“Ultimately, this collaboration seeks to enhance the health and well-being of a tremendously deserving patient population — our nation’s active-duty military, veterans and their families.”
Never has the impact of sharing military medical training, and best practice between military and civilian clinicians, been more apparent than during the Boston Marathon bombing and its aftermath. The very nature of terrorism means that civilians are, in effect, combat casualties with injuries not seen in most stateside emergency rooms.
The Boston Marathon bombing and the injuries some of the victims suffered help to bring this fact to the forefront. No case illustrated the need for sharing best practices between military and civilian medical professionals more than Jessica Kensky. The bomb had destroyed her right Achilles tendon and shattered her ankle and heel. A year after reconstructive surgery, she could still barely walk on it.
She consulted experts in Boston, Baltimore, Seattle, Philadelphia, Orlando, and Houston. Each surgeon offered a different idea to make her leg more stable and less painful by harvesting bone from her hip or her thigh to construct a new heel; weaving this or that tendon to build a new Achilles and fusing the bones in her ankle to lock her foot into place.
Each time, she would get her hopes up. Then doubt would creep in or another specialist would dash the plan. The more her leg ached, the more she felt stranded, lagging behind her own timeline for healing. She grew ready for a doctor to declare they were wasting time and should just amputate. But none did, not yet.
Military Medicine Steps In
Jessica’s sister had an internship at Walter Reed and told Jessica’s story to those she knew there. One recovering soldier called his old surgeon and asked whether he could bring Jessica in for a tour and some advice. They reached out to Veterans Airlift Command, a network of private pilots who transport wounded soldiers and their families. All they had to say was “Boston Marathon,” and immediately everyone wanted to help.
She got a workup from Dr. Benjamin “Kyle” Potter, chief orthopedic surgeon for Walter Reed’s amputee program, and Dr. Paul Pasquina, director of physical medicine and rehabilitation. Jessica’s case presented nothing new to them, and they gave her what she craved, a clear message: it’s premature to give up on your leg, and here’s what we propose to try to save it.
They recommended fusing her ankle while resetting her lower-leg bones, smoothing down the remnant of her heel, and manipulating the tissue underneath for more cushioning. They said her left leg should be shortened to better fit a prosthetic, in addition to the need to excise her painful bone growth and remove more shrapnel.
And they suggested doing it all at once, one long operating session and concentrated recovery, instead of the endless surgery-recovery, surgery-recovery cycle proposed by her civilian doctors. Doctors at Walter Reed even stabilized her vision, as this was common in cases of bomb blasts.
Blast victims can be challenging to treat because they typically have multiple complex physical injuries that may include loss of limbs, fractures, brain damage, and vision and hearing impairment, said Dr. Paul Pasquina, chairman of physical medicine and rehabilitation at the Uniformed Services University and Walter Reed National Military Medical Center. These are the very difficult medical cases that civilian medical facilities seldom see, and have no experience in treating.
New Partnership
Understanding this great need for expanding the training and opportunities for medical services and medical students, a new program and partnership between military and civilian medicine has been developed with Fort Hood and Texas A&M College of Medicine.
Texas A&M University is honoring its military roots with a new partnership with the Carl R. Darnall Army Medical Center (CRDAMC) at Fort Hood. Fort Hood and Texas A&M University announced a new partnership that will place medical students at the forefront of Army medicine for a unique training experience.
Col. Mark W. Thompson, commander of the medical center, said the agreement would enhance the care delivered at Fort Hood. “The education opportunities are mutually beneficial,” Thompson said. “Not only does teaching medical students challenge our physicians to stay at the top of their game, being in a military medical environment allows medical students the chance to sharpen their critical thinking and communication skills.”
During the announcement, Col. James Lucas — deputy commander for surgical services at Darnall, who will serve as campus dean for the program — said the partnership is beneficial to the medical center in helping grow its educational component on site.
“This will afford Texas A&M medical students with unique clinical rotations at an exceptional training facility while also broadening and challenging the CRDAMC teaching staff to stay at the top of their game,” said Lucas, who is a graduate of Texas A&M. “Ultimately, this collaboration seeks to enhance the health and well-being of a tremendously deserving patient population — our nation’s active-duty military, veterans and their families.”
Lucas said students will be able to participate in rounds in a variety of areas, including emergency medicine, internal medicine, psychiatry, surgery and more. Rotations at the medical center will be available to students who are in their second, third and fourth years at the A&M Medical School.
Officials said students who participate in the residency program will be exposed to patients suffering from mental health disorders, such as post-traumatic stress disorder, as well as other injuries more common amongst veterans and active-duty service members than in civilians — an experience they said will hopefully provide “a better appreciation for military medicine.”
Under the agreement, about 60 medical students per year, beginning this fall, will get the chance to learn from Army doctors at the newly expanded Carl R. Darnall Army Medical Center, which reopened last year in a state-of-the-art, $560 million facility. At nearly a million square feet, the hospital serves one of the military’s busiest deployment hubs, as well as serving more than 100,000 family members and retirees.
“Medical and military service are two of the most meaningful ways an American can serve their fellow citizens,” said Dr. Carrie Byington, dean of the Texas A&M College of Medicine and senior vice president of the Texas A&M University Health Science Center. “We encourage our students to learn about the special health needs of a variety of populations. A re-emphasis on military medicine brings our focus back to our charter.”
A&M University President Michael Young said the partnership is a “perfect fit” given the school’s 140-year heritage of military service: “We look forward to serving soldiers and their families at Fort Hood, as well as veterans in the surrounding Killeen area.”
Maj. Andrew Fisher, a medical student at the A&M College of Medicine, said he believes the residency program will provide him and his peers with the chance to work with the “unique population” found in a military medical center.
Ultimately, he said he hopes it will provide future medical professionals with a better understanding of how to serve the specific needs of servicemen and servicewomen.
