Army’s Aggressive Surgeon Is Too Aggressive for Some

NY Times ^ | November 6, 2007 | ALEX BERENSON

[neverdem]

Scientist at Work | John Holcomb

SAN ANTONIO — Since the war in Iraq began, Col. John Holcomb has been working to change the way the military takes care of its wounded.

Along the way he has suffered a few dings himself.

A tall medical doctor with a Southern lilt and close-cropped gray hair, Colonel Holcomb, 48, has spent his entire 27-year career in the Army, earning a reputation as one of the military’s top trauma surgeons. Since 2001, he has headed the Army’s Institute of Surgical Research, based on the campus of the Brooke Army Medical Center here.

Under his watch, Army surgeons have become aggressive users of a controversial drug called Factor VII, which promotes clotting in cases of severe bleeding. He has also guided a redesign of the transport system for wounded soldiers, encouraging helicopter pilots to take the severely injured to the hospitals best able to treat them, even if they are not the closest.

Colonel Holcomb also strongly advocates conducting clinical trials to improve trauma care. It is an ethically tricky area, because trauma research can involve trying novel treatments on severely injured patients who cannot give informed consent. But he argues that any ethical problems pale in comparison to the toll that traumatic injuries take on civilians and soldiers every day.

He is fond of quoting a surprising statistic: trauma is the third-leading cause of death in the United States, taking 160,000 lives in 2004, more than any other cause except heart disease and cancer. Because it primarily affects the young, trauma leads all diseases in terms of life-years lost.

And besides the 4,000 American deaths in Iraq and Afghanistan, there have been 29,000 injuries from hostile fire, including 9,000 severe enough to require transport to hospitals outside the war zones.

In the face...

[Ramius]

Curious that the Times would need to treat this as some ethics issue.

How else can new ideas in trauma care be tested other than by eventually trying a new technique in the field? It’s trauma care. It’s not like you can bring people in off the street to run a study.

Seems to me that field surgeons in combat zones have to make dozens of rapid-fire decisions every hour that affect the life and limb of a person who’s unable to give consent for anything, let alone whether to try a new idea.

If in the Doctor’s expert opinion, some new treatment presents the best hope for a patient, wouldn’t it also be possible to argue that it is unethical to *not* try it?

I’d say that was “expertise” is all about. Yah, it’s guesswork sometimes. But if it were me, I’d rather have this guy’s guesses on how to fix me if I’m all shot up.

[El Gato]

Seems to me that field surgeons in combat zones have to make dozens of rapid-fire decisions every hour that affect the life and limb of a person who’s unable to give consent for anything, let alone whether to try a new idea.

Of course they do. However Brooke AMC (BAMC, BAM-CEE in local parlance) is one member of San Antonio 's triad of level 1 trauma centers that includes University of Texas/San Antonio Medical Center and Wilford Hall Medical Center(USAF). Civilians get choppered, or taken by ambulance, in there after traffic accidents, gun fights, knife fights, etc, etc.

Military wounded have given "implied consent", but the civilians haven't.

Still they are darned lucky if they get taken to BAMC or Wilford Hall. The gang bangers provide practice for military trauma docs, probably the only useful thing many of them ever do.

Under the 2005 BRAC, Brooke and Wilford Hall will be combined into a joint service San Antonio Military Medical Center (more here)