Dr. Patrick Cook, a vascular and general surgeon affiliated with Sharp Grossmont Hospital, served five deployments in Iraq and Afghanistan, treating wounded soldiers on the frontline, as well as in military treatment facilities in the U.S.
A West Point graduate and now-retired U.S. Army colonel, Dr. Cook’s military service spans more than 20 years. He received his general surgery training at William Beaumont Army Medical Center and his vascular surgery training at Scripps Green Hospital and the University of California, San Diego. Following retirement from the Army, Dr. Cook joined the Vascular Associates of San Diego.
He recently shared his thoughts on battlefield medicine.
How has battlefield medicine evolved over time?
What has dramatically changed is that the length of time spent transporting injured military personnel from the frontlines to medical care has markedly improved. The ability for the injured to get surgical care is also faster, as well as the ability to transport patients to tertiary care facilities.
When soldiers are injured in combat, what is the process for getting them medical attention?
Care starts with the man or woman next to them — their fellow soldiers who start administering first aid right there on the spot. Then the injured soldier is transported to the Forward Surgical Team (FST), which are mobile, surgical units located not far from the combat area. The FST is the first opportunity for doctors to perform damage control surgery on the soldier. Once the patient’s injuries are under control, they are then transported to a Combat Support Hospital (CSH). For very critical cases, the patient may then be transported from the CSH to military hospitals in Germany or the U.S., or both, depending on the level of injury.
How has medical treatment of soldiers on the battlefield influenced civilian medicine?
Military medical facilities and civilian trauma centers are very similar in how they assess and manage trauma victims. The only difference I see is the environment, being that in combat areas, doctors may be operating in a chaotic, messy environment, sometimes with limited resources. So a lot of the resources that are found in civilian hospitals here at home need to be duplicated in military treatment centers overseas.
In my vascular surgical practice specifically, my military experience has been helpful in how I care for my patients here at home, particularly when managing their wounds. For instance, in the military, some patients have wounds that are very dirty since they were exposed to all sorts of elements in combat. These patients require multiple visits to the operating room so that we can thoroughly clean the wound, remove damaged tissue and foreign objects, and by doing so, help healthy tissue regenerate and the wound heal. So in my practice, if needed, I am accustomed to seeing patients multiple times in the operating room to ensure that their wound is as completely clean and free of debris to promote healing.
What do you consider to be the future of battlefield medicine as it relates to your specialty?
I think there are two big technological advances that will significantly change the field of vascular surgery on the battlefield. The first is endovascular technology, which is the ability to manage injuries in a more minimally invasive way. Secondly, researchers are exploring the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) on the battlefield. Already being used in several trauma centers in the United States, REBOA allows a surgeon to place a balloon inside the aorta (the main artery in the body) to block blood flow and minimize bleeding until the patient can receive surgical intervention.
What motivated you to join the military to practice medicine?
I think there is something very special to caring for your countrymen abroad. It’s not necessarily the individual case or the gravity of the case that is so meaningful, but rather the commonality and teamwork that makes you feel proud to serve your country and be a part of something bigger than yourself.
For the news media: To talk with Dr. Cook about battlefield and civilian medicine for an upcoming story, contact Erica Carlson, senior public relations specialist, at firstname.lastname@example.org.