Max Dodge:  The biggest hurdle I see for military medics transitioning over to civilian healthcare is the need for certification, licensure, and credentialing.  While we are the masters of battlefield trauma, we don’t learn a lot about the rest of healthcare.  There are a lot of ways to become sick when you aren’t an 18 to 30-year old physically fit person.  I’ve seen a lot of integration of military and civilian medicine in the last decade.  Veterans are playing a big role as they transition into law enforcement and other public service roles.

Andy Fisher:  The idea of the “Dysfunctional Veteran” does nothing except create more differences and issues with the civilian population.  Many of these veterans were the same that complained daily about how awful it was to serve in the military and could not wait to get out of the military.  We can improvise and adapt to multiple situations in combat, but somehow struggle in our integration with fellow Americans.  Veterans need to use those similar mechanisms and adapt to civilian life.

The only challenge I faced was self-induced.  I came off of active duty recovering from a traumatic brain injury [TBI], and started medical school three weeks later.  This was not a smart plan. However, I made this decision seven months prior and had my fall in Afghanistan three months before starting medical school.  As my TBI cleared, and with great support from my wife, things got better and now I have no issues.  I would say, give yourself some downtime when leaving active duty. 

Three days after I interviewed at Texas A&M College of Medicine, I received a call from the admissions office.  It was one of the Deans asking me if I wanted a seat in the 2020 class.  I immediately said yes and turned down every other interview offer.  Texas A&M University has a strong military history and I feel right at home.  The Texas A&M College of Medicine embraces the military and me.  I am extremely fortunate to have been offered such a fantastic opportunity.

Veterans are actively making an impact in medicine. If you look around the trauma and emergency medicine world, you see veterans leading the way.  Whether it is retired colonel John Holcomb in Houston, retired colonels Brian Eastridge and Don Jenkins in San Antonio, retired captain Joe Rappold in Maine, or Dave Callaway in Charlotte, these veterans are bringing the lessons learned from years of combat to civilian medicine.

H.R. Montgomery:  I think this group [NGCM] is doing what many veterans have done for generations before us, taking what we learned in the military and combat and improving things at home.  While some veterans take leadership skills and apply them in business environments, this group is applying what has been learned in tactical medicine.  It is not new!  It is actually very similar to the generation before us that helped set up much of the EMS system and infrastructure we know today. 

The difference is that this is a very deliberate endeavor to pick the most successful combat medicine wins from the last 17 years of combat and give to everyone possible.  We know tourniquets and hemostatic dressings and mastering the basics of bleeding control work and we know that anybody can do the skills if taught to do so.

SOFREP:  How do you see the “whole-community” approach to treating trauma caused by active shooter and terrorist incidents progressing?  Do you think that approach can and will catch on within the wider civilian population, given the seeming rise in the number of such incidents?

Dodge:  I think social media is a powerful tool which can be leveraged to put out important information to bystanders who may find themselves in a position to treat a trauma victim. Face to face instruction will always be best, but for rapidly pushing good information to a community, social media is a great first step. There is a lot of awareness right now, and every time there is a tragedy that awareness seems to taper off rather quickly.  Campaigns like the National Stop The Bleed Day have the opportunity to keep these lessons in mind.

Thompson:  It again starts off with getting the community the training on tourniquet use and basic how-to on other devices like pressure dressings to stop bleeding.  The first place would be to get the community leadership involved – the Police and Fire Departments and then the government officials.  Once people see that placing a tourniquet on a person who may be potentially dying isn’t that challenging at all, and once the community has the knowledge and skill set to provide life-threatening hemorrhage control measures, the next step is to have a Stop the Bleeding kit at every location where there is an AED. 

This country has over 12 million people trained in CPR but very minimal have training in pre-hospital trauma.  If we are able to teach our communities this life-saving technique, the casualty rate — in my opinion — would be far less than what it would be without any civilian intervention.

Fisher:  If we use the same model that the 75th Ranger Regiment uses — teaching every single Ranger how to identify and treat the three most common causes of preventable death — to police officers, we could help eliminate preventable death from airway obstruction, tension pneumothorax, and bleeding.  Police are often the first on the scene.  Furthermore, if bystanders are able to control hemorrhage with direct pressure, pressure dressings, and tourniquets, we could achieve zero preventable deaths in the U.S. from bleeding.

Montgomery:  Many civilians learn CPR because someone close had a close call or they lost someone.  When compared with CPR, the number of lives saved by bleeding control is a significant ratio difference [meaning, the success rate in saving someone with a hemorrhage is higher than for saving someone through CPR].  Bleeding is also something that can happen in so many scenarios from the active shooter to motor-vehicle accidents to just day-to-day mishaps. 

The 911 system has become an “easy button” that too many have become dependent on.  I cannot imagine why anybody would think it is okay to think they are done after calling 911, while watching someone bleed out.  Unfortunately, many people simply do not know that they could easily help and take action.  Their readiness or preparedness is mostly about knowledge and understanding that a few simple actions can save a life.

Featured image courtesy of AP Images.