NAVY MEDICINE Vol. 84, No.3 May-June 1993

32 Pages·1993·9.6 MB·English

by  U.S. Navy. Bureau of Medicine and Surgery

NAVY MEDICINE
May-June 1993
Surgeon General of the Navy NAVY MEDICINE
Chief, BUMED
VADM Donald F. Hagen, MC, USN
Vol. 84, No.3
Deputy Surgeon General May-June 1993
Deputy Chief, BUMED
Chief, Medical Corp8
Department Rounds
RADM Robert W. Higgins, MC, USN
I Branch Navy Hospital Adak to the Rescue
HMCM(SW) C. Phillips, USN
3 Flag Officer Selectees
Editor
Jan Kenneth Herman 5 Commander Seventh Fleet Conducts First Medical Symposium
LT J.E. Brooks, USN
CDR N. Jones, USN
Asllltant Editor
Virginia M. Novinski Forum
8 The Cost of A voiding Risk
Editorial ~nt CDR J.A. Brown, MC, USN
Nancy R. Keesee
10 Navy Nurse Corps: 85 Years of Service
Features
12 Corpsmen Scale Cliff to Rescue Accident Victim
H. S. Samuelson
NAVY MEDICINE. Vol. 84, No. 3, (ISSN 0885·8211 USPS
311..070) Ia publlahed blmonlhty by the ~ ol the 14 The Gospel on Leadership According to John
NIIVY. BurMu ol MediCine and Surgery (BUMED OIH~
Waahlngton. DC 20372·5120. Sec:ond-clasa po.tage paid CAPT J.B. Cotton, MC, USNR
W. ...l ngton. DC. and edcllll-maiNng olllc:ea.
caPreO oS1T NMaAvSaTl EPRul:l lSlceanldlo -na a-nd Fcorhmaa e-leon N.. A-TrT llNe:d Cico/ndee 16 A Comparison of Navy and Civilian Health Habits
301, 5801 Tllbor AYMiue. PIIHaclelphla, PA 11120. M.A. Hoffman, Ph. D.
POLICY: NMty AHdicine is the olllclal publication ol the V.S. Freeman, M.A., M. T. (A.S. C.P.), S.C.
HIIVY MediCal Dapartment.llla inlllnded for Medical Depart
LT C.L. Behmer, NC, USNR
- periOIWiel and contalna prolaeionallnformation Nla
llft 1o medicine. clentlatry, and the aiMed health IICienceaJ S. Kangas-Packett, M.S.N.
Oplnlona exptWMCI are .,_ ol the aulhora and do noi T. M. Kaplan, M.S. N.
-rlly rapNaalllllla official poalllon ol the Dapartment
ol the Navy. lila BurMu of Medicine and Surgery, or any
olllaroo-n....,... ~or agency. Trade nama. .r a 20 Chronology- World War II: Navy Medicine May-June 1943
uaec1 for iclanllflcation only and do notr .,-an anci«M
J. Mitchum
mant by the Dapa-of lila Navy or the BurMu of Medi
cine and Surgery. Although N-r lledlcine may cite or
axtrac1 from diractlvaa,.. ,a..u.nlllcoari.t y for action ahould ba Professional
obtained lrom lila clled
DISTRIBUnON: Navy lledlci,.la cllatributed to active clulj 26 Rapid Screening for Biological Threat Agents by the
MediCal Daper1mant ,.._... ... via lila Standard Navy Dlatri Polymerase Chain Reaction
butlon Uat. The following cllelrlbullon Ia aulllortzad: ona copy CDR J.R. Campbell, MSC, USN
for each Medical. Danlal. Medlclll SeMca. and Nu-CorP'!
o111car; ona copy for aach 10 anNIIed Medical Dapartment CDR S.E. Walz, MSC, USN
lll8lllbara. 1'-quaata 1o inctaUe or clacr.a lila number ol CDR J.R. Crabbe, MSC, USN
allolled coplaa lhoulcl ba for-.Md lo N•vyA Hdicinevi8111a CAPT W. W. Schultz, MSC. USN
local command.
