When war informs medicine

The war zone creeps back in unexpected places. Running across Fort Bliss, Texas, earlier this year to get to the gym, Mark Jackson, D.O., an Army reservist, recalled suddenly stopping and thinking, “Has this area been cleared?”

Or at a supermarket that reminded him of the danger of crowds overseas.

“I was shell-shocked,” Jackson, a part-time emergency room physician at UF Health Shands Hospital , said in an interview about his 10-week medical deployment to war-torn Iraq and Syria starting late in 2017. “I mean, I wasn’t normal around people. I couldn’t be next to somebody. It was bad.”

It’s said that medicine is the only beneficiary of war. Jackson embraces that idea. So, he brought back more than the anguished memories of treating the worst battlefield trauma. He returned with lessons for the latest crop of UF Health emergency medicine residents.

His message during a recent presentation to the residents and others: Be prepared for anything and be mindful that an average day in an emergency room can change in an instant into a mass casualty nightmare every bit as real as a war zone.

Jackson said physicians have to know their procedures cold.

“You may find yourself in a situation where you have multiple patients coming in,” Jackson told a crowd during the Grand Rounds lecture. “The key I’m trying to hit home here, it’s not one patient. You’ve got to stop focusing on one patient. I was taking 13, 15 patients at a time. And then they just kept coming. And it’s just me.”

Jackson, who works full time at the Malcom Randall Veterans Affairs Medical Center, once sat among emergency medicine residents like these. He was a member of the first Gainesville class of UF Health’s emergency medicine residency program in 2006.

During the 90-minute Grand Rounds presentation, Jackson recounted his harried tour, bouncing between far-flung locations in Iraq and Syria to provide medical care to both Iraqis and American troops in an unforgiving environment. As a lieutenant colonel, he also played a leadership role.

The wounds he cared for were psychologically jarring. The obscene way a blast wave from an improvised-explosive device could twist and mangle the human body shook even an ER veteran like Jackson.

Jackson, who spent 15 years in the active duty Army and another 18 as a reservist, recalled his first patient in theater just 23 days after his last shift ended at UF Health Shands, an Iraqi soldier with a blast injury from a rocket-propelled grenade.

He looked down at the man. One leg was missing, the other mangled and twisted at a grisly 90-degree angle.

“He’s white as a ghost,” Jackson said. He asked the man, “‘Hey, sir. Are you all right?’”

“I’m OK,” the soldier answered.

“I won’t forget that,” Jackson said. “That was my first patient (in Iraq).” in Iraq.

It was treacherous psychological terrain, where even a bond with a bomb-sniffing dog used to clear fields of IEDs exposed troops and doctors alike to the potential emotional trauma of suddenly losing a canine friend.

After several he got to know died in combat, Jackson decided, “I didn’t try to get close to these other dogs anymore.”

The dedication of the troops he treated inspired him. Jackson recalled treating one with a severely crushed finger from a vehicle crash. The young Marine teared up when he learned that he would be evacuated to Baghdad.

“Sir, don’t send me,” the Marine pleaded. “I’ve got to stay with my guys.”

“These guys are dedicated,” Jackson said. “These guys are about to go into harm’s way. And instead of him going to the rear … he’s like, no, I’m going with my guys.”

With his much-needed trauma skills, Jackson was much in demand.

He recalled working at what was the equivalent of a family care clinic for the troops at Al Asad Air Base, 100 miles west of Baghdad, when a lieutenant colonel from the Army’s 240th Medical Detachment cornered Jackson and asked if he was an emergency medicine doctor.

“Do you know trauma?” the officer asked Jackson.

Next thing he knew, Jackson was packing his things and was heading to the Middle Euphrates River Valley, an area that was then a stronghold of the Islamic State.

He would be asked if he knew trauma many more times, and his skills were put to the test, including care he provided to Navy SEALs wounded in a rocket attack.

The approach to treating battle wounds differed than that taken in the states.

Stemming bleeding was the highest priority in Iraq and Syria, he said, because of the massive wounds of battle that could lead to fatal blood loss in seconds. In an ER back home, a clear airway was the highest priority.

Jackson emphasized to residents that bringing someone back from the brink must be instinctive in a mass casualty event.

“So make sure you know how to resuscitate people,” Jackson said. “You’ve got to hammer this down because you’re going to find yourself in a (mass casualty) situation,” like the Pulse nightclub shooting in Orlando or the Boston Marathon bombing.

“They actually had an ER doctor who knew what he was doing,” Jackson said of his time overseas. “Not because I was good. But because I was trained at the University of Florida.”