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By: BOB POTTER, PA-C, SAPA CONFERENCE ADMINISTRATOR
The 32nd Annual Society of Army Physician Assistants PA Refresher Course was held
April 11 through April 15, 2011 at the I-95 Holiday Inn and Convention Center in
Fayetteville North Carolina. There were 425 fellow PA's, NP's, RN's and physicians in
attendance. This year the conference was fairly successful. The conference was approved
through the AAPA for 35 category one CME hours.
This year, there were several new and former speakers giving lectures on a wide variety
of topics, both traditional and some nontraditional. Part of my goal as the conference
coordinator is to change at least 80% of the lecture content from year-to-year. As al-
ways we strive to provide our members with high quality, low-cost CME. This was ac-
complished again. In addition to continuing the individual class evaluations and feedback
on individual lectures, we added another new feature this year. This year, the conference
was registered through the NCCPA in advance of the conference. By doing this, people
are able to go directly to the NCC PA website and click on the conference link and log
their hours for the classes that they have attended. This can speed the process of getting
their hours logged with the NCCPA.
This year, personnel attending the conference hopefully saw a well run event. I have
called this the year of OOPS! We did not have any major problems, but we had numer-
ous small things that occurred that we are able to fix at the last minute. This year‟s is-
sues started occurring about two weeks or so before the conference. A few days before
we were due to leave for the conference, the alarm for our chlorination system in our
home began going off. We were told by the company who installed it that this would
not cause a problem for several weeks and to just to shut off the alarm. When we shut
off the alarm, part of the power source to our primary computers was also shut down.
This led to rerouting the power.
Despite Murphy- Another Successful Conference
T H I S I S S U E
SAPA Conference 1
Why Join SAPA? 8
Change of
Command
10
Cordova—Army
PA of the Year
11
Fisher Featured
by AAPA
12
PAs Receive
OSM
14
Hume Retires
Again!!!
15
Army PAs in the
News
17
BMOC Update 19
FOB Keating 21
Critical Care
Transport Course
26
Tactical Combat
Casualty Care
28
Civilian Trauma
Care
40
Altitude Illness 42
LTHET Update 47
IPAP Update 48
Senior Discount 49
SAPA Members 50
SAPA Leadership 51
SAPA JOURNAL The Society of Army Physician Assistants
A Civilian Organization Representing Army PAs
M A Y / J U N / 2 0 1 1 Vol. 23, NO. 6 A P O I N T S O F I N T E R E S T :
Conference Highlights
Cordova PA of the Year
FOB Keating
BMOC Update
Altitude Illness
Critical Care Course
Hume Retires Again!
PO Box 07490
Fort Myers, FL 33919
Phone & Fax
239-482-2162
P A G E 2
Madam President
Another Successful Conference
Normally, in the last few days preceding the SAPA conference, individuals fax in their regis-
tration forms. However, this year just four days prior to the conference, the primary fax
machine had a paper jam that was not able to be cleared. Because of this problem, we had
to remove this fax machine and replace it with a backup fax. When we unplugged the pri-
mary fax machine, we lost all of the faxes stored in the memory. Upon returning home
from work the next day, we found that the replacement fax machine had a stack of papers
on it, but they were all blank. The black ink dried out and all of the faxes came out blank.
Before we leave Illinois each year for the conference, we complete packets on all preregis-
tered attendees. These packets contain the final conference program, nametags, a pad of
paper, any additional inserts that we have received for the year, and their certificates. We
were prepared to put together the packets prior to leaving. The local printer delivered all
the certificates and printed materials for the conference on Friday morning. As I was un-
packing all of these packets, I looked at each packet and noticed that the certificates
looked exceptional, then I turned one over and found that the CME statement was missing
from the back cover. This led to a very quick phone call to the printer, quick trip to the
print shop, and corrected certificates were delivered that evening.
Each year, prior to leaving for the conference, we will pick up a U-Haul trailer to load all
of the computers, equipment, and paperwork for the conference. Unfortunately, U-Haul
instituted a new policy, trailers are no longer brought to your local U-Haul dealer, you
must now pick up your vehicle at the nearest available dealer. This year instead of driving a
mile across town, I drove 25 miles each way to pick up the U-Haul trailer.
This year, in an attempt to avoid computer problems upon arrival in Fayetteville, I had our
SAPA computers professionally serviced by an IT specialist. During servicing, the IT special-
ist, found one of the computers, the primary backup computer, would not start. The local
specialist felt that the problem was either the hard drive or power source. Therefore, the
computer was brought to the conference with the plan of having it fixed in Fayetteville.
However, once in town, a computer specialist identified the problem as the motherboard.
Unfortunately, there were no replacement boards available. After losing the backup com-
puter, I decided to employ my laptop as the backup. This put us one computer down.
S A P A J O U R N A L
P A G E 3
COL (P) Lien
F ORSCOM Surgeon
Another Successful Conference
I started driving toward Fayetteville early on the 6th of April. The last of the conference
items had been loaded into the U-Haul, I locked it, and started our drive. As we were driv-
ing through Kentucky, someone passed while honking their horn and pointing at the trailer.
I stopped and checked the trailer– everything appeared in order. About 100 miles later,
another car passed while the driver honked his horn and moving his hand up and down.
Again, I stopped to check the trailer. Again everything appeared fine. While inspecting the
trailer, I reached down and grabbed the strap to make sure the door was well secured–
the door popped open. While leaving home, I had failed to put the latch across the door.
Luckily nothing was damaged or lost.
On Thursday evening, my family arrived in Fayetteville and we began working to set up the
computers and the office. I have used this approach traditionally to ensure everything is
working and ready to go early the next morning. The computers started without issue
and we left for dinner. After returning, I began to verify that all the equipment was func-
tioning correctly. However, none of the computers would recognize any of the printers.
At 1130 pm, I had fixed the problem and everything was working properly again.
The conference requires large amounts of copying. Copiers can quickly overheat. For
this reason, we keep the air conditioning turned down low to keep the equipment cool.
This year, the circuit breakers on both the office and our sleep room kept tripping. One
morning, it was 89° in both rooms. Fortunately, there were no malfunctions during the
conference. In addition to computer and air conditioning problems, my cell phone would
not receive calls within the office. I spend the entire conference trying to obtain service
while running my battery dead. When I would get it to work, if I walked too far away, it
shut down.
Last year, we received a large amount of donated artwork for the annual banquet auction.
Because we had a large number of items, I stored part of them for this conference. How-
ever, I was unable to find where the artwork was stored leading to less items for this
year‟s auction. Normally, we pick up the SAPA memorial plaque from Fort Bragg. This
plaque contains the names of members who have passed away. This year, the plaque was
unavailable. Additionally, we have our plaques engraved each year locally, this year, those
were not received in a timely manner.
S A P A J O U R N A L
P A G E 4
82nd AB Choir
Another Successful Conference
As many of you may have noticed, the hotel has taken great strides in improving their ap-
pearance. Holiday Inn has replaced the wallpaper. However, each year we put conference
signs on the walls to inform participants of lectures, merchandise sales, registration, etc.
However, secondary to the new wallpaper, the signs would not stay on the walls.
This year we had worked very hard to schedule the assignments officer for the active-duty
(HRC) to attend and be able to meet one-on-one, face-to-face with the people that she is
assigning. However, as Congress was battling the budget, the possibility of a government
shut down loomed on Friday. We received a phone call from MAJ Amy Jackson on Fri-
day stating that her travel had been canceled and that she would not be able to attend.
Through much work by LTC Sherry Womack, many of our active-duty PAs were at least
able to communicate with her via teleconference. Hopefully we can get this corrected and
not have this problem again next year.
Each year conference participants receive a commemorative coffee mug. This year‟s
mugs were delivered the first day of the conference. We verified that all mugs were de-
livered and assumed everything was fine. However, on Tuesday, one of the exhibitors
who was leaving the conference early asked for his mug. Upon presenting the mug, it was
determined that the vendor had delivered mugs with last year‟s date and conference num-
ber. The vendor was unable to correct the mistake prior to completion of the confer-
ence. Because of this, when people attend next year, we will have a roster of the 2011
attendees and cross them off as they get their mug. This will be in addition to the 2012
mug .
As the week progressed, unfortunately, we had a speaker who was scheduled to provide
two lectures, who was unable to attend. Fortunately, I have backup speakers, whose lec-
tures have been approved from previous years ready to present in case this happens. The
replacement lectures went off without issue.
During the last two days of the conference, the hotel internet provider was working on the
cable, we were not able to receive an Internet signal for the last two days.
The Active Duty PAs had a senior leader‟s conference planned for Thursday morning. This
worldwide VTC was conducted on Fort Bragg and hosted by LTC Tom Schumacher. LTC
Balser, PA Consultant to the Army Surgeon General was in attendance. He provided a
briefing for the active-duty PAs and anyone else interested. Additionally, he provided a lec-
ture for all of the personnel attending the conference. S A P A J O U R N A L
P A G E 5
“ SAPA members
are inducted into
the Hall of Fame
for lasting
contributions to
SAPA. This is
not given
annually, but is
only given when
recommendation
s are made. This
year's awardee
was Stephen W.
Ward, PA-C.”
Another Successful Conference
Each year, the annual SAPA banquet is held. For this banquet, there is a standard schedule
and booklet used to ensure the program flows as scheduled. However, this year the pages
became scrambled. Despite this problem, a group of versatile folks conducted the banquet
without any major hitches. The guest speaker was COL (P) Brian Lein. COL Lein is cur-
rently the FORSCOM Surgeon.
On Friday morning, we inventoried and packed all the equipment into the U-Haul trailer.
We left town at about 2 pm and quickly found ourselves driving through 40 mile per hour
winds. Fortunately, we left on Friday before the devastating tornados that hit the area on
Saturday. Despite all of this years mishaps or as I call it the "Year of the Oops" we still had
a successful conference.
There were many highlights of this year‟s conference. On Sunday afternoon, the hotel
again provided a Carolina picnic with pulled pork, barbecued chicken, hot dogs and burgers
with all the trimmings. In addition to this, we had music provided by our favorite DJ,
"Jammin Jimmy." Monday night was the President's Reception. After a few words by our
current president Sherry Womack, PA-C, an enjoyable evening was had by all. The only
way to describe the food was "WOW". The display was tremendous and the food excep-
tional. We will have photos up on the website later showing this display. This was followed
by music by The Band of OZ", followed by DJ music and karaoke with "Jammin Jimmy."
Tuesday night was the evening of choices. The Deuces Wild crew had their Third Annual
Casino Night. All funds raised for this activity is given to the SAPA Scholarship fund. This
year they raised about $800. In addition, Baron's restaurant had DJ music and karaoke
with "Jammin Jimmy" going on well into the night.
Wednesday evening, again became an evening of choices. Karen Reedy and Regina DeMarco
started a movie night with donations going to the scholarship fund. Through this they raised
$68. In addition, the musical voices of karaoke were going full blast in Barron's restaurant."
On Thursday evening, the 32nd Annual SAPA Banquet and Dining Out was held. This din-
ner allows the organization to recognizes individuals who have excelled in their support of
SAPA. The evening began with the posting of the colors by the 82nd Airborne Color-
Guard. The famous 82nd Airborne Chorus sang the national anthem along with several oth-
er songs.
S A P A J O U R N A L
P A G E 6
“Winning first
place in the
poster contest
was Ronald E
Ellison, PA-C for
his poster
entitled
"Keeping Up
with the Kids:
The Army
Learning
Center.”
Another Successful Conference
The winners of the annual poster contest were announced and they received their winnings
and certificates. Winning first place in the poster contest was Ronald E Ellison, PA-C for
his poster entitled "Keeping Up with the Kids: The Army Learning Center.” Second place
was won by Major Roberto E Marin, PA-C, for his poster entitled:" Blood Lead and Zinc
Protoporphin Surveillance." Third place was won by Lieut. Cmdr. Josef Rivero, PA-C, for
his poster entitled: "Unique Roles of PHS PAs at Federal Bureau of Prisons." Congratula-
tions to all three of our winners, and hopefully next year will we have even more entries.
Individuals who had assisted with the conference either in advance or at the conference
were presented President's Certificates. Those individuals receiving present certificates
were: Lori Wysong, Bob Egberg, Tom Matherley, Rita Ward, Phyllis Lowe, Nicole Potter,
Judy Potter, Irv Fish, Gene Crandall, Christa Waller, Karen Reedy, Regina DeMarco, Taryn
Hutchison, Sue Johnson, Jimmy Malone, Megan Malone, Carol Sterche, John Wooten, Ron
Monce, Zabulon Wilkin, Becky Morgan, Ed Limonte, Jonathan Greene, Christopher Adams
and Thomas Walker.
Next former winners of the Scully Award were recognized. The Scully Award is an award
presented annually by the president of the organization to the person that they feel has
done the most for the organization over the last 12 months. President Sherry Womack
presented this years award to John Detro, PA-C. John has taken over the job of newslet-
ter editor and has turned the SAPA newsletter into an outstanding document. Our news-
letter now competes with any of the other chapter newsletters of the AAPA.
