Inside Carl R. Darnall Army Medical Center's second floor surgery suite, surgeons and medical teams are busy honing their critical-care skills. In one room, a retiree is getting a new nose. A few feet away, surgeons are replacing broken knees and performing bariatric surgery on dependents to enhance their quality of life. Regardless of procedure or patient, every incision is an exercise in mission readiness.

"Often, when we think of readiness, we're only thinking of the warfighter or active-duty Soldier," said Lt. Col. Leah Triolo, an orthopedic surgeon and deputy of the Fort Hood hospital's surgical services. "But there're a lot of other green suitors who to go to support that warfighter, and that's our medical team."

That team, said Triolo, includes every member on the nursing and anesthesiology staff to the post-recovery and the ward staff who are taking care of the medications and providing more challenging care.

"Even though the surgery itself is elective, providing care to more complex cases, such as a total joint replacement, helps with the readiness of the entire team," she said.
That's why every surgery is value added when it comes to saving lives, according to CRDAMC's surgical team.

Every surgery a training opportunity

"Everything we do is a training opportunity to better prepare us for such things as gunshot wounds, fractures and IED explosions when we do go downrange," said Lt. Col. Lance Taylor, who as chief of operating and anesthesia services, orchestrates the battle rhythm inside CRDAMC's 8-bay surgical suite.

The elective surgeries, too, said Triolo, offer the medical team exposure to different population groups who often have two or more complex issues that require extensive critical care.

"When we look at our total joint population, they represent a population of complex patients because of their medical comorbidities that we may not see when we treat only our active-duty population who are often young and healthy," said Triolo who has deployed twice to Afghanistan with Forward Surgical Teams. "It's the same with the bariatric care population who are often admitted to the intensive care unit post-op because of other pre-existing conditions that represent critical-care issues."

Maj. Saundra Martinez, a perioperative nurse who saw her share of injuries during her 2007-2008 deployment to Tikret, Iraq, with the 82nd Airborne, said repetition and training in controlled environments translate to surgical excellence and patient safety.

"All that training just clicks in when you are deployed," said Martinez, who is the chief nurse and officer in charge of CRDAMC's operating room suites. "That muscle memory just comes back to you regardless of the procedure and requires you to critically think about what's going on and what you need to do to get that patient stable."

Elective surgeries help refine skills

Open surgeries such as hernias or gastric bypass procedures also offer real-world lessons in anatomy.

"In theater, we get big cases like gunshot wounds to the abdomen and blast explosions, so what we do stateside exposes us to that open-body environment," said Capt. Carolyn Dillon, who deployed to the Helmand Province in Afghanistan in 2013-2014 and now serves as a circulating nurse who helps prep the patient for surgery and oversees operating room preparation. "We saw lots of wounds from IED explosions, burns and gunshot wounds to the arms and chest, so taking care of the patients there from our fixed experiences here, helps you think outside the box. You're just not going to have all the necessities in theater that you have here, so critical thinking is key. Overall, all the experiences refine your skills, so you kind of know a little bit about everything."

On average, the eight surgical teams, which consist of the surgeon, circulating nurse, technician and anesthesiologist perform about 30 surgeries daily.

It's important, said Taylor, who manages the surgical center's operating hub with rapid-fire precision, to keep the operating rooms hopping to maximize both operational resources and the surgical skills of the hospital's medical team.

"If the operating rooms weren't filled all the time, how would we get our skills?" said Martinez. "How would we know how to take care of our patients?"

For CRDAMC physician, Lt. Col. Paula Oliver, who recently returned from a combat deployment, every procedure regardless of simplicity or severity prepares surgeons for combat's worst-case scenarios.

"The more you operate, no matter the procedure, the more familiar you are with the anatomy and are exposed to complications and anatomical differences," said Oliver. "Even those who care for civilian trauma can't be completely prepared for the massive wounds we see with IED blasts, but the more you know, are exposed to, and are comfortable with, helps when you receive your first traumatic multiple amputee."

Repetition builds confidence

That repetition also builds confidence for the Army's operating-room technicians who shadow the surgeons.

"The only way you are going to boost your confidence level is through repetition," said Spec. Matthew Barek, an operating-room technician who has already assisted in more than 300 surgeries in the three months he has been at CRDAMC. "It helps you to not get nervous and to be able to do everything you need to do."

Surgery is not just about incisions and sutures. It's also about patient safety.

"Everyone on that table is someone's mother, father, son or daughter," said Sgt. Mark Johnson who is as the non-commissioned officer in charge of CRDAMC's surgery department, supervises the enlisted, civilian and contracted operating-room technicians.

And that, says Martinez, is why every surgical opportunity is a training exercise in deployment medicine.

"It really is irrelevant what kind of surgery it is," said Martinez. "Having the opportunity to hone our skills during routine procedures is essential downrange when saving lives on the battlefield."
And those skills, said Triolo, are the unifying element for all the medical providers tasked with saving lives.

"When you're forward deployed, you don't have the assets you have here at home, but the skills, which come from the readiness you've developed by taking care of critical patients, you take with you," she said. "Even though the procedures we're performing here may be thought of as elective or not needed in a military setting, the trickle-down effect for the readiness of the hospital's entire team is important. And we like the positive impact it can have on the entire population that we support here at Fort Hood."