how can i be a war doc?

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rangerdad said:
Brother I understand, but I was referring to specific situations. For example, our BN Surgeon went on a mission in the medical Striker, and one of the soldiers got blown-up by a pressure plate IED. He would have died if we didn't have the surgeon with us. Not taking anything from my fellow medics and corpsman (I served 5 yrs as one) but the surgeon cracked the Soldiers chest and pumped the heart all the way to the " cash ." etc... Maybe some medics are massaging hearts in the field, but I have never heard any stories because is out of their scope of care.
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Don't get me wrong, it's great that the soldier survived. This story is extraordinary and wacky and bizarre ... I simply can't accept it at face value.

But even if this event really happened exactly as you think it did, and I suppose there's a non-zero chance that it did because the world is a crazy place full of mystery and wonder, it's still not the argument for putting doctors in the field that you think it is.

Putting a doctor on a Stryker for missions is wrong.
- it's an avoidable risk of a scarce and valuable asset;
- it removes that asset from a well-supplied, well-staffed location where that asset can do the most good;
- it's an unnecessary risk because an enlisted medic or Corpsman is going to be just as field-capable 99.9% of the time;
- it's a risk bad commanders take because they are ignorant, or (even worse!) engaging in showmanship

Just because one time someone got an ace after yelling "hit me" with 20 showing, doesn't make it a good decision at the blackjack table.
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Do you really think that guy would do what you claim happened? He's a great American but not remotely qualified to do that. Open cardiac massage is not taught in any trauma skills class. You are claiming that a battalion surgeon performed open cardiac massage in the field and that the patient survived. Not a CT surgeon, a battalion surgeon. Although SOCOM doesn't use GMOs like the rest of the military, their battalion surgeons are still tend to be trained like the guy in that 2012 article. Some are ER docs. Many of us have significant experience caring for combat wounded and this is highly improbable. Unless you saw him open the chest, this is a fish tale (you may not be fabricating the story but its grown with retelling). What approach did he use? Where did the rib-spreaders, bone saw and the rest of the surgical equipment come from? Why did he do it? Yeah, more than anything else: what was the indication for that procedure?

As for understanding the way they operate, of course we can. We just disagree that there is any evidence that those physicians were anything more than a shiny object that created a perceived but false advantage.
 
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Also, if I was blown-up, I'd want a real surgeon taking care of me. Someone like Joe Rappold. http://www.cbsnews.com/news/navy-surgeon-saves-lives-in-afghanistan-iraq/. Joe didn't look like he could pass a BCA for his last 10 years in the Navy but he kept volunteering and spent half that time in theater and he saved countless lives. It wasn't by doing combat jumps.

Oh, and unless you've gone to medical school, you can't understand the way we operate.
 
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Gastrapathy said:
Do you really think that guy would do what you claim happened? He's a great American but not remotely qualified to do that. Open cardiac massage is not taught in any trauma skills class. You are claiming that a battalion surgeon performed open cardiac massage in the field and that the patient survived. Not a CT surgeon, a battalion surgeon. Although SOCOM doesn't use GMOs like the rest of the military, their battalion surgeons are still tend to be trained like the guy in that 2012 article. Some are ER docs. Many of us have significant experience caring for combat wounded and this is highly improbable. Unless you saw him open the chest, this is a fish tale (you may not be fabricating the story but its grown with retelling). What approach did he use? Where did the rib-spreaders, bone saw and the rest of the surgical equipment come from? Why did he do it? Yeah, more than anything else: what was the indication for that procedure?

As for understanding the way they operate, of course we can. We just disagree that there is any evidence that those physicians were anything more than a shiny object that created a perceived but false advantage.
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I'm tots gonna clam shell someone on my GMO next year!
 
Tired said:
Not sure I necessarily agree with all of this. I think there can be legitimate operational reasons to take doctors on patrol/frontline missions, though this has everything to do with morale/training/local national engagement than any medical reason. I don't know if that's what Stryker units do. We just walked everywhere.

