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Puerto Rico No Vacation For Medical Group

  • Published
  • By Tech. Sgt. Wendy S Ohl
  • 185ARW/PA
San Juan, Puerto Rico --  Car accidents, gunshot wounds, broken bones, stab wounds... these are all things the members of the 185th Air Refueling Wing (ARW) Medical Group don't generally experience on drill weekends. During a recent trip to San Juan, Puerto Rico, however, 32 members of the Medical Group saw it all.

Centro Medico is located on 22 acres in the heart of San Juan, Puerto Rico, and is the third largest level 1 trauma center in the United States and its territories. With a population of over 450,000 people in San Juan alone, they keep busy. The trauma center sees over 7,400 patients and admits around 1,000 per year. Auto accidents account for about 70% of these admissions, and if you've ever driven through San Juan, you can understand why.

With the number of patients that come through the doors, and the types of trauma seen at Centro Medico, spending two weeks there is an excellent training opportunity for the 185th Medical Group. This is the type of hands-on, fast-paced real life training most military medical personnel don't receive on their normal drill weekend. Working with the trauma patients in the worst of conditions, may someday translate to real world battlefield hospital conditions.

"Centro Medico was an ideal location for this type of training because of the size of their trauma center and the cultural and language challenges to overcome", stated 1st Lt. Zac Johannsen, Medical Administrative Officer 185th Medical Group. "Also in Puerto Rico they have the opportunity to treat outside their credentialed field. This is especially helpful if there is something going on they can just jump in and help out rather than standing by and watching because it isn't 'their field'. This gives our staff the opportunity to do more diverse work."

Senior Airman Katie Grenier is a nursing student at St. Luke's School of Nursing in Sioux City, Iowa. She was able to practice her every day nursing skills such as IV starts, medication administration, and more. "We do shots, blood draws and physicals on a normal basis (at the 185th) so when asked to do them at Centro Medico, I was very prepared," stated Grenier. "I also had the opportunity to assist with suturing, chest tubes and surgery, administer meds, suction, and perform wound care."

"The doctors were very helpful and almost all of them spoke English. We stuck with them as much as possible. The nurses were good, but not as many spoke English, making it harder to do things with them," said Capt. Major Anderson, a critical care registered nurse in Tyndall, SD and a nurse with the 185th ARW.
Aeromed is a helicopter transport service used by Centro Medico to increase the response time of getting critical care to critically injured and sick patients in Puerto Rico. Driving can take up to seven hours to transport a patient from one side of the island to Centro Medico, whereas the helicopter can get a patient to much needed care in an hour or less.

"I was surprised how long it takes patients to get from the outlying hospitals or accident scenes to Centro Medico, and how long it takes to get them to surgery once they're here." said Anderson. "In one case we were able to unload a patient from the helicopter. He had gunshot wounds in his head, chest and abdomen. Several of us were able to go to the operating room with him."

Gunshot wounds are quite common in Puerto Rico. Approximately 30% of the trauma patients entering Centro Medico are gunshot victims. Some patients are brought in and taken to OR, but others get patched up and sent home. "A guy came in at 10 a.m. with seven gunshot wounds and was released later that night. He had no surgery done to remove the bullets. They did not suture around the bullet holes, but covered them up with gauze and sent him home," said Grenier.

Maj. Gen. Ray Webster, Air National Guard Assistant to the Surgeon General, was also along for the trip. Webster oversees programs such as this and wanted to get an idea of how things were going.
"This is the 19th group to go through Centro Medico since the program started three years ago," Webster stated. "Things aren't going as smoothly as I'd hoped, but we'll get the bugs worked out. We have Rudy assigned full-time to the program now to see that things get done.

Rudy, Senior Master Sgt. Rudolpho Davila, is the Air National Guard liaison for the program. Davila was on call for members of the 185th to contact if there were any issues, there were a few. When you bring in over 30 members of the U.S. military to a civilian hospital, throw in a few cultural and procedural differences, top it off with a language barrier and you're bound to hit a few bumps. However, the experience gained, and the knowledge received is invaluable.

Dr. Juan Angel Nazario, MD, FAAEM, FACEP is the head of Centro Medico, the "go to guy" for anything that goes on at the hospital and university.

"We are a teaching hospital. If you wish to stand back and watch, that will be fine. But if you want to jump in and work hands-on with the patients, you will be allowed and encouraged to do this, too." stated Nazario during the Medical Group 's in-brief

"We'd like to plan more trips like this in the future," stated Johannsen. "We need to train in all the areas of our Readiness Skills Verification Program (RSVP). Going to Puerto Rico was a very good training opportunity and we look forward to more trips like this."