Duke and SOCOM/SFMS

[Devildoc]

About a year ago my boss approached me and asked me to do what I had to do to establish relationships at the Joint Special Operations Medical School/Special Operations Medical Group at Ft. Bragg and have our institution, Duke, be a host facility for clinical education for the medic/corpsman students. My boss being a vice president of the health system, I saluted and said "aye, aye, ma'am." (not really....I just said "okie doke").

Since last February I have been down there several times, on Zoom calls many times, hosted their staff/faculty. I am pleased to say our contract is finally completed and now at JAG for review. We anticipate first students in February or March.

Along the way I have hosted some of their folks in Advanced Trauma Life Support, ED experiences, and hyperbaric experiences, and we're discussing a handful of journal articles and joint education ventures. And, I have made some new friends.

If people ask me if I have ever had a job that I loved, I would say, this is it.

 

[TLDR20]

This is rad for you. Sucks for the studs tdy though. How is your anesthesia department with this? At VCU they gave us the cold shoulder until their chief got back from vacation. His dad was a SOG GB and he personally took me to every starting room to intubate. Unfortunately sometimes CRNA’s can be the worst about this.

 

[Devildoc]

This is rad for you. Sucks for the studs tdy though. How is your anesthesia department with this? At VCU they gave us the cold shoulder until their chief got back from vacation. His dad was a SOG GB and he personally took me to every starting room to intubate. Unfortunately sometimes CRNA’s can be the worst about this.

One of the big players in anesthesia, his wife is a coworker, so through her I educated him. He got them on board, including the CRNAs. They are pretty excited.

Ironically, the emergency department wants nothing to do with this. But urgent care is all over it. And one of the biggest supporters? Orthopedics.

 

[TLDR20]

One of the big players in anesthesia, his wife is a coworker, so through her I educated him. He got them on board, including the CRNAs. They are pretty excited.

Ironically, the emergency department wants nothing to do with this. But urgent care is all over it. And one of the biggest supporters? Orthopedics.

Have you thought about trying to get the ED directors to the current sites or down to the JSOMTC to witness the training?

 

[Devildoc]

Have you thought about trying to get the ED directors to the current sites or down to the JSOMTC to witness the training?

A few years ago we had a shit-hot but ego-loving trauma surgeon, he tried something like this, under him. He pissed all over the ED, told the ED what the students would and wouldn't do. He left for another job and the program fell apart. ED leadership hasn't forgotten, despite my frequent offers to explain why this is different.

 

[policemedic]

This is rad for you. Sucks for the studs tdy though. How is your anesthesia department with this? At VCU they gave us the cold shoulder until their chief got back from vacation. His dad was a SOG GB and he personally took me to every starting room to intubate. Unfortunately sometimes CRNA’s can be the worst about this.

My experience in training was the opposite, but that may reflect a better understanding of what a paramedic is vs an 18D, or just better buy-in by clinical faculty. The CRNAs and anesthesiologists were all about teaching, and our students got their fair share of tubes, other airways, and other skills. It may have helped that the hospital I trained in and that I sent my students to later on was a knife and gun club of the first order, with no shortage of trauma or surgical cases.

I think that Duke's program will see greater commitment from the reticent departments once they see what the students bring to the table.

 

[TLDR20]

My experience in training was the opposite, but that may reflect a better understanding of what a paramedic is vs an 18D, or just better buy-in by clinical faculty. The CRNAs and anesthesiologists were all about teaching, and our students got their fair share of tubes, other airways, and other skills. It may have helped that the hospital I trained in and that I sent my students to later on was a knife and gun club of the first order, with no shortage of trauma or surgical cases.

I think that Duke's program will see greater commitment from the reticent departments once they see what the students bring to the table.

I think at VCU it was the residents more than anyone. Shoot this was 15 years ago now.

 

[Devildoc]

@policemedic , I am hopeful about your comment regarding once the students are in place the ED (and maybe some other departments) will see the quality and warm up to the idea.

Right now the departments we have on board are very enthusiastic, which is very helpful. The providers are becoming vocal champions of this and will spread the gospel to their colleagues.

