Navy Medics Get Prepared for Combat with Tour of Duty in Chicago | Hacker News Reader

Navy Medics Get Prepared for Combat with Tour of Duty in Chicago

wsj.com

69 pointsoicu81262 comments

A relative served in the U.S. Army as a doctor many decades ago and said some of the training involved shooting goats with a small caliber gun, removing the bullets, and stitching them up. His specialty was not surgery - I assume this was training for basic field medicine and emergencies.

I've read somewhere that Navy Corpsmen have a training exercise in which a pig is anesthetized and then burned or shot and the job of the corpsman is to keep it alive as long as possible.

ETA: This was happening in 2012 but PETA objected (1); I am not sure if it's still part of the program.

1. http://latimesblogs.latimes.com/lanow/2012/03/pigs-military-...

Part fact, part fiction. Some of that did happen but many stories dont add up. For instance the common tale of removing bullets from animals: Why? That isn't part of a medics job. One would never attempt to remove a bullet in the field. Such actions would do far more harm than good. Even in hospital it is often much better to leave the bullet in, at least until the patient is stable.

Anecdotally, one of the reasons that trauma surgeons from chicago and baltimore have a really pristine reputation is that they get a lot of practice.

I remember hearing about programs like this perhaps 15 years ago, so I'm not surprised they're ongoing.

America in general. A surgeon in the Netherlands can wait DECADES for a kid with gunshot wounds. Its just textbook stuff but if you want to see it in action the US is a good place to learn.

> America in general

"America in stereotype" is more accurate.

Your Netherlands comment is also hyperbole. Here's an article about a kid who was shot and killed on an Amsterdam playground a few weeks ago. Two other people were wounded by what in America would be called an "active shooter." But that only happens in America, right?

https://www.express.co.uk/news/world/910572/Amsterdam-shooti...

He's a troll. Read through his comment history, it's nothing but "love socialism; hate capitalism" rhetoric.

Anecdote aside, it's established beyond a doubt that the US has much, much higher rates of gun violence than European countries, across every dimension: wounds, deaths, assault, self-harm, accidents... You name it, there's a statistic documenting it.

For example, according to healthdata.org, in 2016, physical violence by firearm was the cause of 210.5 DALYs per 100,000. In the Netherlands it was 10.8.

A DALY is a standardized metric defined by the WHO as "lost years of life" to measure the burden of a disease or other affliction.

So in 2016 physical violence by firearm caused 20 times more harm per capita to the US population than to the Dutch population. I'm willing to bet that for self-harm and accidental firearm wounds the gap is even larger, given the idiotic habit Americans have of keeping guns and ammunition stored in their homes.

Source: https://vizhub.healthdata.org/gbd-compare/

I'm not disputing that America has far more gun deaths than most (all?) other nations, but to generalize that the violence in Chicago is endemic to the rest of the nation is pure fantasy.

There are tens of thousands of towns, villages, and cities that see little to no gun violence each year. But they don't get written up in the Daily Fail.

There are ~19,000 incorporated places (cities, towns and villages) in the United States so to say 'tens of thousands' of them see little to no gun violence would be a significant overstatement.

If you limit yourself to incorporated places. There are a lot more places in America that aren't incorporated.

And just because a town isn't incorporated doesn't mean it's small. Pahrump, Nevada, for example, is 40,000 people and it's not incorporated.

> to generalize that the violence in Chicago is endemic to the rest of the nation is pure fantasy.

That wasn't the comment.

The comment was that most surgeons in the Netherlands can wait decades before seeing a gunshot wound. If they want hands-on experience, the US is a good place to learn. I think that's a very reasonable comment (EDIT maybe "years" is more reasonable than "decades"...) and if you account for accidents and self-harm, you really don't need to go to Chicago or Baltimore. The vast majority of gun wounds in the US are accidents or self-harm and occur all over the US, including "quiet little towns". I would argue that the real fantasy is to think that the gun violence epidemic is limited to big cities with black guys in hoodies shooting at each other.

It's more common than people like to acknowledge.

The violent crime rate in Chicago is lower than ~30 other US cities. It sits about even with Tulsa.

The thing that makes Chicago stand out is that its population transforms the rate into a larger raw number.

It's really crazy when you look at just how many murders / deaths we have compared to anyone else.

I decided to check the right-wing conspiracy theory that if you dropped the top four Democratic controlled cities from the US numbers, we'd be in the range of other 1st world democracies. No idea which cities those are supposed to be, but I assume Chicago and NY and LA and St Louis.

Spoiler alert, we're not. Even throwing out all gunshot murders from IL, CA, NY, LA, MO (New Orleans), while keeping the population, still doesn't get us below 2x rate of CAN. You have to toss TX, NJ, MT, OK, to get in the ballpark.

