Press Release
☷Family Medicine Residency Experience Tissue Lab and MEDEVAC
U.S. Army ( By Press Release office)
Apr 29,2022
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Grady Health System Interim Trauma Medical Director Dr . Jonathan Nguyen ( green scrubs ) walked 7 Martin Army Community Hospital graduating residents through a cadaver lab during the Family Medicine Residency Experience , April 20 . Pictured here from left to right are Capts . Victoria Hall , Patrick Campbell , Kyle Warren and Samantha Green . Martin Army Community Hospital graduating resident Capt . Victoria Hall tries to stem bleeding during the Family Medicine Residency Experience ( FMRx ) cadaver lab , April 20 . Grady Health System Interim Trauma Medical Director Dr . Jonathan Nguyen ( green scrubs ) watches Martin Army Community Hospital graduating resident Capt . Samantha Green insert a chest tube during the Family Medicine Residency Experience ( FMRx ) , April 20 . Also pictured from left to right are Capts . Patrick Campbell and Kyle Warren . FORT BENNING , GA – “A cricothyroidotomy bleeds a lot , ” warned Grady Health System Interim Trauma Medical Director Dr . Jonathan Nguyen . “Use combat gauze to pack it really tight when the airway is in . Then either whipstitch or take a stapler and physically close the space as much as possible . ” The Atlanta doctor walked 7 Martin Army Community Hospital graduating residents through the emergency procedure to establish an airway as part of the Family Medicine Residency Experience ( FMRx ) . The weeklong operational medicine course is the capstone of the three - year residency program . It’s designed to reinforce the Tactical Combat Casualty Care ( TCCC ) needed to treat trauma on the battlefield . Under the guidance of Nguyen and BMACH Director of Osteopathic Medicine Maj . Michael Aguilar , the residents operated on a cadaver to practice making a quick incision on the throat through the cricothyroid membrane in order to place a breathing tube . Capt . Victoria “Tori” Hall will be pcs’ing to Fort Campbell to serve as a Battalion Flight Surgeon for the 2 - 17 Cavalry Squadron of the 101st Airborne Division , after graduation . The Army brat who chose medicine because she wanted to make a difference in people’s lives said practicing the cricothyroidotomy on a cadaver definitely fortifies their readiness to perform the life - saving measure . “Working on real human tissue is hands - down more valuable than a plastic model , ” said Hall . “[A cricothyroidotomy] is an emergency procedure that is really a last resort . ” Fellow Uniformed Services University of the Health Sciences 2019 graduate Capt . Kyle Warren said while their medical school had a robust cadaver program , this tissue lab was unique . “One of the impressive features that I hadn’t experienced in the past was the capability to perfuse the cadaver ( i . e . blood pumping through the vessels ) , ” said Warren . “As such , we were able to simulate bleeding wounds that we could practice packing with gauze or applying a tourniquet to see if we could control the hemorrhage . ” Perfusing a cadaver enables BMACH faculty physicians to better test the skills they are training . “The blood is coming from the right anatomical positions , ” explained Aguilar . “It more readily translates to ‘real - world’ patient care . Getting realistic training … closer to actual patient care … will bring new insight for the learners . ” A critical skill expected of them as deployed field surgeons is stopping massive bleeding . “When we talk about hemorrhage control , direct pressure is always preferred , ” said Nguyen . “And if you guys have never put a tourniquet on before , I would suggest you put it on each other because it hurts . People will scream at you . It’s a lot of pressure . ” The residents then took turns performing a lateral canthotomy and cantholysis ( LCC ) , in a bid to save a patient’s eyesight after blunt trauma to the face . The 5 - step procedure quickly releases pressure on the optic nerve caused by sudden bleeding behind the eye . “Basically you are going to clamp down on either side of that ligament and then you are going to take your iris scissors and cut all the way through , ” explained Nguyen . “When you place your scissors down there , you are going to feel this really hard thing . It sounds morbid but keep cutting until it stops crunching . ” “The ophthalmologist will tell you , whatever cut you need to make , make it , ” added Aguilar . “But don’t cut the globe . ” If a critically ill patient requires a rapid infusion of blood , medication or fluids , doctors must establish intraosseous vascular access . Nguyen showed the residents how to drill a sturdy hollow bore needle through bone to place an IO ( intraosseous cannulation ) . “Drill perpendicular to the actual bone , ” advised Nguyen . “The tibular ( tibia – larger bone on inside of lower leg ) runs a little bit slower than the humeral ( humerus – bone in upper arm ) , the humeral runs a little bit slower than the sternal ( sternum – bone in middle of chest ) . Medics love the sternal because even if a patient has all four limbs injured , the sternal is still available . “And if you need two IV access sites , I’ve also learned multiple IOs can work unless there is a fracture . If the tibia is intact , you can put two tibular IOs in and run multiple things at the same time . But if there is a fracture