US Army medics train for "shock and horror"

Miami: Army Lt. Col. Donald Robinson is no stranger to bloodshed. As a civilian he served as a trauma surgeon at Cooper Hospital in Camden, New Jersey, a city so violent he says doctors call it the "Knife and Gun Club."Nothing in Camden could fully prepare him for what he saw as chief of surgical and critical care at the U.S. Army's premier medical facility in Iraq, however. He put in long hours there from December 2004 through July 2005.

Improved body armor and medical care mean more soldiers survive war injuries in Iraq than in past conflicts, and Robinson said well-trained army medics are making a big difference.

But Robinson said the injuries caused by Iraq's dreaded improvised explosive devices are unlike anything seen in combat before, posing constant challenges for army field surgery specialists in a conflict that has been dubbed the "Superbowl of Trauma."

Robinson says he can't remember how many amputations he performed as chief of trauma and director of the intensive care unit at the 86th Combat Support Hospital in Baghdad.

"They were too numerous to count," he said.

Now as head of the Army Trauma Training Center at Miami's Jackson Memorial Hospital and the University of Miami, Robinson's job is to prepare other army medics bound for Iraq for what he calls the "shock and horror" of a conflict in which more than 3,250 American troops have been killed and over 24,000 wounded since the U.S. invasion four years ago. About 1,000 soldiers and medics have completed the army trauma training program in Miami since it began in 2002, in the early stages of the U.S.-led war in Afghanistan. That number includes 264 military personnel since Robinson began running the program in February 2006.

The basics of the two-week program would sound familiar to emergency responders anywhere, with an initial focus on a patient's airway, breathing and circulation.

But Robinson puts a premium on speed and ensuring that medical team members are able to cope with the grim reality of what they're seeing.

Part of that involves overcoming what the military refers to as "compassion fatigue," the post-traumatic stress disorder that can affect medical personnel who treat severe wounds, said Robinson.

"Distance yourself"

"I've seen people freeze, standing across the table from me going 'holy shit!' I've seen it," he said.

"I think the only way you can get over that is to be trained to understand that, yes, it's devastating, but you sort of have to disassociate yourself or distance yourself away from what you're looking at."

In places where emergency rooms are regularly full to overflowing -- and that is not just in Iraq -- Robinson said quick and seamless teamwork is also essential. "You can be the greatest surgeon in the world but if you don't have someone passing you the instruments the way that the instruments need to be passed, you will be pathetic. You will not be able to perform your mission and you will not save lives," he said.

"What being in Camden did for me, it allowed me not to hesitate. Because in trauma you hesitate and people die," he said.

"The key is being able to accept what your eyes see in your brain and to have your brain go into overdrive, to not think about what you're doing and to know you're doing the right thing."

Robinson declined to comment when asked about the recent scandal over shoddy conditions and bureaucratic delays for wounded troops at Walter Reed Army Medical Center, the flagship U.S. military hospital. The revelations have compounded a deepening public disquiet with the war in Iraq.

"I have my own thoughts about that. But in all honesty, we were told by our bosses that's out of our lane and we don't have an opinion," he said.