Following the Scully Award, members of the SAPA Hall of Fame were recognized. Each of
the attending members of the Hall of Fame were asked to stand. SAPA members are in-
ducted into the Hall of Fame for lasting contributions to SAPA. This is not given annually,
but is only given when recommendations are made. This year's awardee was Stephen W
Ward, PA-C. Steve has been a past president, past board member, and head of numerous
committees to include the sales committee and the IT committee. Steve plans to retire
from medicine this year and devote his time his ministry and to medical missionary work.
We want to wish him well with his future endeavors. He has promised to come back and
provide a lecture next year on stress fractures afflicting the active-duty soldier. We are go-
ing to hold them to this.
S A P A J O U R N A L
P A G E 7
“Lastly, the 33rd
Annual SAPA PA
Refresher Course
will be held April
23 -April 27,
2012 at the same
location. I hope
to see you all
next April in
Fayetteville.”
Another Successful Conference
We had several special guests also in attendance, the XVIII Airborne Corps Surgeon, LTC
Dwight Rickard, Combat Artist Steward Wavell-Smith, Frank and Diana Delpalazzo, and
our guest speaker, FORSCOM Surgeon Col (P) Brian Lein. After Col Lien's spoke, the
SAPA Grog was prepared and consumed. This was followed by the Annual Auction for the
scholarship fund. Through the sales of the auction, along with individual donations by sever-
al in attendance, $2,405 were put towards the scholarship fund.
During the annual membership meeting, Steve Ward, Chairman of the Sales Booth Com-
mittee reported that an additional $4,145.54 were raised by the sale of merchandise. These
funds will go directly toward the scholarship fund. Our membership director Paul Lowe
reported that we currently have 731 active members.
Despite the enthusiastic attendees, this year‟s conference was down in participant and ex-
hibitor numbers. In the future, SAPA will work with local PAs to assist in finding exhibitors
and work to promote the conference to military PAs. It has been difficult obtaining local
vendors. To correct this shortcoming, if anyone is practicing in the Fayetteville market-
please contact me. I would like members to collect business cards in September and early
October sending them to me. I will make contact with these local exhibitors and invite
them to the conference. Another good source of potential exhibitors comes from other
conferences. If you attend a conference and visit the exhibitor booths collect business
cards. Send the cards to me and I will contact exhibitors to see if they would like to display
their products at our conference.
This year, several people stepped forward offering to present classes for next year's confer-
ence. I am always looking for additional speakers, as I try to rotate most of the speakers
from year-to-year. Some that I did not use in 2011 I will be using in 2012. If you have a sub-
ject that you are passionate about please fill out one of these forms and fax it into me so
that we can add you to our speaker database.
Lastly, the 33rd Annual SAPA PA Refresher Course will be held April 23 -April 27, 2012 at
the same location. I hope to see you all next April in Fayetteville. Keep an eye out on the
website for updates and the projected schedule, and also for the mailing of the hard copy
packets in January of 2012. Thank you
S A P A J O U R N A L
P A G E 8
“As an Army PA
of 14 years, I
believe it’s one
of my duties to
mentor younger
PAs about the
importance of
becoming part of
professional
organizations.”
WHY JOIN SAPA?
By John F. Detro, MPAS-C, SAPA Editor and Commander, 240th FST
In 1997, I finished my PA studies and became an Army Physician Assistant. Shortly after graduating, I
joined the Society of Army Physician Assistants. As a medical professional, I understood the im-
portance of becoming a member of a professional organization which would represent my views to
state and national legislatures, the military, and our national governing body (American Association of
Physician Assistants (AAPA)) and national certification organization (National Commission on Certi-
fication of Physician Assistants (NCCPA)). As a military PA, I felt that SAPA would represent my
concerns more accurately than the AAPA since its original charter is based on this premise.
The AAPA has constituent chapters for each state and for each of the federal services. SAPA is a
constituent chapter of the AAPA; it was chartered, to represent Army PAs, both Active Duty, Na-
tional Guard, Reserve and retired. During the AAPA National Convention, SAPA represents the
needs of military providers and votes on critical issues affecting our livelihoods. However, this pro-
cess is based on the number of SAPA members who are also AAPA members. When joining the AA
PA, you must designate your constituent chapter, if you do not specify Army; AAPA will put you into
the state chapter for the state in which you currently reside. The state will represent interests of
the state but may or may not express the views or concerns of the military PA. For this reason, I
am a member of both SAPA (designated as Army) and AAPA organizations.
Over the last several years, I have seen a change in the commitment to SAPA. I am not sure of the
reason, but less and less newly commissioned Army PAs are joining the organization that represents
their interests. I am not sure whether new graduates fail to join because of a lack of understanding
of the importance of SAPA, a lack of interest of joining professional societies, a lack of mentorship
from current Army PAs, or just a lack of knowledge about SAPA in general.
As an Army PA of 14 years, I believe it‟s one of my duties to mentor younger PAs about the im-
portance of becoming part of professional organizations. I believe that SAPA is the first organization
they should join because it is the most important voice for delivery of our concerns to those who
determine our practice within the military and civilian health care systems.
SAPA is our voice in providing information to our national organization (AAPA) along with our certi-
fying body (National Commission on Certification of Physician Assistants. Let the Board of Direc-
tors of SAPA know what you want and what you need so that they can go forward and lobby on
your behalf at the national level.
S A P A J O U R N A L
P A G E 9
“For SAPA to
continue to
provide the
consultant/
lobbying services
Army PAs
deserve, we need
Active Duty,
Reserve,
National Guard,
and retired Army
PAs to remain or
become
members.”
WHY JOIN SAPA? (CONT.)
Over the years, there have been small core of individuals who have carried the burden of the work
provided by SAPA. These individuals are getting longer in the tooth, some are retiring from practic-
ing as PAs, and others have passed. We need younger members of SAPA to step up and assume
many of the roles these great Americans have performed over the years.
For SAPA to continue to provide the consultant/lobbying services Army PAs deserve, we need Ac-
tive Duty, Reserve, National Guard, and retired Army PAs to remain or become members.
We need all members to become active recruiters. SAPA is an important organization representing
our interests. As leaders in the military community, I ask our members to seek out and mentor
your subordinates, peers, and leaders about the importance of membership.
S A P A J O U R N A L
P A G E 1 0
Rangers Past and
Present attend
Change of
Command
PAs Change Command
On 8 April 2011, LTC John E. Balser and MAJ John F. Detro conducted a Change of Com-
mand Ceremony at Fort Bragg, NC. LTC Balser relinquished Command of the 240th For-
ward Surgical Team. LTC Balser is the first PA to ever command an FST. Currently, MAJ
Craig Paige is commanding an FST in Afghanistan.
During his two year command, LTC Balser deployed the 240th FST to Afghanistan in sup-
port of the Global War on Terrorism (GWOT). MAJ Detro comes to Fort Bragg from
Fort Sam Houston, TX. While at Fort Sam Houston, MAJ Detro served as an instructor at
the Interservice Physician Assistant Program (IPAP) and later as the Deputy Director, Cen-
ter for Predeployment Medicine.
LTC Balser is the current PA Section Chief, Assistant Army Medical Specialist Corps Chief,
and PA Consultant to the Surgeon General. He will move to MEDCOM, Fort Sam Hou-
ston, TX.
S A P A J O U R N A L
LTC Balser, Outgoing
Commander makes remarks
MAJ Detro, Incoming Commander
makes remarks
Preparing to pass the guidon The Army Song
P A G E 1 1
CPT Cordova
earns Silver Star
Cordova Army Surgeon General’s PA Of The Year
S A P A J O U R N A L
CPT Christopher B. Cordova
HHT, 3-61st Cavalry, 41st Brigade Combat Team, 4th Infantry Division
Fort Carson, Colorado
Background
The annual Surgeons General Physician Assistant Recognition Award (TSG-PARA) provides
personal recognition by TSG to a PA who has made a significant contribution to military
medicine. The award is intended to increase PA motivation for exceptional job perfor-
mance. The program applies to all commands, agencies, installations, and activities, and or-
ganizations having PAs assigned on a full-time basis. IAW AR 351
P A G E 1 2
“For his
meritorious
service that day,
he received the
Bronze Star
Medal with
Valor, as well as
the Purple
Heart.”
Fisher Featured in AAPA News
The following article appeared in the AAPAs website on 7 April 2011. MAJ An-
drew Fisher was the 2010 recipient of the Army Surgeon General’s Annual Phy-
sician Assistant Recognition Award. He is the sixth Ranger to win this prestig-
ious award.
Military PAs: Leading By Example, by Janette Rodrigues
The care and safety of fellow Soldiers is the responsibility of all Army medics. But Capt.
Andrew Fisher has taken that commitment one step farther; doing everything he can to
help fellow Rangers, even at the risk of his own life.
While serving in Afghanistan last year as the physician assistant assigned to 1st Battalion,
75th Ranger Regiment, one event in particular put his courage under fire to the test.
Out on a mission the night of May 31, 2010, Fisher was securing a rooftop when his unit
was struck by enemy fire. Shortly after the firefight began, several Rangers were hit by ene-
my fire and trapped on the roof of the building. Without regard for his own safety, Fisher
rushed to aid the wounded Soldiers, even though they remained under heavy enemy fire.
Fisher was hit as soon as he reached the rooftop, but his protective armor stopped the bul-
let from piercing too deeply. Despite his injury, he continued to provide medical care until
all the wounded Soldiers were treated and evacuated from the area. Only then did he tend
to his own wounds.
For his meritorious service that day, he received the Bronze Star Medal with Valor, as well
as the Purple Heart.
This wasn‟t the first time this accomplished Soldier had been recognized. Just weeks prior
to the incident, Fisher was presented with the U.S. Army Surgeon General‟s Annual Physi-
cian Assistant Recognition Award. He was selected from among more than 600 Army PAs
and cited for providing life saving care on two separate combat deployments. His actions in
Afghanistan only further validate that award.
S A P A J O U R N A L
P A G E 1 3
“I didn’t want to
sit around and
watch our
country at war,”
he said. “I
wanted to be
part of
something bigger
than myself, and
I thought being a
PA was the best
way to do that.”
Fisher Featured In AAPA News
“It means a lot that the men I work with think I am worthy of such an award,” he said. “I
work with some of the most amazing men on earth. Professional, dedicated, hardworking
and heroic are a few words that come to mind. It is a privilege to work among the best and
brightest in the Army.”
Although he has served as a PA for only a few years, Fisher has spent nearly two decades in
the Army, many of them as a Ranger. He first enlisted in 1993 as an infantryman and was
assigned to the 75th Ranger Regiment. He went on to serve as a medic with the Rangers
and later transitioned to the Indiana National Guard and worked as a paramedic on the In-
dianapolis Special Weapons and Tactics (SWAT) Team.
the Army‟s Interservice Physician Assistant Program. But it wasn‟t until a friend was killed in
Iraq when Fisher finally decided to enroll.
“I didn‟t want to sit around and watch our country at war,” he said. “I wanted to be part of
something bigger than myself, and I thought being a PA was the best way to do that.”
After earning his PA certification from the University of Nebraska in 2007, he returned to
the 75th Ranger Regiment, and has since completed multiple deployments in support of
Operation Enduring Freedom and Operation Iraqi Freedom.
Even though it was a long road, Fisher sees how each step of his journey helped prepare
him to become a PA.
“Being an enlisted Soldier really helped me understand the mindset of the 75th Ranger Regi-
ment, and I knew what was going to be required of me. My work with the National Guard
and SWAT kept me focused on staying disciplined and focused, and working as a paramedic
helped me obtain skills that help me save lives, even today,” he said.
Fisher will deploy again later this spring with the 75th Ranger Regiment‟s 1st Battalion.
S A P A J O U R N A L
P A G E 1 4
“A nominee for
the Order of Saint
Maurice must have
served the Infantry
community with
distinction; must
have
demonstrated a
significant
contribution in
support of the
Infantry; and must
represent the
highest standards
of integrity, moral
character,
professional
competence, and
dedication to
duty.”
COMPTON AND SMITH AWARDED ORDER OF SAINT MAURICE
By Major John F. Detro, SAPA Editor
Major (retired) Shon Compton and Major (retired) Bret “Smitty” Smith were awarded the Order of
Saint Maurice at Fort Sam Houston on xxxx. A nominee for the Order of Saint Maurice must have
served the Infantry community with distinction; must have demonstrated a significant contribution in
support of the Infantry; and must represent the highest standards of integrity, moral character, pro-
fessional competence, and dedication to duty. Both received the Legionnaire Level for outstanding
or conspicuous contribution to the Infantry. The Order of Saint Maurice is an honor bestowed
upon individuals for their contributions to the U.S Army Infantry Community. Major John F. Detro
presided over the ceremony.
