Central Line
Episode Number: 141
Episode Title: Military
Medicine
Recorded: September 2024
(SOUNDBITE OF MUSIC)
VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. ADAM STRIKER:
Welcome to Central Line.
I'm Dr. Adam Striker, your host and editor. Today, I'm very excited to
introduce the guest that we have with us, both medical officers in the United
States Navy, Dr. Brian Brenner and Dr. Jeffrey Carness. We're going to learn
about practicing anesthesiology in the military today.
And a disclaimer for
this episode: the views expressed in this podcast are those of the guests and
do not reflect the official policy or position of the Department of the Navy,
Department of Defense, Defense Health Agency, nor the US government.
We have the perfect
guest with us here to educate us. So, Drs. Carness and Brenner, welcome to the
show.
DR. JEFFREY CARNESS:
Thank you so much. Thank
you for having me.
DR. BRIAN BRENNER:
Thank you. Excited to be
here.
DR. STRIKER:
Well, I'm excited for
this conversation. I think this is something, surprisingly, we haven't really
covered yet in our podcast series. I think this is going to be a great topic. I
think it's really important for the rest of our
listenership to be able to access some of this information.
Before we get started.
Do you mind both telling our listeners a little bit about yourselves, your
roles and your pathways, how you arrived to where you are? Dr.
Brenner, let's start with you.
DR. BRENNER:
Sure. So
my name is Dr. Brenner. I'm a lieutenant in the Medical
corps in the US Navy. I'm currently a staff anesthesiologist at Naval Medical
Center San Diego. Uh, grew up in a Navy family in Pensacola, Florida, where I
went to college at the University of Florida. Uh, joined the Navy back in 2016
via the Health Professions Scholar program, where I was originally commissioned
as an O1 upon entering medical school at University of Virginia. From there I
did officer Development school, an annual Navy trainings
before I entered residency. I was selected for the what's called the Navy Active Duty Delay for specialists, or NADS program for my
residency in anestheseology where I was placed on IRR,
Individual ready reserve status, while I was finishing my residency at UVA,
where also served as a Chief Resident. I'm currently working in the
anesthesiology department at Balboa, as we call it, teaching medical students
and residents. My other duties include being assigned to the platform known as
Casualty Receiving Treatment Ship Team Eight, where I'm an anesthesiologist
ready to serve aboard one of our amphibious assault ships if the need comes. Luckily
I have not yet, but I feel I've been fortunate to have an experience both in
the military and civilian health care systems, and
hope to get to answer some questions about their similarities and differences
for you all.
DR. STRIKER:
Great. Dr. Carness?
DR. CARNESS:
All right. So my name is Jeffrey Carnes. I'm a commander in the United
States Navy, and I have been in the service for about 26 years now. Did six
years in the Marine Corps before I jumped ship and joined the Navy. I went to
medical school at the University of Texas Medical Branch in Galveston. Did my
anesthesiology residency at the Naval Medical Center, Portsmouth, and then
completed a critical care fellowship out at Brigham and Women's Hospital in
Boston. And I'm currently working as a critical care anesthesiologist out here
at Madigan Army Medical Center. And you heard that right. I'm a Navy
anesthesiologist at an Army installation, so I'm kind of really enjoying it out
here.
DR. STRIKER:
Excellent. Well, let's
start off around the history of military medicine, military healthcare,
specifically anesthesiology, how it's evolved. Dr. Brenner, from what I
understand, you're a little bit of a history buff, so I'm hoping you can share
with us a little bit of information - how the concept of military medicine has
evolved over the years.
DR. BRENNER:
Sure. So
it's a very broad question. I'm going to try my best to make it relatively
linear and interesting.
So back in 1775, before
the Declaration of Independence was signed, the army established its first
military hospital, which interestingly had an apothecary on staff back then. A
few years later, after the Revolutionary War had ended, the Navy kind of ended
its operations before we were officially the United States of America. And it
wasn't until George Washington led the effort to establish a permanent navy in
1794 that any of these things that would be practiced now kind of became more
prevalent. So it was, interestingly, during the War of Tripoli, when Jefferson
kind of spearheaded the effort to not give in to ransom demands for pirates in
the Mediterranean, kind of messing up maritime trade, that the Navy really
began its first test internationally, including hospitals and hospital ships.