It's quite a bit harder to understand why a real surgeon (as opposed to a "battalion surgeon", which I'm thinking has a different meaning in the Army than the Marine Corps, based on the above posts) would be in that situation.

If you recall though, there were certain AOs that had access to that "armored trauma bay on an LVS" that was popular for a little while. Part of the whole "pushing medical closer to the point of injury". Maybe this is what he's talking about?
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Same meaning. Look at the Army threads about putting IM sub specialists in these jobs. There's an Army GI currently serving as a battalion surgeon (pretty much doing what we did as green side GMOs).
 
rangerdad said:
Enough said. Unless you have served with regiment, you won't understand the way they operate. Additionally, I'm not here to debate the veracity of my experiences. The opportunities are there, and physicians in missions have been a tactical advantage numerous times.
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If you'd written "physicians in missions are erroneously perceived by commanders who don't know anything about medical care to have been a tactical advantage numerous times" I could agree.


Gastrapathy said:
Where did the rib-spreaders come from?
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They're over by the ECMO machine. Duh.


Tired said:
I think there can be legitimate operational reasons to take doctors on patrol/frontline missions, though this has everything to do with morale/training/local national engagement than any medical reason.
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Yes. I went on many medcap type missions, Hearts and Minds(tm) excursions to shine on the locals, show some good will, help the PRTs assess existing medical infrastructure, maybe drum up some intel. There's a place for doctors on those missions ... but it sure isn't to provide meaningful medical care.
 
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Tired said:
It's quite a bit harder to understand why a real surgeon (as opposed to a "battalion surgeon", which I'm thinking has a different meaning in the Army than the Marine Corps, based on the above posts) would be in that situation.
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Battalion surgeons are no different in the Army than they are in the USMC with the exception that the Army uses less GMOs and more board certified "primary care" docs in these positions and the BTN level medical billet is often not organic to the unit but is a doc PROFIS'd from one of the hospitals (with usually a PA performing the BTN surgeon duties in garrison). I know internists, medicine subspecialists, pediatricians, FPs, neurologists, dermatologists, and emergency physicians who have filled these positions. And of course internship trained GMOs are readily found in these positions in the Army (as they are in the USMC) because they aren't fit to do much else.
 
Gastrapathy said:
Same meaning. Look at the Army threads about putting IM sub specialists in these jobs. There's an Army GI currently serving as a battalion surgeon (pretty much doing what we did as green side GMOs).
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Just a minor point of clarification...

The Army threads lamenting medical sub-specialists being involuntarily tagged to go operational are generally referring the Brigade level positions. Subspecialists are often PROFS'd into a BTN level spot for a deployment where they're doing primary care type duties within the unit. While this is not "desirable", it's generally not so bad as deployments are 6 months and then you're back to your medical subspecialty practice at a hospital. The Brigade Surgeon tours are infinitely worse as these are 2 year (admin heavy) tours that generally require a PCS to a base that may or may not be able to support the practice of the particular medical subspecialty. The most amazing instance I recently heard about through the grapevine involved a radiation oncologist I know who was sent to one of these positions.
 
Ziehl-Nielsen said:
Just a minor point of clarification...

The Army threads lamenting medical sub-specialists being involuntarily tagged to go operational are generally referring the Brigade level positions. Subspecialists are often PROFS'd into a BTN level spot for a deployment where they're doing primary care type duties within the unit. While this is not "desirable", it's generally not so bad as deployments are 6 months and then you're back to your medical subspecialty practice at a hospital. The Brigade Surgeon tours are infinitely worse as these are 2 year (admin heavy) tours that generally require a PCS to a base that may or may not be able to support the practice of the particular medical subspecialty. The most amazing instance I recently heard about through the grapevine involved a radiation oncologist I know who was sent to one of these positions.
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Worst I've heard: pediatric neuro-ophthamologist. he specializes in 1/200th of the body, but only in kids, and now he's riding a desk into the sunset.
 
