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SANJAY GUPTA MD
War Trauma Care Helps Those At Home; Innovations In Battlefield Medical Trauma Care; Overcoming Claustrophobia To Fly; Fit Nation Tri- Athlete Update
Aired July 16, 2011 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Thanks for joining us. I'm Dr. Sanjay Gupta.
This fall is going to mark a full decade that the United States has been at war. It's left a mark in many ways including the strong connection between the battlefield and medical care right at home.
You see, I work at a Level I trauma center, Grady Hospital, and, as a neurosurgeon, I handle all kinds of things -- gunshot wounds, car crashes, other injuries. And some of the techniques that we use, for example, cutting out part of the skull to relieve pressure on an injured brain, things like that were developed in the military in the last decade out of necessity.
It's not a one-way connection. CNN Pentagon correspondent, Barbara Starr, spent time with a group of doctors, medics, nurses, and medical techs who are all, themselves, getting ready to deploy. For these men and women heading off to war, a big city hospital, like the one where I work, can be a perfect training ground.
BARBARA STARR, CNN PENTAGON CORRESPONDENT (voice-over): Dr. John Renshaw stops to check on one of his injured patients. Jacques suffered massive abdominal injuries at his Maryland factory job when he was caught in a conveyer belt.
DR. JOHN RENSHAW: But right now we don't see any evidence of infection. So, we're just going to keep an eye on that, OK?
STARR (voice-over): His cousin, Peter, translates into the Creole of their native Haiti.
RENSHAW: You mind if I take a look at the area here real quick. Again, I'll leave you covered up here.
STARR (voice-over): But Renshaw is an oncologist. He treats cancer. So, why is he here? Dr. John Renshaw is also Major John Renshaw, United States Air Force, and he is deploying to the frontlines of Afghanistan to treat the war-wounded. But before he goes, he along with other medical personnel, will complete a tour of duty here at the University of Maryland Shock Trauma Center in Baltimore. Sharpening their ability to deal with critical trauma patients.
FEMALE (voice-over): The wounds appear to be superficial.
MALE: Category A now?
MALE: Trooper one. 15 up. Ten minutes back. Fall from trig. Category A. Priority one.
STARR (voice-over): Every day, dozens of trauma patients are wheeled into the bays. Some are accident victims. This young man came with multiple stab wounds. But right alongside the civilian trauma doctors, nurses and techs, military personnel.
Colonel David Powers, a surgeon, runs the military training program here.
COL. DAVID POWERS, FORMER DIRECTOR, C-STARS, BALTIMORE: The injuries that I've treated here and that I see here at this hospital are the closest thing to the injuries I saw in Iraq that I've experienced in the continental United States.
STARR (voice-over): Listen to what Powers has encountered in recent weeks here.
POWERS: I've had a gentleman whose entire scalp was torn off in an industrial accident. I've had an individual who has now been involved in a motor vehicle accident that has intracranial injuries where I have to recreate the cranial vault and the frontal sinus exactly like what I have to do with an IED blast.
STARR (voice-over): Air Force Major Joseph Dubose teaches other military colleagues his specialty - trauma surgery and surgical critical care. He notes many deploying military personnel from state- side bases don't regularly see critical trauma cases.
STARR: What does an Air Force person, a doctor, a medical tech learn before they go to the war zone?
MAJ. JOSEPH DUBOSE, U. S. AIR FORCE SURGEON: All of the basic skill set that they are they going to need in the early phases after injury and the ability to manage that patient air way, treating bleeding and hemorrhage, treating intracranial injury.
STARR (voice-over): And it's skills will come back home with them. Dubose said that the war has led to advances in controlling bleeding, monitoring fluids, and caring for brain injuries.
DUBOSE: All of these things are lessons that we're learning, hard-fought lessons, on the battlefields of Afghanistan and Iraq that can be translated to civilian care.
STARR (voice-over): Lieutenant Colonel Allan Ward is an Air Force flight surgeon who normally certifies air crews are healthy enough to fly. LT. COL. ALLAN WARD, U. S. AIR FORCE FLIGHT SURGEON: Even as a flight surgeon, expect to be a jack of all trades, but, really, in garrison when we're not deployed and I'm an outpatient internal medicine guy.
STARR (voice-over): Before getting to Afghanistan, he says, this will help him learn to prioritize multiple critical patients under battlefield conditions and sharpen his ability to make rapid decisions.
WARD: I expect to see gunshot wounds. I expect to see traumatic brain injuries from explosive devices. It means, burns, as well. A lot of orthopedic injuries and really some horrific stuff. And what I'm doing here is getting exposure to a lot of the things I will be seeing over there. It is an immersion, really, in a high-volume trauma center.
