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July 15th, 2011
09:59 AM ET

U.S. hospital work prepares military docs for battlefield injuries

For a special look at "Battlefield Breakthroughs: Helping at Home," tune in to "Sanjay Gupta, M.D.," Saturday-Sunday 7:30 a.m. ET

The phone does not stop ringing at Baltimore’s shock trauma center.

A trauma tech picks up one of the calls.

“Stabbing, 10 to 15 by land,” he yells out in the emergency room, citing how far away the victim is from the hospital.

Every day dozens of trauma patients are wheeled into their trauma bays. Some are accident victims, others are critically ill. But right alongside the civilian trauma doctors, nurses and techs are military personnel.

Dr. John Renshaw checks on one of his injured patients. Jacques suffered massive abdominal injuries at his Maryland factory job when he was caught in a conveyor belt.

"We want him to go ahead and eat today. Get his nutrition up as much as possible. That is going to help his wound heal. So if you could tell him that,” Renshaw says to Jacque’s cousin Peter, who translates into the Creole of their native Haiti.

But Renshaw is an oncologist. He treats cancer. So why is he here?

Dr. John Renshaw is also Major John Renshaw, United States Air Force, and he’s deploying to the front lines of Afghanistan to treat the wounded. But before he goes, he along with other military medical personnel, will complete a tour of duty at the University of Maryland's Shock Trauma Center in Baltimore - sharpening their ability to deal with critical trauma patients.

Colonel David Powers, a surgeon, ran the military training program here. He has since retired.

"The injuries that I have treated here, that I see here at this hospital, are the closest thing to the injuries I saw in Iraq, that I have experienced in the continental U.S.,” Powers says. “I got an individual who has now been involved in a motor vehicle accident that has intracranial injuries where I have to recreate the cranial vault and the frontal sinus exactly like I have to do with an IED blast."

Air Force Major Joseph Dubose teaches other military colleagues at the trauma center his specialty, trauma surgery and surgical critical care.

DuBose says many deploying military personnel from stateside bases don't regularly see critical trauma cases. Before heading to the war zone, he says, they will learn “all of the basic skill sets that they are going to need in the early phases after injury and the ability to manage that patient airway, treating hemorrhage and bleeding, treating intracranial injury."

Lt. Col Allan Ward is an Air Force flight surgeon who normally certifies air crews are healthy enough to fly.

"Even as a flight surgeon I am expected to be a jack of all trades but really in garrison when we are not deployed I am an outpatient internal medicine guy,” says Ward.

Before getting to Afghanistan he says this will help him learn to prioritize multiple critical patients under battlefield conditions and hone his ability to make rapid decisions.

“I expect to see gunshot wounds. I expect to see traumatic brain injuries from explosive devices, burns as well, a lot of orthopedic injuries, and really some horrific stuff. And what I am doing here is getting exposure to a lot of things I’ll be seeing over there,” says Ward. “It’s an immersion really in a high volume trauma center.”

And it’s skills that will come back home with them. DuBose says the war has led to advances in controlling bleeding, monitoring fluids and caring for brain injuries.

“All these things are lessons that we're learning, hard fought lessons on the battlefield of Afghanistan and Iraq, that can now be translated to civilian care."

Treating the war wounded has long been a source of knowledge for all doctors.

“There has been a century long interplay between civilian and military care. In many ways trauma surgeons have learned from military conflict more so than any other component of care,” says DuBose.

As Major Renshaw's patient Jacques continues to recover the doctor says the training he receives here is vital.

"This has given me exposure to the trauma mindset to know what to look out for, pitfalls to avoid, procedures that I need to get my skills back up on."


soundoff (47 Responses)
  1. iho

    this is what i want to do. i want to be an er doctor and be part of the military, parents wont allow it.

    July 15, 2011 at 14:22 | Report abuse | Reply
    • Trav0

      I can't imagine anyone objecting to that, it seems like such a great thing for someone to do, but I guess they have a different perspective. I'm assuming you're still young, just take it a step at a time, focus on getting into medschool to just be a doctor, not a specific type, you'll have years to convince your parents.