One such ship, the Intrepid, was our first unofficial hospital ship. That was a
small vessel retrofitted to disguise casualties that were coming back from the
front. It wasn't until the mid 1800s that the Navy created its official Bureau
of Medicine and Surgery, where we officially had roles managing Navy hospitals.
And it wasn't until the Civil War that we had our first official hospital ship,
the Red Rover, which actually patrolled the
Mississippi River, treating patients on both sides of the Civil War conflict up
to over 3000 at the end. Interestingly, during World War Two, the majority of
hospital ships were operated by the Army, and their main purpose back then was
to transport wounded soldiers across the ocean for definitive treatment, which
is one big difference from Navy hospital ships that have always been designed
to be fully equipped hospitals to receive, diagnose, and treat casualties and
also support frontline medical teams, not just evacuate patients. After World
War Two, we learned a lot. President Truman and the country saw a need for
robust medical services for service members at home and what we call a ready
medical force in the event of regional or global conflict. And that was when
the first male doctor draft was enacted in the US. And from the mid 50s to the
mid 70s, doctors had a two-year service agreement where many served as staff
physicians. Here, researchers and frontline doctors during the Korean and
Vietnam War. Since then, military service for physicians has been voluntary,
but the government still collects information on civilian doctors who could be
called to serve if needed. In 87, Congress approves the Healthcare Personnel
Delivery System, which gives executive power and legislative power to draft
doctors within weeks if needed.
You know this altogether
is just really important for US practicing physicians
and anesthesiologists, especially to understand kind of where medicine has come
from in the past of our country and the goals of our healthcare system that,
you know, some of them may be called up in time of need, if that were to arise.
DR. STRIKER:
Well, Dr. Carness, do
you mind talking a little bit about the differences between practicing
anesthesiology in the military versus what civilian practice might look like?
DR. CARNESS:
Of course. So I think it's super interesting. And of course, like many
of our civilian counterparts, we work at hospitals. We call them military
treatment facilities. And we engage in anesthesia care delivery in any number
of different places, just in our civilian counterparts do. So
we go to gastroenterology and the plastics clinic and the urology clinics and
MRI and CT and ER and the main operating room and the labor deck and all all over the place inside the hospital. So
our practice there oftentimes looks very similar to a practice that would be
seen at a civilian hospital.
Where it begins to
differ, I think, is when we report to a new unit, when we check in, then we're
assigned a billet--it's essentially a title--attached to some operational unit.
And when we attach to that operational unit, then we find ourselves attached to
maybe a small team, like a damage control surgical team or a fleet surgical
team, or we might find ourselves attached to a field hospital or attached to a
hospital ship or something else. And so then we're
required to train with that unit. And, and that may be aboard ship or that may
be setting up our field hospital out in the field. And that requires a little
bit of extra expertise. And also if our unit that
we're attached to ends up going to the gas chamber, so to speak, for training,
or if they go on a hike or if they go to the range, we too go with them and we
practice those skills. So it does definitely require
some extra expertise, I think. And this this requires an additional degree of
physical fitness. They require a specific body composition. They test us every
year on these things.
And that's because
oftentimes when we are activated in support of military contingency operations
or something along those lines and we have to go
forward, then we may be required to provide austere anesthesiology. And I've
had the fortune of bouncing around to a couple of different institutions across
the country and talking about posterior anesthesia care provision, and that
some of it goes back to our joint trauma system, which was a quality
improvement system that was started back in 2003, 2004, and we tried to improve
the trauma care delivery that we had going forward. So
they created any number, I think there's probably about 70 or 80 clinical
practice guidelines. And one of those also touches base on austere
anesthesiology. And so what we find that we are called
upon to do is dependent upon how we are going to get to the patients. And so they've created what they call a ruck truck house model. So are we going to find our patients using a rucksack and
everything that we take with us, all of our consumables and everything goes in
a pack on our back? Or do we have a truck? If somebody's actually
going to lift us to the location where we're going to find these
patients, or is it going to be a house? And we think of that as a fixed
structure. And so if we're going with a pack, we have
fewer consumables and less capability. If we're going with a truck, we have
more. And of course, in a fixed structure we're going to have our greatest
capability. And so these are things that we think
about. So not only are we providing anesthesia care in a hospital in the
traditional sense, but then we have all of this
additional knowledge that we take with us going forward. So
I think it's it's very different in this regard. And
that's one of the reasons why I think of military anesthesiology as its own
subspecialty of anesthesiology.