Major Compton served over 29 years in both conventional and special operations units and finished
his career as an instructor at the Tactical Combat Medical Care (TCMC) Course. He is currently
employed as a civilian instructor with the same organization. Major Smith completed over 25 years
of service in both conventional and special operations units and finished his career as the Officer in
Charge (OIC) for TCMC. He is currently working in Aviation Medicine and employed at McWethy
Health Care Clinic, Fort Sam Houston.
Below is a description of the establishment of the Order.
Saint Maurice was Primicerius of the Theban Legion. In 287 AD it marched in service of the Roman
Empire fighting against the revolt in the Berguadae Gauls. His men were composed entirely of Chris-
tians recruited from upper Egypt, near the Valley of the Kings. The Legion marched to the Mediter-
ranean Sea, was transported across, and traveled across Italy to an area in Switzerland. Serving under
Augustus Maximian Hercules, Maurice was ordered to have his legionnaires offer pagan sacrifices
before battle near the Rhone at Martigny. The Theban Legion refused to participate, and also refused
to kill innocent civilians in the conduct of their duty, and withdrew to the town of Agaunum. En-
raged, Maximian ordered every tenth man killed, yet they still refused. A second time the General
ordered Maurice's men to participate and again they refused. Maurice declared his earnest desire to
obey every order lawful in the eyes of God. "We have seen our comrades killed," came the reply.
"Rather than sorrow, we rejoice at the honor done to them." At this Maximian ordered the butch-
ery of the Thebans and the martyrdom of Saint Maurice. September 22 is the traditional feast day.
S A P A J O U R N A L
Friends Gather to
honor Tom
P A G E 1 5
Tom Humes Honored
American Hero Retires– Again!!!
By John F. Detro, SAPA Editor
On28 January, 2011, Tom Humes retired from Civil Service. Several of his former colleagues were
present for his retirement ceremony. Mr. Humes served his country for over 26 years. Tom served
in the U.S Army for 20 years. Upon retirement, he worked in the private sector and in 1986 he
became a government servant serving as a PA for xx years. He served as a civilian PA at Fort Leon-
ard Wood for nearly 25 years. Throughout his career, he has exemplified the professionalism of an
Army Officer and Physician Assistant. Below is the citation which was read during the presentation
of the Meritorious Civilian Service Award presented at his retirement ceremony.
“For exceptional service of duty while assigned to the Consolidated Troop Medical clinic as a Physician Assis-
tant from 28 September 1986 to 31 January 2011. His expertise and versatility is highly evident in his daily
interactions with the diverse missions of the section. Mr. Hume consistently exhibited selfless service making
personal sacrifices to ensure the overall success of the section. His commitment to duty and loyalty to the
organization were consistently displayed in daily duties as well as in many instances when he volunteered to
support staffing requirements in the CTMC and Overseas Contingency Operations at Fort McCoy and Mann-
heim, Germany. Mr. Hume‟s initiative and superior job knowledge has greatly contributed to successful opera-
tions. His work initiative, desire and commitment to excellence are unsurpassed and evidenced by numerous
awards. Additionally, Mr. Hume has served as the primary provider supporting the U.S. Army engineer Sapper
School, providing sick call services to Sapper students in a timely manner to get them back to training. In 2007
he was presented the CG‟s Coin of Excellence for his medical support of the Best Sapper competition. Mr.
Hume‟s accomplishments, devotion to duty, 44 years combined military and civilian service and outstanding
work ethics upholds the finest traditions of civilian service and reflects great credit upon himself, this command
and the United States Army.”
Mr. Hume grew up a military brat following his father‟s Naval career. The father and son‟s careers
overlapped and eventually, Tom‟s father swore him in as an Army Mustang. In 1966, Tom quit col-
lege so he could join the Army during Viet Nam. Upon joining the Army, he attended Basic Training
at Fort Lewis, WA. Next, he attended AIT at Fort Sam Houston, TX. On arrival at AIT, he was
selected and sent to the Primary Leadership Development Course (PLDC) and was made the acting
Sergeant for his AIT unit. Initially, he was assigned to Fort Benning and trained with C 502 101st
Abn Div. In 1967, Tom received orders for deployment to Viet Nam. He was promoted to Ser-
geant and arrived in Saigon on 1 December 1967. Three weeks later, the young Senior Aidman was
involved in the Tet Offensive. During the fighting his company commander was killed and he was
wounded. Tom was wounded twice and was assigned to the American Combat Center Training
Area. While deployed, Tom reenlisted and was sent to William Beaumont Hospital to attend the
Charlie LVN Program. After graduation, he was assigned to the hospital. Tom achieved the highest
score on the 91C examination and was promoted to Staff Sergeant in 1969. Next, he became
NCOIC of Labor and Delivery.
S A P A J O U R N A L
P A G E 1 6
Meritorious
Civilian Service
Award
American Hero Retires- Again!!!
In 1971, he took the initial examination for physician assistant training and then oral boards at Fort Sam
Houston. He was the youngest Soldier selected for training (age 23). He was selected for the second
ever Army PA Class (#2 7/72). After completing Phase I, he was assigned to Fort Carson for his resi-
dency training. He finished the program in 1974 while earning an Associated Degree from Baylor Uni-
versity. His father, still on active duty, performed his swearing in ceremony. In 1974, Tom became
the first PA ever assigned to the 1/4 Infantry, 3rd Infantry Division, Aschaffenburg Germany. Tom
became a charter member of both the Society of Army Physician Assistants and Society of European
Physician Assistants. He was promoted to CW2 in 1976. Next, he was assigned to William Beau-
mont. Later, he returned to Germany and was selected by Gen GS Patton Jr to be Brigade PA 7th
Engineer Brigade, Heilbronn FRG. He extended in country with several subsequent assignments
including as TMC Car and Bde PA for Div Artillery, 1st Armor Division. Additional assignments in-
cluded 1st Armor Division PRP officer. Tom was promoted to CW3 in 1981. In 1983, he was as-
signed as Senior PA for TMCs 3/4/5 at MEDDAC Ft Leonard Wood, While there, he completed his
BS degree and retired in 1986. Immediately upon retirement, Tom began his civil service career
working for the Department of Justice, - Bureau of Prisons LaTuna El Paso, Tx with assignment to
Federal Police Academy Glenco, Ga. In 1988, he received a step increase and was appointed assis-
tant hospital administrator. When the U.S Army began hiring civilian PAs, he felt the urge to return
to the military as a civil servant at Fort Leonard Wood. He became the OIC for TMC3-4 and
worked in the General Outpatient Clinic. Later, he completed his Masters Degree from the Universi-
ty of Nebraska. Subsequently, Tom was elected as a Delegate at Large to the Veterans Caucus Na-
tional Office.
Tom volunteered and was twice assigned to Fort McCoy Wisconsin to cover training for National
Guard units deploying to Operations Desert Shield/Storm. In addition, in 1999, he volunteered and
was sent to Germany to provide patient care at the Mannheim Health Clinic. Due to his devotion to
duty and demonstrated professionalism and leadership he received a second quality step increase.
Throughout 1997-2010, he performed duties as the Sapper Medical Officer at Ft Leonard Wood. He
was involved in research and conducted a study of Rhabdomyolysis during the Best Ranger Competi-
tion. His study was published and he won the best article award during the 2007 Society of Army PA
Annual Conference. During his career, he received 4 coins of excellence from General Officers. Dur-
ing his military and civilian careers, Tom received multiple awards and decorations and accolades. Tom
Hume retires from Federal Civil Service with a total time of 44 years 4 months. He has been an inspi-
ration for many young Soldiers to include his fellow physician assistants. The Society of Army Physician
Assistants would like to thank him for his unwavering service to our nation. We wish him the best in
all future endeavors and hope to see him at next years SAPA Conference.
S A P A J O U R N A L
P A G E 1 7
Iron Majors Named
Each year, the Chief of the Army Medical Specialist Corps recognizes deserving majors
for their contribution to the Corps. This year COL Teresa Schneider selected five Phy-
sician Assistants for recognition as Iron Majors. Below is a list of this years PA recipi-
ents.
MAJ George Barbee
MAJ Marni Barnes
MAJ Kane Morgan
MAJ Michael Franco
MAJ David Hamilton
Iron Majors week is a selection process to identify outstanding captains promotable and
majors of the SP Corps who have displayed outstanding leadership skills, the ability to
mentor junior officers, and who can foresee and participate in the future growth and
potential of the SP Corps.
The following PAs have recently assumed new leadership positions.
LTC Sherry Womack, FORSCOM PA MAJ Karl Kisch, DCCS, Grafenwoer Clinic
LTC Larry France, JRTC Surgeon
LTC Johnny Vandiver, 1 Corps PA
MAJ Kohji Kure, III Corps PA
MAJ Rob Heath, XVIII Corps PA
MAJ Pat O'Neil, Deputy, Center for Predeployment Medicine (CPDM)
MAJ Jeff Oliver, IPAP Phase II Director
MAJ Amelia Duran-Stanton, Fort Bragg Phase II Coordinator
MAJ Chris Hintz, Orthopedic PA Director
MAJ David Broussard, 1st Cavalry Division PA
MAJ Todd Lindsay, 2nd Infantry Division PA
MAJ Thomas Bryant, 4th Infantry Division PA
MAJ Dustin Martin, 82nd Airborne Division PA
MAJ Craig Paige, Commander, 745th FST
MAJ John Detro, Commander, 240th FST S A P A J O U R N A L
PAs Assume Senior Leadership Positions
P A G E 1 8
LTC Tom Schumacher Sets Firsts
LTC James “Tom” Schumacher is currently the Commander of the Warrior Transition Unit (WTU)
at Fort Bragg, NC. This is a battalion level command. Recently, Tom was selected below zone to
Lieutenant Colonel. This makes him the first Physician Assistant to be promoted below zone to
both Major and Lieutenant Colonel. In addition, he was recently selected for primary battalion
command. He is the first PA to receive this honor.
Over the years, Tom has commanded an Area Support Medical Company, served as a PA with the
3rd Ranger Battalion, performed duties as the 82nd Airborne Division Senior PA and XVIII Airborne
Corps PA, and directed students as the Interservice PA Program‟s Phase II Site Coordinator at Fort
Bragg.
On the 25th of February, LTC John Balser, PA Consultant to the Surgeon General completed the
Georgia Tough Mudder. The event was held in Highland Park Georgia. Not only did LTC Balser
encounter mud but also live electric wires among other obstacles. According to the National Tough
Mudder website, “The Tough Mudder series was created because there is not an event in America
that tests toughness, fitness, strength, stamina and mental grit all in one place and all in one day. Sure,
there are a few that will test these things – for thousands of dollars and a week of your life. But in
one day in one location? We don‟t think so. Other mud runs like the Muddy Buddy series? Forget it
– unless you want to run alongside your 60-year-old grandmother. Tough Mudder is a truly excep-
tional event for truly exceptional people. Fair weather runners should stay at home.”
S A P A J O U R N A L
LTC Balser Is One Tough Mudder
Electric Shock to the system! Misery Amongst Friends!
“Many Brigade and
Battalion Command-
ers have commented
on the fact that their
new PA‟s lack the
experience and ex-
pertise of the former
generation of PA‟s.
This is not a reflec-
tion on the quality or
caliber of today‟s
PA‟s; but rather, it is
a reflection that the
PA field is simply ac-
cepting a younger
and less experienced
group of individuals
than before.”
P A G E 1 9 Update Battalion Medical Officer Course (BMOC)
Filling A Training Gap
By Major Patrick O’Neil, Deputy Director, Center for Predeployment Medicine
When asked, most PA‟s will readily admit the anxiety of showing up to their first assignment
as a Battalion Medical Officer. The standard answer to questions about how to perform
tasks at that level was commonly answered with, “Get with your fellow PA‟s at the unit and
find out how they are doing it.” My personal favorite was the comment, “Your Platoon Ser-
geant will square you away when you get there.” Not only were these answers grossly in-
correct, but it let the PA know that they were on their own. Many will openly comment
about the pain and frustration of having to learn through trial and error; hoping to not lose
the confidence and trust of the Battalion Commander. On-the-job training is fine if you are
an apprentice plumber or electrician; however, it should never be acceptable for a position
as important as the Battalion PA or Surgeon.
Many Brigade and Battalion Commanders have commented on the fact that their new PA‟s
lack the experience and expertise of the former generation of PA‟s. This is not a reflection
on the quality or caliber of today‟s PA‟s; but rather, it is a reflection that the PA field is
simply accepting a younger and less experienced group of individuals than before. Their ex-
perience and expertise will grow as they accumulate more time in the military. So, how do
we bridge the gap and prepare these PA‟s for success?
The AMEDDC&S already conducts Division and Brigade Surgeon‟s Courses. Both of these
courses are designed for Field Grade Officers, many of whom have several years in opera-
tional units. Due to their experiences in TOE units and years in service, the learning curve
for these individuals is rather shallow. This begs the question, “If we are willing to offer
courses for the Division and Brigade level Medical Officers; why do we not have one for the
entry level Battalion position?” “How can we send out these individuals with no experience,
and no formal operational training, and expect them to perform at a high level?”