NAVY MEDICINE Ia pullllahed from appropriated lunda
authority olllla Bureau o1 Medicine and Surgery in accord Notes
ance with Navy Publlcallona and Printing Ratulallona P-~
Tha s.c..wy olllla Navy haa determined lhallhia publica 7 Naval Medical Research and Development Command Highlights
lion Ia -ry In lha tranuctlon ol bual-required
18w oflha Dapa-ollha Navy. Funda for prtnang IIIIa A Look Back
publlcallon have bean approved by lha Navy Publlcallo111
and Prtntng Polley Commlltea. Mlclea. 1a1tera. and a--. 29 Navy Medicine 1919
c:hangM may ba lorW8rded 1o lha Eclllor. Navy lledlciMj
Dapartmant of lha HI!VY. Bu..u o1 Medicine and Surgery
(BUMED OIIH), Walhington, DC 20372-5120. T~
(Area Code 202) 153-1237, 153-1217; Aulovon 214-1237
214-1217. Contrtbutiona from lhallalclare walcoma and
ba published aa apace parmita, aubjact 10 editing and poul
COVER: HM3 James F. DeJanon examines a patient at Branch Medi
bi8 abriclgmanl
For ula by lila Superintendant of Documanta, U.S. cal Clinic, Marine Corps Recruit Depot, San Diego, CA. As the Hospi
Gover~ Printing Olfica. Waahington, DC 20402. tal Corps celebrates its 95th anniversary, corpsmen continue a proud
tradition of service to the Navy and Marine Corps. Story on page 12.
NAVMED P-5018
Department Rounds
Branch Navy Hospital Adak
to the Rescue
A t 0230 on 6 April 1993, the needed to land immediately. Attempts landed at Shemya AFB-325 miles
duty officer at U.S. Branch by Branch Navy Hospital Adak to west of Adak in the Aleutian chain,
Navy Hospital Adak received divert the airliner to Adak, where med with a staff of one medical officer and
a phone call for help. It was from the ical capabilities are more readily avail three medics. They called Navy medi
sole Air Force medical officer at able, were futile. The traumatic air cine, which was standing by, ready to
Shemya Air Force Base, Shemya turbulence that injured more than half assist.
Island, AK. A civilian Chinese airline the 265 passengers aboard had The 15-bed, 75-person Branch Navy
was attempting an emergency landing. seriously damaged the aircraft, and the Hospital immediately initiated a total
The pilot stated that he had many pilot was unsure of its airworthiness. staff recall. By 0410 everyone had
seriously injured passengers and At 0355 the airliner and its injured arrived. Within an hour, a 12-member
Left to right: HM1 Geoffrey Hughes, HM3 Jason Farlow, and
LT Jeff McNeil prepare to place an IV into one of the victims of
the Chinese airliner accident.
May-June 1993
HM3 Dennis Matlock, LT Brian Smullen,
and LCDR Chris Stokke check vital
signs as HMC Robert Spindle looks on.
medical team was identified for mobi
lization to Shemya, contingency sup
plies were gathered, and people and
packages were loaded aboard a P-3
from VP-40's Fighting Marlins, an air
squadron stationed at NAS Adak.
Upon landing at Shemya, about an
hour after takeoff, the team quickly
assessed the situation and called for
additional supplies and medical staff.
Again, Branch Navy Hospital Adak
was standing by to assist and answered
the call. An additional 13 staff
members and the urgently needed
medical supplies were soon aloft in
N AS Adak's C-130 transport and
arrived at Shemya by 0900.
The three medical officers, two
nurse anesthetists, one Medical Ser
vice Corps officer, and six hospital
corpsmen of the Branch Navy Hospi
tal's first team were joined by three
Nurse Corps officers, another Medical
Service Corps officer, one Army vet
erinarian, one Army vet tech, and
seven more hospital corpsmen.
As Adak's teams arrived, they
immediately joined the four on-site
Air Force medical personnel in triag
ing the 265 passengers, many of whom
were very critically injured and were
still inside the MD-11, a modified DC-
10 aircraft.
Triage and immediate lifesaving using the P-3 that had brought the first treatment and medical evacuation of
procedures took an hour and a half. Navy medical team to the scene. 89 critically and seriously injured pas
Then medical evacuation could begin. By 1100, 15 additional patients had sengers. By 1500 the 60 less seriously
Using an Air Force RC-135 that had been evacuated via a Coast Guard C- injured passengers had been evacuated
been at Shemya at the time of the 130. Finally, at 1228, the last of the by an Air Force C-141.
crisis, the first 27 critically injured pas seriously injured passengers were News service reports indicated one
sengers were medevaced to Anchor evacuated off Shemya Island by NAS passenger died of his injuries. Without
age. With them were Navy physicians, Adak's C-130, which carried 38 U.S. Branch Navy Hospital Adak's
nurses, and corpsmen, who provided patients attended by 4 Navy medical rapid and capable response, the toll
inflight medical care. At Shemya, personnel. would have been higher. o
triage and treatment continued, and In the space of 8 hours, the Branch
- Story by HMCM(SW) Clifford Phillips,
the joint Navy-Army-Air Force medi Navy Hospital had mobilized 25 staff
Command Master Chief, Director for Adminis
cal team prepared and evacuated 10 personnel, moved more than 2 tons of
tration, U.S. Branch Navy Hospital, Adak, AK.
more critical patients to Anchorage, supply items, and provided lifesaving Photos by JOI Walter H. Panych.
