Another skill to save your buddy

I mentioned previously that the medics and I were (finally!) going to treat some simulated patients during a base defense exercise. Well, it went fair. In the course of the day, we touched four or five casualties and, since the proctors had no medical knowledge, we really weren't being critiqued. The lack of supplies may have made a difference as well. Everyone knows how hard it is to care for simulated patients (really your peers describing their wounds to you) while using simulated supplies.

That all changed in the last three days while our group completed the Combat Lifesaver course. This is an Army-developed curriculum designed to give typical soldiers some skills to save themselves or their buddies in the event of a traumatic injury. The soldiers are taught the four leading causes of death on the battlefield (hemorrhage, pneumothorax, airway compromise and hypothermia) and how to correct them. They learn to stop serious bleeding of an extremity using a combat tourniquet. They are taught how to recognize a chest wound, apply a chest seal dressing and even how to decompress a collapsed lung by inserting a needle through the chest wall.

The soldiers are also instructed in the use of a nasopharyngeal airway and how to insert an intravenous catheter (IV) into their partner's arm. The course culminates with seven-man teams entering a darkened simulation room that has fog machines and sound effects. The team must assess four casualties (utilizing some of the best simulation technology available), perform the necessary interventions and prepare their patients for air evacuation. The photo shows two airmen treating their simulated casualty.

The two medics assigned to the team and I have had a great three days instructing portions of the course, providing oversight during practical segments and observing during the final exercise. We have also had an opportunity to gain some incredible knowledge from the medics who instruct the course. These dedicated individuals have all spent time in combat zones around the globe and are enthusiastic to teach the average troop these necessary skills.

The simulation exercise was an eye-opener for many. I had a discussion with an instructor about how these men are trained to “shoot to kill” and have no qualms doing it to save themselves or their buddies. Yet, I was amazed how the cocky infantry soldier can freeze when faced with medical casualties whose lives hang in their hands. As a nurse and health-care provider, the opposite is so true—the idea of firing a weapon to harm another individual causes me some hesitation!

The idea for this course is to provide a foundation of knowledge that we now get to build on. We will definitely spend some time assessing a casualty and proper placement of tourniquets. The military works from a theory of muscle memory, and I plan to apply this approach to these lifesaving skills.

The skill the soldiers were most apprehensive about was starting an IV. They talked a big game, trying to sound tough to their buddies, but when the needle hit the arm, many became a bit squeamish and a few even passed out. I continue to reassure the troops that an IV is not an immediate intervention in battlefield medicine, as the military uses the latest in interosseous technology, making an IV nearly obsolete on the battlefield. But, it is another fear conquered, another skill learned, something else to add to their virtual “battlefield toolbox” and take along for reassurance.

Is the training of a non-medical individual to perform these procedures a concept we medical people have a hard time with? YES! I do worry they will believe they are now “medics” and “experts” in combat care. But, if we don't teach them how to save their buddy, we are doing them a disservice. Most combat fatalities would be lost, whether medical personal administered care or not, but the individuals who survive often do so because of the care their buddies rendered in the field. There are only three of us medics on this mission and we can't be everywhere at once. I will rest easier knowing we gave these soldiers one more skill set to help them and their buddies return home safely. Ensuring we all come home together is the ultimate goal of our year in Afghanistan.