DR. STRIKER:
Well, let's follow up a
little bit on that. Dr. Brenner, do you mind elaborating a little bit on what
kind of career paths are possible for those that are in the military practicing
anesthesiology. Dr. Carness mentioned the necessity of remaining physically
fit. So it's interesting because A, how long can you
realistically spend in the military practicing this way? And then along with
that, what kind of career paths are available for those that have come from the
military background?
DR. BRENNER:
Sure. And Dr. Carness,
feel free to chime in. He's much more of an expert in this area than myself,
but so I kind of have thought about it, especially since I had training and
residency in the civilian world, that there's multiple practice environments
like Dr. Carness was alluding to, where you can be at
a large treatment center that has residents, medical students and other
learners. And in that sense, you kind of take on an academic role teaching. You
can also get an appointment with the military medical School Ussu out of Bethesda, Maryland, to have those resources and
support from the greater USU Anesthesiology Department for Faculty Development,
that sort of thing. So it can look very academic in
some facets and for some part of your career. It could also feel very like
rural private practice-y. If you're the only doc that's hundreds of miles. For
example, if you're stationed in Guam, you may be taking care of the patients
that are civilians in that area of the world as well.
So, you know, we can get
placed in multiple different locations in the world where we practice seeing
different pathologies that, you know, maybe we didn't learn about in medical
school necessarily. So there's some aspects of being
adaptable and having to learn how to interact with a global health system when,
you know, maybe you're receiving patients from another country, you know, how
do you interact with that? That's kind of an interesting thing.
Also, the other half of
our job, other than the traditional anesthesiologist role in the operational
side, is that we're military officers and like all military officers, many of
us end up in leadership roles where we have to lead
teams of other officers or enlisted sailors and Marines to achieve objectives
of the Navy. And that can be many different things: readiness, fitness, medical
readiness, that sort of thing. So many of us get kind of put into leadership
roles just because we're military officers. And for those of us that choose to
serve and use this as a career, many of us develop and gain roles, leading
departments or other groups of sailors and marines, which is kind of
interesting.
DR. STRIKER:
Yeah, certainly. Dr.
Carness, do you have anything you want to add?
DR. CARNESS:
Well, I think that's that's exactly it. There's, there's quite a bit of
opportunity and it really just depends upon how you
want to tailor your career. So we have our
academicians, we have our clinicians, we have our executive medicine
individuals who are targeting more of that leadership role in our hospitals. We
have our health staff and our medical staff within our hospitals, and we cover
down on a lot of the same requirements that you would find at a normal hospital
with our different committees and our, as we call it, our medical executive
committee. So there's any number of different
opportunities. And I think it's it's just interesting
to note that anesthesiology in the military encompasses probably about a little
over a thousand providers. So if you think about a
given practice being 50 or 60 providers at a large tertiary care facility, and
in our military anesthesiology, we have, um, probably a little over a thousand,
inclusive of our CRNAs and our anesthesiologists combined. And so there's really a lot of opportunity, and you can tailor
your career to to what it is that you want to do. And
the the military recognizes that you may not just be
a primary clinician, and they give you time for that, which I think is is really great.
DR. STRIKER:
Yeah, absolutely. Well,
Dr. Brenner, the ship you're currently serving on the casualty receiving
treatment ship, can you take us inside that a little bit? Explain how it works.
From what I understand, this is fairly new to you,
but, um. Is this what you expected? Is it surprised you at all? Just give us a
little bit of insight into that, if you don't mind.
DR. BRENNER:
Sure. So
I think what we're alluding to, this is the platform that I'm assigned to that,
like Dr. Carness had mentioned, is one of my dual responsibilities as a
military anesthesiologist and officer. Um, so I'm on casualty receiving treatment
ship team eight, like you mentioned. These are medical teams that get activated
in medical times of need that would exceed normal operational medical
capacities on our amphibious assault ships. Um, think things like regional or
global conflicts, humanitarian effort, natural disasters, or exceptional events
like an astronaut retrieval or something like that, where there may be an
atypical anticipated medical need from normal operational requirements. Um, LHD
amphibious assault ships are warships primarily. But as Dr. Carness has
recently written about and I'll reference what he calls these are role two
maritime medical vessels that have medical capabilities to remove, diagnose and
stabilize patients so we can get them effectively transported safely to our
dedicated role three hospital ships, or rear area hospitals, such as Naval
Medical Center San Diego, where I currently work most of the time providing for
definitive care.