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HighPriest said:
Worst I've heard: pediatric neuro-ophthamologist. he specializes in 1/200th of the body, but only in kids, and now he's riding a desk into the sunset.
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And I've now seen two advertisements looking for a civilian to fill the pediatric ophthalmology job at Bethesda/Walter Reed. First one was back in the early Fall and I just saw another a couple weeks ago.....wonder where they could find someone to do that job that they already pay......
 
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I hate to say it, but I can't fully discount the story about the down-range thoracotomy/massage. In residency a few years ago, I actually took care of the only patient, of which we were aware, to have survived a downrange clamshell thoracotomy with cardiac massage. I can't remember, though, if it was cracked in the field, or in the trauma bay. The guy just could not be killed, despite multiple catastrophic events during his time with us. About two years ago, I saw a video of the guy back with his old unit (to boost morale, his injuries preclude combat).

If Rangerdad is still reading this, what year was this, and what was the soldier's rank?
 
rangerdad said:
Enough said. Unless you have served with regiment, you won't understand the way they operate. Additionally, I'm not here to debate the veracity of my experiences. The opportunities are there, and physicians in missions have been a tactical advantage numerous times.
Click to expand...

the "unless you've walked in my shoes" argument is always available -- it's like "i feel like XXX"-- no one can really argue with it. rangers, ODA, the SF community at large all operate by their own rules- written or otherwise. i've had good experiences and bad experiences with them, but the underlying common theme is they all to a degree have the "we are different" aura. they basically get anything they want (which i doubt has changed) and i think we are arguing reality vs perception. in reality, no one can argue that a physician escort to the "front line" is a good use of resources, or even a smart use of resources. the perception though-- whether it is the (bottome line: artificial) comfort in knowing there is a doctor there, or feeling like you are important enough to have this asset sent with you-- i can see being a "force multiplier" to the combat arms team. are they more aggressive? less tenative? more rambo-esque? true or not, if there is an impact like this, which i suspect the line commanders probably suspect there is, one could argue that it might be worth it. but from a strictly medical standpoint, it makes no sense and is counter to the good of the many vs good of the few stance the military tends to take on everything else.

Gastrapathy said:
Do you really think that guy would do what you claim happened? He's a great American but not remotely qualified to do that. Open cardiac massage is not taught in any trauma skills class. You are claiming that a battalion surgeon performed open cardiac massage in the field and that the patient survived. Not a CT surgeon, a battalion surgeon. Although SOCOM doesn't use GMOs like the rest of the military, their battalion surgeons are still tend to be trained like the guy in that 2012 article. Some are ER docs. Many of us have significant experience caring for combat wounded and this is highly improbable. Unless you saw him open the chest, this is a fish tale (you may not be fabricating the story but its grown with retelling). What approach did he use? Where did the rib-spreaders, bone saw and the rest of the surgical equipment come from? Why did he do it? Yeah, more than anything else: what was the indication for that procedure?

As for understanding the way they operate, of course we can. We just disagree that there is any evidence that those physicians were anything more than a shiny object that created a perceived but false advantage.
Click to expand...

i wonder how he cross clamped the aorta in the desert. i suspect what happened given the mechanism of injury was that he placed a chest tube-- which to the unititiated may have been a bloody mess and looked like a open thoracotomy. that plus CPR, some fluids, AED-- the guy lives, the legend grows, and before long the guy is braveheart, MD.

--your friendly neighborhood this one time a KBR trucker underwent a CABG at my level 1 caveman
 
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psychbender said:
I hate to say it, but I can't fully discount the story about the down-range thoracotomy/massage. In residency a few years ago, I actually took care of the only patient, of which we were aware, to have survived a downrange clamshell thoracotomy with cardiac massage. I can't remember, though, if it was cracked in the field, or in the trauma bay. The guy just could not be killed, despite multiple catastrophic events during his time with us. About two years ago, I saw a video of the guy back with his old unit (to boost morale, his injuries preclude combat).

