Back to Top Skip to main content

Elective surgeries hone surgical skills, prepare medical team for combat

Inside Carl R. Darnall Army Medical Center’s second floor surgery suite, surgeons and medical teams are busy honing their critical-care skills. Regardless of procedure or patient, every incision is an exercise in mission readiness. (U.S. Army photo by Marcy Sanchez) At William Beaumont Army Medical Center, surgeons and medical teams are busy honing their critical-care skills. Regardless of procedure or patient, every incision is an exercise in mission readiness. (U.S. Army photo by Marcy Sanchez)

Recommended Content:

Military Hospitals and Clinics | Health Readiness

FORT HOOD, Texas — Inside Carl R. Darnall Army Medical Center’s second floor surgery suite, surgeons and medical teams are busy honing their critical-care skills. In one room, a retiree is getting a new nose. A few feet away, surgeons are replacing broken knees and performing bariatric surgery on dependents to enhance their quality of life. Regardless of procedure or patient, every incision is an exercise in mission readiness.

“Often, when we think of readiness, we’re only thinking of the warfighter or active-duty Soldier,” said Army  Lt. Col. Leah Triolo, an orthopedic surgeon and deputy of the Fort Hood hospital’s surgical services. “But there’re a lot of other green suiters who to go to support that warfighter, and that’s our medical team.”

That team, said Triolo, includes every member on the nursing and anesthesiology staff to the post-recovery and the ward staff who are taking care of the medications and providing more challenging care.

“Even though the surgery itself is elective, providing care to more complex cases, such as a total joint replacement, helps with the readiness of the entire team,” she said.

 “Everything we do is a training opportunity to better prepare us for such things as gunshot wounds, fractures and IED explosions when we do go downrange,” said Army Lt. Col. Lance Taylor, who as chief of operating and anesthesia services, orchestrates the battle rhythm inside CRDAMC’s 8-bay surgical suite.

 “When we look at our total joint population, they represent a population of complex patients because of their medical comorbidities that we may not see when we treat only our active-duty population who are often young and healthy,” said Triolo who deployed twice to Afghanistan with Forward Surgical Teams. “It’s the same with the bariatric care population who are often admitted to the intensive care unit post-op because of other pre-existing conditions that represent critical-care issues.”

Army Maj. Saundra Martinez, a perioperative nurse who saw her share of injuries during her deployment to Tikrit, Iraq, with the 82nd Airborne, said repetition and training in controlled environments translate to surgical excellence and patient safety.

“All that training just clicks in when you are deployed,” said Martinez, who is the chief nurse and officer in charge of CRDAMC’s operating room suites. “That muscle memory just comes back to you regardless of the procedure and requires you to critically think about what’s going on and what you need to do to get that patient stable.”

Open surgeries such as hernias or gastric bypass procedures also offer real-world lessons in anatomy.

“In theater, we get big cases like gunshot wounds to the abdomen and blast explosions, so what we do stateside exposes us to that open-body environment,” said Army Capt. Carolyn Dillon, who deployed to the Helmand Province in Afghanistan and now serves as a circulating nurse who helps prep the patient for surgery and oversees operating room preparation. “We saw lots of wounds from IED explosions, burns and gunshot wounds to the arms and chest, so taking care of the patients there from our fixed experiences here, helps you think outside the box. You’re just not going to have all the necessities in theater that you have here, so critical thinking is key. Overall, all the experiences refine your skills, so you kind of know a little bit about everything.”

On average, the eight surgical teams, which consist of the surgeon, circulating nurse, technician and anesthesiologist perform about 30 surgeries daily.

It’s important, said Taylor, who manages the surgical center’s operating hub, to keep the operating rooms hopping to maximize both operational resources and the surgical skills of the hospital’s medical team.

“If the operating rooms weren’t filled all the time, how would we get our skills?” said Martinez. “How would we know how to take care of our patients?”

For CRDAMC physician, Army Lt. Col. Paula Oliver, who recently returned from a combat deployment, every procedure regardless of simplicity or severity prepares surgeons for combat’s worst-case scenarios.

“The more you operate, no matter the procedure, the more familiar you are with the anatomy and are exposed to complications and anatomical differences,” said Oliver. “Even those who care for civilian trauma can’t be completely prepared for the massive wounds we see with IED blasts, but the more you know, are exposed to, and are comfortable with, helps when you receive your first traumatic multiple amputee.”

That repetition also builds confidence for the Army’s operating-room technicians who shadow the surgeons.

“The only way you are going to boost your confidence level is through repetition,” said Army Spec. Matthew Barek, an operating-room technician who has already assisted in more than 300 surgeries in the three months he has been at CRDAMC. “It helps you to not get nervous and to be able to do everything you need to do.”

