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November 2006 Issue

Air Force medical personnel transport an injured soldier using a mobile intensive care unit. This is part of the training medical personnel receive through the C-STARS program, led locally by Stephen Barnes, MD.
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Trauma Surgeon Trains Air Force Docs for Life on the Battlefield

By Amanda Harper
Published November 2006


Stephen Barnes, MD, lives a dual life that not everyone knows about.

Most of the time, he’s a level 1 trauma surgeon at University Hospital and volunteer assistant professor at UC. But when duty calls, he travels across the world as an Air Force medical officer to care for critically wounded soldiers in a maze of canvas and plywood hospital tents in the middle of a war zone.

Despite these drastically different scenarios, he says the jobs are similar. In Cincinnati, injuries are usually much more isolated—a single gunshot wound versus someone who has been blown up by an improvised explosive device and suffered blunt, blast, burn and inhalational injuries in addition to gunshot or fragmentation wounds.


“Battlefield injuries are much more complex than the injuries we see at University Hospital, but the principles and practices are the same: rapid transport and rapid treatment saves lives,” Barnes explains. “That applies to patients  coming off the streets of Cincinnati or off a helicopter in Iraq.”


Barnes, who recently returned from a three-month medical duty tour as chief of critical care services at the 332nd Air Force Theater Hospital in Balad, Iraq, leads one of the three Air Force centers designated for the pre-deployment training of Air Force medical personnel.


Housed at University Hospital, the program is part of a larger Air Force initiative known as the Centers for Sustainment of Trauma and Readiness Skills (C-STARS).


The Cincinnati C-STARS program specializes in teaching Air Force medical personnel the technical and trauma skills necessary for delivering care to critically wounded soldiers in a moving aircraft.


“Downsizing of the Air Force Medical Service and closure of military treatment facilities has decreased the ability to field medical teams with current casualty care and management skills,” Barnes explains.


“We want to reduce the amount of on-the-job training necessary for these doctors, nurses and medical technicians so they can hit the ground running and start saving lives,” he adds. “Everyone has to come together to treat the patient in the end.”


Trainees spend their first two weeks in Texas at Brooks Air Force Base learning the technical skills they need to administer care in an aircraft—for example, how to hook up an oxygen system or which frequency converters to use for redirecting power from the aircraft to run medical equipment.


The last two weeks of the course are spent in a combination of classroom lectures and laboratory work with cadavers at UC and human patient simulators at University Hospital. They also receive hands-on experience caring for fragile patients in University Hospital’s level 1 trauma center and intensive care unit.


Barnes says most trainees are within 90 days of deployment, so the goal is to give medical personnel experience dealing with intense trauma situations before being dropped into the middle of a war zone.


Medical personnel selected to serve as part of a Critical Care Air Transport (CCAT) team are an elite and honored group in Air Force medicine, according to Barnes. These highly specialized medical teams can create and operate a portable intensive care unit on board any available transport aircraft during flight. Teams are rapidly deployable and serve as the primary component of the Air Force’s Aeromedical Evacuation System.


The three-person CCAT medical teams—consisting of a criticalcare- trained physician (such as a cardiologist, pulmonologist or surgeon), a critical care nurse and a respiratory technician—must have experience treating critically ill or injured patients with multi-system trauma, shock, burns, respiratory failure, multiple organ failure and other life-threatening conditions. The complex, critical nature of the patient’s condition requires continuous stabilization, life-saving invasive interventions during flight and life-or-death decision making.


“You can’t fully prepare someone for life as a medical officer on the battlefield,” Barnes says, “but the C-STARS training program helps ensure that our folks are well trained and safe before taking care of our wounded soldiers.”


Barnes and his team have built an aircraft training simulator that accurately mimics all the conditions of critical care air transport, except the fatigue that results from constant vibration and movement inside the aircraft. Trainees experience that fatigue on the last day of class when the newly formed CCAT team flies its first mission on a real aircraft (using the patient simulator) at Wright-Patterson Air Force Base.


The walls of the simulated aircraft are painted dark gray, and only red emergency lights illuminate the cabin, which recreates the environment inside C-130 and C- 17 aircrafts used to move wounded soldiers out of danger. The sounds of churning aircraft engines and wind resistance are pumped in at 65 decibels during training exercises.


And in the middle of it all are two human patient simulators—complete with beating hearts, breathing lungs and real-time vital signs—that the CCAT team must keep “alive” until reaching their destination.


“Some of our trainees have accused us of making the scenarios unrealistically complex,” recalls Barnes. “But after they’ve been in a combat zone, they realize that many patients survived because the simulator training prepared them to deal with an extreme set of circumstances.


Advanced human patient simulation has become a valuable tool in the preparation of our military medics.


“It doesn’t matter if you are part of an enemy force or a United States Army commander—if you come through that hospital door with a pulse, we’ll do our best to fix you,” says Barnes.


Barnes, who expects to be deployed to the Middle East again in January 2008 for a four- to six month tour of duty, lives in Northern Kentucky with his wife, Mary, and four children.

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