One of the top senior enlisted personnel for the Army Medical Department Center and School (AMEDDC&S), located at Joint Base San Antonio (JBSA), Fort Sam Houston, TX, recently participated in an event normally expected for senior medical officers in Military Medicine. SGM Christopher R. Marshall, NRP, SO-ATP, Sergeant Major for the Directorate of Training and Academic Affairs (DoTAA), was one of over 20 committee members who, in residence, significantly contributed to the update of the Fifth Edition of the Emergency War Surgery (EWS) reference book.

The committee members were multi-service (Army, Navy, and Air Force) doctors and specialists of various disciplines, who ranged in grade from O-4 through O-6--with the exception of SGM Marshall, who was the only enlisted member.

The actual update took place at the AMEDDC&S over the Labor Day Holiday weekend, August 31st through September 3rd, because many of the committee members came in on their own time and on their own expenditure. Some committee members were from the local JBSA area, but others came in from various locales out of state, including Hawaii. A long holiday weekend seemed to be conducive for this. "Everyone came in on their own accord from all over," said SGM Marshall. "It wasn't like a TDY that they got paid for or anything."

This committee was headed up by Navy Captain Miguel Cubano, the commanding officer of Naval Health Clinic Corpus Christi, TX, who headed up the last two EWS updates. He arrived to this particular update late because he had his own challenges dealing with the aftermath of Hurricane Harvey in Corpus Christi.

Ed Lindeke, the acting executive director of the Borden Institute, called this update to SGM Marshall's attention. This was the first time an NCO had been involved in the update process of the EWS. Borden oversaw the updating of this publication to the EWS Fifth Edition, and they also coordinated all the conference rooms and meeting venues for the committee. "When he (Lindeke) first asked me, I didn't know how I was going to help a bunch of Docs and traumatologists write this update," said SGM Marshall. "But then I opened it up, and saw that I did know a lot of this from my involvement on the ground level," he said.

SGM Marshall added, "What an opportunity to be a part of this group! To be surrounded by SMEs (subject matter experts) in their sub specialty fields of medicine, is an opportunity I jumped at and took full advantage off!"

SGM Marshall, who is also a current (because he keeps his credentials up) nationally registered paramedic and a special operations advanced tactical paramedic, took special exception to Chapter Six in the EWS. "When I saw Chapter Six, the Hemorrhage Control chapter, in its current form, it didn't nest well with current guidelines--from point of injury to hemorrhage control--so I took Chapter Six personally," he said. "To bring it more on line with the standards of the Committee on Tactical Combat Casualty Care (CoTCCC), I asked for an insert to be added, because normally the TCCC guidelines would be updated every six months," he said. "So I wanted an insert that could be removed from the book directing service members to a website that would have the latest guidance, that way any service member would have the latest information out the door for hemorrhage control."

Along with Chapter Six: Hemorrhage Control, SGM Marshall also helped shape Chapter Two: Roles of Medical Care, and Appendix Three: Department of Defense Trauma Registry.