Care Providers Prepare for Wartime Medicine
A newly recruited trauma and vascular surgeon will play a key role in expanding the St. Louis branch of a national training program that prepares U.S. Air Force doctors, nurses and medical technicians to provide trauma care to soldiers during wartime.
Air Force Colonel Gerald Fortuna Jr., MD, will direct the program, called C-STARS (Center for Sustainment of Trauma and Readiness Skills). Fortuna recently joined both the acute and critical care surgery section and the vascular surgery section after completing a vascular fellowship at the University of Texas at Houston. He will also join the faculty of Saint Louis University, where C-STARS training courses are held. As a member of the armed forces, Fortuna deployed twice to Afghanistan and was recently chief of general surgery at Landstuhl Regional Medical Center in Landstuhl, Germany.
Fortuna’s background will be pivotal in developing new courses on emerging vascular techniques for controlling bleeding, which could significantly improve survival of wounded soldiers.
“The military’s Joint Theater Trauma System found that 20 to 25 percent of deaths that occurred before soldiers reached a hospital could be attributed to lack of bleeding control,” says Fortuna. “These deaths are potentially preventable.”
Another possible program expansion will be training care providers in a new type of tactical critical care that involves administering lifesaving techniques and blood products on the battlefield. Fortuna also wants to incorporate research into the program.
Fortuna is the second Washington University surgeon to be a C-STARS trainer; colorectal surgeon Sean Glasgow, MD, an Air Force lieutenant colonel, conducted training courses in St. Louis for three years.
Grant Bochicchio, MD, MPH, the Harry Edison Professor of Surgery and chief of the Section of Acute and Critical Care Surgery, says he had a very positive experience in the C-STARS program when he served at the R Adams Cowley Shock Trauma Center in Baltimore.
“This is a great opportunity to work with Saint Louis University and the Air Force to expand the program at Washington University in education and research,” Bochicchio says.
A specially equipped monitoring facility five miles from Barnes-Jewish Hospital now allows physicians and nurses to keep a close watch on patients in the hospital’s ICUs. From the “e-ICU,” a team observes patients and their vital signs 24 hours a day, providing an extra set of eyes for on-site care providers. The e-ICU was introduced in the surgical ICU in July and has since been rolled out to cardiothoracic and cardiac ICUs, with plans for all ICUs eventually to come on board. Sara Buckman, MD, PharmD, e-ICU associate director, says the unit’s objectives are to reduce mortality and length-of-stay.
Barnes-Jewish Hospital is one of a handful of institutions that has established a trauma care program tailored to geriatric patients, who often have longer lengths of stay and higher utilization of hospital resources. A Washington University study led by Douglas Schuerer, MD, medical director of trauma, found that unplanned 30-day readmission rates in this population decreased significantly after implementation of the unit.
Barnes-Jewish Hospital, which has the busiest trauma center in the region, set a new monthly record in July 2016 with 390 trauma admissions. The highest number of admissions previously was 355 in July 2015. The trauma center treats about 13,000 trauma patients annually with a 99 percent survival rate.
A trauma surgeon from the section will be appointed at Memorial Hospital in Carbondale, Illinois, to expand trauma services in the Southern Illinois region. Memorial Hospital is part of the BJC Collaborative.