I'm also excited about the other second and third order effects. We have some folks who will go down and do some guest teaching, and we will have some of their folks come up to do some teaching as well. Some collaborative writing for journal articles. We are in conversations with the PA school about having preferential acceptance.

 

[TLDR20]

@policemedic , I am hopeful about your comment regarding once the students are in place the ED (and maybe some other departments) will see the quality and warm up to the idea.

Right now the departments we have on board are very enthusiastic, which is very helpful. The providers are becoming vocal champions of this and will spread the gospel to their colleagues.

I'm also excited about the other second and third order effects. We have some folks who will go down and do some guest teaching, and we will have some of their folks come up to do some teaching as well. Some collaborative writing for journal articles. We are in conversations with the PA school about having preferential acceptance.

If you could do what UNCG and UNC do and actually give credit for SOCM and SFMS that would be awesome.

 

[Devildoc]

If you could do what UNCG and UNC do and actually give credit for SOCM and SFMS that would be awesome.

That is the plan with the PA school (What we are after). I'd be curious to know what the nursing school would do given that it is an accelerated BSN.

 

[TLDR20]

That is the plan with the PA school (What we are after). I'd be curious to know what the nursing school would do given that it is an accelerated BSN.

Yeah I only meant for PA school.

 

[bvvanes]

About a year ago my boss approached me and asked me to do what I had to do to establish relationships at the Joint Special Operations Medical School/Special Operations Medical Group at Ft. Bragg and have our institution, Duke, be a host facility for clinical education for the medic/corpsman students. My boss being a vice president of the health system, I saluted and said "aye, aye, ma'am." (not really....I just said "okie doke").

Since last February I have been down there several times, on Zoom calls many times, hosted their staff/faculty. I am pleased to say our contract is finally completed and now at JAG for review. We anticipate first students in February or March.

Along the way I have hosted some of their folks in Advanced Trauma Life Support, ED experiences, and hyperbaric experiences, and we're discussing a handful of journal articles and joint education ventures. And, I have made some new friends.

If people ask me if I have ever had a job that I loved, I would say, this is it.

I just saw this post and wanted to add my 2 cents. After well over a decade at jsomtc as a doctor as well as a prior SF medic and SF task force surgeon in Afghanistan and DMO for a class at the SF dive school I may have some insight. I admire your goals and enthusiasm. My med boards also include anesthesiology and hyperbaric or dive medicine. You may have support from academia ie hyperbarics and anesthesia (ER med will be +/- given the nature of the beast). I tried to firmly establish hyperbaric training at jsomtc, got some traction but got major pushback from Key West. It seems logical that the jsomtc should be the repository for SF med training and we made some headway towards that with hyperbarics. To crack that nut takes much time and the Key West guys can point to their dive med tech program but as far as I knew at the time I was the only md in all of USASOC to have the medical boards I had to include hyperbaric med. Key West had DMOs that didn't have the med ed for hyperbaric boards but they did have their fellow DMOs and the USASOC surgeons' ear and resistance to change.

 

[Devildoc]

I just saw this post and wanted to add my 2 cents. After well over a decade at jsomtc as a doctor as well as a prior SF medic and SF task force surgeon in Afghanistan and DMO for a class at the SF dive school I may have some insight. I admire your goals and enthusiasm. My med boards also include anesthesiology and hyperbaric or dive medicine. You may have support from academia ie hyperbarics and anesthesia (ER med will be +/- given the nature of the beast). I tried to firmly establish hyperbaric training at jsomtc, got some traction but got major pushback from Key West. It seems logical that the jsomtc should be the repository for SF med training and we made some headway towards that with hyperbarics. To crack that nut takes much time and the Key West guys can point to their dive med tech program but as far as I knew at the time I was the only md in all of USASOC to have the medical boards I had to include hyperbaric med. Key West had DMOs that didn't have the med ed for hyperbaric boards but they did have their fellow DMOs and the USASOC surgeons' ear and resistance to change.

Thank you for your input.

"Dive medicine" at Duke is a bit of a misnomer, is 98% wound management and 2% diving emergencies and CO poisoning. I know they have done some work with the guys at Bragg regarding dive medicine. The Navy OIC and number three guy at the schoolhouse did his fellowship at Duke. We have tried to work to get more experiences and I can make observation and shadowing happen anytime, but Big Army seems to always get in the way.