The proposed Battalion Medical Officer Course (BMOC) is an attempt to fill the training gap
that currently exists at that level. The mission is to conduct a course that will allow the stu-
dent to arrive at their first unit and already know the tasks related to that job. They should
not have to shadow another PA for a few weeks to learn their job. They should not have to
go ask their Platoon Sergeant what they are supposed to be doing. They should know how
to brief at Command and Staff and know what information the Commander is going to
want. In simple terms, we want the PA to be able to hit the ground running, with confi-
dence that they know how to perform all aspects of their job.
As with any new course, there are certain steps that must be taken. The Decision Brief and
Business Case Analysis have already been done. The next step will be to conduct Pilot
Courses of five days and ten days. Initially, these will be scheduled during the PA track
training of the AMEDD Basic Officer Leadership Course (BOLC). The idea is to ensure that
they receive this training prior to arrival at their first unit. The students will also attend the
Tactical Combat Medical Care Course prior to arriving at their first unit.
The five day BMOC is basically a didactic “death by PowerPoint.” It will consist of very basic
blocks of instruction that only introduces the PA to the subjects they need to know. There
is simply not enough time in the five day course to bring the students to the “familiarization”
stage; much less the “know” stage of learning. We know the five day course is not the an-
swer to the problem, but that is the purpose of the Pilot Course; to emphatically demon-
strate that five days is simply not enough time. S A P A J O U R N A L
P A G E 2 0 Update Battalion Medical Officer Course (BMOC)
Filling A Training Gap
The ten day BMOC is what we believe to be the best option. It affords the time to instruct
the students in what they need to know, and also time for practical exercises. There will be
a didactic phase and a field phase where the students will be broken down into groups of six
personnel, led by PA cadre that have several years in Operational Battalions. In this setting,
the students will have multiple opportunities to practice and make their mistakes in a school
environment, and not in their actual units.
The proposed subjects that will be covered during the ten day course are:
Roles and Responsibilities of the Battalion PA
WARNORD/OPORD MASCAL Planning
Intro to the BAS Disposition of the Dead
Mission Prep/Planning MC4 and CHCS
MES/SKO Controlled medications
Sick Call Concepts DNBI
68W Training Nine Line MEDEVAC/MiRC
Four Quarter training cycle TMDS
Soldier Readiness Program Medical Boards (MEB/PEB)
PDHRA and Health Assessments Telemedicine
Command and Staff MWDE and MEDPROS
Unit Status Report Medical Plan Back Brief
The first five day BMOC Pilot Course is scheduled for Sep 2011. We are hoping that the 10
day Pilot Course will be in place by March 2012, with full approval for the new course by
summer 2012. It is expected that there will be five BMOC Courses in 2012 that are linked
directly to BOLC. There may be an additional two courses for those personnel that are
civilian accessions or Officers that served in a different branch and did not have to attend
the AMEDD BOLC.
We also fully anticipate that the Medical Corps will eventually want to send their Physicians
that will be serving as Battalion Surgeons. The belief is that they will want their personnel
to have this same standardized training for the Battalion Level. This will most likely add an-
other five courses per year.
By implementing the Battalion Medical Officer Course, the AMEDD will fill the current gap
in training and provide a more professional, knowledgeable, and experienced officer to the
operational units. It will also prevent a lot of PA‟s from having to continually tell their Bat-
talion Commander, “Sorry, Sir, it won‟t happen again.”
I would like to thank Pat, the remainder of the CPDM staff along with the PAs
and medics of TCMC for continuing on with the development of BMOC. When
I first brought the idea to the PAs I was unsure of the response. I was surprised
by the enthusiasm for taking on a second course that would be conducting dur-
ing the refit time between TCMC classes. The PAs of TCMC have nearly 40
years of combined combat experience and a combined 200 years of active ser-
vice. Due to their efforts, this program will no doubt reach the level of TCMC.
S A P A J O U R N A L
FOB Keating
P A G E 2 1
Medical Operations at Combat Outpost Keating on 3 Oct 09
By Captain Christopher Cordova
“On 3 October 2009, Soldiers of Bravo Troop, 3rd Squadron, 61st Cavalry, repelled an enemy force
of 300 Anti-Afghan Forces (AAF) fighters, preserving their combat outpost and killing approximately
150 of the enemy fighters. US forces sustained eight killed in action and 22 wounded, all but three of
whom returned to duty after the attack. The Soldiers distinguished themselves with conspicuous
gallantry, courage, and bravery under the heavy enemy fire that surrounded them.”
-Executive Summary of AR 15-6 Investigation
Situation
In May 2009, the Soldiers of “Black Knight” Troop occupied Combat Outpost (COP) Keating. Im-
mediately upon arrival, the danger associated with our tactical and medical situation was clearly evi-
dent. At 7,000 feet in elevation, the COP was located on the river valley floor and surrounded by
high ground on all sides. The average time for a medical evacuation asset to arrive to the isolated
outpost was approximately sixty minutes, with optimal conditions. In addition to the lengthy medical
evacuation time, the rotary wing assets could be delayed for numerous reasons, including weather,
enemy activity, and the current operations in other areas. My medical team consisted of the Aid
Station NCOIC, SSG Shane Courville, the Troop senior medic, SGT Jeff Hobbs, and two platoon
medics. During the attack on October 3rd, the platoon medic present was SPC Cody Floyd.
Throughout the months that preceded the attack, we, the Aid Station staff, constantly rehearsed our
battle drills and updated and refined our techniques for each possible course of action. While our
situation was grim, the general morale of the Troop was relatively high as a result of the special ca-
maraderie developed between all of the soldiers on COP Keating. In addition, we were constantly
tested by the enemy, which led to the seamless integration of medical tasks into Black Knight
Troop‟s battle drills. I have no doubt that the cohesion of the unit, including the medical team‟s inte-
gration into the unit, contributed to the overall success on October 3, 2009.
Initial contact
Previous engagements with local fighters typically consisted of a few rounds of indirect fire with spo-
radic small arms fire. It was apparent from the first moments on October 3rd that this attack was
different. The enemy fighters initiated the attack at 0600 with multiple weapon systems. The out-
post received coordinated incoming fire from mortar rounds, rocket-propelled grenades (RPGs), and
B-10 recoilless rifle rounds. It was estimated that COP Keating was impacted with accurate indirect
fire at a sustained rate of one round every fifteen seconds for the early part of the battle. In addition
to the indirect fire, the enemy utilized key terrain, the Afghan National Police Station and a nearby
mosque as both heavy machine gun positions and precision small arms fire. The Aid Station crew
began our battle drill of preparing the Aid Station for casualties. It was clearly evident, based on the
sustained rate of enemy fire, that the events of this day would exceed my experiences from previous
deployments.
S A P A J O U R N A L
Defending FOB
Keating
P A G E 2 2
Medical Operations at Combat Outpost Keating on 3 Oct 09
Influx of casualties
Once the aid station was prepped and all members of the team were accounted for, I received radio
traffic of a severely injured Soldier at our casualty collection point (CCP). The aid and litter teams
were fully engaged resupplying ammunition resupply to remote battle positions. This necessitated
the decision to send my Aid Station NCO to the CCP to assess the casualty and, if additional treat-
ment was required, evacuate him to the aid station. Shortly after SSG Courville departed, an RPG
round impacted in the entrance of the aid station, spraying the treatment area with shrapnel and
wounding three Soldiers. Two of the medics, SGT Hobbs and SPC Floyd, sustained minor shrapnel
wounds, while another Soldier suffered deep shrapnel wound to his calf. After assessing the wounds
of Hobbs and Floyd, we placed the other wounded Soldier in a safer location to receive treatment.
Moments later, SSG Courville returned with the severely wounded Soldier from the CCP.
My attention was focused solely on this Soldier‟s resuscitation, as he presented with profuse bleeding
from the occipital region, agonal respirations, and extreme pallor. I knew his prognosis was poor,
but attempted to resuscitate him despite the outlook. SSG Courville made continuous attempts to
reinforce the blood soaked dressing on the occipital region, while continued explosions impacted on
and around the aid station. I started a 500 mL bag of Hextend® through a FAST1® intraosseous
infusion system, managed his airway with a King LT® supraglottic airway system, and directed SSG
Courville to provide respirations with a bag valve mask after he finished applying the bulky dressing.
While my attention had been focused on our critically wounded casualty, an additional seven casual-
ties had arrived to the aid station along with our first Soldier killed in action (KIA). I assessed the
pulse of our first casualty and, as I expected, our attempts to resuscitate him were ineffective. I
discontinued our efforts to focus on the other casualties.
By 0645 hours, forty-five minutes into the fight, I was in the process of managing two US KIAs and
the treatment of an additional seven US and Afghan Soldiers. The severity of the casualties ranged
from major facial avulsion, to open abdominal wounds and deep shrapnel wounds of the extremities.
While I expected the day‟s events to exceed my previous experiences, at this point, the battle sur-
passed what I believed possible. I didn‟t think the situation could worsen.
Enemy in the wire
Upon my initial arrival to COP Keating in May 2009, one of my biggest concerns about the aid sta-
tion was its small size. In optimal conditions, the treatment area could hold two litter casualties.
One of the early improvements made was the fortification of an area immediately outside of the aid
station for overflow patients. This foresight provided an invaluable asset as we dealt with a number
of casualties that exceeded our treatment capacity.
S A P A J O U R N A L
On Patrol Near
FOB Keating
P A G E 2 3
Medical Operations at Combat Outpost Keating on 3 Oct 09
Over the subsequent hours, I spent most of the time directing treatment, placing casualties in areas
based on severity of wounds, and collecting patient data to update our tactical operations center
(TOC). We received five additional US and Afghan wounded Soldiers and one additional US KIA
during this time. As I notified the TOC of our casualty status, I was advised that the ANA had aban-
doned the east side of the COP and multiple enemy fighters were inside the wire. I was also notified
of an additional US KIA in the mortar pit and multiple US Soldiers were unaccounted for. At this
point, I notified my team of the situation and set up security positions at both entrances of the aid
station.
All casualties received initial treatment and required monitoring of IV fluids and pain management. I
directed one medic to monitor the casualties, but the focus of our efforts was ensuring the security
of our aid station. The security of the aid station was not only essential for its occupants, it was vital
for the security of the COP as we were now the eastern-most building of COP Keating‟s now col-
lapsed security perimeter. In addition to the seven US KIAs, the wounded Soldiers, and the enemy‟s
perimeter breach, a fire engulfed the buildings on the abandoned, eastern side of the COP. The fire
slowly spread to the main buildings on the COP, and the day‟s events continued to worsen.
Blood Transfusion
Around 1200 hours, a team maneuvered around the COP to re-establish security. I received radio
traffic that the team located additional Soldiers at a battle position and one of them was severely
wounded. At that time, we were treating an Afghan Soldier for a gunshot wound to his knee with
vascular compromise. The medical team quickly achieved hemostasis with a combat application
tourniquet (CAT), administered 500 mL bag of Hextend®, and placed him in our overflow area. A
severely wounded US Soldier, arrived at the Aid Station, and I assessed penetrating shrapnel wounds
to his lower left abdomen and left pelvic region.
This Soldier was wounded at the beginning of the battle six hours earlier. After he was wounded,
another Soldier, SPC Ty Carter, ran under heavy fire, picked him up, and carried him to a nearby gun
-truck. While in the gun truck, SPC Carter performed first responder treatment on this severely
injured Soldier. He also had sustained a gunshot or shrapnel wound to his left upper thigh. SPC
Carter placed a tourniquet on the proximal femur, preventing additional blood loss.
When he arrived to the Aid Station, there were no distal pulses in his upper or lower extremities,
and his level of consciousness was diminished. His pulse rate was 150 beats per minute, taken from
his carotid pulse. Over the next two hours, he received two 500 mL bags of Hextend®, one 500 mL
bag of normal saline with 3 grams of Unasyn®. The tourniquet was assessed for effectiveness. His
fractured left tibia and fibula were splinted.
S A P A J O U R N A L
Resting Following
the Battle
P A G E 2 4
Medical Operations at Combat Outpost Keating on 3 Oct 09
His wounds were dressed, his pain was managed, and hypothermia prevention was addressed. There
were no changes in level of consciousness or vital signs.
Meanwhile, the fire that originated on the eastern, Afghan side of the compound now engulfed the
TOC, which was located less than three meters from the Aid Station. A tree that spanned the dis-
tance had caught fire and spread to the Aid Station appeared imminent. I directed the movement of
all ambulatory patients to another location and coordinated litter teams to standby for movement of
the four litter patients. My Aid Station NCOIC secured a chainsaw for another Soldier to cut down
the tree. While the tree was in flames, and enemy small arms fire continued to impact the area, SPC
Carter successfully cut down the tree, preventing the aid station from catching fire.