Surgery is not just about incisions and sutures. It’s also about patient safety.

“Everyone on that table is someone’s mother, father, son or daughter,” said Army Sgt. Mark Johnson who is as the non-commissioned officer in charge of CRDAMC’s surgery department.

And that, says Martinez, is why every surgical opportunity is a training exercise in deployment medicine.

“It really is irrelevant what kind of surgery it is,” said Martinez. “Having the opportunity to hone our skills during routine procedures is essential downrange when saving lives on the battlefield.”

And those skills, said Triolo, are the unifying element for all the medical providers tasked with saving lives.

“When you’re forward deployed, you don’t have the assets you have here at home, but the skills, which come from the readiness you’ve developed by taking care of critical patients, you take with you,” she said. “Even though the procedures we’re performing here may be thought of as elective or not needed in a military setting, the trickle-down effect for the readiness of the hospital’s entire team is important. And we like the positive impact it can have on the entire population that we support here at Fort Hood.”

Disclaimer: Re-published content may have been edited for length and clarity. Read original post.

You also may be interested in...

Focus on prevention … not the cure for heart disease

Article
2/21/2018
Navy Lt. Cmdr. Cecily Dye is chief cardiologist at Naval Medical Center Camp Lejeune, North Carolina. (U.S. Navy photo by Petty Officer 2nd Class Nicholas N. Lopez)

Many heart health problems can be avoided

Recommended Content:

Health Readiness | Heart Health | Preventive Health

Health care of the future: Virtual doctor-patient visits a reality at NCR

Article
2/20/2018
In a demonstration of the telehealth process at Fort Campbell’s Blanchfield Army Community Hospital, clinical staff nurse Army Lt. Maxx Mamula examines mock patient Army Master Sgt. Jason Alexander using a digital external ocular camera. The image is immediately available to a provider at Fort Gordon’s Eisenhower Medical Center, offering remote consultation. (U.S. Army photo by David E. Gillespie)

Experts from MHS, NCR come together at Virtual Health Summit

Recommended Content:

Access to Health Care | Military Hospitals and Clinics | Technology

‘Kissing disease’ exhausting, but it strikes only once

Article
2/15/2018
Mononucleosis is nicknamed the “kissing disease” because it’s spread through saliva. U.S. Navy Logistics Specialist 3rd Class Michael Zegarra shares the traditional first kiss with his wife Caterina Zegarra, after the aircraft carrier USS Nimitz pulled into port at Naval Base Kitsap, Washington, Dec. 10, 2017. (U.S. Navy photo by Seaman Greg Hall)

Mononucleosis: Learn how virus spreads, who’s most vulnerable

Recommended Content:

Health Readiness | Preventive Health | Public Health

Air Force robotic surgery training program aims at improving patient outcomes

Article
2/9/2018
Air Force Col. Debra Lovette (left), 81st Training Wing commander, receives a briefing from Air Force 2nd Lt. Nina Hoskins, 81st Surgical Operations squadron room nurse, on robotics surgery capabilities inside the robotics surgery clinic at Keesler Medical Center, Mississippi. The training program stood up in March 2017 and has trained surgical teams within the Air Force and across the Department of the Defense. (U.S. Air Force photo by Kemberly Groue).

Robotic surgery is becoming the standard of care for many specialties and procedures

Recommended Content:

Technology | Innovation | Military Hospitals and Clinics

Lose to win: Some service members struggle with weight

Article
2/7/2018
Navy Petty Officer 3rd Class Jovanei Taito, shown here receiving his information warfare qualification certificate, credits the ShipShape program for enabling him to pass the Navy's body composition and physical fitness assessments.  (Courtesy photo)

With numbers rising, programs help keep you shipshape

Recommended Content:

Health Readiness | Heart Health

Outbreak of Influenza and Rhinovirus co-circulation among unvaccinated recruits, U.S. Coast Guard Training Center Cape May, NJ, 24 July – 21 August 2016