For reference, these LHDs
can accommodate up to 600 patients at a time. Uh, the ship's corpsman also provide routine medical and dental care for the crew, and
also embarked personnel with them. Uh, these ships have four operating rooms
with two emergency ORS and x ray blood bank labs and provisions for patient
wards. In comparison to our rule three hospital ships like the Mercy Dr.
Carness has served on, these are dedicated hospital ships that have 12
operating rooms and can manage up to a thousand patients at a time.
Fortunately, thus far,
I've only been engaged in training, preparing for deployment readiness for this
aspect of my job. If the need comes for my CRTs team to be activated, I'll be
ready. But the majority of my day to day role right
now, this time is at Naval Medical Center San Diego.
DR. STRIKER:
Okay, Dr. Carnes, how
was it working on the Mercy Ship?
DR. CARNESS:
Well, you know, I think
it was an excellent experience. It was just a wonderful opportunity to provide
some humanitarian aid while we were out there floating in the South Pacific. We
went to some more remote areas, some underserved areas of several different
countries, and we found any number of different patients that were out there
with chronic conditions that had been there for years, that they've been
suffering from for years. And we were able to provide direct anesthesia care,
direct surgical care, and alleviate some of that suffering that they were
dealing with from their conditions.
It was super interesting
because they they were a little bit more remote, so
they didn't have access to an adequate amount of preventive health care, if you
will. So they would show up with very little
preoperative evaluation. And we didn't have a whole lot to to
do for them preoperatively. There was a making an assessment or a judgment on
our ability to safely provide anesthesia care for them based on some vital
signs. The use of translators in discussing their histories and their
employment of point of care ultrasound. And it was interesting to see them in
different stages of convalescence from any number of different illnesses that
we don't see too much over here in the United States.
So patients that were suffering from dengue fever
and convalescing, or patients that were convalescing from malaria, an
increasing amount of tuberculosis in the area. So it
was a it was a really wonderful experience.
Of course, being on the
ship, it's a it's a deep draft ship. So we weren't able to get up skinny
to get into some of the areas that would have facilitated probably a little bit
easier movement of patients since we had to have some logistic foresight and we
had to think, how do we get these patients on board the ship, and how are we
going to disembark them from a floating dock onto a water taxi to get them back
to shore? But being on the mercy itself, they do have 12 operating rooms. It's
kind of interesting because you have to think about
the differences of being in essentially a floating operating room. So so the operating room tables
are strapped to the deck, the anesthesia machines are strapped down to the deck
to make sure that nothing is moving or going to run away from you. And we have
an oxygen generating plant which takes liquid oxygen and converts it into
gaseous oxygen. And so we have your normal pipeline
oxygen as you would think about. We have our normal volatile anesthetic
capability on board. But if that were to go down we have it's not just E
cylinders, but we have the large H cylinders. And maneuvering some of those
large beech cylinders into place. And then ensuring that they didn't present a
danger to to our staff was also extremely important.
It was a it was a little difficult at times to to move and maneuver them and to move them around.
So it was definitely a different kind of
experience. What I would say is that we did employ a lot of point of care
ultrasound when we were ashore, which I think was wonderful, to have some
individuals that had that kind of background and skill set. And we certainly
used it to help us to rule out and found some interesting pathology. But
unfortunately, we were unable to provide anesthesia services and surgical
services to a few patients based on some of our findings with point of care
ultrasound. So it was it was just it was a remarkable
experience. And if I had the opportunity to do it again, I would do it in a
heartbeat.
DR. STRIKER:
Now, you don't have to
be in the military to serve on the mercy ship, is that right?
DR. CARNESS:
So there's two different types of mercy ships. I
think there's the Mercy Ship, which is a humanitarian organization that does
civilians. And and then there's the USNS mercy, which
is the hospital ships there. The crew of the USNS mercy is a civilian crew. So they're the ones that are sailing the vessel, so to
speak. But but all of the what
we call it, again, a medical treatment facility. So
it's like a floating hospital for us. And that's how we look at it. The
individuals that were on the floating hospital, they were serving in, the
capacity of clinical care providers, were all military members.
DR. STRIKER:
Okay. So
it's a different Mercy. The one I'm thinking of.
DR. CARNESS:
Yes, sir. Okay.
