Director Sees Room for Growth in Trauma Training Program Published Feb. 13, 2012 By Donna Miles American Forces Press Service BALTIMORE, Md. -- Six months after arriving here at one of the nation's busiest trauma centers to run a program that trains Air Force medical personnel in trauma care, its director already sees potential to expand it to ensure trauma-care expertise gained during a decade of conflict isn't lost as combat operations draw down. Air Force Lt. Col. (Dr.) Raymond Fang is director of the Air Force's Center for Sustainment of Trauma and Readiness Skills Program, known as "C-STARS," here at the R. Adams Cowley Shock Trauma Center. The program, affiliated with the University of Maryland School of Medicine and Medical Center, gives airmen headed to Afghanistan deployments the chance to treat real-life casualties like those they could encounter overseas. The Air Force launched its C-STARS program about 10 years ago, when the military saw very few trauma patients. With only a few exceptions, its providers looked to civilian trauma centers to treat military trauma patients. Now, through C-STARS, Air Force physicians, nurses and medical techs rotate through these centers before their deployments, providing hands-on trauma care under the supervision of military and civilian staff. Fang knows more than most just how valuable this training is. He came to his C-STARS assignment from Landstuhl Regional Medical Center in Germany, where he spent seven years as the top trauma surgeon treating the most severely wounded warriors. Ten years of war has developed tremendous trauma-care expertise within the military, but Fang worries about how to preserve those gains when combat operations end. He said he sees tremendous potential at C-STARS to lock in those skills while taking the program to a new level. "After being involved in warrior care for so long, my main goal is to ensure that that care is as good as it can be, always," he said. "And so I have a lot of ideas on how the opportunities here in this facility can be better used by the military." Fang said he sees "lots of training opportunities that we haven't tapped yet" at the Baltimore shock-trauma center and the entire University of Maryland Medical Center and system. C-STARS training now offered to doctors, nurses and medical specialists could be expanded to include paramedics, air evacuation crews, and even laboratory and pharmacy technicians who play vital roles in the trauma-care network, he said. Most Air Force pharmacy technicians, for example, typically spend their days dispensing prescriptions at small outpatient clinics. "That is much different than doing intravenous medications and things like that for a busy hospital," Fang said. "But when you are in the war zone, that is what you have to do." So he envisions a C-STARS training program for pharmacists and a whole range of other medical specialists. "We may be able to create training opportunities that simply aren't available for plenty of other people," he said. Fang drew parallels between the civilian and military trauma-care systems. The Maryland State Police members who transport patients from scenes by ambulance or helicopter operate much like the military's casualty evacuation teams, he said. The transport teams that transfer patients between hospitals to receive different levels of care operate much like Air Force critical care air transport teams. "The way they work is very similar," Fang said. "So I think they offer some interesting training opportunities for military responders." These opportunities will become increasingly valuable now that military operations have ended in Iraq and are drawing down in Afghanistan. "When you think about it, right now we maintain all our [trauma-care] training by sending all our people to the war," Fang said. "But how do we keep all these capabilities that we have created at a high level when we don't have the war to support? There really are no other opportunities in the military for the medics to go to the scenes of accidents with scheduled frequency to practice those skills." Fang said he's impressed by the reception C-STARS has received at the Baltimore shock trauma center, and the openness he's found to expanding the current partnership. Beyond patient care, it already extends into research, he said, with researchers at the university's School of Medicine exploring issues military trauma teams grapple with every day. "There are a lot of things that we have military-specific questions about, so we have partnered with this academic medical center to try to answer those questions," Fang said. One study is looking into how flight affects patients with brain injuries. The findings are expected to provide valuable keys to improving patient care. "We have all these soldiers we are flying around the world after head injuries. And our question is, 'Are we doing the right thing?'" Fang said. "We do it now because we have to. But if we had an option to keep them longer in Germany or Bagram [Airfield in Afghanistan], should we do it? Or is it better to fly them right away in the early stages? "We really don't know," Fang said. "So researchers here at the University of Maryland Medical Center are looking at that question." Another study here is exploring the best way to insert an intraosseous infusion, a procedure that delivers fluids or medications directly into bone marrow when standard intravenous delivery isn't possible. These injections can go into the humerus in the arm, the sternum in the chest or the tibia in the shin. What researchers and military trauma-care teams want to know, Fang said, is: "If you had a choice of all three sites, which is the best to use?" Still another research project is using advanced computerized algorithms to predict which trauma patients are most likely to experience complications. These findings will provide vital and possibly life-saving forewarning to providers as they transport and treat patients, Fang said. "There are many things that partnering with the civilian side can do to benefit us, both for training and research," he said. "And I think it's important that we take advantage of it, especially as the wars hopefully wind down." The Baltimore C-STARS program is among three the Air Force conducts through its Air Force Expeditionary Medical Skills Institute. The others are at St. Louis University and the University of Cincinnati. The Army and Navy have similar programs. The Army runs its program through the Army Team Training Center at Jackson Memorial Hospital's Ryder Trauma Center in Miami. The Navy Trauma Training Center is affiliated with the Los Angeles County and University of Southern California Medical Center.