“Emergency Care for America's Heroes”

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History of Military Emergency Medicine

This edition, we continue our “History of Military Emergency Medicine” series by sharing several excerpts from an interview with GSACEP and Brigadier General (R) Andre Ognibene. General Oginbene’s earliest impact on military emergency medicine was the revolution of the Fort Sam Houston EMS system.  He transformed the antiquated system of empty ambulances that were unable to provide en route care into a functioning EMS system with trained responders and the ability to provide critical care en route.  Additionally, during the late 1970s, Gen Ognibene recognize that Brooke Army Medical Center needed a mission to carry it forward in the medical community in San Antonio, and oversaw the creation of multiple subspecialty fellowships, which have trained generations of physicians for the military and driven BAMC’s graduate medical education mission. As always, If you want to learn more about how you can support GSACEP’s “History of Military Emergency Medicine Project”, or have a story you feel should be included, click here

GSACEP: Take us through the call to go to Vietnam.

OGNIBENE: I got orders to go be a medical consultant to the US Army in Vietnam. I went there in 1969. I had a great experience. I put it all in the book. It took 10 years to write. I was an editor in chief of developing that. I got a helping hand from Colonel William Barrett who worked with me. It's called Internal Medicine in the Vietnam War.

GSACEP:  Do you believe the experience in Vietnam influenced emergency physicians and departments moving forward?

OGNIBENE: I'm not sure. One problem we had in Vietnam, and when I was there I wrote a program for it, the hospitals were geared more toward war and war injuries and little by little as the division was clearing they were sending a lot of patients to the hospital with rashes, with pneumonia, with bloody nose, with hemorrhoids, with diarrhea, just clogging up a hospital that really had no emergency room. They didn't have an emergency room area, and these had to be built up. I developed a program, Have Specialty, Will Travel. We got dermatologists to go out to various clearing stations in this area and see the skin problems, see them right there so they didn't have to be flown in and flown out and lose time from duty. Same thing with the neurologist…We didn't free up rooms, we freed up time. We didn't have doctors who were overwhelmed with sick hospital patients and trauma from having to run down to a room somewhere to see somebody who had a boil on his rear end.

GSACEP: Sometimes a young physician has an experience which sort of turns him on to a need. Was there something like that, which really made you focus on the need for these two issues, time and triage?

DR. OGNIBENE: No lights went on. It was just slowly over time piling information on information somewhere down deep that finally culminated in putting together something that we thought would work. As I said, it couldn't be done unless you had personnel who could share your dream. I think the key of the personnel was Barry Wolcott because wherever he came from, he understood, he knew, and he had the capability to be my front man.

GSACEP: Tell me about your first meeting with Barry Wolcott. How did that come about?

OGNIBENE: As a resident, Barry was the one resident when I was on call for the ward that would call me all night. He was an intense physician, taking care of his patients, and he always wanted to discuss the patient and decide on what to do when he already knew what to do, but he was always confirming. So when I was on calls as a supervisor, Barry and I talked a lot, day and night, actually. I got to feel that he was a different person. A person who thought things through, who had great ideas.  Barry would give you ten ideas on doing something, and nine of them were insane, and one was brilliant. You had to know him and work with him to pick out the brilliant move. 

I'll tell you one brilliant move he made at BAMC.  I was having problems as the commanding general with the fact that we still had 35 or 36 cracker box ambulances. They were not ambulances. They were industrial. They were big cracker boxes with nothing in them. People would call them and come in with a sore finger, a headache, and I thought, I’ve got to stop this. I need intensive care ambulances. I need ambulances that are built like ICUs, what we know now to be EMT ambulances. We didn't have them. I said, but if I take this away from the community and the generals, also, on the post, there's going to be an uproar. I don't know how we go about it. One of Barry's ideas was fantastic. It turned out to be brilliant. He said, “Let's get rid of them. Let's get the new ambulances, and then we go on a program saying BAMC improves ambulance service. Get this out all over. Posters, everywhere. Then when you call an ambulance, give them an ambulance.” This is what we meant. First call we got with the new ambulances was a soldier with a headache who wanted to come by ambulance. Well, we strung out a gurney, put a neck brace on him, rolled him in on a gurney. He was just flabbergasted. We did the same to some lieutenant colonel who had a little cut on his finger. Soon the word got around, Jesus, don't call an ambulance. You know, they send this damn thing, and put you on the gurney. It worked like a charm.

GSACEP: I have to ask, what these early ambulances before you got what we consider modern-day ambulances, what were they like inside? What deficiencies were there?

OGNIBENE: They had basically stretchers in the back, you had a driver and an aide who was either poorly trained or passably trained. They would go about and put you in the back and drove you to the hospital.  It was barebones. 

This was before the word EMT was en vogue. The new ambulances were ICUs in the back. I had trained individuals in that ambulance. The reason we had to do that, if you came in with a myocardial infarction to the emergency room, we had to put you in the back of the ambulance to take you to Beach Pavilion and drive over a mile, so we had to start your CCU care in the ambulance. We had to start your ICU care in the ambulance, so our ambulances, they traveled back and forth between Beach and Main, were state of the art even today.

I'll give you a little anecdote that'll make you laugh. We had at one time two cardiac arrests in the ambulances going to Beach Pavilion, and that was intolerable. We tried to figure it out. We investigated what's happening because we checked the records. Patients were stable. Nobody seems to come up to why that occurred, and one day I was at the ambulance talking to people, one guy who wasn't even an EMT, he was an assistant in the ambulance. He said to me, “I know why they arrested.” I said, “What do you mean, you know why they arrested?” He said, “Yeah, it's the bump.” I said, “What do you mean the bump?” He said, “Going into Beach Pavilion, there's a bump, and the ambulance, we have to go over a speed bump, and that's when they arrested.” Sure enough, he was right.  We got rid of the speed bump, and the incidence of arrests in the ambulance went to zero. In this investigation, nobody talked to the little guy. You got to talk to folks at every level. I went out every day somewhere and talked to the little guy. You got the information many times that you couldn't get from all the top brass looking into things.

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