DR. STRIKER:
Gotcha. Well, um, what
do you both think about the collaboration of the different branches of the
armed forces? For instance, neither of you works in the Air Force. And how
integrated are they? How collaborative are they? Just like to get your thoughts
on on how how that all
works. Uh, Dr. Brenner, let's start with you.
DR. BRENNER:
Sure. So
I guess starting with, like, medical school, the Armed Forces medical school is
not one specific service. It's tri service. And you could commission into the
Navy, Army or Air Force and be a physician and train at the same medical school
and then go do, uh, residency at various different
locations. But I think the big thing, and Dr. Carness knows this very well,
working in an Army facility currently, but is that we're trying to integrate
care for our service members so it's easier for patients and family members of
patients to navigate care in this system. That's one big facet of it. I think
that's been a goal of DA's since kind of grabbing the
reins of the management of a lot of our mtfs. And
what I mean by that is we've created like an electronic medical record that
could be used in Yokosuka, Japan, or in Germany. And, you know, if the closest
facility for an airman, for example, is a Navy hospital, we could have their
records, treat them effectively, and get them back in the fight or back where
they need to be safely. Um, the second facet of that is going to be operational
aspects that Dr. Carness knows much better than I do.
DR. STRIKER:
Dr. Carness?
DR. CARNESS:
I think that's exactly
it. You know, we're looking for interoperability. We're trying to encourage
this collaboration and the sharing of expertise between the Air Force
anesthesiologists and the Navy anesthesiologists, Army anesthesiologists. We
call it going purple. So if you think about the Green
Army and the navy blue navy and that white blue Air force, we're trying to
blend those three colors together and we call it going purple. And so we have certainly we have our anesthesiologists that are
familiar with provision of care on some of these air platforms, like our C-17s.
They're the critical care air transport teams, and we have our individuals that
go out to sea and are more familiar with the provision of care on a large deck
amphibious vessel. And so there's certainly a degree
of collaboration that has to occur if we’re ever in one of those large scale
conflicts. Or if there ever is a significant event, a large
scale natural disaster, that we're called upon to utilize all of these
services together. And I think that's what we're moving towards. So I joke around with my colleagues that I'm still looking
for my ship here at Joint Base Lewis-McChord, here in Washington, because I
can't find it. And but it's just, you know, helping to to
blend and come together.
And I think Dr. Brenner
said it perfectly in terms of our electronic medical record systems and our and
our equipment. So imagine if you had a patient and
they sustained some significant injuries requiring surgical intervention and
intubation, and now they're sedated and intubated. And maybe they need plus or
minus and and you have your pumps and then an
aircraft lands to take your patient and you roll up and your pumps aren't the
same as the pumps on the aircraft. And your consumables aren't the same as their
consumables. And now you're taking time with this unstable patient that you're
trying to quickly mobilize and move and evacuate from this location. And here
you are. Okay, well, let's set up new pump. You know, we'll set up your
consumables on your pump. They'll switch over from mine. And if we can, we can
find a way to streamline that transport as much as possible. I think that's
going to be to the benefit of all of our service
members. So that's that's the goal for the future to to try to blend the services both operationally as well as
clinically back here in the States.
DR. STRIKER:
Yeah, that makes sense.
Going back to the differences between civilian anesthesiology and military
anesthesiology, Dr. Brenner, is there anything you wish that we not in the
military understood better about what it is you do?
DR. BRENNER:
Sure. Um, yeah. So, like
I said, I did residency at a civilian hospital. And the biggest thing that
comes to mind for me is for our civilian colleagues, understanding that, you
know, there's a distinction between veterans like VA anesthesiologists and military
anesthesiologists, it's a different system. So, you know, I think a lot of my
colleagues, when I was training thought that I was going to work at a VA and
didn't understand some of the facets that, oh, you know, you're not just going
to be working at a veterans hospital or just taking
care of 20 year old Marines. I think, um, a big thing for our anesthesiologists
practicing out there is that at these big military treatment facilities
especially, we take care of a, you know, broad, uh, breadth and depth of physiology,
pathology, patient populations. We're taking care of current active
duty service members, their families, uh, retired service members. So we see the extremes of age. Obstetrics, really everything.
And services depend on the facility. But overall, I think the patient
population is more diverse than many civilian anesthesiologists think we may
take care of. And also that, you know, a large portion
of our role is, as we've kind of alluded to, preparing for the potential need
to deploy with one of our platforms in assistance of our sailors, Marines or
other service members.
