- The Washington Times - Tuesday, October 2, 2001

BALTIMORE Gunshot wounds, gaping incisions and exposure to toxic agents are the grim fruits of war. They're also what doctors at the University of Maryland Shock Trauma Center face on a daily basis.
Medical staff from the Air Force will tap into that experience as they heed President Bush's message to the military to get ready after the Sept. 11 terrorist attacks that killed nearly 7,000 people.
In November, a group of about 10-15 Air Force doctors, nurses and medical technicians will come through Shock Trauma on a 30-day rotation to refresh their skills in treating severe injuries.
Then, starting in January, groups of about two dozen will come through each month, said Lt. Col. Dr. Tyler Putnam, the Air Force's chief of disaster response and a Beltsville native who trained as a surgeon at Shock Trauma in 1994.
Thirteen Air Force doctors, nurses and technicians also will join the medical school staff.
Similar programs are starting in other states. A team of Army surgeons, nurses and medics is heading this week to the trauma center at Jackson Memorial Hospital in Miami. The Navy is planning a training program for its medical personnel at a Los Angeles County hospital.
Why Shock Trauma? The work there, from emergency anesthesia to amputation, is markedly similar to what military medical staff would encounter in war.
"What the Air Force was looking for was very high volume with a very high standard of care, and I think Shock Trauma fits in that perfectly," Dr. Putnam said.
A 1995 congressional study found that only 5 percent of the cases military surgeons encounter on bases during peacetime actually match what they would face on the battlefield, but 98 percent of the cases at civilian trauma centers do.
Enhancing that similarity, guns on the streets today have gotten larger and more powerful more like military firearms. And in Baltimore, where more than 300 people were murdered each year during the 1990s, Shock Trauma staff see plenty of bullet wounds.
Shock Trauma treats an average of 1,500 gunshot and stab wounds a year, said Dr. Thomas Scalea, chief of the trauma center. It also receives thousands of car crash victims.
"When you think about war, you think about obviously gunshot wounds and stab wounds, but also high-energy blunt force wounds, like explosions," Dr. Scalea said. "And the closest thing to that in the civilian sector is high-speed car crashes."
But Shock Trauma's reputation is based not just on volume, but on quality of care, especially its 'golden hour' treatment philosophy of bringing patients to the hospital within an hour of injury. That policy of rapid evacuation, often aided by Medevac helicopters, fits in well with military strategy.
"Very few states have anything quite as organized, coordinated and well-supported as we do here in Maryland," said Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems. "It's a unique place."
The military has worked with Shock Trauma before, including working with surgery residents from the Walter Reed Army Medical Center. In fact, the Air Force program was in the works, although it was expanded significantly after Sept. 11, Dr. Putnam said.
Dr. Scalea said he is looking forward to two-way street, where Shock Trauma doctors also will learn from the military. The massive number of casualties from the attacks on the World Trade Center make it imperative that civilian medical services be vigilant too, he said.
"The timing here is both perfect and tragic, given the recent events in New York and the Pentagon," Dr. Scalea said. "Anybody that thinks that that's not going to be repeated is perhaps optimistic, but not necessarily realistic."
As part of that preparedness, Shock Trauma also will enhance its ability to deal with outbreaks of disease such as anthrax and ebola in the event of a bioterrorist attack.
"We are getting up as fast as we can," Dr. Scalea said, "and I'm sure the military people will help us tailor our readiness to that."

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