Consultations in emergency medicine

Abstract

A . Medical support of troops during combat is complex, involving front-line medics, stateside rehabilitation specialists, and an entire in between. Combat medical care from the point of initial injury/illness rearward to mobile military hospitals has many things and many concepts in common with civilian emergency medicine. Some of these are combat medics, EMTs, ground ambulances, helicopters, urgency of management of airway occlusion, bleeding, and shock. Although there are also many differences in setting and equipment, the discipline of emergency medicine is as essential to the proper function of the Army Medical Department as it is to the orderly function of the civilian medical sector. Currently, the Army has some skilled emergency physicians originally trained in other disciplines; each year there are additions to this group. However, the backbone of our emergency physician strength will come from residency training programs at Brooke Army Medical Center, San Antonio, Texas; Madigan Army Medical Center, Tacoma, Washington; and Darnall Army Community Hospital, Fort Hood, Texas. Twenty-four residents can enter these three programs at the second post-graduate year, and there are sufficient applicants to allow us a choice of quality physicians for training. Each residency stresses to its house staff the same areas of emergency medicine as do civilian residencies. In addition, each must teach those skills necessary to provide direct emergency medical care to patients and to operate emergency medicine services on a battlefield. Learning both the standard and the military-specific material in 24 months takes time and hard work; we expect and receive both from our emergency medicine residents. In peacetime, our qualified emergency physicians manage emergency services on a large basis; simultaneously, in order to minimize death and disability among our combat soldiers, they train themselves, other physicians, their corpsmen, and the medical and nonmedical personnel of their units in combat medical care. Military emergency physicians are more than shift workers; they must be able to pick up, move, put down, and effectively operate the immense military '~prehospital care system wherever the needs of this country dictate. Retention of military emergency physicians will vary exactly as does retention of all skilled military professionals physicians, pilots, chemists, and critical care nurses, to name a few. Professional satisfaction, public attitude toward the military, and relative pay will continue to be the major determinants. Neither the Army nor the Army Medical Department determines the last two; however, we hope meeting the challenge of practicing quality emergency medicine while adapting this discipline to a new environment will provide our military emergency physicians the professional satisfaction we all need. Our military pctients need these physicians in peacetime and will need them even more should there be combat.