Infographic
2/5/2018
On 29 July 2016, the U.S. Coast Guard Training Center Cape May (TCCM), NJ, identified an increase in febrile respiratory illness (FRI) among recruits who were unvaccinated against seasonal influenza as a result of the annual vaccine’s expiration. This report characterizes the outbreak and containment measures implemented at TCCM during the outbreak period. In 2016, respiratory infections affected more than 250,000 U.S. service members and comprised approximately 22% of medical encounters among military recruit populations – who are highly susceptible to respiratory infections. Seasonal influenza and rhinovirus are two of the leading respiratory pathogens. During the Surveillance Period: 115 recruits reported respiratory infection symptoms. Pie chart 1 shows the following data: •	41 (35.7%) suspected cases •	74 (64.3%) confirmed cases Among confirmed cases, lab specimens tested positive for: •	Influenza A 34 (45.9%) •	Rhinovirus 28 (37.8%) •	Influenza A and rhinovirus co-infection 11 (14.9%) •	Rhinovirus and adenovirus co-infection 1 (1.4%) Data above depicted in pie chart 2. •	24 July – 6 August, Influenza predominated •	7 August – 20 August, Rhinovirus predominated Although the outbreak significantly affected operations at TCCM, a timely and comprehensive response resulted in containment of the outbreak within 5 weeks. Key Factor for Outbreak Control •	Rapid detection through FRI sentinel surveillance •	Quick decision-making •	Streamlined response by using a single chain of command •	Rapid implementation of both nonpharmaceutical and pharmaceutical interventions Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

This report characterizes the outbreak and containment measures implemented at the U.S. Coast Guard Training Center Cape May (TCCM), New Jersey, during a July 24 – August 21, 2016 outbreak period.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report | Integrated Biosurveillance | Influenza Summary and Reports

2018 #ColdReadiness Twitter chat recap: Preventing cold weather injuries for service members and their families

Fact Sheet
2/5/2018

To help protect U.S. armed forces, the Armed Forces Health Surveillance Branch (AFHSB) hosted a live #ColdReadiness Twitter chat on Wednesday, January 24th, 12-1:30 pm EST to discuss what service members and their families need to know about winter safety and preventing cold weather injuries as the temperatures drop. This fact sheet documents ...

Recommended Content:

Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report | Winter Safety | Preventive Health | Health Readiness

Department of Defense Global, Laboratory-based Influenza Surveillance Program’s Influenza vaccine effectiveness estimates and surveillance trends, 2016 – 2017 Influenza Season

Infographic
2/5/2018
Each year, the Department of Defense (DoD) Global, Laboratory-based Influenza Surveillance Program performs surveillance for influenza among service members of the DoD and their dependent family members. In addition to routine surveillance, vaccine effectiveness (VE) studies are performed and results are shared with the Food and Drug Administration, Centers for Disease Control and Prevention, and the World Health Organization for vaccine evaluation. This report documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season VE results. The analysis was performed by the U.S. Air Force School of Aerospace Medicine Epidemiology Laboratory, and the DoD Influenza Surveillance Program staff at Wright-Patterson Air Force Base, OH. FINDINGS: A total of 5,555 specimens were tested from 84 locations: •	2,486 (44.7%) negative •	1,382 (24.9%) influenza A •	1,093 (19.7%) other respiratory pathogens •	443 (8.0%) influenza B •	151 (2.7%) co-infections The predominant influenza strain was A (H3N2), representing 73.8% of all circulating influenza. Pie chart displays this information. Graph showing the numbers and percentages of respiratory specimens positive for influenza viruses, and numbers of influenza viruses identified, by type, by surveillance week, Department of Defense healthcare beneficiaries, 2016 – 2017 influenza season displays. The vaccine effectiveness (VE) for this season was slightly lower than for the 2015 – 2016 season, which had a 63% (95% confidence interval: 53% - 71%) adjusted VE. The adjusted VE for the 2016 – 2017 season was 48% protective against all types of influenza.  Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

This infographic documents the annual surveillance trends for the 2016 – 2017 influenza season and the end-of-season vaccine effectiveness.

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | Influenza Summary and Reports | Medical Surveillance Monthly Report | Influenza Seasonal | Immunizations | Vaccine-Preventable Diseases | Force Health Protection

Global Influenza Summary: January 28, 2018

Report
1/28/2018

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | AFHSB Reports and Publications | Influenza Summary and Reports

Insomnia and motor vehicle accident-related injuries, Active Component, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
Insomnia is the most common sleep disorder in adults and its incidence in the U.S. Armed Forces is increasing. A potential consequence of inadequate sleep is increased risk of motor vehicle accidents (MVAs). MVAs are the leading cause of peacetime deaths and a major cause of non-fatal injuries in the U.S. military members. To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia. After adjustment for multiple covariates, during 2007 – 2016, active component service members with insomnia had more than double the rate of MVA-related injuries, compared to service members without insomnia. Findings:  •	Line graph shows the annual rates of motor vehicle accident-related injuries, active component service members with and without diagnoses of insomnia, U.S. Armed Forces, 2007 – 2016  •	Annual rates of MVA-related injuries were highest in the insomnia cohort in 2007 and 2008, and lowest in 2016 •	There were 5,587 cases of MVA-related injuries in the two cohorts during the surveillance period. •	Pie chart displays the following data: 1,738 (31.1%) in the unexposed cohort and 3,849 (68.9%) in the insomnia cohort The highest overall crude rates of MVA-related injuries were seen in service members who were: •	Less than 25 years old •	Junior enlisted rank/grade •	Armor/transport occupation •	 •	With a history of mental health diagnosis •	With a history of alcohol-related disorders Access the full report in the December 2017 (Vol. 24, No. 12). Go to www.Health.mil/MSMR Image displays a motor vehicle accident.

