When the ambulances started rolling in and news trickled out that multiple police officers had been shot, Kathy Barnard braced herself for one of the worst days in her 26 years on the job. One thing gave her confidence though.
“I pray we never, ever experience that again, but there were military doctors on duty. I had military nurses on duty,” said Barnard, a nurse manager at Atrium Health in Charlotte, N.C.
The day was April 29, when four officers died trying to serve an arrest warrant and four others were wounded. The hospital’s experienced civilian staff were shored up by active duty Army doctors and nurses from nearby Fort Liberty.
“We had the right team here to carry out the amazing care we gave everybody that hit our door that day,” Barnard said.
Techniques learned in war
A partnership funded by the Mission Zero Act, passed by Congress in 2019, has resulted in dozens of civilian-military public health partnerships across the country, ideally suited to collaborate in just such a crisis.
“Eight shooting victims that involved a rifle with high caliber wounds — this is what we train for. We train for multiple patients. We train for these high-velocity wounds,” said Dr. Michael Clemens, an Army Special Operations combat surgeon who pulls shifts at Atrium Health in Charlotte.
The partnership offers more than extra staff and expertise for mass casualty events. It’s a possible solution to twin health crises. Civilian hospitals are struggling with staff shortages nationwide, made worse by COVID burnout. At the same time, the Pentagon has acknowledged that an effort to outsource health care to the private sector has gone too far and is starving its own practitioners of valuable experience. And the collaboration allows the hard-won medical gains from 20 years of war to be preserved and practiced in peacetime, which is where Mission Zero got its name.
“The idea behind this was how do we get to zero preventable deaths from trauma?” said David Callaway, chief of crisis operations at Atrium Health.
Callaway is himself a veteran. He became a military surgeon just in time for 9/11. He watched the U.S. military’s steep learning curve in Iraq, where medical advances like the use of whole blood and tourniquets cut combat deaths nearly in half. Callaway was dismayed to learn that some of these life-saving techniques were not new; they had been discovered in previous wars only to be forgotten. It’s a phenomenon called the “Walker dip,” used to describe how crucial medical advances, going back more than a century, get repeatedly forgotten during periods of peace.
“We’ve invested trillions of dollars, thousands of lives. We have to take lessons out of this that help our community members in the U.S. and, and then also help our men and women serving overseas,” said Callaway.
His hope is that these Mission Zero collaborations can keep that knowledge current in an ongoing cycle between military and civilian providers.
Dr. Michael Clemens said it’s worked for him. He finished med school as the Iraq and Afghanistan wars wound down. He worried that his work treating troops and their families at military hospitals wasn’t enough to keep his skills sharp between special operations missions.
“It was a very stark contrast. I see appendicitis, I see hernia repairs, and I’m treating those daily processes. … All of a sudden I’m thrown into a war zone where the majority of my patients are now coming in multiples and they’re coming with explosive trauma from IEDs. They’re coming with rifle wounds and high caliber wounds,” Clemens said.
Working shifts in Charlotte gives Clemens the chance to do more complicated surgeries and keep his skills up to date, he said, and he can often see ways that civilian medicine and battlefield techniques build on each other. One example is a balloon used to block the aorta.
“That is something we use to decrease bleeding in traumas. That is a skill that has evolved and been used commonly on the battlefield and so I get to have firsthand experience with that device before I go use it in a more austere environment,” said Clemens.
Stateside, that same device is now being used to stop bleeding in high-risk pregnancies, which also happen on deployment. In war zones like Syria, American medics often treat civilians — and not just for war wounds. Clemens said he and his colleagues regularly perform emergency cesarean sections.
The knowledge flows in both directions. Experienced civilian surgeons often have plenty to teach newer military staff, and it’s also a good way for them to learn about civilian hospital culture for the day when they transition from active duty into non-military work. Military medical staff train on working in low or zero light and other disaster conditions, something they’re able to share with their civilian colleagues. That came in handy as teams from Atrium health traveled last month to help parts of North Carolina hard-hit by Hurricane Helene.
Dr. Callaway was on the scene of the shootout on April 29, and he came back to the hospital to treat patients. He said there’s one more thing this exchange and mentoring can provide.
“The other piece is to be able to put a hand on the shoulder of someone afterwards and say ‘There’s nothing else that could have been done.’ And to have that trusted. It’s not a platitude of, ‘Hey, good job.’ It is a deep solemn knowledge that nothing else could have been done,” he said.
Transcript:
STEVE INSKEEP, HOST:
Now we have a follow-up to several NPR exclusive reports on a crisis in military health care. The Pentagon was trying to privatize and outsource health care for troops and their families. NPR found there’s a shortage of health providers nationwide, which has hurt the military’s ability to keep its fighting force healthy and even to keep its medics trained and ready. Now there is a start at solving the problem. NPR’s Quil Lawrence reports from Charlotte, North Carolina.
