By Dr. Dave Campbell
Chief Medical Correspondent Morning Joe/MSNBC, Major United States Army Reserve Medical Corps-retired and Jon Clarke, FMF Navy Corpsman Veteran
Surgeon General Jerome Adams told America that “Everyone needs to act as if they have the virus right now. So, test or not test, we need you to understand you could be spreading it to someone else. Or you could be getting it from someone else. Stay at home.”
Governor Cuomo is telling America that the State of New York is running out of medical supplies. Dr. Birx and Dr. Fauci are informing Americans of up-to-date medical information regarding the pandemic. New Yorkers who have fled the City have been advised to self-quarantine for 14 days.
One of the essential components of providing healthcare to people who develop COVID-19, the disease caused by the novel Coronavirus, SARS-CoV-19, is an ample supply of skilled, trained, competent healthcare workers. Personnel trained in combat casualty care, and healthcare workers that have training and experience in delivering health care under harsh, stressful or austere environments will be a premium within a few weeks, or less, in the United States.
There is an arsenal of doctors, nurses, EMT’s, and paramedics are on the front line caring for people infected by the virus. Some of them may contract COVID-19 forcing their quarantine and removing a valuable member of the fight. A growing number of retired healthcare professionals are volunteering to come out of retirement and help with the crisis. Yet, they are the very demographic at a heightened risk for severe disease or death if infected with the Coronavirus.
There are thousands of Navy Hospital Corpsmen known for their versatile scope of practice and respected by all branches of the military. There are various subspecialties that these paraprofessionals occupy, from biomedical technician, lab and x-ray tech, to the Field Medical Service Technician who is trained in Combat Casualty Care.
Veterans across the country are pondering how they can help. The military teaches how to serve and thrive under adversity. These are invaluable traits in today’s global pandemic.
“The U.S. Navy Hospital Corpsman is the most uniquely trained military medic between all of the armed services,” Joe Hamm PA-C, a former Navy Corpsman and Physician Assistant Instructor told us. “Hospital Corpsman skills and training are the envy of other services. You can take a Hospital Corpsman anywhere in any condition, train them and they will deliver. They have proven it in armed conflicts and real-world operations, so much so, the Duke’s PA Program was based off U.S. Navy Hospital Corpsmen”
In this time of imminent crisis, with a looming shortage of healthcare workers, the United States needs healthy, young healthcare workers to fill the void. We supply this need in part by deploying the National Guard. The Guard is an organized group of individuals, who under non-crisis circumstances, are practically invisible to the average American. Yet when a National Emergency surfaces, the National Guard rises to the challenge. We trust in their authority and ability to serve the public.
In the same way, in this time of National Emergency, we can consider special Federal authorization can be considered to allow corpsmen and medic veterans to volunteer and register to provide healthcare services. They will rise to the occasion once more. These veterans can use their training and experience in the effort to fight through this pandemic. They can support the essential medical staff, in or out of the hospital. There is no field operation too harsh or forbidding for a corpsman or medic.
Given the opportunity to serve again, these paraprofessional veterans already have resources to perform house calls. They can act as community screeners and answer some of the challenges that hospitals are wrestling with today.
The United States is in the early curve of healthcare infrastructure devastation seen in China, Italy, Spain and France. It’s possible, New York is next, or maybe San Francisco, Los Angeles or elsewhere. The corpsman can help. On active duty, corpsmen perform a host of procedures, from laceration repairs, inserting IV’s, and assisting physicians with complex medical procedures, including assisting in surgery. The VA hospital has recognized this invaluable resource, creating an entire profession surrounding a corpsman or medic veterans’ abilities: The Intermediate Care Technician.
One of the greatest threats to date is the risky exposure to these essential physicians, nurses and other medical staff. A doctor performing a nasal swab is potentially placed at an unnecessary risk of exposure when there is an alternative. Corpsmen and medics are untapped resources that could limit essential medical personnel from being pulled off the front line of this pandemic war.
Corpsmen and medics could perform many of the necessary screenings and testing far from the front line. As community screeners utilizing telehealth, corpsmen and medics can treat homebound individuals, while maintaining the social distancing precautions and using personal protective equipment. It will better serve the sick with face-to-face care, with that clinical information transmitted to the front line and to the doctor or hospital.
With the medical bag in hand once more, this time armed with nasal swabs and a pulse ox, rather than a pressure dressing and tourniquet, everyone’s health will be well-served.
“Throughout my Naval career Corpsmen played a vital role in assisting military doctors while serving as sick call screeners for military personnel in the fleet.” Dr. Sharon Miller, retired Navy Captain and ER physician told us. She described her recent experience with patients suspected of being infected with coronavirus and some with symptoms of COVID-19. A majority of mild and moderate symptoms could have been screened and managed from home.