STARR (voice-over): You may not realize it, but treating the war wounded has long before a source of knowledge for all doctors.
DUBOSE: There has been a century long interplay between civilian and military care. In many ways, trauma surgeons have learned from military conflict more so than any other component of care.
STARR (voice-over): As Major Renshaw's patient, Jacques, continues to recover, the doctor says the training he receives here is vital.
RENSHAW: So, this gives me exposure to the trauma mindset to kind of know what to look out for, pitfalls to avoid, procedures that I need to get my skills back up.
GUPTA: Joining us, again, is Barbara Starr. You know, it's one of the things. I wonder, no matter how much you prepare, it's going to be completely different, still, in some ways. You have seen this firsthand, as I have, in Afghanistan and Iraq. Were they nervous? Did they feel well-prepared?
STARR: Well, I think the doctors that we spoke to were very happy to have this 30-day tour of duty before they go to the combat zone, at Baltimore Shock Trauma. Because it really began to show them, they tell us, what they are going to be facing over there.
As you saw in the piece, one of the doctors is an oncologist. He treats cancer patients. You know, he said he's learning, yet again, how to put in chest tubes, control bleeding, restore breathing when someone may be so traumatically injured. They have that trouble. It is the kind of thing doctors may not have done since they were interns or residents.
So, they are getting back to the basic skills and really learning how to step it up and move fast and make decisions fast.
GUPTA: Yes, I think people forget that. If you're an oncologist, you are not taking care of traumatic injuries on a daily basis. When you go there to Afghanistan and Iraq, I mean, the conditions are different in different places. You can't paint it with one broad brush. So, do they know what specific settings they're going to be in ahead of time?
STARR: Some of them did and some of them don't know yet. They're doing a variety of jobs. But one of the other things that is going on at the shock trauma hospital we went to, they have regular conference calls with medical folks in the war zone every week to say, OK, what's going on? What are you seeing? How are you treating that? How do we need to fix our training program back here?
So, it's a completely dynamic environment. Everybody is always on the move trying to stay up with the latest.
GUPTA: I think, that's fascinating because sometimes there's non-intuitive things. You have a perfect idea, you think, of what you are going to face and it is just different. So, those conference calls probably really help.
STARR: They do. Or they tell us they do. I think what really has emerged from everything you and I have been talking about is if you have to go to your local emergency room, your community hospital, your doctor, the chances are you that will encounter someone that has done a tour of duty in the war zone. There are thousands of medical personnel that have served. They've now come back home fanning out across this country. So, the war isn't so far away. It may be helping you back at home.
GUPTA: That's right. And it's a unique experience for those doctors and, hopefully, translates into better medical care. Thanks so much, Barbara.
STARR: It's been great.
GUPTA: You may want to stick around for this as well. We are going to talk to a man who stirred up a lot of controversy running, essentially what were life and death experiments for the army.
We'll explain. Right back.
GUPTA: You know, the advances in military medicine over these past ten years at war have been nothing short of astonishing. What you might not realize is just how much these battlefield breakthroughs affect just about every aspect of our health back here at home.
Joining me to talk about this from Houston is Dr. John Holcomb, he's Chief of Trauma at Memorial Hermann Medical Center.
Doc, good to see you again. Thank you for being on the show again. Appreciate it.
DR. JOHN HOLCOMB, CHIEF OF TRAUMA, MEMORIAL HERMANN MEDICAL CENTER: Sanjay, it is nice to hear from you again. GUPTA: We've been reporting on this for some time as you know, Dr. Holcomb. As a starting point, can you talk about some of the things that have changed over the last ten years? What we are starting to learn from the battlefield and apply back home?
HOLCOMB: Right, it's a great question. I think that you kind of have to divide this up into different areas. I think of advances in the pre--hospital area, advances in the hospital, and advances from a systems point of view working across the entire battlefield and then obviously advances from the research point of view and how those intermingle with the civilian community.
GUPTA: Right, and if you think about, for example, let's take pre-hospital as a starting point. The way that a patient is assessed in the field at the time of trauma. Are there some examples that you can you share of what we have learned on the battlefield that they're not doing at home?
HOLCOMB: Right. So, I think at the beginning of the war, we put in place with a lot of people all working together tourniquets on the battlefield, intraosseous devices and these hemostatic dressings. Dressings that actively stop bleeding. They are a lot better than the gauze or cotton dressings that were in place for thousands of years.
Those three technologies, devices really have been implemented in the civilian communities in the United States and around the world. In some places obviously more than others, but starting to spread like wildfire across the United States.
GUPTA: What about within the hospital within itself? When they come to see you, for example, as a trauma surgeon, what may be different?