      July 15, 2011 at 16:24 | Report abuse |
    • Sirius

      Once you're 18, they have no say. Do what you want.

      July 15, 2011 at 16:25 | Report abuse |
    • JeramieH

      It's your life, do want you want to do with it. You don't want to turn 50 years old and wonder why you never did – too many of us do that already. I wish I had known at your age what I know now, and that is: do the career you want from the beginning, and don't let anything stop you.

      July 15, 2011 at 17:10 | Report abuse |
    • Tiffany

      iho~

      I am going into the Air Force as an RN, hopefully, this coming fiscal year when I go before the selection committee. If you are going to go medical, Air Force is THE way to go, no disrespect to any other branch because many of my friends from all branches agree to that. I can not wait for that day that I get my commission. If this is something you want, it is never too late. Trust me, I will be 30 when I go in. My advice, go talk with an Air Force Healthcare Professional Recruiter to get information to take home, what you can potentially be offered and the benefits that you would potentially receive. Once you parents realize you will get out of the military route what you could only dream of in the civilian world, I can't imagine there being much of an argument they could make.

      July 15, 2011 at 17:20 | Report abuse |
    • Jack

      If you're still in school, or have already completed pre-medical requirements or are considering a post-bacc, look at the Uniformed Services University of the Health Sciences. It is (essentially) the military's service academiy/medical school.

      July 15, 2011 at 17:32 | Report abuse |
    • S1N

      Once you turn 18, you do not require their permission. Once you sign a contract and swear in, you will have a ship date to basic. If you inform him that you believe your parents will try to forcibly prevent you from reporting to MEPS as required by law, I'm sure he'll be more than happy to give you a ride to the recruiting station to wait for the shuttle. He may also be inclined to inform them that they would be violating federal law by doing so. Uncle Sam owns you as soon as you sign the contract and swear in, and there's little your family can do about it at that point. Unless they like kidnapping charges, that is.

      July 15, 2011 at 17:39 | Report abuse |
    • Retired Army

      Once you are 18 you don't leagally need their permission BUT...it makes life much easier when you have their support. Talk to them and explain WHY you want to do this. Let them tell you why they don't want you to do it. See if you can talk through the issues. If their only worry is that you might get killed then tell them that you might get killed in a drive-by or in a traffic accident. Having a goal in life helps you stay happy and sane. Plus, the benefits are good!

      July 15, 2011 at 18:37 | Report abuse |
    • frank

      Hi there iho,

      If you are interested in becoming a military er doc, there is noone that can or should stop you. Make sure you ace all your medical prerequisites in school (biology, chemistry, physics, english, statistics, math, etc.) as many of these will make up important parts of your non-science, science, and overall GPAs. Going ROTC can help you pay for college if you are really into the military thing...and if you are set on med school, definitely look into applying to the federal/military medical school called USUHS in Bethesda. It is an EXCELLENT school and you will receive training vital to your success in the military as well as a great medical education. Good luck.

      July 15, 2011 at 18:59 | Report abuse |
    • MaryAnn in VA

      If this is your heart's desire then make a way and find a way to do it. Your parents have lived their lives and you deserve the opportunity to live yours in a way that fulfills you. Go and be the best MD you can be and good luck.

      July 15, 2011 at 19:05 | Report abuse |
    • GiGi

      I was in the same situation where my parents did not want me to join the military...So I basically had to sneak around to get the whole process done. I am happy I did what I had to do to get in. Currently I am a medic in the army continuing my education to become a nurse. So if you feel the military is the choice for you dont let any one stop yo...your parents will eventulally forgive you for what you did. Mine had no choice

      July 16, 2011 at 10:04 | Report abuse |
    • angelikabertrand

      I am a widow of a military member. I applaud you want to do such a job. If you are old enough, you have the right to make your own decissions in life! However, if your parents are smart, they let you join the military. It's the best job in the whole world. Besides, can they afford to send you to college? And hence to medical school for these many years? With you serving our country, you earn credit and you earn money towards college. Why don't you point this out to your parents? Good luck and may God bless you for servin!