Eh? Canada has a lower rate of gun deaths than ANY US state; 1.97 vs 2.78 in Hawaii, the lowest. Canada’s rate is still high for a developed country, incidentally.

Edit: sorry, missed you were talking about murders; I was using data for all deaths.

The US has 10.5 gun deaths per 100k per year; the Netherlands has 0.58. The lowest US state is Hawaii, with 2.71. Hawaii is higher than almost anywhere in Western Europe; only Finland, France and Switzerland are higher.

Obviously not everywhere in the US has the same rate of gun deaths, but compared to The Netherlands anywhere is high.

I take your point. But its also true that if you measure violent death over the last 100 years Europe is way, way, way ahead. Around 90 million Europeans have died violently over the last century -- guns, bombs, gas, starvation -- at the hands of its governments and people.

The US would have to have a Parkland style school shooting every hours on the hours for the next 600 years to catch up.

I'm don't think that including a world war is a reasonable comparison.

Today, or even in the last decade, the risk of gun violence is far, far greater in the US is far greater than Europe.

We could discuss violent deaths over the last 100 years... But that would be incredibly off topic given that we're discussing how surgeons in different countries have different exposure to gun trauma today...

How many gunshot murders are there per year in the NL? How many emergency surgeons are there?

You posted a ton of nationalistic swipes to HN after we asked you not to. That counts as arson here. It reliably leads to flamewars. We've banned the account.

https://news.ycombinator.com/newsguidelines.html

As was Northern Ireland during the troubles and they still deal today with a fair number of Kneecappings or 50/50's

I hadn't heard 50/50 in that context before, it is a gunshot to the spine?

Apparently so 50% chance of walking after

I think its because there's a 100% chance of having the lower 50% of the body paralyzed [1].

[1] https://www.irishtimes.com/news/killing-may-end-the-blind-ey...

A lot of practice, it seems. Chicago has one shooting every 4 hours and one murder every 17 hours.

Gun control didn't help that much after all

The fact that the naval training base is in Chicago probably has something to do with it too.

I believe for combat trauma surgery (the navy supplies all doctors and medics for the usmc), they typically send MDs to Johns Hopkins or UCLA surgery residency programs.

The surgeon who operated on Gabrielle giffords was a us Navy fleet marine force surgeon.

This article is referring to Navy Corpsman. They are medics, closer to an EMT than a surgeon. After boot camp at Naval Station Great Lakes, they go to "A" School (basically, their specialty school) in San Antonio.

It is my understanding that this training at a hospital trauma center would be after their school in San Antonio, before they were attached to a Marine unit and deployed.

Chicago and Baltimore are the most desired spots for all trauma surgery interns. Note that I went to McGill in Montreal, Canada.

Detroit used to be, probably still is up there, but maybe not as bad as it once was.

I'm always afraid of the (incredibly little) chance of getting shot here in Germany, because I'm sure the doctors wouldn't have a lot of experience

No matter where you live, it's always good to be versed in first aid, cpr, and some basic self-defense. Our civilized world can turn itself upside in a hurry, via natural disasters or man-made causes.

Genuinely curious, when was the last time that our civilized world turned itself upside down in a hurry?

Areas where natural disasters have hit have been very problematic, and the US has had large scale riots. Houston seems to be the exception. Local area reversions to anarchy can get you shot.

Paris train attacks, hurricanes in Florida, the machete attacks in London...

Pretty much any natural disaster.

The quakes in Mexico and the hurricanes that hit the gulf region islands and countries last year spring to mind.

As of right now, it might be upside down if you're stuck in Syria or Yemen?

In the US, you might recall the outcome of the Rodney King verdict as an example.

Happened in America recently, 2005 Hurricane Katrina:

https://www.npr.org/templates/story/story.php?storyId=506379...

Right now the best examples are Venezuela and Zimbabwe.

Haiti

Tornado's are frequently a thing. Emergency services become easily overloaded.

Puerto Rico?

The us govt actually sponsors some good (free) first aid training like https://www.dhs.gov/stopthebleed. That class is worth it, and i carry a basic 1st aid kit from Dark Angel medical in my backpack/car now.

I feel like I'm not very likely to need to perform CPR, but I've seen two people sustain major injuries doing yard work of all things. The 2nd time it took about 20 minutes for EMS to arrive. Had their cut been a bit deeper things could have easily ended up being much worst, and my crappy attempt at stopping their bleeding with a towel would have done nothing.

Stop the bleed is a 1 hour class, everyone should take it.

Yeah, since I took a wilderness first aid course I've been bitching about how crappy the first aid kit is at work. There's a machine shop and a lot of power equipment, and if someone manages to cut an artery they'll likely bleed out before EMS arrives.

