FORT SAM HOUSTON, Texas — On an Iraqi military base in sweltering heat, Jacob Whitlock faced his first bout with life and death.
During a training exercise, a Soldier on the firing range began stumbling in his boots between rounds. With his face flushed red, he then vomited uncontrollably in the dry desert air.
Whitlock, an Army combat medic on his first deployment, acted instinctively, checking the Soldier’s vitals and heart rate. He quickly recognized the signs of heat stroke.
“I 100% recognized that his life was in danger,” Whitlock said.
Whitlock signaled to the unit’s commander to stop the live fire. Whitlock and another unit member then loaded the sick Soldier onto a Humvee to take him to the nearest treatment facility. He established an IV into the Soldier’s arm to administer fluids. In addition to heat stroke, the Soldier also suffered hypoglycemia, or low blood sugar levels.
Heatstroke occurs when the body temperature reaches 104 degrees or higher. Patients will suffer from slurred speech and can even go into a coma or cardiac arrest.
Whitlock’s actions possibly saved the Soldier’s life.
“It becomes instinctual after a while,” Whitlock said. “You can just kind of recognize those signs and symptoms.”
Whitlock, now a staff sergeant and instructor, tries to impart that to his students at the Combat Medic Specialist Training Program, the Army’s schoolhouse for combat medics. He doesn’t take his job lightly. Commanders often seek the counsel of combat medic specialists or 68Ws, one of the most trusted Soldiers on the battlefield.
Whitlock, a 10-year veteran, has seen significant changes in the career field.
Army medics must be certified as basic Emergency Medic Technicians or EMT-Bs and will likely be moving to higher levels of certification soon according to program faculty. Soldiers will be able to earn certifications to provide care to life-threatening ailments, administer IV fluids and parenteral medicines to patients, perform advanced airway techniques to ventilate patients and treat medical emergencies such as anaphylaxis and cardiac arrest in both the civilian and military setting.
Medics act as the first responders when Soldiers suffer injuries that include gunshot wounds, trauma and training injuries. Sometimes, they must treat injured U.S. allies and civilians.
But they must be prepared to adapt to the unexpected.
Operational innovation
During a patrol through Baghdad in 2008, fellow Soldiers called Nicholas Morales to find an injured troop laying immobile at the bottom of a stairwell.
After evaluating the Soldier, Morales learned the Soldier had fallen through the roof of the building onto the second floor and rolled to the bottom of the stairs. He had suffered a broken leg.
“It’s something that you don't typically see,” said Morales, now a senior instructor and sergeant first class. “All of a sudden, you're not prepared for that. You're ill-equipped. A lot of times a combat medic on the battlefield has things to stop major bleeding, respiration issues, breathing issues.”
“Then all of a sudden you see somebody with the possible broken leg, and you're thinking, ‘how can I treat this?’” he continued. “It's not like I have this magic endless bag.”
With no ambulance immediately available, Morales had to get creative. He found a wooden two-by-four that he splintered and secured against the Soldier’s injured leg. With the help of his fellow troops, the Soldier returned to a field hospital for further treatment.
Morales, now Whitlock’s supervisor, said that Whitlock epitomizes what it takes to be a combat medic instructor, from his mastery of first responder skills to his ability to react to the changing environment.
As the Army shifts to longer sustained battlefield operations medics must adapt too. They now learn to treat injured Soldiers for hours or even days as future Soldiers may find themselves in environments far from hospitals and adequate facilities.
“The Army's moving to this new type of thinking, where we're not just going to have the upper hand all the time, we're not just going to fly jets over and bomb people,” Morales said. “We're actually gonna have to be on the battlefield for an extended period of time, almost like reverting back to the times of Vietnam, World War II, where we had to think outside the box as far as how do we treat patients.”
“We can't just call on a medivac and get somebody in and out in a pinch. We might have to be with the casualty for four hours.”
Morales said Army medics had to innovate and adopt on the fly. In Morales’ two decades in the career field, the medics have grown more sophisticated in how they provide care. Medics went from using makeshift tourniquets made from popsicle sticks to applying Velcro devices with straps. They now have dedicated chest seals to treat injuries in the chest cavity, when formerly they applied pieces of plastic cut from meal packets.
Once a last resort, medics now use a procedure called cricothyroidotomy, where they make an incision through the skin to provide an airway for patients. And medics have also applied more sophisticated, life-saving procedures.