      July 16, 2011 at 10:21 | Report abuse |
    • Paul

      Go to medical school and show your parents the tuition bills and debt figures. Your parents will likely support your military career choice which will help pay for your education once they see the financial burden placed on you. If you want to do trauma though I would look more towards surgery than ER, as most places ER docs don't do trauma.

      July 16, 2011 at 11:02 | Report abuse |
    • US Navy Veteran, Theresa H

      iho,
      If you want to join the military and become an ER doctor, then, do it! Its your life. If you feel that you are being called to serve this capacity – – listen to it. Don't let anyone tell you differently. Its your life and you should use your talents to the best of your skills and abilities. Being called to serve in the military and in healthcare is not a calling for everyone, but if you feel it in your heart, pursue this path in service for the greater good of others. There is truly no higher calling than being in service to others. Good luck.

      July 17, 2011 at 23:36 | Report abuse |
  2. Vincent

    Hmmmm, not to stir up a hornet's nest ...... but the doctor said that a Baltimore hospital was the closest thing to seeing combat injuries that was possible in America. That doesn't say much for Baltimore now does it?

    July 15, 2011 at 17:04 | Report abuse | Reply
    • Firsthandinfo

      What is "says" about Baltimore is that Baltimore's Shock Trauma Unit responds with excellence and leadership in dealing with these types of injuries; which, by the way, are frequently encountered in virtually every big-city environment.

      July 15, 2011 at 18:16 | Report abuse |
    • war for profit

      Mums the word on Balitomore's higher than average crime rate then I guess. I recall sometime in the last decade seeing it top for something – pretty sure it was for violence. Good thing as this guy pointed out that they are good at their job, because Baltimore is #$%^ED UP!

      July 15, 2011 at 18:37 | Report abuse |
    • pork

      It's true Vincent...baltimore is not a pleasant place. It's also the syphilis capital of the world, I believe. Lots of stuff is wrong in the inner city there.

      July 15, 2011 at 19:01 | Report abuse |
    • Kathy

      Baltimore's shock trauma unit receives patients from all over Maryland and is well-known for its expertise. There are also specialty hand trauma and eye trauma centers there.

      July 16, 2011 at 12:46 | Report abuse |
    • Elizabeth

      I would hate this to be true, but it is. If any city in America seems exactly like a war zone, then why are we cutting off more funds to the poor and middle class, and refusing to put back the taxes on the rich? After WWII, the "Marshall Plan" built Europe again so that it would not be bombed out with terrible social problems. Who is going to do a "Marshall Plan" for the U.S.? Could all the billionaires and millionaires donate some money to America? Please?

      July 16, 2011 at 22:34 | Report abuse |
    • Elizabeth

      And something else very disturbing: "DuBose says the war has led to advances in controlling bleeding, monitoring fluids and caring for brain injuries." Does this mean that both the war and the appalling conditions of inner cities is continued on purpose for scientific research? It wouldn't be the first time, sad to say.

      July 16, 2011 at 22:37 | Report abuse |
    • IH

      Baltimore a little like Washington, some sections are very nice but other areas can be downright dangerous. The Inner Harbor area is pretty upscale, but a large area of the city leaves much to be desired. I guess the flip side of this is that medical residents and hospital staff can get some great training by staying in the area. The University of Maryland has an excellent Shock Trauma Center and treats many cases each year, anything from motor vehicle accidents to gun shot wounds and stabbings. John Hopkins is also in the area and students become very good at recognizing and treating diseases there. Only problem is that crime rates can really be a problem. I know this one student who had his car broken into 3 times in 4 years but hey...one can't have everything....

      July 16, 2011 at 22:48 | Report abuse |
  3. Tiffany

    @Vincent~

    Baltimore Shock Trauma pretty much the gold standard for trauma care. Their system of how they manage the trauma patient is studied by other trauma centers across the nation. While it sounds bad, they do amazing work there and they are the resource trauma center for HUNDREDS of miles. So it's not just Balitmore, that just happens to be where it's located.