The real shame is 90 minutes from Fort Bragg we have perhaps the best subject matter experts in dive medicine, but the Army still defers to the people how many hundreds of miles away at Key West.

 

[Muppet]

Thank you for your input.

"Dive medicine" at Duke is a bit of a misnomer, is 98% wound management and 2% diving emergencies and CO poisoning. I know they have done some work with the guys at Bragg regarding dive medicine. The Navy OIC and number three guy at the schoolhouse did his fellowship at Duke. We have tried to work to get more experiences and I can make observation and shadowing happen anytime, but Big Army seems to always get in the way.

The real shame is 90 minutes from Fort Bragg we have perhaps the best subject matter experts in dive medicine, but the Army still defers to the people how many hundreds of miles away at Key West.

Egos and government red tape.

 

[bvvanes]

Thank you for your input.

"Dive medicine" at Duke is a bit of a misnomer, is 98% wound management and 2% diving emergencies and CO poisoning. I know they have done some work with the guys at Bragg regarding dive medicine. The Navy OIC and number three guy at the schoolhouse did his fellowship at Duke. We have tried to work to get more experiences and I can make observation and shadowing happen anytime, but Big Army seems to always get in the way.

The real shame is 90 minutes from Fort Bragg we have perhaps the best subject matter experts in dive medicine, but the Army still defers to the people how many hundreds of miles away at Key West.

Don't take this wrong or that I'm being disparaging also I think the best way to answer your comments is to take them one at at time and with all due respect but some comments manifest a misunderstanding of the Army as the parallel universe it in fact is so here goes:

1 It looks like DAN like most dive facilities has gone the way most have, to make enough money to stay financially viable most facilities embrace wound healing, NOT being the reason I undertook dive medicine. It is what it is.

2 I don't know what school house the Navy OIC is at that you mention or the #3 guy but like most of us, including me, went through the Panama City USN Treatment and Recognition hyperbarics program. With that said, those Army DMOs at Key West will not give a lot of weight to what Navy medicine says, as ironic as it seems since they are on a Naval base! Territorial turf battles are not infrequent between those two but also kept on the down low.

3 When I attended the Key West program you could count members from all four services (the SEALs were part of the instructor staff as 'cross pollination" or on the exec staff. Now you only see Army guys (SF and Rangers and some DOD and a sprinkling of civilians dive candidates).Why so, because of turf. So now the Air Force spec ops guys have their own facility in Texas etc

4 I don't know who the 'guys from 'bragg' would be that DAN mentored, I can guess who but that wouldn't be a large, Army acknowledged training program.

5 I can't imagine most of the SF guys are interested in shadowing and if they are, their interests may not align with those at DAN.

6 Geographical concerns are really a no-go. In an organization where not too long ago officers every 2 years looked at selling their house, pulling their kids out of school and moving cross country only to do that again in another 2 years, or where the members can be sent at a moments notice half way around the world or in my case where a SF sniper team accompanied me to Afghanistan for only a few days, and then they returned home to 'bragg, in a career of 30+ years only in SF, geo concerns seemed nothing more than a 'hiccup' during considerations.

7 For many years, the SF med course that I went through was in Texas, 1300 miles from 'bragg. It stayed there for many years without a major issue, what brought it back to 'the flag pole' as they say was among other things the new academic facility at SWC (Special Warfare Center) at 'bragg and jsomtc. So a 900 mile trip isn't a major issue esp with VTC abilities.

8 I think that from my point of view looking out of the tent and your view, looking into the tent, DAN is sitting on a gold mine in terms of the center of excellence for dive medicine. Each branch of DOD has some centers of excellence, done appropriately DAN could be for USASOC what Walter Reed Hospital is for the military.

