Yale trauma training preps Navy corpsmen

When the Navy submarine USS San Francisco struck an uncharted, undersea mountain in early January, responsibility for the dozens of injured sailors fell to James H. Akin, the vessel’s medical corpsman. For 22 hours, Akin triaged the wounded—whose injuries ranged from bruises and pulled muscles to a fatal blow to the head—and put sailors and officers to work cleaning and irrigating lacerations until he could suture them.

As he stitched up the wounded, Akin’s main concern was machinist’s mate Joseph A. Ashley, who had struck his head during the impact. Akin immobilized Ashley, checked his airway, breathing and circulation, and inserted an IV. He showed other sailors how to monitor Ashley’s airway while he tended to other patients. As rescue vessels approached the stricken submarine, Navy doctors on ships and bases around the Pacific advised the medical corpsman by radio. But when the rescuers arrived, heavy seas made evacuations impossible. Ashley ultimately died of his injuries.

In March, Akin received a Meritorious Service Medal for his performance during the crisis. And he credited his ability to handle the medical emergency to the trauma training he received at Yale, under the direction of Reuven Rabinovici, M.D., professor of surgery and chief of the Section of Trauma, Surgical Critical Care and Surgical Emergencies.

For the past several years, Rabinovici has directed a course in the basics of trauma treatment for the Navy’s independent duty corpsmen, or IDCs, given by trauma surgeons at Yale. It’s part of the 56 weeks of training the corpsmen receive before they’re assigned to submarine duty and the care of crews of between 130 and 170 men.

“Their scope of practice is very narrow—primary care medicine for adult males, 20 to 45 years old,” said Lt. Donald Harris, PA-C, clinical program manager at the Naval Operational Medicine Institute Detachment. The detachment is stationed 50 miles east of New Haven at the Naval Undersea Medical Institute (NUMI) at the Naval submarine base in Groton, Conn. (In May the base appeared on a Pentagon list of military facilities to be considered for closing.)

In addition to medical duties, the IDC monitors shipmates for exposure to radiation, practices preventive medicine and is responsible for environmental and occupational health. Corpsmen are also responsible for the mental health of the crew, not an unlikely concern in a cramped, self-contained environment that recycles its own air, converts sea water into drinking water and can stay under-water for as long as food supplies last—up to 65 days.

“They’re the doctor, nurse, chaplain and psychologist,” said Capt. Paul C. Kelleher, M.D., director of education at NUMI. Their emergency medical supplies and equipment, Kelleher said, roughly correspond to what is available on a paramedic’s ambulance. And their training at Yale covers different kinds of trauma, including blunt injuries as well as gunshot and stab wounds. One classroom scenario involves a wounded Navy seal coming on board for emergency treatment.

The sessions at Yale began three years ago when NUMI sought to enhance trauma training. Yale’s in-house program that teaches residents advanced trauma life support was adapted for IDCs. “This program is less than what the doctor needs, but it’s what the IDCs need,” said Harris. As the first line of care, IDCs learn how to stabilize patients until they can be evacuated to definitive medical facilities.

The training starts with classroom sessions that cover the initial evaluation and resuscitation of a trauma patient. Then corpsmen move on to an animal lab to practice basic surgical techniques such as intravenous access, chest tube placement, opening a surgical airway and emergency amputations. “They are all basic lifesaving procedures that the IDC may need to perform on board,” said Rabinovici.

The next day the IDCs attend interactive sessions with Yale trauma surgeons who pose real-life scenarios— such as a stab wound in the neck—and expect the IDCs to describe the appropriate treatment. The IDCs also rotate through clinical electives in surgery and anesthesia at Yale-New Haven Hospital.

The training made a difference for Akin when the USS San Francisco collided with the uncharted mountain 350 miles southeast of its base in Guam. According to Harris, the program manager in Groton, “he felt confident in his knowledge and management of the injuries to his crew because of the trauma training he received” from Yale surgeons.

Rabinovici said he was glad to learn that the training had paid off. “It is not that we said we could help—indeed, we did help. I feel very good about that.”