KISSIMMEE, Fla. — Dr. Emily Mayhew, military medical historian and author, spoke on Aug. 20 at the 2019 Military Health System Research Symposium at the Gaylord Palms Resort and Convention Center. Mayhew holds a dual appointment as imperial lead for the Paediatric Blast Injury Partnership and historian in residence in the Department of Bioengineering at the Imperial College of London. She has written three books on complex casualty in contemporary warfare and is working on her fourth, titled, “War, Pestilence, Famine and Death: the Four Horsemen and Those Who Seek to Save Us.”
Introduced by Air Force Col. Todd Rasmussen, professor of surgery and associate dean for clinical research at Uniformed Services University of the Health Sciences, Mayhew took the stage and spoke eloquently about her specialization studying shared casualty care contexts and capabilities across a century of modern warfare. She used military medical care developments during World War I to illustrate how the concept of unexpected survivors evolved. Unexpected survivors are just that – warfighters who survive in spite of injuries sustained on the battlefield, thanks to the remarkable advances in casualty care that began during World War I.
From her perspective, as a historian, Mayhew said she would “like to emphasize the need to develop human-based solutions alongside the technology of field care.” The most critical of these skills is situational awareness, according to Mayhew. “Complete situational awareness indicates the ability to manage complexity. It is a sense of where you are because having a sense of the battlefield is supremely important.”
Mayhew also noted complementary skills to situational awareness – organizational ability to keep an aid post running smoothly and assessment capabilities to identify strategic areas for aid post stations. Mayhew noted that medics, called stretcher-bearers in World War I, were former miners who knew how to mitigate threats by digging trenches and identifying evacuation routes, thereby underscoring their important situational awareness skills.
She likened these situational awareness skills to someone who, as a child, was good at building forts.
“If you could identify a safe area, an item that could be naturally converted into a shelter like a discarded box, and a way to sustain the fort from collapse, you’re an ideal candidate for today’s field medic,” she said.
Before taking a few questions from the audience, Mayhew asked the audience to remember the lessons of history when looking at future casualty care scenarios and to identify the team members needed to provide a full complement of care.
“Capable combat casualty care is human decision-making in the toughest situations around the world,” Mayhew said.
A panel discussion titled, “Creating Unexpected Survivors in a Real World Scenario: Decision Points in Contemporary Combat Casualty Care” followed Mayhew’s presentation. Air Force Lt. Col. Brian Beldowicz, surgeon at Madigan Army Medical Center, moderated the session.
Beldowicz presented a realistic plane crash scenario in a remote location with limited land or air transport support for medical care. He posed questions to the panelists on how they would use their expertise to respond the needs of the wounded.
A few important themes emerged from the panelists’ responses – all of which speak to the need for research and development that contributes to warfighter readiness and a medically ready force.
The first theme addressed advanced resuscitative care principles, using whole blood and controlling hemorrhage. For whole blood resuscitation, speed is important and the need for flexibility is paramount. Controlling hemorrhage is an ability and capability needed as far forward as possible, according to the panel experts.
A second theme that emerged was on the make-up and function of the casualty care team. A team has to work together and be flexible, regardless of the number of members. Individual proficiency, when a provider is current and competent in his or her skills, allows a team to function at its best. Knowledge base, skills and practice are the three key components to a successful team.
The panelists also focused on a third theme of provider training, much of it happening at medical treatment facilities. As part of training to achieve a ready medical force and a medically ready force, it is imperative to put providers in locations where they can get the right expertise and to train in teams when possible.
The panelists discussed how sub-specialty physicians such as vascular, plastic and orthopedic surgeons, for example, and intensivist critical care providers should be part of what the panelists referred to as “smart deployment” strategies. Their expertise should also be tapped to teach and train other providers in order to expand the ability to provide prolonged casualty care at the injury site when they are not immediately available.