Whitlock, 30, took the lead on applying “whole blood” training to the CMSTP curriculum, a new approach to shock therapy that treats patients with blood transfusions. Ten years ago, active-duty Army medics rarely participated in blood transfusions, he said.
When Whitlock went through medic training a decade ago, the Army used starch-based colloids like Hextend to treat injuries with severe blood loss or trauma. But the treatment does not have the oxygen-carrying capacity of blood’s hemoglobin to fully resuscitate patients.
“The true problem with shock is that your body's not perfusing correctly,” Whitlock said. “And so, if we want to resuscitate somebody out of shock, we need to help them perfuse better, and the best way to do that is to give them whole blood because whole blood contains the hemoglobin, which is the only thing that can carry oxygen to all the tissues.”
Whitlock now trains students to procure 450 milliliters of blood from another student so that Soldiers will already be familiar on the battlefield.
Preparing for the unpredictable
Whitlock, who spent 8 years as a combat medic and the last two as an instructor, takes extra time to work with students on each particular skill. He calmly encourages students who struggle performing under pressure.
Whitlock grew up in Lawrence, Georgia, a northern suburb of Atlanta. As a student studying psychology at Georgia Gwinnett College, he decided he needed a change in his life. He also wanted to help patients but decided he wanted to work more closely in health care.
After completing training at Fort Sam Houston, Whitlock found himself excelling in his duties during assignments at Fort Liberty, North Carolina and in Vicenza, Italy.
Then after fellow medics returned from combat deployments, Whitlock faced an unexpected call for help — from fellow medics.
Army medics often experience the worst of battlefield injuries. They see nearly every injury on the front lines, from amputations to burn victims. Soldiers can suffer from post-traumatic stress disorder, sometimes years following a deployment. Several of Whitlock’s peers surprised him when they confided their mental health struggles to him.
“I've had a lot of situations where I've had friends, Soldiers that I worked with that have dealt with some tough mental battles,” he said. “I'm not a behavioral health specialist but I have always been in that trusted position where if somebody needs help, they're willing to reach out …I've always been the type of Soldier that my buddies trusted enough to reach out to.”
Fellow medics and infantrymen Whitlock had grown close to would contact Whitlock with messages and phone calls. Whitlock said that the Soldiers just needed someone to listen.
Medics must learn to apply care sometimes during an enemy attack or must treat a patient convulsing with extreme pain.
Since joining the faculty as an instructor two years ago, his peers named him as subject matter expert on curriculum, trusting him with the management of curriculum and course work.
To help students keep their composure in such moments, Whitlock trains medics through repetition and muscle memory, “So … in the heat of the moment, when your heart rates really high, you're shaking, [and] your adrenaline's going, your body is already trained to respond adequately without losing all the fine motor skills that you typically have.”
Whitlock himself has seen his share of gruesome injuries while treating casualties while assigned to airborne units at Fort Liberty and Vicenza, Italy. Many of the Soldiers he treated suffered injuries from accidents during exercises where Soldiers had to leap from military aircraft.
To ready Soldiers to treat the range of injuries troops see the on battlefield, instructors structure the 16-week training into three parts. First, students must take the National Registry of Emergency Technicians exam and become certified as EMTs. During that phase they learn emergency medical care and patient evacuation, and airway ventilation.
In the field craft phase, students build upon their EMT skills by learning and employing the principles of Tactical Combat Casualty Care, or TCCC. They work with mannequins, battlefield props and fake blood in realistic combat training situations such as medical evacuation and working in simulated casualty collection points.
Instructors focus the training on stabilizing the most commonly preventable battlefield injuries that result in fatalities including massive hemorrhaging, airways occlusion from trauma, tension pneumothorax and hypothermia.
In the final phase, students travel to Camp Bullis, a 28,000-acre training area in northern San Antonio. There students must complete an eight-day field training exercise on limited rest.
Instructors create a high stress environment, moving students through the training at a frenetic pace. Their goal: recreate the intensity of a battlefield. Army Medics must complete a three-part exercise consisting of dismounted patrols, simulating a battalion aid station and prolonged casualty care.
Whitlock will remain at the schoolhouse to continue improving the curriculum for future combat medics before moving onto a new assignment in Germany. And instructors, who each have experienced the rigors of working in the field, hope that during the training they will create a more versatile, resilient Army medic.
“The most rewarding part is just watching new trainees — people who just came off the street, coming into our schoolhouse and just seeing the evolution of them gaining the confidence to put hands on patient and do things in dangerous situations,” he said.
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