    July 15, 2011 at 17:14 | Report abuse | Reply
  4. John Lincoln,MD

    I suggest Dr.Gupta should join for some training,he keeps on talking about medical and surgical issues he has no clue about

    July 15, 2011 at 17:56 | Report abuse | Reply
    • Dr Perry Fisher

      you are so right, he is an actor and not a surgeon of any type

      July 15, 2011 at 19:17 | Report abuse |
    • Elizabeth

      Don't you guys remember what he did helping medical emergencies in Haiti after the earthquake?

      July 16, 2011 at 22:39 | Report abuse |
    • Oncologist in Cali

      He is a Neurosurgeon (who yes does not know everything about all specialties but come on...)

      July 17, 2011 at 23:17 | Report abuse |
  5. Laura

    Tiffany – thanks for the explaination as that's what I was thinking. Is it part of Johns Hopkins?

    July 15, 2011 at 18:15 | Report abuse | Reply
    • BDGMD

      Laura~ Baltimore Shock Trauma is part of University of Maryland... UMDMC is the premier shock trauma center/orthopaedic shock trauma center in the country, probably the world...

      July 15, 2011 at 19:03 | Report abuse |
  6. war for profit

    I've disliked Gumpta ever since he rattled off a bunch of misinformation about medical marijuana. Hey Sanjay, usually Doctors research something before they get it wrong right?

    July 15, 2011 at 18:24 | Report abuse | Reply
    • duke

      Before you bust on Gupta too much, check your facts. He is a pretty boy, but he is still a practicing surgeon. He has performed emergency surgery several times in Iraq because his speciality was beyond the military doctors. As a former MEDEVAC pilot, I appreciate his willingness to help out.

      July 15, 2011 at 22:28 | Report abuse |
  7. Susan

    If you are interested in becoming a military physician, here are some parts of the process: Take all the science you can in college. Volunteer or intern at some sort of healthcare facility, even a nursing home. Get great grades. Begin studying for the MCAT whose score is a big part of the medical school application process. Apply to any medical school in the US. After you get accepted into a regular medical school, you can apply to any branch of the military, except the Marines, whose doctors are Navy. You become a lieutenant, go to a sort of boot camp for future medical military, most likely in Texas. Then you go back to medical school just like anyone else. After you graduate, you will be matched with a military hospital where you will do between 3 and 6 years of residency before you owe begin to serve your active duty that is four years. BTW, your medical school is completely paid for, and as a lieutenant you get about $1500 a month to live while in school. When you graduate, you are a captain.

    July 15, 2011 at 18:45 | Report abuse | Reply
  8. Dr Perry Fisher

    Civilian trauma medicine is entirely different than war zone trauma medicine,,,,,,,,,,,,,

    July 15, 2011 at 19:10 | Report abuse | Reply
    • Dr Perry Fisher

      Anyone in doubt? Go visit Walter Reed Hospital there you will see the horrors created by ,for the most part, by poorly trained military surgeons.MSF has got the best trauma programme and trauma protocols also the most acclaimed trauma units are at The London Hospital, U.K. and the Royal Infirmary ,Edinburgh,Scotland. American doctors are poorly trained simply because the best minds no longer enter medicine all thats left are the dolts and average minds

      July 15, 2011 at 20:32 | Report abuse |
    • Matt

      Ever been to Baltimore? Essentially the same thing.

      July 16, 2011 at 12:54 | Report abuse |
  9. mj

    perry, please do elaborate on your claims

    July 15, 2011 at 21:39 | Report abuse | Reply
    • Jorge

      In the Tinycat collectibles I need refelx hammer and stethoscope. But I've gone through everyone's messages above and no one needs what I can offer: cone, broccoli, goldfish, laser pointer, and band-aid.Other collectibles I need are yarn, cake, karot, invisible bike, invisible trophy, carrier, and dress. For any of those I'll trade one of cone, broccoli, goldfish, or laser pointer. Thanks.