If Rangerdad is still reading this, what year was this, and what was the soldier's rank?
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If you are referencing the same soldier that i know of who had his chest cracked (massive blast injuries, became asystolic during the evacuation, significant subsequent anoxic brain injuries, etc). His chest was cracked at the CSH.
 
There must be a way to train a man for a high paying assignment, then pay him a quarter of what he's worth, then high another man to do his job for him and pay that second man three times as much while the firs
backrow said:
And I've now seen two advertisements looking for a civilian to fill the pediatric ophthalmology job at Bethesda/Walter Reed. First one was back in the early Fall and I just saw another a couple weeks ago.....wonder where they could find someone to do that job that they already pay......
Click to expand...

There must be a way to train a man for a high paying assignment, then pay him a quarter of what he's worth, then high another man to do his job for him and pay that second man three times as much while the first man does nothing......but how.......
 
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I am not qualified to crack open a chest and perform cardiac massage because I'm not parachute qualified. Clearly the latter is required to be good at the former.
 
Homunculus said:
the "unless you've walked in my shoes" argument is always available -- it's like "i feel like XXX"-- no one can really argue with it. rangers, ODA, the SF community at large all operate by their own rules- written or otherwise. i've had good experiences and bad experiences with them, but the underlying common theme is they all to a degree have the "we are different" aura. they basically get anything they want (which i doubt has changed) and i think we are arguing reality vs perception. in reality, no one can argue that a physician escort to the "front line" is a good use of resources, or even a smart use of resources. the perception though-- whether it is the (bottome line: artificial) comfort in knowing there is a doctor there, or feeling like you are important enough to have this asset sent with you-- i can see being a "force multiplier" to the combat arms team. are they more aggressive? less tenative? more rambo-esque? true or not, if there is an impact like this, which i suspect the line commanders probably suspect there is, one could argue that it might be worth it. but from a strictly medical standpoint, it makes no sense and is counter to the good of the many vs good of the few stance the military tends to take on everything else.



i wonder how he cross clamped the aorta in the desert. i suspect what happened given the mechanism of injury was that he placed a chest tube-- which to the unititiated may have been a bloody mess and looked like a open thoracotomy. that plus CPR, some fluids, AED-- the guy lives, the legend grows, and before long the guy is braveheart, MD.

--your friendly neighborhood this one time a KBR trucker underwent a CABG at my level 1 caveman
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Agreed, and if I may add:

As a 13 year former member of one of these units that "operate by their own rules", I can tell you that any commander who allows a doc to go out the door on an operational mission is at the least completely misguided and at the most subjecting his soldiers to undue risk.

First, as has already been mentioned, our medics can do 99% of what is possible in the field and frankly, they offer something which no doc does: the ability to shoot move and communicate. This brings me to the next and possibly bigger reason to leave the docs in the rear.

Anyone who can not return fire effectively and move efficiently will be more of a liability than an asset. This is why our team members cross-train on battlefield interrogation, breaching, etc. At the end of the day, if you can't secure the objective or close on and kill the enemy you can not accomplish the mission. Leave the docs/Female support teams/SIGINT teams/ blah blah blah in the rear.

Support personnel have a place and that place is rightly "behind the wire" (OK, maybe a JMAU team at a MSS is justified). Having said that, I will gladly join these fine folks when the day comes. Only 7 years to go...
 
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I won't get into specific.

A public record is out for another case of a ranger from an airborne unit and his chest was cracked in the Helo. One more thing, couple years later two of our guys were hit and something similar was done 10 minutes later at the first level trauma and both of them die. No physicians at the mission (probably wouldn't have made a difference) but I wonder. Our understanding is based in our experiences.

I personally will never serve in the military when I become a doctor. Im hoping for a good hospital and a nice office to serve the community. Once again if you want to be a "war doctor", start by joining the military and volunteering to the most elite units then you'll find out what is their real duties vs their job descriptions.
 
Saw a patient today who is 100% sure she has celiac based on her experiences. But...she's dq2 and dq8 negative. She has IBS.

