On cue, they simultaneously cut their engines and the rotors spun slowly to a halt. Into the ensuing silence the First Sergeant issued the command: “Task Force, Attention!”. We all came to attention, face forward, perfectly still. “Present Arms!”. Every soldier, all 250 or so of us, snaps and holds a salute as the body of the fallen soldier, draped in an American flag, is wheeled slowly between the two columns of troops and is placed reverently on the helicopter. “Order Arms!” We dropped our salutes, remaining at attention. The chaplain said a prayer for the soldier, for his family, and for his team, who must continue their work, their mission, without him. In the darkness, I heard soldiers, warriors, sniffling quietly as they suppressed their tears. Me too. As we were dismissed and silently began to depart, the two helicopters fired up their rotors and launched into the dark Afghan night, carrying the body of this young man home to his family.

It is difficult to describe the emotions this long day held for me. Many conflicting but very powerful feelings come to mind as I write. The tragedy of the accident. The heroism of this man’s selfless act protecting his fellow soldiers. The pride I had in my fellow docs and nurses who raced him into surgery and in our Utah medics who quickly and efficiently organized the blood donation operation. The amazement I felt as soldiers from all over the base, few of whom knew the injured troop, lined up to give blood without question. The disappointment when the soldier died despite everyone’s heroic efforts. The pride, respect, and honor of the silent Hero Flight ceremony as we paid our last respects to our brother in arms. A very dramatic, very sad, and very real day here at the War. I just wanted you to know about it. These kinds of things need to be shared.

Peace,

Peter

It’s my pleasure to share this with you.

Teaching advanced combat first responder care in Iraq

Story by Sgt. Ben Hutto, 3rd HBCT, 3rd Inf Div PAO
Photos courtesy of Sgt. Deshon Bell, 203rd BSB

CONTINGENCY OPERATING SITE KALSU, Iraq – Ten policemen from Babil and Karbala provinces graduated from the 3rd Heavy Brigade Combat Team, 3rd Infantry Division’s tactical combat medical care course at Contingency Operating Site Kalsu June 15.

The five-day course was designed to teach students practical ways to treat combat injuries.

“It is an advanced first-responder course,” said Staff Sgt. Timothy Mollett, a medic assigned to Headquarters Company, 2nd Battalion, 69th Armor Regiment. “Most of them know the basic things like clearing an airway or stopping bleeding. What we do is break everything down to the basics and build from there.”

Both medics said the course was more about demonstrations and exercises than formal classroom instruction.

“They are just like [U.S.] Soldiers,” said Mollett, a native of Columbus, Ohio. “They don’t like slide shows but love hands-on training. They learn better that way, too.”

via Digital Video & Imagery Distribution System.

I’m glad ‘normalizing’ operations are still going on, and that it’s their 8th 5 day class there’s a good amount of support for this mission from both sides.

(I was contacted by someone @iraq.centcom.mil and alerted to this story.  Thanks!)

Book Review: Paradise General; The Nightingale of Mosul – WSJ.com

When Americans think about wartime medicine, “MASH” reruns and the comic antics of Hot Lips Houlihan and Hawkeye Pierce are likely to come to mind. A decidedly more authentic view can be found in “Paradise General” and “The Nightingale of Mosul,” books by a real-life Army surgeon, Dr. Dave Hnida, and an Army nurse, Col. Susan Luz. Both authors served in Iraq during some of the bloodiest days of the war in 2006 and 2007.

via Book Review: Paradise General; The Nightingale of Mosul – WSJ.com.

So, my summer book list is set…

via He who Shall Not be Named…

Soldiers’ Angels Germany: DUSTOFF Association Flight Medic of the Year

Recently SSG Matthew Kinney was named Flight Medic of the Year at the DUSTOFF Association and AMEC Conference for his actions on Oct. 16, 2008, and for which he was also awarded the Silver Star.

via Soldiers’ Angels Germany: DUSTOFF Association Flight Medic of the Year.

Wow.  Just reading the citation impressed me.  There are heroes in this world.

via Mudville Gazette