HOLCOMB: I think the general consensus is the way that patients are resuscitated. In the beginning of the war, you would see the people in the hospital hanging clear bags of fluid. The crystalloid fluid. Then starting red cells and sometime afterward starting plasma and platelets in a serial fashion.
What many places around the country do now, as soon as the patient comes in that needs resuscitation or is in shock, is you don't hang the clear fluid. You hang red cells -- plasma and platelets and get those things in as soon as possible.
What we are seeing, it's not level one data, so it's not the high quality, but we are seeing that this appears to be associated with improved outcomes and a decreased use of blood products. Using them earlier decreases the total amount.
GUPTA: So you may not need as much later on if you use those red blood cells earlier. Let me ask you a broader question. Is it easier to innovate on the battlefield than back home, and why is that?
HOLCOMB: Well, that's a pretty complicated question, actually. Innovation happens all the time and in multiple places. The rules for research and innovation are the same or about the same as they are back home with institutional review boards and et cetera. There are no differences.
What is different on the battlefield is that the number of seriously injured patients is three to four times greater than what we see in the civilian community. The other major difference in the battlefield is that the doctors and nurses are living together and eating together. All you really do out there is work, eat, sleep and occasionally workout.
That's it. There are no other distractions. It is a very simple lifestyle, focused completely on patients. I think that, you know, lifestyle and the larger number of injured patients coming in is what causes innovations to spring from war.
GUPTA: If you have these situations of war where you have mass casualties and you have in some situations, you may have fewer resources as a result of the setting in which these doctors are practicing and these nurses.
Are they forced to innovate, though, in a different way? When you talk about advances being made on the battlefield, why, if it is the same, do they occur on the battlefield in this manner versus in civilian populations?
HOLCOMB: It goes back to what we just talked about. I think that all you do on the battlefield all day long every day is think about how to do things better. There is no other -- it is a cauldron of innovation and absolute desire to take better care of the next patient. That happens in the civilian world, but not to the same degree. It's just a different environment where everybody is thinking constantly of how to do better the next time, the next hour, the next day.
GUPTA: Do you think there are enough resources, money being spent on medical research, in the battlefield situations?
HOLCOMB: I think medical research for trauma in general is underfunded. Trauma is the leading cause of death in the United States in civilians in ages 1 to 44. It's the leading cause of life years lost. It has been well-documented for the last 40 to 50 years by Institute of Medicine Reports, et cetera. The societal impact of injury is unbelievable and the amount of funding coming from the federal agencies is insignificant compared to the impact on society.
The reason that's important is because if we had studied optimal resuscitation in the civilian world when the war started, we would know exactly the best way to resuscitate the patients. Those were the conversations we had when the congressmen and senators came to visit us in San Antonio. You have to study these things in the civilian world with respect to randomized studies so when the war starts, you have those level one data and know how best to take care of the injured casualties. Right now, what we're seeing is it's kind of backwards. We are starting to do those level one high quality studies now, ten years into a war.
GUPTA: It's always fun visiting with you, Doctor Holcomb, appreciate it. I always learn something. HOLCOMB: No problem.
GUPTA: Thank you, sir. Coming up, facing your fears. Would you believe the man flying this plane was terrified of small, confined places? Seems like this would be the last place he would want to be. Hear how he beat it. That's next.
GUPTA: Want you to imagine something. You've got severe claustrophobia, a real fear of tight places. Now imagine your job is to get into a seat the size of an arm chair, lean back, strapped in tight on all sides with the ceiling just a foot over your head. Sounds fun, right? Most people would want to scream, but Air Force Lieutenant Colonel Rob Waldman has faced his fears. And he did it the hard way.
GUPTA (voice-over): Screaming engines. Mind-numbing speeds of over 1500 miles an hour. This was Lieutenant Colonel Rob "Waldo" Waldman's daily ride. He had what many would consider one of the coolest jobs in the world.
LT. COL. ROB WALDMAN, UNITED STATES AIR FORCE PILOT: It's an amazing jet, F-16.
GUPTA (voice-over): But an innocent diving trip would change everything.
WALDMAN: Three years into my eleven year flying career, I almost died in a scuba accident in the Caribbean.
GUPTA (voice-over): Thirty feet underwater, Rob's scuba mask broke. Physically, he was fine, but mentally he was shaken to the core. He developed severe claustrophobia.
WALDMAN: So, if you can imagine barely being able to move with this helmet and mask on, gloves, your head two inches from the top of that canopy. You're like in a little coffin. Enough for a guy with claustrophobia to really feel panicky. For every single mission I flew, I had to deal with this fear of having a panic attack.