After confirming the Aid Station was no longer in danger of catching fire, I reassessed the condition
of the severely injured Soldier whose vital signs had not improved and his mental status was dimin-
ishing. At this time, approximately 1430 hours, I began to consider other methods of hypotensive
fluid resuscitation. I confirmed with the ground commander that an air medical evacuation platform
would not be available for at least five hours, as enemy forces still surrounded the COP, as well as
the helicopter landing zone. A review of his identification tags revealed his blood type was A posi-
tive. Three members of the Aid Station crew also possessed the A positive blood type, including
myself. Using a standard blood collection bag, I collected one unit of blood from SPC Floyd. We
slowly administered the first unit of blood after obtaining IV access through his external jugular vein.
During the administration of the first bag, I closely monitored his vital signs and watched for transfu-
sion related reactions. Shortly after the first bag was complete, his level of consciousness and his
vital signs improved. He began to communicate his level of pain and his strong desire for a cigarette.
His pulse dropped from 150 to 125 beats per minute, and his femoral pulse was now palpable. His
improved status was reported to the chain of command, and was pushed out to the rest of the COP.
The ground commander noted and reported a significant improvement of the COP‟s morale with
this news.
However, approximately thirty minutes after a unit of blood was transfused, his level of conscious-
ness and vital signs began to diminish. This prompted the collection and administration of another
unit of whole blood. Each time the whole blood was administered, his level of consciousness and
vital signs improved. Over the next five hours he received five units of whole blood from A positive
donors. At 2015 hours, fourteen hours after the beginning of the attack, I was informed the first air
medical evacuation platform was en route to our location and he remained in relatively good spirits.
In a day with many losses, it seemed as if his will to live provided a morale boost to the Soldiers that
were still fighting on the COP. Despite our losses, his ability to survive until the arrival of the medi-
cal evacuation assets lifted all of our spirits.
S A P A J O U R N A L
Remains of FOB
Keating
P A G E 2 5
Medical Operations at Combat Outpost Keating on 3 Oct 09
Medical evacuation
The evacuation process required three turns using UH-60 Blackhawks. The first turn evacuated the
four urgent patients from COP Keating to supporting forward surgical teams (FSTs). The second
and third turn evacuated four US ambulatory casualties and five Afghan ambulatory casualties respec-
tively. After the patients were medically evacuated, we began a thorough refitting and restocking of
the aid station, knowing that there was always the potential for further casualties. I eagerly awaited
an update on his status. Unfortunately, the update I received was not the update I both anticipated
and hoped for. Despite our best efforts, and his will to live, he succumbed to his wounds during
attempted life-saving surgical intervention at Forward Operating Base Bostick.
Conclusion
At the conclusion of the fierce, twelve-hour battle, a total of forty-three US and Afghan casualties
were treated. There are many medical lessons that can be learned from this event, and I encourage
the audience to consider their own situation and apply lessons learned to maximize their medical
preparedness. It was imperative that our team was prepared to manage multiple casualties for pro-
longed periods of time, due to our remote location and the limitation of our only source of medical
evacuation being rotary-wing aircraft. Independent medical providers in remote locations should
always be prepared to do the same. The relative success of the medical treatment on 3 October
2009, under extreme circumstances was largely due to the integration of our medical tasks into the
unit‟s regular battle drills. Our repeated rehearsals revealed minor flaws in our system, which led to
continuous refining of our techniques. While this is not a “ground-breaking” lesson learned, it has its
merits in discussion, as I firmly believe the continued rehearsals led to the readiness of the medical
team at COP Keating. Finally, it is crucial to prepare for the worst-case scenario to become reality.
The enemy‟s ability to inflict significant damage to coalition forces in remote locations has been prov-
en on multiple occasions. Medical teams at these locations should expect these scenarios to happen,
and implement training, battle drills, and rehearsals to improve the team‟s confidence in the event of
a “worst-case” scenario.
The attack on FOB Keating lasted over 12 hours. Eight US soldiers were killed and 22
wounded during the massive, complex attack. Soldiers from Bravo Troop, 3rd Squad-
ron, 61st Calvary, numbering around 80, were outnumbered nearly four-to-one. They
fought heroically for each other. Their expertise and bravery prevented many more
deaths. Along with CPT Cordova, many were honored for their bravery during that
fateful day.
S A P A J O U R N A L
P A G E 2 6
82nd AB Division’s Critical Care Transport Course
By Captain Carl R. Kusbit, MPPM, BS, RN
During the Iraq and Afghanistan wars, the United States realized the need to provide for advanced
healthcare personnel onboard air medevac in the situation where the patient (s) were, and are
considered “urgent”. Urgent patients are those wounded who have life threatening injuries, and
must be transported by air ambulance immediately to a higher level of care, such as a level three
facility such as the trauma center at Bagram Air Base in Afghanistan.
These critical patients are generally intubated and sedated from an FST, or could potentially need
to be intubated enroute, may be receiving blood products in flight, vasopressors via medication
pumps, have multi intravenous access lines, chest tubes, etc. Providers, both medics and advanced
healthcare personnel (flight surgeons, PA‟s, and nurses) will have to be prepared to transport not
only American wounded, but also coalition wounded, local nationals, and children.
Prior to the implementation of advanced healthcare providers, Army medics were tasked to
transport urgent patients via air ambulance, but most did not have the critical care training they
initially needed to transport critically ill patients. One exception to this was an Army medic unit
from a National Guard Base in California, Charlie Company, 168th Aviation Regiment. The medics
from this unit are all, in their civilian jobs, full time firefighter, paramedics, trained in the Blackhawk
Helicopter during monthly battle assemblies, and were well equipped to fly critical patients in
Bagram, Afghanistan.
In August of 2009, I was on deployment with the 82nd Airborne Division Surgeon‟s Cell in Bagram,
and was assigned to “DUSTOFF” as a “Critical Care Flight Nurse”, and a critical care educator. I
was a reservist on active duty at the time. In civilian life I work as an Emergency/Trauma nurse in a
level one ED at the University of Pittsburgh Medical Center, Presbyterian University Hospital, Pitts-
burgh, Pa. I also have an ICU and civilian EMS background.
My position as a critical care nurse was an experimental pilot project as the first critical care flight
nurse in Afghanistan. When I arrived at the aviation hangar, I was told that for the next three
months or so, until they redeployed, I would be flying with Charlie Company, 168th Aviation Regi-
ment, out of California, the same unit I mentioned earlier. There were five medics assigned in
Bagram who are all civilian trained paramedic/firefighters, and who had a firm grasp on the critical
care flight aspect of transporting critically ill soldiers, local nationals, and children. After an orienta-
tion period to the Blackhawk HH60 Helicopter, and flying wounded, as this was my first time doing
so, I was able to fly with the medics on urgent flights as an extra set of hands with one patient, and I
assumed patient care with more than one patient. The pilot program I was involved in as the first
critical care flight nurse in Afghanistan proved to be a valuable tool and asset, was adopted by the
Joint Theater Trauma System, and after I redeployed home in the spring of 2010, 17 critical care
flight nurse positions were approved by the Department of the Army, and these nurses were sent
various sites in Afghanistan.
S A P A J O U R N A L
P A G E 2 7
82nd AB Division’s Critical Care Transport Course
I also functioned as a critical care flight skills instructor, both classroom on the ground, and as a
preceptor in flight. SSG Robert Walters, a flight medic and the 168th staff educator, and I, collabo-
rated as co-instructors, largely on an educational agenda and program that SSG Walters developed,
and taught continuing educational classes to staff members, and other healthcare providers.
During the October 2009 timeframe, right before the 168th redeployed, they were replaced by
medics from Charlie Company, 2-3 Aviation Brigade, 3rd Infantry Division. The 2-3 AVN BDE
medics were very strong ground medics with some flight time in the Iraqi theater. SSG Roberts,
SGT Keith Rudd, the 2-3 aviation education NCO, and I taught the critical care course to the 2-3
medics, and they were up and running in a very short time, and were excellent clinicians with criti-
cal patients in flight.
While in Bagram, I was asked by my chain of command from the 82nd ABN Division Surgeon‟s Of-
fice, LTC Bryan Sleigh, Division Surgeon, MAJ Robert Heath, Deputy Clinical Surgeon, and MAJ Neil
Nelson, Deputy Operations Surgeon, if I would be interested in staying on active duty, for an extra
year, which is now two years, at Fort Bragg, North Carolina, as a Critical Care Education Coordi-
nator, to teach the same critical care flight skills to flight medics at Fort Bragg, prior to their de-
ployment to Afghanistan, as we taught in Afghanistan. I accepted the position, as well as the OIC of
the Taylor/Sandri Medical Training Center, and the critical care program was initiated. This was,
for all intents and purposes, the first program of its type in the Army.
Since last fall, 2010, we have taught four classes, and will be starting our fifth class in the near fu-
ture, and have had great success. Our course is three weeks in duration, and the academics in-
clude, as an example, Advanced Pharmacology, Advanced Airway, Mechanical Ventilation, Rapid
Sequence Intubation, EKG Rhythm Recognition, Advanced Cardiac Life Support, Pediatric Assess-
ment and Pediatric Trauma, followed by Pediatric Advanced Life Support, as well as several other
pertinent critical care flight classes and hands on scenarios. The last day of class is a flight evalua-
tion on a Blackhawk Helicopter in flight, working on intubated manikins outfitted with cardiac mon-
itors, portable ventilators, chest tubes, intravenous pumps, arterial blood monitoring lines, and in-
travenous lines to simulate real critical care patients. We present real life scenarios to our stu-
dents, as a measure of how well they have learned in class, and to acquaint them with what they
will experience working on live patients in theater.
Our class is not limited only to medics, but also to healthcare providers such as Flight Surgeons, Phy-
sician Assistants, Nurses, and any other healthcare provider who may eventually flight critical care
patients in theater, and need the critical care skills this course provides.
S A P A J O U R N A L
P A G E 2 8
Updates on Tactical Combat Casualty Care
The following updates are provided by the Committee on Tactical Combat Casualty
Care (CoTCCC). CoTCCC falls within the Defense Health Board, meets quarterly and
recommends medical guidelines on Tactical Combat Casualty Care (TC3) for all ser-
vices. CoTCCC includes researchers, trauma specialists, medics, and military medical
officers amongst its ranks. TC3 has been recognized by the National Association of
Emergency Medical Technicians (NAEMT) and the American College of Surgeons. The
principles of TC3 have led to the lowest died of wounds rates in World combat history
and have been implemented by military and civilian first responders and medical per-
sonnel.
Tactical Combat Casualty Care Guidelines 1 November 2010
Basic Management Plan for Care Under Fire
1. Return fire and take cover.
2. Direct or expect casualty to remain engaged as a combatant if appropriate.
3. Direct casualty to move to cover and apply self-aid if able.
4. Try to keep the casualty from sustaining additional wounds.
5. Casualties should be extricated from burning vehicles or buildings and moved to places of relative
safety. Do what is necessary to stop the burning process.
6. Airway management is generally best deferred until the Tactical Field Care phase.
7. Stop life-threatening external hemorrhage if tactically feasible:
- Direct casualty to control hemorrhage by self-aid if able.
- Use a CoTCCC-recommended tourniquet for hemorrhage that is anatomically amenable to tourni-
quet application.
- Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casual-
ty to cover.
S A P A J O U R N A L
P A G E 2 9
Updates on Tactical Combat Casualty Care
Basic Management Plan for Tactical Field Care
1. Casualties with an altered mental status should be disarmed immediately.
2. Airway Management
a. Unconscious casualty without airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Place casualty in the recovery position
b. Casualty with airway obstruction or impending airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Allow casualty to assume any position that best protects the airway, to include sitting up.
- Place unconscious casualty in the recovery position.
- If previous measures unsuccessful:
- Surgical cricothyroidotomy (with lidocaine if conscious)
3. Breathing
a. In a casualty with progressive respiratory distress and known or suspected torso trauma, consider
a tension pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25
inch needle/catheter unit inserted in the second intercostal space at the midclavicular line. Ensure
that the needle entry into the chest is not medial to the nipple line and is not directed towards the
heart.
b. All open and/or sucking chest wounds should be treated by immediately applying an occlusive ma-
terial to cover the defect and securing it in place. Monitor the casualty for the potential development
of a subsequent tension pneumothorax.
4. Bleeding
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a
CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomi-
cally amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin
2-3 inches above wound.
S A P A J O U R N A L
P A G E 3 0
Updates on Tactical Combat Casualty Care
Basic Management Plan for Tactical Field Care (cont.).
b. For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet re-
moval (if evacuation time is anticipated to be longer than two hours), use Combat Gauze as
the hemostatic agent of choice. Combat Gauze should be applied with at least 3 minutes of direct
pressure. Before releasing any tourniquet on a casualty who has been resuscitated for hemorrhagic
shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character
and normal mentation if there is no traumatic brain injury (TBI).
c. Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so,
move tourniquet from over uniform and apply directly to skin 2-3 inches above wound. If a tourni-
quet is not needed, use other techniques to control bleeding.
d. When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal
pulse is still present, consider additional tightening of the tourniquet or the use of a second
tourniquet, side by side and proximal to the first, to eliminate the distal pulse.
e. Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indeli-
ble marker.
