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Miami on front line
The city's trauma center is like a war zone, and Army medics train there.
Published October 27, 2007
MIAMI - The trauma center's radio crackles an alert: A 34-year-old woman injured in an auto wreck is being brought in by helicopter. Parts of her scalp have been torn back, exposing her skull. Broken bones may be sticking out through the skin of her left leg.
Her injuries may help save the lives of U.S. soldiers in Iraq.
For two weeks, 28 Army medics, nurses, doctors and nurse anesthetists have been learning trauma medicine and teamwork under pressure at the Ryder Trauma Center at downtown Miami's Jackson Memorial Hospital, a place that sees such carnage it often resembles a war zone.
Ryder is one of the busiest trauma centers in the nation, seeing an average of 11 patients a day - about as many as the biggest military hospital in Iraq.
Jackson Memorial serves some of the city's most crime-ridden sections, and patients arriving at the trauma center have been stabbed, injured in grisly auto accidents, wounded in shootouts with high-powered assault weapons, or hurt in falls and fights.
The Army sends 10 forward surgical teams a year through Ryder, which was selected six years ago because of the volume of bloodshed. It is the Army's only trauma training center. The Air Force has similar programs in Baltimore, St. Louis and Cincinnati; the Navy's trauma program is in Los Angeles.
This time, the professionals being trained are Ohio reservists with the Army's 848th Forward Surgical Team. In their civilian lives, some of them raise families, tend bar, go to college or work for the post office. The team leader is Col. Michael Oddi, a 59-year-old thoracic surgeon in Akron, Ohio.
"My practice consists of a lot of surgery, but we don't do a lot of trauma surgery. So a program like this, to prepare us for acute, multiple casualties, really helped us on our last deployment, and it will help us again," Oddi said. "It is extremely busy here."
On this particular day, Oddi and two medics, a nurse and a nurse anesthetist from his team slip into green, long-sleeved aprons and blue gloves, then make their way to the roof with other Ryder staff members to meet the helicopter.
The chopper blades slice through the air as the reservists ease the woman's stretcher onto a gurney, their green aprons whipping around their legs in the wind. Her head and neck are immobilized in a brace. Her left arm is heavily bandaged, but both legs appear okay - the radio alert about a broken leg was inaccurate.
She is wheeled into an elevator, then into a trauma room. The reservists are identified by their color-coded caps: beige for the medics; maroon for the nurse; dark blue for the nurse anesthetist; and green for Oddi.
The reservists have been taught an Army teamwork system for treating multiple injuries simultaneously.
They take up positions around the woman's body. The medics stand near her feet, remove her sneakers, help keep her motionless and check her IV lines. The nurse anesthetist at her head monitors her breathing, checks her eyes and ears and asks for her date of birth.
Oddi hovers by her side, examining the wounds and assessing whether she has suffered any brain injuries through a series of questions and her responses to pain. Also at her side is the nurse, Capt. Brent Tuma, checking her vital signs, medications and lab results.
Tuma, in civilian life, is a trauma nurse in Cleveland. In the emergency room where he works, "usually when you get a trauma or a code scenario, you have 10 to 15 people in the room. People are screaming. It's controlled chaos," he said after returning to Ohio.
Under the Army's system, however, there are only a few people around the patient and there is no need to scream out for something to be done. Each team member has a list of tasks and does them.
"You trust your buddies. You know what's got to be done on the opposite side is going to be done, it's going to be done proficiently and it's going to be done swiftly," Tuma said.
About an hour after she arrives, the patient is wheeled away for more scans and observation. Spent gloves and aprons, plastic packaging and gauze are dropped on the floor in a smear of blood. The back of Sgt. Robert Bartl's green scrubs is dark with sweat.
Bartl, Oddi and about half the current team passed through Ryder for training before being sent to Iraq in 2004. It is not clear whether they will sent back for another tour of duty.
Team members said their training in Miami primed them well to care for wounded soldiers and Iraqi civilians. In Miami, they saw similar injuries - head trauma, multiple gunshot wounds - and worked at a frenzied pace sometimes hindered by a language barrier.
"Coming down here before we got deployed and getting hands-on with real patients, doing IVs again with actual people instead of rubber plastic arms, it did wonders for my confidence," said Bartl, a 27-year-old bartender and waiter.
At Ryder, the forward surgical teams spend most of the two weeks' training in lectures and a lab with a fleshy, plastic "patient simulator." On the last day, the teams are given command of the trauma center for a 24-hour shift.
This team's live-action day turned out to be relatively quiet, with just a trickle of stabbing, motorcycle crash and car accident victims arriving. Just a week earlier, four police officers shot with high-powered assault weapons had been rushed to Ryder.
One died and two suffered easily treatable wounds, but one had her knee blown apart and required extensive treatment by Ryder's nonmilitary staff.
"That one cop, she was shot by an AK-47," said Spc. Joshua McCann, a 22-year-old medic and Kent State nursing student. "That's exactly what we're going to see over there."