QUIL LAWRENCE, BYLINE: David Callaway became a Marine Corps surgeon just in time for 9/11. He saw the military quickly learn lessons that cut battlefield fatality rates in half.
DAVID CALLAWAY: We need to capture all of these lessons learned from Iraq and Afghanistan and what they call the war dividend.
LAWRENCE: Because Callaway later discovered that the military had already learned those lessons in Vietnam and in Korea and then forgotten – he wants to preserve the war dividend this time.
CALLAWAY: The idea is we’ve invested trillions of dollars, thousands of lives. We have to take lessons out of this that help our community members in the U.S. and then also help our men and women serving overseas.
LAWRENCE: Callaway says that is starting to happen with civilian-military partnerships funded by the Mission Zero Act that Congress passed in 2019.
CALLAWAY: The idea behind this was, how do we get to zero preventable deaths from trauma?
LAWRENCE: Mission Zero collaborations do more than preserve knowledge. They solve a staff shortage.
CALLAWAY: He’s stable there.
LAWRENCE: Callaway is chief of crisis operations at Atrium Health here in Charlotte, North Carolina, where active-duty docs and nurses from nearby Fort Liberty come and work shifts, like army doc Michael Clemens.
MICHAEL CLEMENS: I am a surgeon for the United States Army’s Special Operations Command.
LAWRENCE: Clemens finished med school as Iraq and Afghanistan wound down. He’s with special forces, so he still goes all over the world. But between trips, he ran into what’s now a widely recognized problem for military providers. The Pentagon has outsourced so much that he can’t get enough practice for his next combat deployment.
CLEMENS: It was a very stark contrast. I see appendicitis, I see hernia repairs, and I’m treating those kind of daily processes. All of a sudden, I’m thrown into a war zone where the majority of my patients are now coming in multiples.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON: C-O-C point 0-1, Special Care 3 (ph) is 15 minutes out to…
LAWRENCE: Working shifts here in the ER, Clemens can stay sharp and even practice battlefield techniques. One example is a way to stop blood flow at the aorta with a balloon.
CLEMENS: That is something we use to decrease bleeding in traumas. That is a skill that has evolved and been used commonly on the battlefield. And so I get to have firsthand experience with that device before I go use it in a more austere environment.
CALLAWAY: So, Quil, the important part of what Dr. Clemens is talking about is…
LAWRENCE: Dr. Callaway again.
CALLAWAY: …This device was specifically created because we were seeing so many servicemen and women get their legs amputated in Iraq and Afghanistan, and they needed a way to stop the blood flow. And so this device that was designed to save amputees in war zones is now saving mothers who are having high-risk pregnancies.
LAWRENCE: Civilian-military collaborations like this are now happening at dozens of hospitals around the country. But here in North Carolina, the partnership got tested this year in a way no one ever wanted.
(SOUNDBITE OF ARCHIVED RECORDING)
JOHNNY JENNINGS: Today is an absolute tragic day for the city of Charlotte and for the profession of law enforcement. Today, we lost some heroes.
LAWRENCE: That was Police Chief Johnny Jennings last April on the day Charlotte lost four police in a shootout that also wounded four others. The casualties went to Atrium Health.
KATHY BARNARD: My name is Kathy Barnard. I am the nurse manager here in the emergency department.
LAWRENCE: Barnard was working that afternoon when the ambulances started arriving.
BARNARD: So, you know, we started getting the calls. Obviously, there’s lots of law enforcement showing up.
LAWRENCE: Here’s Dr. Clemens again.
CLEMENS: We had, you know, eight shooting victims that involved a rifle with high-caliber wounds. And so when they come into Atrium Health, on call that day were two military surgeons fully integrated with our civilian partners.
BARNARD: Everybody had a role. Everybody knew what room they were going to. A well-orchestrated dance.
CLEMENS: And I will say, the triage officer that day did look to one of my surgeon colleagues, who is a combat surgeon, and said, hey, I’m going to give you this first patient because we know that you’re ready for this.
BARNARD: I pray we never ever experience that again, but we had the right team here to carry out the amazing care we gave everybody that hit our door that day.
LAWRENCE: Dr. Callaway worked that day as well on the scene of the shooting and back at the hospital, and he says there’s one last thing this kind of mentoring can provide when the immediate trauma work is done. That’s to have an experienced surgeon – maybe one who’s seen war – be able to tell someone they did everything they could.
Quil Lawrence, NPR News, Charlotte, North Carolina.
(SOUNDBITE OF MUSIC)
