Army Surgeons Training for War--at King Hospital


The Army, in an effort to ready young surgeons to treat war casualties, is sending doctors to work in the trauma unit at Martin Luther King Jr./Drew Medical Center in Watts, which receives most of Los Angeles County's gang shooting victims.

Two Army residents recently finished two-month tours of duty at King. And under an agreement expected to be approved by county supervisors today, the Army will send four more surgeons, from medical centers in Texas and Colorado, to King beginning next year.

"At King, we see the kind of penetrating trauma that we just don't see at other hospitals," said Dr. John McPhail, chief of surgery at William Beaumont Medical Center in El Paso. "It's a place where the residents will have to treat a large volume of high-velocity wounds, the kind we would see in war."

While most of the eight Army medical centers across the nation provide residency programs for everything from internal medicine to pediatrics, Army officials say only a handful of U.S cities offer the combat-like setting where its doctors can receive training in high-volume trauma surgery. And although public hospitals in New York, Miami, Detroit, and Washington receive thousands of gang- and drug-war victims each year, "King probably has as much significant trauma as any hospital in the country," McPhail said.

Army officials say it is rare for doctors to be sent across the country to get specialized training in trauma surgery. Most receive their training at public hospitals near their medical centers. However, military officials say that their young surgeons rarely see the kinds of gaping, multiple-penetration wounds caused by automatic and semiautomatic weapon gunfire associated with the escalating gang violence in Los Angeles. Law enforcement officials reported 353 gang-related murders in Los Angeles County last year.

"In a setting like King, you not only learn good critical and intensive-care training, but you have to deal with an impressive volume of trauma cases," McPhail said. "In hospitals like the one in El Paso, you see wounds caused by maybe a .22-caliber gun going off accidentally. But there, at King, you see wounds comparable to the kind soldiers receive in combat from automatic weapons."

Dr. John Holcomb, a fourth-year resident at Beaumont Medical Center, completed his two-month stint in trauma surgery at King last week .

"It was like nothing we've ever been exposed to, some nights were just chaos," Holcomb said in a telephone interview from El Paso. "One Saturday five people died (in gang shootings) and we saw most of them (in the trauma unit).

"It makes sense that since we're military surgeons, we'll treat the kinds of wounds that we would see in combat. And that's definitely what I saw there."

Holcomb said his training at King didn't quite prepare him for the battlefront, but added that there is no better way to expose young surgeons to the rigors of combat duty.

"It is absolutely incredible the amount of trauma surgery they do," he said. "There is no substitute for actually doing that kind of trauma work. And one of the best parts of the program is that it frees up some of their doctors to do other kinds of surgeries."

King hospital officials said in testimony before the county last summer that the 430-bed county-operated teaching facility in 1988 treated almost 3,500 trauma victims, or nearly 40% of the county's trauma patients. County health officials estimate that doctors in King's emergency room see more than 100 gunshot cases and dozens of stabbing victims each month. Doctors and nurses at King often refer to the hospital's trauma unit as "a combat zone."

Dr. Arthur Fleming, King's chief of trauma and surgery, told the Los Angeles County Emergency Medical Services Commission in June that it should set up a joint program with the military to help the county's overburdened trauma units and provide valuable training to military surgeons. "I think it's time to offer the military a chance to set up their combat support hospitals on the front line of (King)," said Fleming, who described the Watts facility as the "busiest little trauma city in the world."

McPhail said Fleming proposed the idea during a medical symposium this summer and that the Army jumped at the chance.

King officials could not be reached for comment Monday on the Army program.

The first Army surgeon to train at King was Dr. Kevin Dwyer, a resident at Fitzsimmons Army Medical Center in Aurora, Colo., who completed his tenure in August. Two more surgeons from Beaumont and two others from Fitzsimmons are scheduled to rotate through King's trauma center during the next year. County health officials said the pilot program may be expanded and Army officials indicated that they hope to make it a permanent part of their surgical training.

Supervisor Kenneth Hahn, who is sponsoring the motion to expand the program, said it would provide "much-needed additional medical staff" for King, which officials maintain has been chronically underfunded and understaffed. The county will not receive any money under the agreement, and the Army will pay its doctors' salaries.

"The basic philosophy is that civilian hospitals are one of the few places Army doctors can get trauma surgery training when there's no war going on," said Dr. Jeffrey Clark, chief of general surgery at Fitzsimmons. "It just makes sense to utilize these hospitals where they can see a lot of the injuries they would see during wartime."

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