All you need to do is stock some quick-clot gauze and a tourniquet or two. About $50.00 in materials could be the difference between an employee or coworker walking onto the ambulance versus that same person being carried out in a bag.

The kit can't treat anything more serious than a paper cut. It's seriously just a big box full of band-aids and ointment.

I carry the RATS tourniquet in my range bag, and with my bmx race gear (with other first aid craps). In the cars are trauma kits with celox. I should add celox to the range bag. I’ve taken a few first aid classes, the wife has training in how to handle medical emergencies from her time as a 911 dispatcher.

I keep trying to get a buddy’s former ranger nephew to give us some “classes” based on what he experienced in Afghanistan.

> Our civilized world can turn itself upside in a hurry, via natural disasters or man-made causes.

Is this true? It sounds more like doomsday prepper propaganda.

Katrina, Sandy, LA riots, what other situations am I missing?

First Aid and CPR training is usually part of a drivers license in Germany (though anecdotally, I had a laugh-cramp halfway through that course which I'm hoping will not repeat in a real emergency situation)

Yeah most germans know basic first aid and CPR

Also, was it when you had to give the puppet mouth-to-mouth? Because I was slightly stoned when I had to do that and I almost died laughing

Yeah that was the exact moment when I lost it, though I was sober.

Hospitals which experience surges of unexpected trauma victims publish post-event write ups. I've read a couple on the web. They basically go to triage, training and practice.

Your german hospitals will all be thinking about this, all the time. Any construction site in a german city is only one mis-placed digger bucket away from an unexploded wartime 4000kg blockbuster bomb event.

https://en.wikipedia.org/wiki/Mass-casualty_incident

Just google "mass casualty incident" -They think about this. You will be looked after as best you can, because its planned for.

One doctor from the November Las Vegas shooting wrote a review of the incident for his ER that got attention on HN: https://news.ycombinator.com/item?id=15688900

That was one of the ones I read recently. I think another one was about dealing with the Bali bombing victims, hundreds of people with life-changing deep burns flooding into a system designed to handle 1-2 patients at a time

http://archive.is/MtjAr

There's an old narrative, so familiar we hardly notice it, that American cities are dangerous and crime-ridden. It's something that many WSJ readers and others grew up hearing, and which is a popular setting in entertainment - a setting for genre we all know, like the Victorian period pieces - and entertainment is the only exposure many have to cities outside of commercial and entertainment districts. That narrative is obsolete; generally, crime is very low, gangs are a thing of the past, and so are drug wars. I've spent time in cities, outside the commercial and entertainment (and wealthy loft) districts, and you'd be surprised what you find - regular people going about regular days, boringly normal. Lots of infrastructure that needs attention too.

I'm concerned that articles like this one further the old, dramatic narrative, and there's a cost: It depicts these places as almost different countries, stereotyped settings for genre entertainment like a Hollywood backlot, not as real communities; and it writes off the residents as a criminal class that need to be suppressed by police (and fuels a lot of racism), not as people with talent, hard work and dreams who need transit, education, jobs, freedom, opportunity, and all the same things we need sitting at our desks reading about it.

(There are dangerous, crime-ridden areas in the U.S.; some are in cities and some are not. On the other hand, I guess Wall Street is in a city, and what's the per capita crime rate there? They should send JAG for training!)

EDIT: Some minor edits

Arguably a more deadly place than the war-zones they would be deploying to

https://www.forbes.com/sites/niallmccarthy/2016/09/08/homici...

So at it's peak we had ~160k Americans in Iraq. At Afghanistan peak, we had ~100k.

Chicago has ~11 times as many Americans. I'll take my chances with Chicago.

It's actually shows how remarkably low we were on the casualty rate in the wars we had. Far cry from the civil war (~25% casualty rate).

Variants of this have been happening for a while. Here's 2008 article: https://www.cbsnews.com/news/intense-training-for-military-s...

The trauma surgeon who treated the North Korean soldier that escaped through Panmunjom was trained in San Diego, and that makes him one of the most experienced trauma surgeons in the country. There's much less practice available in countries with gun control.

I went through paramedic school in Los Angeles in the early 90s and worked along side US Army medics who were sent there to learn how to deal with trauma cases.

Ah, good times at UCLA Medical Centre and MLK.

> “The experience here can’t be replicated elsewhere, unless you have a major land invasion,”

Parkland, Columbine, Newtown, . . .

https://en.wikipedia.org/wiki/List_of_school_shootings_in_th...

We should not overlook the fact that in the 1970s, trauma surgeons practiced in the Bronx. Nothing ever really changes in the human condition, but new generations forget the old lessons.

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