2 NAVY MEDICINE
Flag Officer Selectees
R ADM-selecteeJamesHoward Association of Military Surgeons of tion, Sea Service Ribbon, and Over
Black, MC, assistant chief of the United States; Association of seas Service Ribbon (with two bronze
staff for fleet medical/ fleet Military Osteopathic Physicians and stars).
surgeon on the staff of the Com Surgeons (past president I 982-1984);
mander in Chief U.S. Pacific Fleet, Texas Osteopathic Medical Associa RADM-selectee Noel K. Dysart,
Pearl Harbor, HI, was born in Camp tion; Society of U.S. Naval Flight MC, assistant chief for plans, analysis
Hill, P A. He received his B.A. degree Surgeons; Aerospace Medical Asso and evaluation, Bureau of Medicine
from Gettysburg College, Gettysburg, ciation; member, Joint Committee of and Surgery, is a native of east St.
PA, and his D.O. degree from Phila Aviation Pathology (1977-1980); Louis, IL. He attended several colleges
delphia College of Osteopathic Medi member, Naval Aviation Evaluation in Minnesota and received his B.A.
cine, Philadelphia, P A. He completed Board at Chief of Naval Personnel degree from the University of Minne
a rotating internship and an anesthesi (1977-1982); military representative, sota in 1967.
ology residency at Fort Worth Osteo Alumni Board of the Philadelphia Following acceptance to medical
pathic Hospital, Fort Worth, TX. College of Osteopathic Medicine; school, he was commissioned an
Subsequently, Dr. Black entered pri member, Committee on Postdoctoral ensign in the Navy 1915 Early Com
vate practice and served as a member Training of the A.O.A. (1984-1986), missioning Program in May 1966. He
of the Admissions Committee and was San Diego Osteopathic Medical Asso received his medical degree from the
appointed clinical instructor at the ciation; and delegate, A.O.A. House University of Minnesota on 10 June
Texas College of Osteopathic Medi of Delegates on six occasions. 1970 and completed a straight pediat
cine during 1973 and 1974. His military awards include the ric internship followed by I year of
After being commissioned in the Legion of Merit (two awards), Meri pediatric residency at Children's
Medical Corps, he completed a course torious Service Medal with gold star Orthopedic Hospital and the Univer
in aerospace medicine at the Naval (two awards), Navy Commendation sity of Washington, Seattle, W A.
Aerospace Medical Institute in Pen Medal, Meritorious Unit Commenda- He was assigned to the Naval Hospi
sacola, FL, and was designated a flight tal, Bremerton, W A, as a pediatrician
surgeon in March 1975. Subsequent in June 1973 and then moved to San
duty assignments include: senior medi Diego, CA, for a final year of resi
cal officer, USS Ranger (CV-61); dency and a 2-year assignment as a
head, Aerospace Physical Examina staff pediatrician before moving to the
tion Review Section, Bureau of Medi University of Minnesota for a 2-year
cine and Surgery; assistant for medical fellowship in pediatric nephrology.
officer distribution, Bureau of Medi Subsequently, he returned to San
cine and Surgery; senior Medical Diego where he was assigned as a staff
Corps assignment officer, Naval pediatric nephrologist with additional
Military Personnel Command; region responsibilities as director of The Elec
al healthcare coordinator, Naval tron Microscopy Laboratory in the
Regional Medical Center, Oakland, Clinical Investigation Center. During
CA; commanding officer, Naval Hos this tour, he was the operational medi
pital, Oak Harbor, WA; commanding cine training coordinator and the
officer, Naval Hospital, Yokosuka, director of interns. In 1982, he was
Japan; and force medical officer, assigned to the Naval Health Sciences
Naval Surface Force United States Education and Training Command as
Pacific Fleet. director, Medical Corps Programs
Dr. Black is affiliated with the and Clinical Investigations. Shortly
American Osteopathic Association; CAPT James H. Black, MC thereafter, he transferred to the newly
May-Jure 1993 3
dation Medal, and National Defense
Medal with bronze star.