5. Intravenous (IV) access
- Start an 18-gauge IV or saline lock if indicated.
- If resuscitation is required and IV access is not obtainable, use the intraosseous (IO) route.
6. Fluid resuscitation
Assess for hemorrhagic shock; altered mental status (in the absence of head injury) and weak or ab-
sent peripheral pulses are the best field indicators of shock.
a. If not in shock:
- No IV fluids necessary
- PO fluids permissible if conscious and can swallow
b. If in shock:
- Hextend, 500-mL IV bolus
- Repeat once after 30 minutes if still in shock.
- No more than 1000 mL of Hextend
c. Continued efforts to resuscitate must be weighed against logistical and tactical considerations and
the risk of incurring further casualties.
S A P A J O U R N A L
P A G E 3 1
Updates on Tactical Combat Casualty Care
Basic Management Plan for Tactical Field Care (cont.).
d. If a casualty with an altered mental status due to suspected TBI has a weak or absent peripheral
pulse, resuscitate as necessary to maintain a palpable radial pulse.
7. Prevention of hypothermia
a. Minimize casualty‟s exposure to the elements. Keep protective gear on or with the casualty if feasi-
ble.
b. Replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as
possible.
c. Apply the Ready-Heat Blanket from the Hypothermia Prevention and Management Kit (HPMK) to
the casualty‟s torso (not directly on the skin) and cover the casualty with the Heat-Reflective Shell
(HRS).
d. If an HRS is not available, the previously recommended combination of the Blizzard Survival Blan-
ket and the Ready Heat blanket may also be used.
e. If the items mentioned above are not available, use dry blankets, poncho liners, sleeping bags, or
anything that will retain heat and keep the casualty dry.
f. Warm fluids are preferred if IV fluids are required.
8. Penetrating Eye Trauma
If a penetrating eye injury is noted or suspected:
a) Perform a rapid field test of visual acuity.
b) Cover the eye with a rigid eye shield (NOT a pressure patch.)
c) Ensure that the 400 mg Moxifloxacin tablet in the combat pill pack is taken if possible and that IV/
IM antibiotics are given as outlined below if oral Moxifloxacin cannot be taken.
9. Monitoring
Pulse oximetry should be available as an adjunct to clinical monitoring. Readings may be misleading in
the settings of shock or marked hypothermia.
10. Inspect and dress known wounds.
11. Check for additional wounds.
S A P A J O U R N A L
P A G E 3 2
Updates on Tactical Combat Casualty Care
Basic Management Plan for Tactical Field Care (cont.).
12. Provide analgesia as necessary.
a. Able to fight:
These medications should be carried by the combatant and self administered as soon as possible
after the wound is sustained.
- Mobic, 15 mg PO once a day
- Tylenol, 650-mg bilayer caplet, 2 PO every 8 hours
b. Unable to fight:
Note: Have naloxone readily available whenever administering opiates.
- Does not otherwise require IV/IO access
- Oral Transmucosal fentanyl citrate (OTFC), 800 ug transbuccally
- Recommend taping lozenge-on-a-stick to casualty‟s finger as an added safety measure
- Reassess in 15 minutes
- Add second lozenge, in other cheek, as necessary to control severe pain.
- Monitor for respiratory depression.
- IV or IO access obtained:
- Morphine sulfate, 5 mg IV/IO
- Reassess in 10 minutes.
- Repeat dose every 10 minutes as necessary to control severe pain.
- Monitor for respiratory depression
- Promethazine, 25 mg IV/IM/IO every 6 hours as needed for nausea or for synergistic analgesic ef-
fect
13. Splint fractures and recheck pulse.
14. Antibiotics: recommended for all open combat wounds
a. If able to take PO:
- Moxifloxacin, 400 mg PO one a day
b. If unable to take PO (shock, unconsciousness):
- Cefotetan, 2 g IV (slow push over 3-5 minutes) or IM every 12 hours or - Ertapenum, 1 g IV/IM
once a day
S A P A J O U R N A L
P A G E 3 3
Updates on Tactical Combat Casualty Care
Basic Management Plan for Tactical Field Care (cont.).
15. Burns
a. Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury.
Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical
airway for respiratory distress or oxygen desaturation.
b. Estimate total body surface area (TBSA) burned to the nearest 10% using the Rule of Nines.
c. Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the
casualty in the Blizzard Survival Blanket in the Hypothermia Prevention Kit in order to both cover
the burned areas and prevent hypothermia.
d. Fluid resuscitation (USAISR Rule of Ten)
– If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as
soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer‟s, normal
saline, or Hextend. If Hextend is used, no more than 1000 ml should be given, followed by Lactated
Ringer‟s or normal saline as needed.
– Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr. for adults weighing 40- 80 kg.
– For every 10 kg ABOVE 80 kg, increase initial rate by 100 ml/hr.
– If hemorrhagic shock is also present, resuscitation for hemorrhagic shock takes precedence over
resuscitation for burn shock.
Administer IV/IO fluids per the TCCC Guidelines in Section 6.
e. Analgesia in accordance with the TCCC Guidelines in Section 12 may be administered to treat
burn pain.
f. Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics should be given per
the TCCC guidelines in Section 14 if indicated to prevent infection in penetrating wounds.
g. All TCCC interventions can be performed on or through burned skin in a burn casualty.
16. Communicate with the casualty if possible.
- Encourage; reassure
- Explain care
17. Cardiopulmonary resuscitation (CPR)
Resuscitation on the battlefield for victims of blast or penetrating trauma who have no pulse, no ven-
tilations, and no other signs of life will not be successful and should not be attempted.
S A P A J O U R N A L
P A G E 3 4
Updates on Tactical Combat Casualty Care
Basic Management Plan for Tactical Field Care (cont.).
18. Documentation of Care
Document clinical assessments, treatments rendered, and changes in the casualty‟s status on a TCCC
Casualty Card. Forward this information with the casualty to the next level of care.
Basic Management Plan for Tactical Evacuation Care
* The term “Tactical Evacuation” includes both Casualty Evacuation (CASEVAC) and Medical Evacua-
tion (MEDEVAC) as defined in Joint Publication 4-02.
1. Airway Management
a. Unconscious casualty without airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Place casualty in the recovery position
b. Casualty with airway obstruction or impending airway obstruction:
- Chin lift or jaw thrust maneuver
- Nasopharyngeal airway
- Allow casualty to assume any position that best protects the airway, to include sitting up.
- Place unconscious casualty in the recovery position.
- If above measures unsuccessful:
- Laryngeal Mask Airway (LMA)/intubating LMA or - King LT or
- Endotracheal intubation or
- Surgical cricothyroidotomy (with lidocaine if conscious).
c. Spinal immobilization is not necessary for casualties with penetrating trauma.
2. Breathing
a. In a casualty with progressive respiratory distress and known or suspected torso trauma, consider
a tension pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25
inch needle/catheter unit inserted in the second intercostal space at the midclavicular line. Ensure
that the needle entry into the chest is not medial to the nipple line and is not directed towards the
heart.
b. Consider chest tube insertion if no improvement and/or long transport is anticipated.
S A P A J O U R N A L
P A G E 3 5
Updates on Tactical Combat Casualty Care
Basic Management Plan for Tactical Evacuation Care (cont.)
c. Most combat casualties do not require supplemental oxygen, but administration of oxygen may be
of benefit for the following types of casualties:
- Low oxygen saturation by pulse oximetry
- Injuries associated with impaired oxygenation
- Unconscious casualty
- Casualty with TBI (maintain oxygen saturation > 90%)
- Casualty in shock
- Casualty at altitude
d. All open and/or sucking chest wounds should be treated by immediately applying an occlusive ma-
terial to cover the defect and securing it in place. Monitor the casualty for the potential development
of a subsequent tension pneumothorax.
3. Bleeding
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a
CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomi-
cally amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2
-3 inches above wound.
b. For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet re-
moval (if evacuation time is anticipated to be longer than two hours), use Combat Gauze as
the hemostatic agent of choice. Combat Gauze should be applied with at least 3 minutes of direct
pressure. Before releasing any tourniquet on a casualty who has been resuscitated for hemorrhagic
shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character
and normal mentation if there is no TBI.)
c. Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so,
move tourniquet from over uniform and apply directly to skin 2-3 inches above wound. If a tourni-
quet is not needed, use other techniques to control bleeding.
d. When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal
pulse is still present, consider additional tightening of the tourniquet or the use of a second tourni-
quet, side by side and proximal to the first, to eliminate the distal pulse.
e. Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indeli-
ble marker.
S A P A J O U R N A L
P A G E 3 6
Updates on Tactical Combat Casualty Care
4. Intravenous (IV) access
a. Reassess need for IV access.
- If indicated, start an 18-gauge IV or saline lock
- If resuscitation is required and IV access is not obtainable, use intraosseous (IO) route.
5. Fluid resuscitation
Reassess for hemorrhagic shock (altered mental status in the absence of brain injury and/or change in
pulse character.) If BP monitoring is available, maintain target systolic BP 80-90 mmHg.
a. If not in shock:
- No IV fluids necessary.
- PO fluids permissible if conscious and can swallow.
b. If in shock and blood products are not available:
- Hextend 500-mL IV bolus
- Repeat after 30 minutes if still in shock.
- Continue resuscitation with Hextend or crystalloid solution as needed to maintain target BP or
clinical improvement.
c. If in shock and blood products are available under an approved command or theater protocol:
- Resuscitate with 2 units of plasma followed by packed red blood cells (PRBCs) in a 1:1 ratio. If
blood component therapy is not available, transfuse fresh whole blood.
Continue resuscitation as needed to maintain target BP or clinical improvement.
d. If a casualty with an altered mental status due to suspected TBI has a weak or absent peripheral
pulse, resuscitate as necessary to maintain a palpable radial pulse. If BP monitoring is available,
maintain target systolic BP of at least 90 mmHg.
6. Prevention of hypothermia
a. Minimize casualty‟s exposure to the elements. Keep protective gear on or with the casualty if feasi-
ble.
b. Replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as
possible.
c. Apply the Ready-Heat Blanket from the Hypothermia Prevention and Management Kit (HPMK) to
the casualty‟s torso (not directly on the skin) and cover the casualty with the Heat-Reflective Shell
(HRS).
S A P A J O U R N A L
P A G E 3 7
Updates on Tactical Combat Casualty Care
d. If an HRS is not available, the previously recommended combination of the Blizzard Survival Blan-
ket and the Ready Heat blanket may also be used.
e. If the items mentioned above are not available, use poncho liners, sleeping bags, or anything that
will retain heat and keep the casualty dry.
f. Use a portable fluid warmer capable of warming all IV fluids including blood products.
g. Protect the casualty from wind if doors must be kept open.
7. Penetrating Eye Trauma
If a penetrating eye injury is noted or suspected:
a) Perform a rapid field test of visual acuity.
b) Cover the eye with a rigid eye shield (NOT a pressure patch).
c) Ensure that the 400 mg Moxifloxacin tablet in the combat pill pack is taken if possible and that IV/
IM antibiotics are given as outlined below if oral Moxifloxacin cannot be taken.
8. Monitoring
Institute pulse oximetry and other electronic monitoring of vital signs, if indicated.
9. Inspect and dress known wounds if not already done.
10. Check for additional wounds.
11. Provide analgesia as necessary.
a. Able to fight:
- Mobic, 15 mg PO once a day
- Tylenol, 650-mg bilayered caplet, 2 PO every 8 hours
b. Unable to fight:
Note: Have naloxone readily available whenever administering opiates.
- Does not otherwise require IV/IO access:
- Oral Transmucosal fentanyl citrate (OTFC) 800 ug transbuccally
- Recommend taping lozenge-on-a-stick to casualty‟s finger as an added safety measure.
- Reassess in 15 minutes.
- Add second lozenge, in other cheek, as necessary to control severe pain.
- Monitor for respiratory depression.
S A P A J O U R N A L
P A G E 3 8
Updates on Tactical Combat Casualty Care
- IV or IO access obtained:
- Morphine sulfate, 5 mg IV/IO
- Reassess in 10 minutes
- Repeat dose every 10 minutes as necessary to control severe pain.
- Monitor for respiratory depression.
- Promethazine, 25 mg IV/IM/IO every 6 hours as needed for nausea or for synergistic analgesic ef-
fect.
12. Reassess fractures and recheck pulses.
13. Antibiotics: recommended for all open combat wounds
a. If able to take PO:
- Moxifloxacin, 400 mg PO once a day
b. If unable to take PO (shock, unconsciousness):
- Cefotetan, 2 g IV (slow push over 3-5 minutes) or IM every 12 hours, or
- Ertapenum, 1 g IV/IM once a day
14. Burns
a. Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury.
Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical
airway for respiratory distress or oxygen desaturation.
b. Estimate total body surface area (TBSA) burned to the nearest 10% using the Rule of Nines.
c. Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the
casualty in the Blizzard Survival Blanket in the Hypothermia Prevention Kit in order to both cover
the burned areas and prevent hypothermia.
d. Fluid resuscitation (USAISR Rule of Ten)
– If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as
soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer‟s, normal
saline, or Hextend. If Hextend is used, no more than 1000 ml should be given, followed by Lactated
Ringer‟s or normal saline as needed.
– Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr. for adults weighing 40-80 kg.
– For every 10 kg ABOVE 80 kg, increase initial rate by 100 ml/hr.
S A P A J O U R N A L
P A G E 3 9
Updates on Tactical Combat Casualty Care
If hemorrhagic shock is also present, resuscitation for hemorrhagic shock takes precedence over
resuscitation for burn shock.
Administer IV/IO fluids per the TCCC Guidelines in Section 5.
e. Analgesia in accordance with TCCC Guidelines in Section 11 may be administered to treat burn
pain.
f. Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics should be given per
TCCC guidelines in Section 13 if indicated to prevent infection in penetrating wounds.
g. All TCCC interventions can be performed on or through burned skin in a burn casualty.
h. Burn patients are particularly susceptible to hypothermia. Extra emphasis should be placed on bar-
rier heat loss prevention methods and IV fluid warming in this phase.
15. The Pneumatic Antishock Garment (PASG) may be useful for stabilizing pelvic fractures and con-
trolling pelvic and abdominal bleeding. Application and extended use must be carefully monitored.
The PASG is contraindicated for casualties with thoracic or brain injuries.
16. Documentation of Care
Document clinical assessments, treatments rendered, and changes in casualty‟s status on a TCCC
Casualty Card. Forward this information with the casualty to the next level of care.
The CoTCCC has met twice since these guidelines were issued. The newest guidelines
(2011) should be issued xxx. For more information visit the Military Health System
website at http://www.health.mil/Education_And_Training.aspx. The TC3 guidelines can
be found under education and training. In addition, the Joint Theatre Trauma System
(JTTS) Clinical Practice Guidelines (CPGs) can be found in this folder. The CPGs pro-
vide guidance on multiple topics for deployed medical providers.
S A P A J O U R N A L
Senator Giffords
Visiting Troops
Aftermath
P A G E 4 0
Tactical Combat Casualty Care Training Saves Civilian Lives
Despite the horrific shooting of Representative Gabriel Gifford's and others in Arizona,
the loss of life would have been much higher if not for the outstanding work of the Tuc-
son Police Department. Members of the department had been trained to perform Tac-
tical Combat Casualty Care (developed by the military) and were equipped with lifesav-
ing equipment used in Iraq and Afghanistan. Below is an article related to the incident
written by Sandhya Somashekhar and Sari Horwtiz and published in the Washington
Post.
First-aid kits credited with saving lives in Tucson shooting
Washington Post Staff Writers Friday, January 21, 2011; 9:57 PM
TUCSON - Some of the first deputies to arrive at the scene of the Jan. 8 shooting rampage here
described a scene of "silent chaos" on Friday, and they added that the carnage probably would have
been much worse without the help of a $99 first-aid kit that recently became standard-issue.
Pima County Sheriff's Department deputies said they were dispatched to what they believed was a
routine shooting. But they arrived, they found a blood-drenched parking lot that looked more like
the scene of a plane crash. Sgt. Gilberto Caudillo got on his radio and pleaded, "Send every ambu-
lance you have out here."
"Innocent people looked like they were just massacred," Caudillo said Friday.
He was among about 10 sheriff's deputies who found themselves doing the duties of paramedics ra-
ther than police. In the six minutes before paramedics flooded the site, they had to stanch chest
wounds, open injured airways, apply tourniquets and try to calm down victims and the blood-
covered bystanders who tried to help.
"We told them, 'All the bad stuff is over, you're safe. We'll stay by your side,' " said Deputy Matthew
Salmon.
In the end, 13 of those shot survived, while six did not. One of the injured, Rep. Gabrielle Gifford's
(D-Ariz.) was the last person still hospitalized until Friday morning, when she was discharged and
transported to a rehabilitation facility in Texas.
Doctors and law enforcement officials told reporters here that the incident would have been much
worse without a small brown kit devised by David Kleinman, a SWAT team medic who had become
concerned about rising violence.
S A P A J O U R N A L
“It would have
been a lot worse"
without those
tools, Gwaltney
said. The deputies
were trained to
use the kit, in a
program the Pima
force called "First
Five Minutes," six
months ago.”
P A G E 4 1
Tactical Combat Casualty Care Training Saves Civilian Lives
Kleinman cobbled together the Individual First Aid Kits out of simple items used by combat medics in
Iraq and Afghanistan: an emergency bandage pioneered by the Israeli army; a strip of gauze that con-
tains a substance which coagulates blood on contact; a tactical tourniquet; shears that are sturdy and
sharp enough to slice off victims' clothing; and sealing material that works especially well on chest
wounds.
The items in the kit were each inexpensive; the Israeli bandage, for example, cost only $6, but depu-
ties reached for one "over and over at the scene," Kleinman said.
It is unusual for police officers to carry such medical equipment, but Capt. Byron Gwaltney, who
coordinated the sheriff's office's response to the shooting, said it proved crucial in this case because
the deputies were the first to arrive.
"It would have been a lot worse" without those tools, Gwaltney said. The deputies were trained to
use the kit, in a program the Pima force called "First Five Minutes," six months ago.
The deputies who initially responded said they were not the ones who arrested the suspect, Jared
Lee Loughner. Instead, their focus was conducting triage through the parking lot: figuring out who
was dead, who was injured and who was simply a helpful person who had jumped in to help.
They used the tourniquets and gauze to stop the bleeding. They used a chest seal, also in the kit, to
close bullet wounds. They used the shears in the kit to cut off the victims' clothes.
"When I look back, I don't know if we drowned out the moans to focus or if it was quiet," said Dep-
uty Ryan Inglett, who treated several victims with combat gauze and assisted in CPR. "This is some-
thing I will never forget."
S A P A J O U R N A L
P A G E 4 2
ALTITUDE ILLNESS
By Jonathan R.C. Green, MAJ, SP, Ret
A few months ago, a mining company employee was sent to our clinic for a special type of physical
examination. He was being assigned to work for a couple of weeks at a jobsite high in the Andes, and
the host country‟s government required him to have a medical evaluation to ensure that he can
work at elevations over 3000 m [9,800 ft.] without endangering his health.
Altitude illness can occur in anyone who ascends to 2,500 meters [8,125 feet] or more above sea
level, especially if he/she ascends rapidly without taking time for acclimation. Other risk factors for
altitude illness include (possibly) genetic susceptibility [some mountain climbers get altitude illness
while their companions do not], previous history of altitude illness, excessive exertion, and pre-
existing chronic illness. No one is free from risk, however: even some recreational mountain climb-
ers in the peak of physical condition have developed altitude illness after climbing too high too fast.
In other words, there is no way to tell in advance if a person is going to develop altitude illness if he/
she has never been to high altitudes before.
Some of the early signs of altitude illness are shortness of breath on exertion, tachypnea, polyuria,
and/or sleep disturbances. A classic sign is altered breathing patterns during sleep: a gradually de-
creasing rate of respirations leading to apnea lasting 10 to 15 seconds, followed by a gradually in-
creasing respiratory rate. These symptoms are not in themselves cause for alarm, and will resolve
after descent.
More serious symptoms of altitude sickness include headache, loss of appetite, nausea and vomiting,
fatigue, dizziness, confusion or difficulty walking. These symptoms can come on gradually and insidi-
ously, so increased vigilance is essential. A good rule of thumb is: if a person began feeling unwell
while gaining altitude, it is altitude illness until proven otherwise. If not treated promptly, altitude
illness can be life-threatening.
Although rest, increased fluid intake, and certain medications can help [the Andean locals swear by
coca tea], by far the best treatment for altitude sickness is descent. In any case, tell the patient
DON‟T GO ANY HIGHER unless and until the symptoms have completely resolved. If there is no
improvement after resting for a day or so, then rapid descent is a must. Although descent should be
rapid, it must be done gently as well: too much bouncing and jostling can induce a CVA while the
patient is being carried downhill.
S A P A J O U R N A L
P A G E 4 3
ALTITUDE ILLNESS (CONT.)
To prevent or alleviate altitude sickness, gradual ascent is best; it can take up to 4 days after arrival
at altitude for someone to acclimate completely before engaging in strenuous activity. Unfortunately,
time constraints often lead workers (and, needless to say, soldiers) to ascend rapidly and begin vigor-
ous activity immediately after arrival. It is prudent for someone who is flying directly to an area of
high elevation from sea level and/or someone with a previous history of altitude illness to take medi-
cation for prophylaxis. Acetazolamide [Diamox®] is commonly prescribed, at a dosage of 125 to 250
mg BID, beginning one day before travel, and continuing until after being at altitude for 2 or 3 days.
Common side effects include paresthesias, metallic taste, and ruining the taste of carbonated bever-
ages. Persons at higher risk may wish to bring a small supply of steroids to take in case they become
ill despite taking these precautions. Dexamethasone 4 mg every 6 hours as you are being taken
downhill is a reasonable dosage.
Ginkgo biloba has also been touted for prevention of altitude illness, but studies of its efficacy have
been inconclusive. It is harmless, however, so you need not discourage anyone from taking it, provid-
ed he/she is also taking other precautions. Unlike with most other herbals, ginkgo biloba‟s exact dose
per pill is quite well standardized, so a reasonable dosage would be 100 mg twice a day, beginning a
few days before ascending to altitude and continuing while at altitude.
Dehydration can mimic altitude illness, so it is important to keep drinking liquids whether feeling
thirsty or not. Tell your soldiers that “by the time you start to feel thirsty, you are „a quart and a half
low.‟” Drinking alcoholic beverages when at altitude is a bad idea, because it is easy to become intox-
icated after drinking smaller amounts than usual.
Determining fitness for working at altitude can be difficult, especially if the worker in question has
never been to high altitudes before, as with the worker we were asked to evaluate. We had to ask
ourselves: what are the risk factors for developing altitude illness, and which health conditions might
be worsened by living and working at altitude?
Although intrinsic asthma might be worsened at altitude, asthma due to allergies usually improves,
because one is exposed to fewer triggers [e.g. pollen, cockroaches]. Exercise-induced asthma carries
about the same risk as at sea level. In general, asthmatics with good control will do well at altitude,
but they should carry along rescue medications and/or steroids as well.
Workers with COPD are of particular concern. Pulmonary function must be optimized before con-
sidering ascent, and supplemental oxygen should be provided persons who have a PaO2 less than 70
mm Hg at sea level and wish to ascend to 8000 ft. (the altitude at Vail and Aspen, CO). Supplemental
oxygen does NOT suppress the process of acclimation to altitude.
S A P A J O U R N A L
P A G E 4 4
ALTITUDE ILLNESS (CONT.)
Persons with obstructive sleep apnea do better at altitude, because of increased airway muscle tone,
but they should be prescribed acetazolamide before ascent just in case. Those with central sleep
apnea do worse, but their condition is easily treated with acetazolamide.
There are insufficient data about hypertension, but most persons should be able to tolerate moder-
ate elevations of their blood pressure while living at altitude for a few weeks, provided they were
well controlled when at sea level. It would not be a good idea to increase their dosage or add a drug
while they are at altitude, because this might induce syncopal episodes after their return to sea level.
Although there have been some disquieting reports of cardiac sudden death at altitude, in fact the
overall rate of coronary events is no greater than at sea level. A cardiac patient‟s level of exercise is
probably a more important factor than altitude for estimating his/her health risk.
Persons with psychiatric problems are at risk of recurrence or worsening of depressive or cyclothy-
mic behavior at altitude, and may need adjustment of their medication dosage. Consultation with
their treating clinician is vital.
Cornea‟s undergo edema at high altitude. Persons who have had radial keratotomy will swell more
peripherally, causing major changes in their vision. Persons who have had Lasik surgery are less at
risk, but they too ought to ask their optometrists to prescribe a pair of spectacles to carry along just
in case. Persons wearing contact lenses may have problems at altitudes over 8000 ft. due to the dry-
ness and lowered oxygen content of the air. It would be a good idea for them to bring along a pair of
spectacles.
Migraines can be triggered by high altitude. Then, the problem is how to differentiate a migraine from
the headache induced by altitude illness, since 50% of the latter will also respond to sumatriptan. If
you have oxygen, take a few whiffs of it; if your headache goes away in half an hour, it was due to the
altitude.
