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medpundit |
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Monday, April 14, 2003I will probably not be the only former "Special Operations Medic" to let you know that we were doing all of this, as well a fair amount of not-so-minor surgery, in the Vietnam War. In fact, Special Forces medics in the 1960's could intubate, insert chest tubes, do venous cut-downs, and insert central lines when necessary- in the field. I have repaired hand tendons in the field, completed traumatic amputations, done fasciotomies for burns, delivered babies, done myringotomy- not "minor" procedures. ("There is no 'minor' surgery, only minor surgeons", as I recall being told many times in training). We also did a fair amount and a wide variety of lab work, primarily concerned with diagnosis of tropical disease (thick and thin smears for malaria, identification of the huge variety of parasites- a couple of which I managed to contract- Gram stains, AFB's for TB, etc etc.)We had quite a good lab kit, including microscope, centrifuge, and a number of stains that was packaged so as to be parachutable. We also did a lot of preventive medicine, some Pediatrics (treating local village children), and even dentistry (primarily extractions) and Veterinary medicine, farm animals being extremely important to the people we worked with in Southeast Asia. To serve on a "A" Team required a minimum of three Military Occupational Specialties , chosen from a list of five at that time (Medical / Weapons / Demolitions / Operations and Intelligence / Communications). I was trained in, and taught, Light Weapons and Demolitions, in addition to my duties as a Medic. Although Special Forces Medics carried Geneva Convention cards, it is highly doubtful that we were really entitled to the protections afforded full-time medical personnel... I have been a P.A. since 1976, and I realized early in P.A. training (Baylor) that we S.F. Medics knew practically nothing about Internal Medicine, aside from tropical infectious diseases. Most of my P.A. class, by the way, were former Special Forces Medics. But we DID know trauma. In fact, I was struck, when I took the ATLS course for the first time in 1983, by just how closely it followed the protocols of the old Special Forces "Dog Lab" at Fort Bragg. And the emphasis on rapid decision-making and fast, effective interventions was precisely the same. (The dogs in the dog lab have long since been replaced by goats- apparently few people grow misty-eyed over a wounded goat.) I would also expand on your theme, that war brings rapid medical advancement. I recall the haphazard ambulance services of the 1950's and 1960's clearly- they were basically "scoop-and-run" operations, with little to no capability for lifesaving interventions en route. I grew up in Manhattan, and once in awhile an intern would be sent out with an ambulance, to do what he or she could with what was in their little black bag. Generally, however, ambulance attendants were poorly-paid hospital aides, or drivers with zero medical training. The experience of the Vietnam War changed that, as highly-trained military Physicians and medics returned home, and put the lessons of triage, forward lifesaving treatment, and advanced trauma training for ambulance attendants into practice across the country. Of course, this was the genesis of the whole EMT/ Paramedic system that we have today, which saves many thousands of lives a year. I include aeromedical evacuation as part of this system. Would this evolution have occurred without the war? Probably- but at a very much slower pace, and with many experimental approaches (some of which would probably have been disasters). As it happened, the military brought the system to a high level of efficiency, and then it was further refined by expert trauma surgeons, ER staff, and others back in the U.S. Much of this history has been forgotten, or deliberately neglected. Many of the Physicians who wound up training and working with EMT's and Paramedics had not been to war, and were very dismissive of any possibility that military training could be useful in the civilian environment. And the country REALLY wanted to forget the Vietnam experience- so those with military backgrounds did not advertise the fact in their new, civilian occupations. There is an almost complete lack of appreciation for the tremendous strides brought about in emergency treatment of patients at accident scenes, etc, which we owe to the military. He’s right. I didn’t notice it at the time, but all of the sources I used to research the past contributions of wars to medical technology neglected the Vietnam War. I went back and looked at the book that inspired that article, Combat Surgeons by John Laffin, and its description of the Vietnam War is only one of lament - of the horrible conditions that medics and surgeons had to face and the terrible toll it took on them. There was one thing, though, that stood out in his description of combat medicine in Vietnam - the Vietcong would deliberately shoot to wound the scout who walked ahead of a line of soldiers. They knew that he would call for the medic, then when the medic came running, they would shoot to kill the medic. They figured they’d do far more harm to the platoon that way than just shooting the scout. It’s a tremendous credit to the bravery of the medics that they always came running when called. posted by Sydney on 4/14/2003 07:38:00 AM 0 comments 0 Comments: |
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