DR. STRIKER:
Before I get to my
follow up question, Dr. Carness, is there anything you want to talk about with regard to what we should know on the civilian side?
DR. CARNESS:
Well, I always talk
about the, and again, just to reiterate, military anesthesiology being a
subspecialty in and of itself, recognizing that austere anesthesia care
provision is is very different. And we actually train our resident physicians while they're in the
operating room to also think about, okay, well, this is how we're doing the
case here, and we're stateside and we have all of these resources available to
us. But how would you do the same case if you were forward, if you were in the
Middle East, if you were on a small team, if you let's say you didn't have
Rocuronium or you didn't have Succinylcholine and you were using Vecuronium,
does that change your plan? What if you didn't have fill in the blank this you
don't have a video laryngoscope, you only have the capability for direct
Laryngoscopy does that change your plan? How would you approach it? And what if
you don't have blood or how would you get blood?
And one of the things
that that I like to talk about is how we think of ourselves as one part nurse,
one part pharmacist, one part physician. And that's very, very true when we're
providing care and we're forward, because oftentimes we are the ones who are
responsible for our narcotics, and we're responsible for all the medications. So you essentially show up and they give you your narcotics,
and you take accountability for them and you maintain that chain of custody.
But on top of that, you're also looking at whatever kind of medications,
pharmaceuticals that you have available to you, and then also looking at
aspirations and how the quantities and resupply and considering how you're
going to get more. It's not something as simple as, I'm just going to pick up
the phone or talk to my perioperative nurse and ask them to call the pharmacy
to get me what I what I want or what I need. But this may actually
be something that I'm just not going to have, or something that might
not come in and I might might not have access to for
anesthesia care provision. So something that we have
to think about is the pharmacist in us. But then also, as the nurse, some of
our patients, when we care for them, then we might not have immediate medical
evacuation, requiring us to actually care for this
patient for a period of several days. And then during that time, we have to think about things like wound care, and we have to
think about bathing the patient. Do we have to think about IVs in the patient, whether or not we're circulating IVs. And do we have enough
consumables for circulating IVs at the 72 hour mark
like we're supposed to or like, as is often times the case in, in any number of
civilian hospitals. And so that's that nurse part as well that we have to think about in combination with our physician
anesthesiologist role. So so
I think we put all of those things together. And I think it's just very
different in that practice. So that's that's why I
just express and stress that military anesthesiology seems to be a subspecialty
of its own.
DR. STRIKER:
Along those lines, what
I was going to follow up with is, demographically speaking, of the military
anesthesiologists, how much extra subspecialty training, aside from the
military piece do your colleagues have or yourselves, whether it's pediatric or
obstetrics, um, neuro anesthesia, cardiac, etc.?
DR. CARNESS:
So so I think every year we have a joint service
graduate medical education selection board, and we're given a certain number of
billets to attend to any number of different fellowships. And and of course, we always want more. We always wish there
were more, but we are restricted in terms of how many folks that we can send to
fellowship, but we still have the entire collection of all of
those subspecialties. So we have cardiothoracic
trained, critical care trained, obstetric trained, pediatric trained. We have
pain anesthesiologists. We have folks that have done trauma anesthesiology
fellowships and, um, just all all across the board. We would always be happy to have more.
Undoubtedly. But but I think we have a good selection
of some specialists.
DR. STRIKER:
Okay. Well, my last
question to both of you, and Dr. Brenner will start with you. What is next for
military anesthesiologists? How do you see these roles evolving, the military
evolving as it pertains to healthcare. What do you think?
DR. BRENNER:
Sure. So
one thing that's fascinated me about military medicine in general is just how,
over the years, this cohort of physicians and researchers have always innovated
out of necessity to solve unique problems that have faced our country, our
service members and our patients. And my hope and things that excite me is that
going forward, we continue that foundation and use it to, you know, continue to
do things like, how do we shrink ventilators to get them closer and closer to
the patients, and how do we help take care of these patients who come back and
have disabilities from their time in service and help them live meaningful
lives with chronic pain they may develop? Or how do we keep patients alive
longer and safer in the intensive care unit so we can get them back to their homes
and families? And I'm sure just based on the history of what we've been a part
of and what we've seen over the past couple hundred years in military medicine
and military anesthesiology, will continue to push the envelope and hopefully
be people on the front line solving some of these problems for our patients and
our nation.
