CSTARS “Center for Sustainment of Trauma and Readiness Skills” is essentially the military’s solution to get Docs, nurses, and medics that are about to deploy some trauma training. There are a couple of sites where they send us, but the main one, and the one I find myself at is at the University of Maryland’s Shock Trauma Center in Baltimore. Shock Trauma as it’s better known as is a freestanding trauma center, and as far as I know the only of its kind. What that means is that there is no emergency department, there are no real “wards” filled with old ladies complaining of dizziness.
This hospital, if I can even call it that deals only with the grittiest most devastating traumas. Instead of an ER they have a Trauma resuscitation unit filled with about 12 trauma bays, instead of normal hospital beds they have ICU beds. To be admitted to Shock Trauma you have to first either get shot, stabbed, or get hit by a bus, all of which seems pretty easy to do in Baltimore, or the surrounding area. Then the ambulance or helicopter will get permission to bring you in.
This place is notorious for being the best of the best when it comes to Trauma surgery, and renowned for being the best training in the country. Add to its list of credentials that the military sends medical teams here before deploying to war zones, and you start to get the picture.
Some of the staff here at Shock Trauma are actually part of a medical active duty Air Force detachment, and they head up the CSTARS program. There are about 28 or so people enrolled in my course, only five of us are physicians, the rest are an assortment of techs, and nurses. The basic course layout starts with a few days of lectures concerning the management of the trauma patient in Afghanistan/Iraq, these lectures go over just about every organ system and management of battle time injuries. The best part is that the lectures are given by trauma surgeons who have actually deployed and have been knee deep in it before.
The majority of the three weeks, which for me starts tomorrow, is actually being assigned to one of the three trauma teams. This comes fully loaded with every third day 24 hour call, and apparently being treated as some thing between a senior resident and a full-blown trauma fellow. Today I was introduced to my fellow. Just to remind everyone the food chain goes, med student, intern, resident, fellow, staff. I was introduced as a Special Forces flight surgeon, and although I’ve enjoyed hearing that title before, this time I cringed a little at how the title grossly over represents its bearer. The fellow then questioned “so your board certified, right?” I swallowed a lump that tasted like excitement and fear as I quickly corrected him. I explained how I had just finished intern year, and this was part of my training for deployment. In my head I was screaming “ Jesus, I haven’t done any surgery since third year of med school, and the only thing I can tie off are my shoelaces, if you have someone with a cold I can manage that, but please don’t send me to crack open someone’s chest by myself in the middle of the night”!
He said that I should come in on Friday and they would start me off light with four patients, as there were 34 on the team. The concept of 34 patients is something I simply can’t wrap my head around, the most we ever had on medicine last year was about 15. So when he made the promise that I would be busy it was easy to believe.
In thinking about the weeks in front of me it becomes easy to revert back to the mentality of medical school. The goal back then was to simply survive, get a good grade, and try not to piss anyone off. But, the game has changed significantly. Back then it was hard to see the need to really learn the skills of surgery, and justifiably so, I knew fairly early on that I didn’t want to be a surgeon. I only cared about passing the exam at the end of the block.
The lectures I received at the beginning of this week took on a new intention, however. I listened with a new purpose, not because I was about to work on one of the busiest trauma services in the country as a quasi-trauma fellow, but because I am soon about to deploy, and do what I'm being taught for real. It’s becoming frighteningly obvious that I may very well be faced with these types of injuries in a “far forward” environment and be the most qualified guy around to do anything about it. At the beginning of the week the CSTAR course director left us with a pearl of wisdom and said, “This training is not about the Air Force, its not about you, its about that 18, 19 year old kid that’s serving his country, and you may be the only one there for him when he gets hit”. I think its all the motivation I needed, and I no longer care about the shelf exam or passing grade.