- MOD EDIT to add paragraphs

 

[Devildoc]

Don't take this wrong or that I'm being disparaging also I think the best way to answer your comments is to take them one at at time and with all due respect but some comments manifest a misunderstanding of the Army as the parallel universe it in fact is so here goes:
1 It looks like DAN like most dive facilities has gone the way most have, to make enough money to stay financially viable most facilities embrace wound healing, NOT being the reason I undertook dive medicine. It is what it is.
2 I don't know what school house the Navy OIC is at that you mention or the #3 guy but like most of us, including me, went through the Panama City USN Treatment and Recognition hyperbarics program. With that said, those Army DMOs at Key West will not give a lot of weight to what Navy medicine says, as ironic as it seems since they are on a Naval base! Territorial turf battles are not infrequent between those two but also kept on the down low.
3 When I attended the Key West program you could count members from all four services (the SEALs were part of the instructor staff as 'cross pollination" or on the exec staff. Now you only see Army guys (SF and Rangers and some DOD and a sprinkling of civilians dive candidates).Why so, because of turf. So now the Air Force spec ops guys have their own facility in Texas etc
4 I don't know who the 'guys from 'bragg' would be that DAN mentored, I can guess who but that wouldn't be a large, Army acknowledged training program.
5 I can't imagine most of the SF guys are interested in shadowing and if they are, their interests may not align with those at DAN.
6 Geographical concerns are really a no-go. In an organization where not too long ago officers every 2 years looked at selling their house, pulling their kids out of school and moving cross country only to do that again in another 2 years, or where the members can be sent at a moments notice half way around the world or in my case where a SF sniper team accompanied me to Afghanistan for only a few days, and then they returned home to 'bragg, in a career of 30+ years only in SF, geo concerns seemed nothing more than a 'hiccup' during considerations.
7 For many years, the SF med course that I went through was in Texas, 1300 miles from 'bragg. It stayed there for many years without a major issue, what brought it back to 'the flag pole' as they say was among other things the new academic facility at SWC (Special Warfare Center) at 'bragg and jsomtc. So a 900 mile trip isn't a major issue esp with VTC abilities.
8 I think that from my point of view looking out of the tent and your view, looking into the tent, DAN is sitting on a gold mine in terms of the center of excellence for dive medicine. Each branch of DOD has some centers of excellence, done appropriately DAN could be for USASOC what Walter Reed Hospital is for the military.

DAN is a great organization, and used to be married to Duke (hyperbarics and dive medicine). There was a divorce a few years ago and DAN went its own way and Duke started its own DAN-like 'Duke Dive Medicine' program. Also ironic given that DAN's HQ is 2 miles from Duke and there had been a lot of cross-pollination. I assure you NONE of us went into dive medicine/hyperbarics (call it what you will) to do wound treatment, but if we just treated divers we'd never generate enough money to stay open. We do get a metric crap-ton of grant money for research (esp from DOD, NOAA, and NASA), but as you well know the research $ doesn't crossover to clinical $.

The Navy guy to whom I am referring at JSOMTC is Brian Kueske, he's the OIC of the Navy contingent, the Naval dean of the school, and nominally heads NSOMI. He's dual boarded in dive med/hyperbaric med and EM.

Interesting that army DMOs don't give a lot of weight to what the Navy says, especially given that the Navy wrote the books and continues to write the addendums. Every branch follows the Navy's tables and the DOD has given dive medicine/hyperbarics to the Navy. I loathe turf battles. I have seen them play out between the Navy and Marine Corps (when the Marines stood up their own school), and within the Navy (when the Navy shut down scuba in four other bases). There were some legit issues like redundancy and money, but also NOMI and NDSTC protecting their turf.

We have a lot of guys, instructors, who are coming up shadowing (until the ink on the contract is dried) because they are largely away from clinical practice, and very few MTFs can offer the experiences to guys at Bragg that Duke can. Shameless plug for Duke, I know, but true. Hyperbarics/environmental physiology is just an example. I agree our dive med/hyperbarics could be a great relationship for USASOC.

Looking at what we can do for SOCOM from the 30,000 view is pretty cool, given the proximity to Bragg. They can can come up for a day, even half a day, and we go down there. Lejeune is a bit more of a drive, but very doable. We're looking at some collaborative education and training as well as some potential inroads to the PA school, med school, and nursing school.