DR. STRIKER:
Dr. Carness?
DR. CARNESS:
I agree. I think that
mortality on the battlefield has dropped substantially, and I think it it decreased from Vietnam and certainly has decreased over
our time with Operation Iraqi Freedom and Operation Enduring Freedom. And I
think that our joint trauma system and our clinical practice guidelines and our
improvement in the application of technology has significantly decreased that
mortality rate. And I hope that we continue to to
decrease that mortality rate.
I think one of the
things that we have to do is we have to combat what we
call the peacetime effect. So we have any number of
individuals that gain a certain amount of experience in providing care for
these combat wounded individuals. And then we enter into
this period of peace time, which is what we all desire. But then that skill set
starts to atrophy a little bit. And so we we have to find ways to, to maintain that skill set. And I
think we're going to see more engagement and more relationships with our civilian
counterparts. We refer to them as military civilian relationships or mil-civ
relationships. And I think we're going to see more of those. I think we're
going to try to move forward with pushing our military anaesthesiologists
into those tertiary and quaternary care facilities, trying to get them involved
in more trauma care delivery in those large facilities so that we can maintain
that skill set that is so important. We always say that we never want to be
fighting the last war when the next war occurs. And so
we need to make sure that we are maintaining throughout and combating that that
side effect.
I don't think that
anesthesiologists in the military are going anywhere. We call them a critical
wartime specialty. So I think that they will continue
to be needed for years and years and decades to come. And but I agree with Dr.
Brenner that we will find new ways and innovative ways to provide care, and we
will hopefully find new technologies. And I alluded a little bit to point of
care ultrasound and video laryngoscopy. And now they even have new devices that
are trying to combine video laryngoscopy, point of care ultrasound and vital
signs machine. Get them small enough, put them in a pack and really move that
care delivery closer and closer to to the point of
injury to decrease that mortality rate moving into the future. So I think that's what we're going to see.
DR. STRIKER:
Well, that's an
excellent point. Hadn't thought about that with regard to
skills keeping up whether it's peacetime or wartime. Uh, very interesting but
makes perfect sense to try to vary the experience during those lulls, if you
will, where your acute skills need to be kept up.
DR. CARNESS:
Yeah. And a great case
in point is where we brought blood administration into World War Two when we
learned that patients are military injured or combat injured, patients did
better with blood administration than without. And then we moved into Vietnam and we had fractionating of our blood products as our
blood system came online in the late 60s, if memory serves me correctly. And
then we identified that they still did better with whole blood, but we were
fractionating our products. And and then we moved forward
into OIF and OEF. And we're still learning that patients just do better with
whole blood. And I think the trauma systems across the United States are
starting to see that. And there's some additional low tide or whole blood
that's being administered in the setting of trauma and trauma resuscitation.
And when I talk about that, because that seems like something that we learned,
and then the folks who learned it move on, and then we forget to and then we
relearn it, and then maybe we forget a little bit and then we relearn it again.
And so what we're trying to do is, is hopefully
maintain that skill set, hopefully maintain that knowledge. And there's a
program right now that we've created within the Department of Defense through
the Uniformed Services University looking at knowledge, skills and abilities.
How do we maintain that knowledge? How do we maintain those skills and
abilities, and how do we combat that peace time effect? So
I think it's I think it's an interesting topic discussion for the future.
DR. STRIKER:
Yeah, absolutely. I
mean, as is usually the case in a lot of these podcast episodes, we could talk
for hours. So hopefully we can get you guys back in the future to talk about
some other aspects of your practice. But this has been a fantastic conversation.
Um, so not only thank you for joining us, but certainly want to say thank you
for what you do every day, not only your service, but also your expertise that
differs so much from what we do on the civilian side. So
thank you both for for all those things.
DR. CARNESS:
Yes, sir. Thank you so
much. It's been wonderful chatting with you, and I look forward to potentially
chatting with you guys more in the future.
DR. BRENNER:
Yeah. Thank you guys so
much for having us. This was an awesome experience.
(SOUNDBITE OF MUSIC)
DR. STRIKER:
Well, and hopefully we
get to see each other soon and talk soon. Thank you for all our listeners who
have tuned in to this episode of Central Line. Please don't forget to leave a
review or some comments, or tell a colleague about the
podcast and tune in again next time. So thanks again.
Take care.
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