The 2004 Fitts Lecture: current perspective on combat casualty care.

I would like to thank the American Association for the Surgery of Trauma and President Cryer for the opportunity to deliver the 2004 Fitts Lecture. When Dr. Cryer asked me to deliver this lecture, I actually wondered whether he had called the wrong number. Dr. Basil Pruitt described Dr. William P. Fitts in his 1992 Fitts Lecture as a ‘physician soldier in World War II, an author, a chairman, an editor of the Journal of Trauma, and a past President of our association’. To deliver a talk named after such an esteemed surgeon soldier is indeed a privilege. So, as Commander of the U.S. Army Institute of Surgical Research (USAISR), and Trauma Advisor to the Army Surgeon General, I am here to represent the men and women who serve in uniform, and I hope to do them justice today. At this point, I would like all Operation Iraqi Freedom and Operation Enduring Freedom personnel to please stand and be recognized. Dr. Donald Trunkey discussed his experiences as a deployed Chief of Professional Services of the 50th Field Hospital during Desert Shield/Desert Storm in the 1991 Fitts Lecture and in a paper in ‘The Archives of Surgery’ in 1993. Subsequently, he lectured and wrote multiple afteraction reports, resulting in numerous Government Accounting Reports about these experiences. In summary, Dr. Trunkey believed there was significant room for improvement in our ability to care for injured casualties in a deployed setting. Dr. Basil Pruitt eloquently described the interaction between the AAST and military medicine. Both men are retired Army Colonels who have spent the better part of their careers serving in the military. To prepare for this lecture, I went back and read their articles and reports and discussed their findings with the respective authors, among many others. Consequently, my approach in this Fitts oration is to tell you about the current medical story—where we are and what we are doing in Operation Iraqi Freedom and Operation Enduring Freedom—to give you a flavor on what is going on right now, to discuss what has gone well, and, of course, to convey to you where I think we could do better. My comments are based on the five visits I have made to Iraq as the Trauma Consultant for The U.S. Army Surgeon General. In Iraq, I have had the honor of working with many deployed units, operating on wounded Soldiers and Marines at different locations throughout the country. I have had the privilege of talking to many surgeons, nurses, and medics about their clinical practice, discussing logistical and communication challenges, and the training they thought they should have had or did have that made a difference in their care of casualties. We also discussed the research requirements that have been generated by this war. Most of this lecture is based on their conclusions and observations. On these trips into Iraq I was fortunate to travel with multiple teams of consultants and logistics personnel. We traveled from Kuwait City in the south up to Tallil, Babylon, Al Hillah, Karbala, Fallujah, Ar Ramadi, Baghdad, Baqubah, Balad, Samarra, Tikrit, Kirkuk, and Mosul. On one trip, I went into Jordan. Trips by consultants to observe battlefield medical conditions were common in WWII and Vietnam and were reinstated by LTG James Peake, the Army Surgeon General in 2003. He expressly wanted his consultants to deliver reports directly to him, from the docs, nurses, and medics doing the work. Traveling the country is an amazing experience whether in an open jeep or 5-ton truck, a C-130 aircraft, in a Marine CH-46 helicopter, an Army CH-47, or a Blackhawk. I even had the opportunity to walk, as a touristfor-a-day, through the throne of Alexander the Great in Babylon.