SAPA JOURNAL - Wild Apricot · “ 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

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


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.


P A G E 4

82nd AB Choir


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.”


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.


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.”


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.


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.”


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


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.


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.


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.


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


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.


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.


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.


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.


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.


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.”


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.


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.


Defending FOB

Keating

P A G E 2 2


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.


On Patrol Near

FOB Keating

P A G E 2 3


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.


Resting Following

the Battle

P A G E 2 4


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.


Remains of FOB

Keating

P A G E 2 5


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.


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.


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.


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.


P A G E 2 9


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:



- 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.


P A G E 3 0


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.


P A G E 3 1



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.


P A G E 3 2



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


P A G E 3 3



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.


P A G E 3 4



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:



- Place casualty in the recovery position

b. Casualty with airway obstruction or impending airway obstruction:



- 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.


P A G E 3 5


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.


P A G E 3 6


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).


P A G E 3 7


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.



P A G E 3 8


- 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.


- 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.


P A G E 3 9


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.


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.


“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."


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.


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.


P A G E 4 4


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.


P A G E 4 5


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


P A G E 4 6


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.]


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

[email protected].


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.


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.


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


IMMEDIATE PAST PRESIDENT Steven W. Ward, PA-C


SECRETARY Karen McMillan, PA-C


TREASURER James L.C. Miller, PA-C

E-mail - [email protected]

DIRECTOR, ACTIVE DUTY ARMY PAs Pauline Gross, COL, SP, U.S. Army


DIRECTOR, US ARMY NATIONAL GUARD PAS Nolan Wright, CPT, PA-C Texas Army National Guard


DIRECTOR, US ARMY RESERVE PAS Tonya Moore, LTC, PA-C

E-Mail: [email protected]

MEMBERSHIP DIRECTOR Paul W. Lowe, PA-C


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


CONFERENCE REGISTRAR: Bob Potter, PA-C Info for Bob Potter same as immediately above

ASST. CONFERNECE COORDINATOR:

Pat Malone, PA-C


Dave Paulson


CO-REGISTRAR: Judy Potter

DECORUM AND MORALE: Nicole Potter


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


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)


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


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.

Documents

SAPA JOURNAL - Wild Apricot · “ 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