“Using retired corpsmen during this crisis would enable them to provide valuable first-line screening of COVID patients (with vital signs and cursory exam) outside hospitals,” Dr. Miller said. “Corpsmen could perform the COVID testing in the less ill patients while simultaneously determining which patients need referral to the Emergency Room. We are seeing many COVID-infected patients who are being discharged home to self-quarantine because they are not in any distress and are maintaining their oxygenation. Experience in other countries tells us this crisis will get worse before it gets better, so we must continue to prepare to manage large numbers of sick patients.”
Dr. Miller addressed another valid concern an influx of paraprofessionals could mitigate. The United Kingdom witnessed an incredible response in doctors and nurses who volunteered to come out of retirement in response to this dire pandemic. Four thousand five hundred have already volunteered. In the United States at least 2000 have responded and more will. We acknowledge that older people with chronic underlying health conditions are at increased risk from COVID-19. Young doctors and nurses do not retire. Young corpsmen and medics do.
“Recall of retired military doctors would provide a wealth of experience while battling this crisis,” Dr. Miller told us. “However, those doctors who retired from medicine are likely to be those in the age groups which are most at risk should they contract the virus while serving on the front lines.”
We must treat and protect essential medical staff as valuable assets. There is an excellent reason the senior commanding officers are often positioned well behind the front line.
The time for Corpsmen and Medic Veterans emergency mobilization is now. President Trump is the Commander-in-Chief with the power of his pen. One can appreciate that such a measure would require a substantial amount of organization and federal involvement to tap into the valuable personnel resource. Extraordinary times call for extraordinary measures.
“Setting up a registry such as the Selective Service but for CRITICALLY needed healthcare professionals may be helpful in future catastrophes, pandemics or social unrest/conflict,” Joe Hamm PA-C told us. “It would have to be voluntary or a service they could volunteer on their way out of the service.”
There is one final scenario that the veteran corpsman or medic can be purposed for. There is an anticipated shortage in ventilators for patients with severe respiratory compromise in the United States. This shortage has already hit other countries and is creating profound challenges in ethical decision-making. The question of who gets a ventilator and lives and who does not, hangs like a toxic cloud of doom over Italy. That doom may roll like fog over the United States. Soon there will not be enough ventilators in the United States to accommodate need. Heaven forbid it comes to this, but the alternative decision is to manually “bag” a patient until a ventilator becomes available.
In combat, should a troop sustain a sucking chest wound, or a lung collapse as the result of tactical trauma, the corpsman will provide such manual ventilation. Ideally a CASEVAC helicopter or medical vehicle will promptly be called in from the rear to get the severely injured casualty to a higher echelon of care. But what if such support is not immediately available due to the zone being too hot? The corpsman will remain with his injured Marine or Sailor as long as it takes, providing lifesaving intervention, including ‘bagging’ the patient, until help arrives, no matter the personal cost.
So, when the ventilators run out, do we sit idly by as patients succumb to hypoxia, saying there is nothing more we can do? One would posit that a far greater alternative is to delve into the active duty military and veterans in our community who can support the soon to be overwhelmed hospital system, even if it is as simple as performing round the clock manual ventilation so the essential physicians and nurses can do their job, while the service-members and veterans do theirs, once again.
Danny Jazarevic MD, PhD, FACS Colonel U.S. Army (ret) is the Director of Trauma/Surgical Critical Care and Acute Surgery at Halifax Medical Center in Daytona Beach, Florida. Daytona shares the unfortunate distinction with other beach communities of hosting thousands of spring breakers that have brought the Coronavirus down to the Sunshine State. Dr. Jazarevic had a different take on solutions for the looming shortage of trained healthcare workers due to the exploding number of COVID-19 victims.
“Military doctors, nurses and Army and Air Force medics and Navy and Marines corpsmen are exceptionally trained hybrid with skills between EMTs and nurses,” Dr. Jazarevic told us. “After twenty years of war, they are trained and capable to function in most austere environments, under massive pressure and with peril to their own lives. These exceptional personnel serve with unparalleled discipline and commitment. Contingency response is their life calling. Unfortunately, many of these reserve and retired military members are employed in civilian medical hospitals and medical facilities already battling personnel shortages. Using these to “backfill” medical institutions elsewhere, will take them out of the present positions. A workable and more desirable alternative would be to use active duty medical professionals to augment the civilian medical facilities around the country. This especially applies to attending and resident physicians, PAs, ARNPs and medics/corpsmen currently in large military hospitals, greatly underutilized and overstaffed for the levels of patients.”
Mayor Bill Di Blasio implored the Federal government to deploy active duty military to New York City Tuesday on Fox. Dr. Jazarevic’s alternative fits the request made by the Mayor.
“In addition,” Dr. Jazarevic told us. “Any physician, military and civilian, with a clean medical license should be immediately eligible to apply for a new “Federal Medical U.S. License” valid across State borders.”
In this time of crisis, solutions need to be inclusive and innovative. Bringing active duty service members and veterans into the fight to save lives from the Coronavirus pandemic has never been more urgent.