Pregnant women are actually at less risk of getting altitude illness, because they have higher PaO2‟s
due to increased ventilation secondary to increased progesterone levels. Acetazolamide is a Pregnan-
cy Category C drug, so it is best to do without it in pregnant women, especially since they are less
susceptible to altitude illness anyway. A major exception to this is pregnant women who smoke, who
are definitely at increased risk of altitude illness. Although pregnant women who live at high altitudes
have higher rates of hypertension and low birth weight babies, this information may not be relevant
to women who make brief visits to altitude. The fetus‟ PaO2 at sea level is similar to that of an adult
at the summit of Mt. Everest, so a transient additional decrease in maternal PaO2 is probably not a
significant threat. If a pregnant woman is at risk from visiting high altitude areas, it is probably more
related to her remoteness from obstetric care in an emergency than the altitude per se.
S A P A J O U R N A L
P A G E 4 5
ALTITUDE ILLNESS (CONT.)
For further information on altitude illness, consult www.ismmed.org and www.hypoxia.net.
As for our worker going to altitude, this is the documentation we provided the company and the
host country on the form they provided:
REPORT OF OCCUPATIONAL PHYSICAL EXAMINATION
The occupational examination performed on Mr. John Doe, 54 years old, on 10 November 2010 has
permitted us to draw the following conclusions:
The examination does not show any abnormalities that would impair his performance at high altitude
(over 3000 meters above sea level).
Job title: CONSTRUCTION ENGINEER
Potential exposure to the following hazards: HIGH ALTITUDE
Findings: CAPABLE OF PERFORMING JOB DUTIES AT ALTITUDES UP TO 35OO METERS
ABOVE SEA LEVEL.
Pulse Blood Weight Height BMI
Pressure (kg) (cm)
Vital Signs: 92 140/86 93 178 29.4
Pulmonary Function Testing Results:
FVC: 102% of predicted value; FEV1: 90% of predicted value;
FEV1/FVC: 88%
Blood Testing Results:
WBC: 7.1 K/UL; RBC: 4.97 M/UL; Hgb: 15.6 g/dl; Hct: 45.2% [all values are within normal range]
[Blood testing was requested by the employer, and presumably by the host government, but in fact,
RBC count, hematocrit and hemoglobin are much less important than PFT results for evaluating a
person‟s risk of altitude illness.]
Recommendations: LOSE WEIGHT AND QUIT SMOKING
S A P A J O U R N A L
P A G E 4 6
ALTITUDE ILLNESS (CONT.)
CAUTION: No diagnostic test or examination used in this type of evaluation can guarantee that a
worker will not have altitude illness or develop complications of other, not previously diagnosed
ailments as a result of living and working at high altitude. Bearing in mind that even mountaineers
who are in excellent physical condition can develop altitude illness, and that Mr. Doe has a long-term
history of smoking, we considered it prudent to prescribe him acetazolamide for prophylaxis. We
instructed him to take one 250 mg tablet twice a day, beginning 24 hours before ascent, and to con-
tinue to take it until 48 hours after arrival at high altitude. We also provided him an information
sheet on the warning signs of altitude illness, and how to prevent or treat it.
[Major Green graduated from the U.S. Army physician assistant course in 1983, and received a Mas-
ter of Public Health degree in occupational medicine from the University of Oklahoma in 1993. Since
retiring from the Army in 1998, he has been working at St. Mary‟s Occupational Medicine Clinic in
Evansville, Indiana.]
S A P A J O U R N A L
Brooke Army
Medical Center
Madigan Army
Medical Center
William Beaumont
Army Medical
Center
P A G E 4 7
Long Term Health Education Training (LTHET) Update
From LTC Rick Villarreal, LTHET Program Manager
CURRENT PROGRAMS
Emergency Medicine Orthopedics Intensivist PhD
BAMC BAMC BAMC University of Choice
CDAMC WBAMC TAMC Masters
WBAMC MAMC University of Choice
MAMC Baylor Health Care Admin
Cardiovascular Perfusionist
No longer offered
APPLICATIONS:
Due to very low numbers in last year‟s applications we will only be starting five residents this
academic year. This year‟s application pool increased dramatically from last year. We may
be short one or two but most if not all residency positions should be filled this year, for ma-
triculation next year. The selection board is scheduled to meet May 2011, we will know the
exact numbers by June/July 2011.
FUTURE / CHANGES
After talking to PA‟s throughout the Army at all levels of care, we identified several areas
that we can target to improve the application process, increase selection potential and en-
sure completion of the residency. Mentoring and guidance from senior PA‟s to those junior
will be pivotal in early identification of those that are considering residency training. The
Graduate Record Examination (GRE) has been a hurdle that many have chosen not to engage
or have fallen short on. Early prepping for the GRE (one or two years out of school) and
taking the exam early will help ensure that if a soldier falls short they have time to retake the
exam and achieve the score that is needed to apply for our residencies.
We have had several PA‟s that decide during the residency that they are not interested in
the area of medicine that they are training in, and resign. One soldier resigning is one too
many. To help those that are applying so they know exactly what the residency entails we
will start an On The Job (OJT) training program for next year‟s applicants. All applicants will
be required to complete 40 hours of OJT with a PA that works in the specialty that they are
interested in. This will help the applicant in their decision making process and a specialty
trained PA will evaluate the prospective resident at work and give his or her input on the
potential for that PA to complete the residency.
CONCLUSION
In these times of change, the potential draw down in the military and fighting wars on multi-
ple fronts, we need to keep in mind that training to fill our peace time and war time posi-
tions must continue. We are working hard to ensure that each change we implement will
increase the number of applicants and ultimately the caliber of the residency trained Physi-
cian Assistant. I am always available for questions or recommendations at
S A P A J O U R N A L
P A G E 4 8
Interservice PA School (IPAP) Update
From COL Pauline Gross, IPAP
Another semester has started at IPAP. Class. 2-11 arrived and completed orientation last
week. This class of 77 students has 12 Air Force, four Coast Guard, four USAR, 10 National
Guard, and 47 active Army. This class is our second under the new 29 month schedule.
Class 2-10 graduated from Phase 1 on 22 April. The speaker for the event was USAF MAJ
(R) Zwanziger, Mr. "Z" as he likes to be called. Mr. Z graduated with the first Air Force
class in 1973. He spoke about what it was like to be a PA at the beginning.
Class 2-09 with 43 Army students will graduate on 13 May. IPAP said goodbye to our Med-
ical Director of five years LtCol Alesia Carrizales. She has moved to Patrick AFB, FL to fill
the DCCS position. During her tenure Alesia was responsible for moving IPAP to on-line
Phase 1 and 2 testing, the OCSE, and improving "Clinical Correlations". Her replacement is
CAPT (USN) Frank Reynolds. LT Amrien (CG) retired in March. Jay is well-known by the
students for his "interesting" way of teaching Cardiology. MAJ Pam Roof left IPAP in March
and moved to the Directorate of Health Education Training. Her is now Chief, SP/VC Edu-
cation Programs. MAJ Jeff Oliver is now the Army Phase 2 Coordinator.
S A P A J O U R N A L
PANCE Preparation Competition, Phase II IPAP, Fort Bragg
P A G E 4 9
Senior Discount!
From Paul Lowe, SAPA Membership Director
SAPA desires to honor our “more seasoned” military veterans with reduced membership dues or
the ability to purchase an “Indefinite” membership. This benefit is for Federal Service PA‟s age 65 or
above. For this category of PA‟s, annual dues will be reduced to $15.00 or you can purchase an in-
definite membership for $100.00. This change will take effect 31 July, 2010. Any dues paid at the
regular rate of $25.00 after this date will be credited toward “future dues” or your “indefinite”
membership status. Please email or write at the below listed address to update your membership
status. Signed, Paul W. Lowe, Membership Director.
SAPA
ATTN: Membership Update
P.O. Box 07490
Ft. Myers , Florida 33919
Or EMAIL: [email protected]
This is an outstanding opportunity for senior PAs to remain active in SAPA even after
retiring from practice.
S A P A J O U R N A L
SAPA Membership News
P A G E 5 0 V O L . 2 3 , N O . 6 A
Retirements/ETS
The SAPA Leadership would like to thank the following PAs for their service to the US Army and our Nation.
They will leave the military in the next several months. Please wish them luck with their new endeavors.
CPT Veronica Alston MAJ Theodore Wallace
CPT Shirley Bauman CPT Lance Ware
CPT Diane Boor MAJ Tim West
MAJ Brian Burgemaster MAJ Rick Whitley
MAJ Jeff Clark CPT Stanley Yee
MAJ John Dana
CPT Buddy Davis
MAJ Brendon Ewers
MAJ Bradley Frey
MAJ Lynn Grosvenor
MAJ Michael K. Garcia
MAJ Shon Kroger
CPT Paul D. Hoffman
MAJ Robert Howes
MAJ Sue Love
CPT Robyn L. Mason
MAJ Michael McClendon
CPT Vincent Reed
MAJ John Slevin
MAJ Hollis Smith
COL Louis Smith
CPT Donald Turner
SAPA OFFICERS SOCIETY OF ARMY PHYSICIAN ASSISTANTS
P O Box 07490, FT. MYERS, FL 33919-6402 Phone and Fax - 239-482-2162
EXECUTIVE DIRECTOR: Harold E. Slusher, PA-C
Address and phone as above, e-mail - [email protected]
SAPA Web Page: http://www.sapa.org
(Webmaster: Orie Potter)
PRESIDENT Sherry L. Womack, Lieutenant Colonel, SP, PA-C
E-mail: [email protected]
PRESIDENT ELECT Steven L. Briggs, Major, SP, PA-C
E-mail: [email protected]
IMMEDIATE PAST PRESIDENT Steven W. Ward, PA-C
E-mail: [email protected]
SECRETARY Karen McMillan, PA-C
E-mail: [email protected]
TREASURER James L.C. Miller, PA-C
E-mail - [email protected]
DIRECTOR, ACTIVE DUTY ARMY PAs Pauline Gross, COL, SP, U.S. Army
E-mail: [email protected]
DIRECTOR, US ARMY NATIONAL GUARD PAS Nolan Wright, CPT, PA-C Texas Army National Guard
E-mail: [email protected]
DIRECTOR, US ARMY RESERVE PAS Tonya Moore, LTC, PA-C
E-Mail: [email protected]
MEMBERSHIP DIRECTOR Paul W. Lowe, PA-C
E-mail: [email protected]
RETIRED COMPONENT DIRECTOR Jan (Casey) Bond, PA-C
E-Mail: [email protected]/[email protected]
SAPA CONFERENCE STAFF CONFERENCE COORDINATOR: Bob Potter, PA-C
PO Box 623 2Monmouth, IL 61462
SAPA Voice Line: 309-734-5446 Fax: 309-734-4489
E-mail: [email protected]
CONFERENCE REGISTRAR: Bob Potter, PA-C Info for Bob Potter same as immediately above
ASST. CONFERNECE COORDINATOR:
Pat Malone, PA-C
E-mail: [email protected]
Dave Paulson
E-mail: [email protected]
CO-REGISTRAR: Judy Potter
DECORUM AND MORALE: Nicole Potter
E-mail: [email protected]
SALES AND MARKETING: Stephen Ward, PA-C,
Bob Egbert, PAC,
Tom Matherly, PA-C
MODERATORS/AUDIO/VISUAL: LCDR Irwin Fish, PA-C
SAPA JOURNAL STAFF Editor: Major John F. Detro, MPAS, PA-C
E-mail: [email protected]
COMMITTEES SCHOLARSHIPS/AWARDS
LTC-R Donald Parsons, PA-C (Chair)
COL -R Sherry Morrey, PA-C
CW4-R Marvin W. Cole, PA-C
COL-R Donald Black, SP, PA-C
POC for Captain Sean P. Grimes
Physician Assistant Educational Scholarship Award)
E-mail: [email protected]
SAPA HISTORIAN William Long, PA-C
MINORITY AFFAIRS Karen McMillan, PA-C
PUBLIC EDUCATION Harold E. Slusher, PA-C
PROFESSIONAL WELLNESS Michael Champion, PA-C
LEGISLATIVE AFFAIRS Harold E. Slusher, PA-C
DELEGATES TO AAPA HOUSE OF DELEGATES Sherry L. Womack, PA-C (Chief Delegate)
Steven L. Briggs, PA-C
ACADEMY LIASON COL Pauline Gross, SP, PA-C
E-mail: [email protected]
COMMUNICATIONS/ELECTRONICS Stephen Ward, PA-C
Irvin Fish, PA-C
Bob Potter, PA-C The SAPA Journal staff and SAPA Board of Directors encourages
membership participation in this publication. Feel free to use this
forum to present your views on any topic you desire. The publication
of clinical articles on any subject is also solicited, however, to reduce
our workload, we do request articles be presented typed, double-
spaced format, and on CD, Microsoft Word format. The editor
reserves the right of final acceptance of articles as well as the right to
serialize articles which are too lengthy to be included in a single issue.
Articles will be accepted via email.
The SAPA Journal is the official publication of the Society of Army
Physician Assistants. The views and opinions expressed herein are not
necessarily those of the editors, SAPA, the SAPA Board of Directors or
the Department of the Army unless explicitly expressed as such.
This is not an official Army Publication.