GUPTA (voice-over): But a panic attack while going Mach-2 would be devastating.
WALDMAN (voice-over): When you're strapped into a jet, you just can't say, pause, let me deal with this. Or on combat missions where there was a job to do and my wingman needed me, there was no abort option for me.
GUPTA (voice-over): Ultimately, Rob says it was planning, family, and faith that helped him overcome his fears.
WALDMAN: I would simulate the environment that I would be in on the ground before the flight and I would say, OK, I may have a panic attack here. How am I going to deal with it? I would look down at my checklist and I would see a picture of my niece and nephew and it reminded me of what I loved. And I said I've got to get home for them.
GUPTA (voice-over): Now after 56 combat missions over Iraq and Serbia, Waldo says he's kicked claustrophobia for good.
WALDMAN: I think about the challenge and that personal growth that I had because I took a risk to fly that plane. I didn't want to look back on my life and say, if I only had that courage to take action, I could have flown the coolest jet in the world which in my opinion is the Lockheed-Martin F-16.
GUPTA: You know, another thing I'll tell you is that I've flown in one of these jets before and it is pretty frightening. Even if you don't have claustrophobia. Thanks a lot, Lieutenant, for sharing your story with us.
Up next, we're going to talk about practicing what you preach. Introduce you to a doctor who takes care of kids looking to set a better example for them.
GUPTA: Checking in now with another member of our six-pack.
We first met Dr. Scott Zahn when he submitted his video to be part of our Fit Nation triathlon challenge. He did it after his own doctor put him on medications for both high cholesterol and high blood pressure. We did tell you after just a few months of training with us, he was able to stop taking one of those medications.
Now we've got another good update from Scott. He weighed 270 pounds when this all began and has dropped now to less than 200 for the first time in a long time. In fact, I'm not even sure how long it's been. I'm going to ask him. Dr. Scott joins us now from Green Bay, Wisconsin.
Hey, Doc, how you doing?
DR. SCOTT ZAHN, FIT NATION TRIATHLETE: I'm doing good.
GUPTA: So how long has it been since you weighed below 200?
ZAHN: I was trying to figure that out. It's been at least probably since college. So I'm 46, so at least 20 years.
GUPTA: Wow. That's got to feel pretty good, I'm sure. You're also able to run, I guess you say nine-minute miles, which is -- it's quite remarkable. You weren't running a lot before. How does it just feel to be becoming that athletic?
ZAHN: I really wasn't running much at all. I probably couldn't run a mile. To be running nine-minute miles for me is incredible. I never thought I would ever get to that point. I just feel great, I have lots of energy. The things that I'm able to accomplish now, I never thought that I would get to this point.
GUPTA: What has been the hardest part? Have there been walls? People talk about the proverbial wall that you hit in the midst of your training, did you hit that, and how did you get through it, if you did?
ZAHN: I've hit some walls, just really sore and achy. Didn't really think that I could, you know, even get up the next day to work out and just kind of worked my way through it. Just exercised more, changed my routine a little bit, and that helped me to get through some of those walls.
GUPTA: You're a doctor. You take care of kids primarily. Has there been a reaction from your patients to seeing you, the physical difference in you and just your attitude?
ZAHN: The teenagers have the noticed it, but probably more the parents have noticed. Some I haven't seen for six months or a year and they're shocked when I walk in the door. That's kind of a cool thing to see, you know, the reactions that I get when I walk in and they're surprised at how different I look.
GUPTA: Yes, I bet. I mean, I'm just even looking at you, it's quite a transformation. The question I get all the time, I want to ask you as well. You're a doctor, you have a wife, have you four children. You're a busy guy, and yet you have made this time to incorporate this triathlon training into your life. No small commitment. How do you do it? What's the advice you would give to other people?
ZAHN: Well, you've got to put it as a priority in your life. Equal to everything else -- work and family and friends. I get up earlier in the morning and get in a lot of workouts in before I have to come to the office. The other thing I do is I'm working out a lot with friends and family. So I'm working out and spending time with those people at the same time.
GUPTA: You know, it's interesting because I do a lot of the same things. I try and take my kids, who are very young, but sometimes they come along on the workouts with me, pushing them along in the jogging stroller or going to the park while I swim. I'm proud of you, Scott. You look great. I can't wait to cross the finish line with you. Thanks so much.
ZAHN: Yes, looking forward to it.
GUPTA: All right, sir. If you want to follow along with me, Scott, or any members of the six-pack, you can check out www.cnn.com/sanjay. Get a lot more there on our Fit Nation challenge. Join us. Thanks for being with us today. I'm Dr. Sanjay Gupta. More news on CNN starts right now.