I'll concede that its not impossible this happened but I spent a lot of time caring for SF wounded both in theater and at LRMC and find it really hard to believe (particularly the part about the patient surviving, the clamshell is the easy part of the case).

As long as we are telling sea stories, remember this one old-timers?
A GMO with a surgery internship under his belt performed an appy on a small deck amphib in 1999 off the coast of Singapore. The greenside embarked GMO was a wannabe anesthesiologist and did a spinal. Teamwork! Of course, the right answer was abx and fly the patient to the first-world surgeons a couple of hours away.

I had to check with a military trauma surgeon I know well, here's his text(s) back:

Take a look at PUBMED re: prehospital thoracotomy. All the cases in the literature were done by a surgeon. Theres a 2007 case series trumpeted as a success (1 of 6 survived) and another small series where all the patients died before leaving the hospital (but the authors argued that it helped). Overall mortality in patients with ED thoracotomies is 80+%.

Only 20% of battlefield deaths were from wounds that are potentially survivable (ie there was any chance at saving the patient in the best of circumstances after injury). So, this intervention would only help with potentially survivable wounds with isolated penetrating chest trauma (mortality in emergency thoracotomy from blunt trauma is 98%) when performed by a surgeon with all the necessary equipment.

No one came to me in TQ or Kandahar already open.
 
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DocRGR said:
US Army Special Operations Command (USASOC) is always recruiting docs. Basically you would just chat with a recruiter for these units which are located on many major posts. Assuming you didn't have some major red flag in your record, i.e. you can't pass a standard pt test, then they would probably be interested in you. At that point you would talk with the command surgeon, COL Peter Benson, or one of the component surgeons for Special Forces, Ranger Regiment, etc. and go from there. Those folks would dictate additional schooling options (ranger school, Q course, etc). PM me if you have more questions.
Click to expand...

Found this post in the Army Doctor & Ranger? thread.

The thread has additional reliable information and contacts.
 
You can always volunteer to get deployed with a line unit, and you will not be denied. You can even join BCT or go to a BSB unit or even a special forces unit They always get sent to high risk areas. I would not do it though. Being out there for 10 to 12 months will be very grueling for numerous reasons. This isn't a game.
 
Shikima said:
Probably easier to build a time machine and go back to WW1/WW2/Korea.
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What a waste of a time machine! Go see the dinosaurs, or the Middle Ages, or even better, go see the western US before white people screwed it up.

Sorry, but a time machine comes with a pretty big responsibility, and using it to go to a depressing warzone is a major party foul in the world of time travel.
 
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BigNavyPedsGuy said:
Sorry, but a time machine comes with a pretty big responsibility, and using it to go to a depressing warzone is a major party foul in the world of time travel.
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Yea...you don't want this guy to come after you...

timecop.jpg
 
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BigNavyPedsGuy said:
What a waste of a time machine! Go see the dinosaurs, or the Middle Ages, or even better, go see the western US before white people screwed it up.
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Mmmm, giant lizards hungry for my flesh ... or subsistence living and brutal oppression ... or subsistence living and tribal warfare. If only I could be there.

:)
 
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pgg said:
Mmmm, giant lizards hungry for my flesh ... or subsistence living and brutal oppression ... or subsistence living and tribal warfare. If only I could be there.

:)
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It's not permanent. It's like a really good camping trip. Take a few days supplies and then come home. Assuming Native Americans don't shoot the gas tank of your Delorean.
 
MIs and appendicitis out at sea calls for medivac (pun intended). We were in helo range of the carrier for the appy. I had no meds for general anesthesia on my ddg. The old timers talked about dripping ether on a surgical mask. That would have been interesting.
 
JasonGom said:
Ah that's a shame. What would be considered a good reason to join?
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There's a certain type of dude that joins up looking to go to war, and they are usually idiots and more often than not are a liability rather than an asset. You need to take a REAL good look at yourself and figure out if you're "that guy".
 
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