 

[bvvanes]

Interesting stuff. Sometimes change is the only constant. About jsomtc, the Navy side is basically that, a side. The Army OIC is just that, officer in charge. Navy will have some input, but as with the Army OIC, the Navy will be gently reminded they are in an Army facility, not in Coronado. As you probably know, those in varied commands will live and die by the charge "fulfill the commanders' intent". Many an officer lost his/her way not following that edict. That being said, there are many moving parts to dive medicine and the military. Some things are immutable and permanent as stone. While Duke may make some headway here and there, but that firewall is there. It's an undercurrent (no pun) I dealt with a few times that will severely limit change. To not acknowledge that facet is too fail before you even get started. That aside, everyone I ever dealt with in SF will acknowledge the Navy's contribution to dive medicine, but also will acknowledge fights over dive turf. SEAL command and SF command have been at loggerheads for years given that Key West steps on their toes. Aside from the branch fights I believe the two sites, Key West and jsomtc could have a reluctant but amicable relationship like a marriage between a Republican and a Democrat. Symbiotic peaceful coexistence as it were that benefits the candidates. As to jsomtc instructors, I would be surprised to hear, if pressed, any of them is actually doing clinical practice, if they are then either things have really changed dramatically at jsomtc/SWC/USASOC in the last few years or they found a way to put more than 24 hours in a day.

 

[Devildoc]

Interesting stuff. Sometimes change is the only constant. About jsomtc, the Navy side is basically that, a side. The Army OIC is just that, officer in charge. Navy will have some input, but as with the Army OIC, the Navy will be gently reminded they are in an Army facility, not in Coronado. As you probably know, those in varied commands will live and die by the charge "fulfill the commanders' intent". Many an officer lost his/her way not following that edict. That being said, there are many moving parts to dive medicine and the military. Some things are immutable and permanent as stone. While Duke may make some headway here and there, but that firewall is there. It's an undercurrent (no pun) I dealt with a few times that will severely limit change. To not acknowledge that facet is too fail before you even get started. That aside, everyone I ever dealt with in SF will acknowledge the Navy's contribution to dive medicine, but also will acknowledge fights over dive turf. SEAL command and SF command have been at loggerheads for years given that Key West steps on their toes. Aside from the branch fights I believe the two sites, Key West and jsomtc could have a reluctant but amicable relationship like a marriage between a Republican and a Democrat. Symbiotic peaceful coexistence as it were that benefits the candidates. As to jsomtc instructors, I would be surprised to hear, if pressed, any of them is actually doing clinical practice, if they are then either things have really changed dramatically at jsomtc/SWC/USASOC in the last few years or they found a way to put more than 24 hours in a day.

Oy, turf wars, cronyism, and protectionism. I saw this between the Navy and the Marines, and within the Navy with certain communities.

As for instructors working clinically, I've had several come up to Duke, and I know several who are also medics with Cumberland County EMS.

 

[bvvanes]

Majority of the instructors as far as I know are retired SF medics that on weekends very few may choose to work with either EMS or the fire dept. The active duty SF medic instructors, I may be wrong, I don't think their command would allow that commitment to moonlighting. Whether getting clinical time or not, the overwhelming majority don't have that clinical exposure on a regular basis for many reasons. As for the hyperbaric med education roadmap I think it can be pretty defined, shaped by the exigencies of the Army, the local commander and the commanders intent. Either way I think all things are doable. I hope you have good luck with your endeavors with USASOC and SWC, they can be a tough nut to crack. If you need any further musings on this topic just shoot me the question.
De Opresso Liber

 

[Devildoc]

Majority of the instructors as far as I know are retired SF medics that on weekends very few may choose to work with either EMS or the fire dept. The active duty SF medic instructors, I may be wrong, I don't think their command would allow that commitment to moonlighting. Whether getting clinical time or not, the overwhelming majority don't have that clinical exposure on a regular basis for many reasons. As for the hyperbaric med education roadmap I think it can be pretty defined, shaped by the exigencies of the Army, the local commander and the commanders intent. Either way I think all things are doable. I hope you have good luck with your endeavors with USASOC and SWC, they can be a tough nut to crack. If you need any further musings on this topic just shoot me the question.
De Opresso Liber

Thank you. They are indeed a tough nut to crack but getting the contract and establishing relationships, plus having been in the military, have been instrumental.