To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia.

Recommended Content:

Armed Forces Health Surveillance Branch | Health Readiness | Medical Surveillance Monthly Report

Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post ...

Recommended Content:

Health Readiness | Posttraumatic Stress Disorder | Armed Forces Health Surveillance Branch | Medical Surveillance Monthly Report

Global Influenza Summary: January 23, 2018

Report
1/23/2018

Recommended Content:

Health Readiness | Armed Forces Health Surveillance Branch | AFHSB Reports and Publications | Influenza Summary and Reports

Cold weather injuries during deployments, July 2012 – June 2017

Infographic
1/18/2018
During the 5-year surveillance period, 105 cold weather injuries were diagnosed and treated in service members deployed outside the U.S. of these, 39 (37%) were immersion injuries; 33 (31%) were frostbite; 16 (15%) were hypothermia; and 17 (16%) were “unspecified” cold weather injuries. Pie chart for cold weather injuries during deployments displays depicting the information above. Number of cold weather injuries bar chart: Of all 105 cold weather injuries during the surveillance period, 68% occurred during the first two cold seasons. Bar chart shows the number of cold weather injuries by year: •	2012-2013 cold season had 35 cold weather injuries •	2013-2014 cold season had 100 cold weather injuries •	2014 -2015 cold season had 13 cold weather injuries •	2015-2016 cold season had 11 cold weather injuries •	2016 – 2017 had 10 cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

This infographic documents cold weather injuries during deployments for the July 2012 – June 2017 cold seasons.

Recommended Content:

Women's Health | Armed Forces Health Surveillance Branch | Health Readiness

Five cold seasons: July 2012-June 2017, Active reserve component service members who were diagnosed with a cold weather injury

Infographic
1/18/2018
Did you know during the 5-year surveillance period, the 2,717 service members who were affected by any cold weather injury included 2,307 from the active component and 410 from the reserve component. Overall, Army members comprised the majority (61.6%) of all cold injuries affecting active and reserve component service members. Of all affected reserve component members, 71.7% (n=294) were members of the Army. Cold weather injuries During Basic Training Of all active component service members who were diagnosed with a cold weather injury (n= 2,307), 230 (10.0% of the total) were affected during basic training. Additionally, during the surveillance period, 60 service members who were diagnosed with cold weather injuries during basic training (2.6% of the total) were hospitalized, and most (93.3%) of the hospitalized cases were members of either the Army (n=32) or Marine Corps (n=24). Cold weather injuries during basic training pie chart: The Army (n=122) and Marine Corps (n=99) comprised 96.1% of all basic trainees who were diagnosed with a cold weather injury. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness Image of service member tracking in the snow is the infographic background graphic.

This infographic provides information on active and reserve component service members who were affected by any cold weather injury during the July 2012 – June 2017 cold seasons.

Recommended Content:

Winter Safety | Armed Forces Health Surveillance Branch | Health Readiness

Update: Cold Weather Injuries, Active and reserve components, U.S. Armed Forces, July 2012 – June 2017

Infographic
1/18/2018
The total number of cold weather injuries among active component service members in 2016 – 2017 cold season was the lowest since 1999. 2016 – 2017 versus the previous four cold seasons  •	A total of 387 members of the active (n=328) and reserve (n=59) components had at least one medical encounter with a primary diagnosis of cold weather injury. •	Rates tended to be higher among service members who were in the youngest age groups, female, non-Hispanic black, or in the Army. •	Cold weather injuries associated with overseas deployments have fallen precipitously in the past three cold seasons due to changes in military operations in Iraq and Afghanistan. There were just 10 cases in the 2016 – 2017 season.  •	Frostbite was the most common type of cold weather injury. Bar chart displays numbers of service members who had a cold injury (one per person per year), by service and cold season, active and reserve components, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

This infographic provides an update for cold weather injuries among active and reserve components, U.S. Armed Forces, July 2012 – June 2017.

Recommended Content:

Winter Safety | Armed Forces Health Surveillance Branch | Health Readiness
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 43

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing: Download a PDF Reader or learn more about PDFs.