there , it’ll leak out of the fracture . ” Troop Command Commander Lt . Col . Ryan Knight warned placing the wrong size needle in the wrong location can lead to failure . He shared the tried and true technique which has not let him down in a decade of emergency medicine . “I personally make room for my drill in my kit bag and carry a boatload of needles , ” said Knight . “It’s not that heavy . And I’ve had that same drill since 2012 . I’ve trained with it . I don’t know when it will finally die . ” A penetrating injury or severe trauma to the chest can cause air to fill the cavity , thereby limiting the lung’s ability to expand . To prevent the patient’s lung from collapsing , doctors must quickly release the air trapped in the chest by a temporary measure such as needle decompression ( needle D ) or inserting a more durable chest tube in between the ribs . “When we do chest tubes in trauma , there is blood coming out , ” said Knight . “When you clot those things off , you are causing tension pneumothoraces ( air trapped in chest cavity or the very condition you are trying to treat ) in our patients . When you go to altitude ( i . e . helicopter evacuation ) that’s where we are really noticing it . “Don’t put a Heimlich valve ( one - way valve ) on there when you put your chest tube in , until the blood flow is stopping . You can’t clean it out . There is nothing you can do . All you can do is change it out . ” After the tissue lab , the 3rd - year residents tested their combat medical readiness by treating simulated mass casualties , before calling for a medical evacuation ( MEDEVAC ) to Lawson Airfield . “The overarching goal of the FMRx is to intentionally expose the graduating residents to operational/battlefield medicine themes and topics , ” explained Aguilar . “The intention is to expand their knowledge by stressing translation of their existing practice to new settings and different patient scenarios that are common to an austere medical provider . The MEDEVAC lanes are a culmination of 3 years of leadership , medical and Army officer instruction; giving the graduating seniors a chance to put it all together . ” Airborne and Ranger Training Brigade ( ARTB ) Capt . Aaron Spera developed several different scenarios such as severe burns , partial amputations and gunshot wounds to test the residents’ medical skills under stress . “The best patient simulations are gunshot wounds to the chest that can develop into tension pneumothorax , ” said Spera . “That would require a chest tube . And if they missed an injury , they would need to stabilize the casualty mid - flight . ” After carefully organizing and packing their kit bags , the residents ran through the exercise . Just as in combat , the field doctors had no idea what kinds of wounds they would encounter until they came upon the role player . They worked in pairs to assess , continually treat and MEDEVAC the casualty , all while under threat of enemy fire . “If I have ten seconds to run out there and I see he has a partial amputation and it’s spurting blood everywhere , how much time do I have I’m going to throw a tourniquet on him and I’m just going to move him out of there , ” advised Spera . “The last thing we need is for me to become a casualty , or anybody I have with me . I’m going to get him out of harm’s way where I have got a little bit more time so I can do a more thorough assessment . “Look at the big things . What is going to kill this guy Probably not being in the hospital . I want to do what interventions I can . Hey , do I have a pulse on that ankle Yes , I’m going to splint it as it lies . I’m going to stop these bleeds , I’m going to try to push meds , try to get fluids or blood on board . And I’m going to try to get to that bird as fast as possible . ” Hall said operating in the field and simulating even a portion of what the boots on the ground might experience was the most enjoyable part of the FMRx . “I’ve flown on UH - 60s [Black Hawks] and CH - 47s [Chinooks] before and don’t generally get motion sick , ” said Hall . “I’m looking forward to working more closely with the flight community soon!” Warren , who will also be serving as a flight surgeon for one of the aviation units after pcs’ing to Fort Carson , said he chose that particular duty assignment because he is ready to experience the operational aspect of the military after being in school for the past decade . “My favorite rotation during residency was my time spent on the labor and delivery unit , ” said Warren . “There are a lot of raw emotions and it is very humbling to be part of the birth experience and help bring life into this world . It was also one of the most challenging because medical emergencies can happen in the blink of an eye . ” Both Warren and Hall said they will miss the camaraderie among their graduating class … strong friendships that got them through challenges posed by constant staff turnover and COVID . “There is something comforting about being surrounded by a group of individuals going through the same difficulties as you who are able to comfort you after the loss of a patient , stress of a hard day , or difficult 24 hour call shift , ” said Warren . “As I move onto my future assignment , I won’t be surrounded by as many close friends who I can bounce ideas off of or who will intimately understand what I am going through . ”
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