      October 13, 2012 at 22:15 | Report abuse |
  10. Halito

    I have had many medical issues throughout my life. To those who criticize Dr Gupta- especially the other doctors – I have yet to meet a doctor who was perfect. My OB/GYN was close and others – well lets say that two almost killed me. So – I have adopted a process years ago that many are just now doing – Taking control and insisting that the Dr work with me not at me. I know my body, what works and what doesn't. If a doctor does not listen – well there are others who will. After all, I have had 15 surgeries – including two for appendicitis. Don't know of anyone else who can say they had the same.

    July 16, 2011 at 19:21 | Report abuse | Reply
  11. Chalupa

    Unfortunately, lessons learned are often lessons forgotten. We have learned how important it is to resuscitate critically injured troops in the operating room. n the US, this is often forgotten while another study is obtained. Also military medicine is often an incestuous training program with mediocre senior staff training residents. Good docs do their tour, usually at a small community type hospital and get out when their obligation is over. Those that can't succeed in the private sector make the military a career. Question their ability, and your career is over.

    July 17, 2011 at 02:16 | Report abuse | Reply
    • chakemba

      You are spot on!! When I served, I swore that there were doctors who hadn't passed their boards because the information they gave me was so bizarre and then it turned out in 1996 that I was correct-if you cannot pass your boards then you can be a doc in the military. Now I am sure there are many fine physicians but I cannot imagine that the better ones will remain for some hokey military career.

      July 17, 2011 at 09:07 | Report abuse |
    • mj

      Chalupa, you have a lot of opinions, can you substantiate any of them? ***

      Chakemba, you might be amazed how many military physicians are AOA. Also, being a doctor and passing boards are two different things. You have your facts confused. *** I think both of you have missed people like this http://en.wikipedia.org/wiki/Eleanor_Mariano.

      July 17, 2011 at 21:42 | Report abuse |
  12. USN, SS RET

    Thank you to all medical personnel that train to treat our wounded.

    July 17, 2011 at 19:06 | Report abuse | Reply
  13. Lola

    Military Doctor's will be the greatest trauma Doctor's. Their experience here will be tremendous, thus setting them up for much success when they return to the Civilian life. The things these guys do here are amazing.. Even the nurses and the comabt medics... these guys are angels from heaven.. being in Afghanistan I can attest to that.. So if you are a MED student, consider even doing one term of military service, you won't regret it.. On the bad note, you will need to be mentally tough and be able to seek counseling to deal with a lot of the stuff you see here...

    July 18, 2011 at 01:41 | Report abuse | Reply
  14. Lola

    Chalupa.. not all providers are Doctor's.. some are nurses, some are Physician assistants... the fact is that before the war, the need for Doctor's wasn't that great.. other than preventive care, critical patients were refered to Civilian Specialty Doctors. However, after 10 yrs of war, I can assure you, that the quality of care has much improved and so has that of the Doctors in todays military...

    July 18, 2011 at 01:45 | Report abuse | Reply
  15. Tracie

    I went against my parents wishes when I was 18 and joined the military and got my RN degree. They were upset at first, but tell me all the time it is the best decision I have made so far. I agree and the experience you will get and the people you will meet will be amazing. Good Luck!!

    July 18, 2011 at 05:05 | Report abuse | Reply
  16. Headcase

    I was taken to shock trauma in Maryland after a traumatic head injury that happened an hour away. So they don't just serve Baltimore. That said, Baltimore does have an issue with violence, though it's been getting better in the last few years. The "wave" of the crack cocaine epidemic seems to be subsiding, I hope.
    Now, as for the care I got at shock trauma, it was top notch. The team that took care of me did so professionally, very caring. What little I can remember in the minutes after I got there, everyone seemed to be on the ball. Once I came to and was more awake, the docs and nurses were all about making sure I was going to be fine.
    If they take that good care of me, a lowly civilian, I hope they train the military medics to be even more professional and even more caring.

    July 19, 2011 at 11:26 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.