RADM-selectee M. Eugene Fussell,
MC, USNR, force medical officer,
Reserve Naval Construction Force,
Gulfport, MS, and reserve specialty
advisor to the Surgeon General in
orthopaedic surgery, Bureau of Medi
cine and Surgery, is a native of Black
shear, GA. He received his B.S. degree
in chemistry from Morehouse College,
Atlanta, GA, in 1959 and his doctorate
degree from Meharry Medical Col
lege, Nashville, TN, in 1964. While a
freshman medical student, he was
commissioned an ensign, United
States Naval Reserve in the 1915 pro
CAPT Noel K. Dysart, MC gram. He did three internships at U.S. CAPT M. Eugene Fussell, MC, USNR
Naval Hospital, Bethesda, MD, in the
created position of assistant for pro summers of 1961, 1962, and 1963. (Port Hueneme), and NR NAY
fessional education, Office of the After completing a rotating intern HOSPCPEND. From 1987 to 1990,
Director of Naval Medicine. After ship at George W. Hubbard Hospital, Dr. Fussell served as director, health
serving as director, Medical Education Meharry Medical College, he was services, COMNAYREDRESCOM
and Training (OP-939), Dr. Dysart called to active duty in June 1966. He Reg 19, San Diego, the largest RED
reported to Naval Hospital, Roosevelt was assigned to the ADCOM Com COM in the nation.
Roads, Puerto Rico, as executive mand at Great Lakes Naval Training During the Marine Corps Cold
officer in July 1986. From June 1988 Center, Great Lakes, IL. Subse Winter '89 exercise in Norway, Dr.
to June 1990, he served as executive quently, he was augmented to the Reg Fussell served as brigade surgeon. In
officer of the Naval Health Sciences ular Navy and was assigned as a 1991 he was selected to work on an
Education and Training Command. first-year resident in general surgery at elite group of naval officers to serve on
Following a 2-year tour as command U.S. Naval Hospital, St. Albans, NY, OP-06 Innovative Naval Reserve
ing officer, Naval Hospital, Groton, in June 1967. In 1968, he was assigned Workshop, Newport, Rl.
CT, he assumed command of Naval to U.S. Naval Hospital, San Diego, In civilian life, Dr. Fussell partici
Hospital, Jacksonville, FL, in June CA, as a second-year resident in ortho pates in several civic activities. He was
I 992. In April 1993, Dr. Dysart paedic surgery. He completed his chief of staff at St. John's Regional
reported to the Bureau of Medicine residency in I 970 and then served as Medical Center in Oxnard and now
and Surgery. chief of orthopaedic surgery, U.S. serves on the board of directors of St.
Dr. Dysart is certified by the Ameri Naval Hospital, Port Hueneme, CA, John's Pleasant Valley Hospital in
can Board of Pediatrics and holds at the Construction Battalion Center. Camarillo, CA, and St. John's
state licenses in Washington and Min He became board certified in ortho Regional Medical Center in Oxnard.
nesota. He has authored or co paedic surgery in 1972 and in Sep He is a fellow of the American
authored nine articles published in tember of that year, Dr. Fussell Academy of Orthopaedic Surgeons
medical literature. He is a member of resigned his regular commission and and a diplomate of the American
Alpha Omega Alpha, the American became a reservist. In addition, he Board of Orthopaedic Surgery. He is
Academy of Pediatrics, American began private practice in Oxnard, CA. also a member of the National Medical
Medical Association, American His first reserve assignment was Association, American Medical Asso
Society of Nephrology, and Associa consultant to the commanding officer, ciation, and California Medical Asso
tion of Military Surgeons of the U.S. Naval Hospital, Port Hueneme, ciation.
United States. He is past alternate CA. He served in this capacity for 3 In addition, Dr. Fussell is a life
chapter chairman and past president years and then became officer in member of the Naval Reserve Officer
of the Uniformed Services Chapter charge, 1st MARDIV MED Detach Association, Reserve Officer Associa
East of the American Academy of ment, Camp Pendleton, CA. Subse tion, Flying Physicians Association,
Pediatrics. His awards include the quently, he became commanding and U.S. Naval Institute. His military
Legion of Merit, Meritorious Service officer of NR NAYHOSP Unit Camp decorations include the Meritorious
Medal with gold star, Navy Commen- Pendleton, NR NAYMEDCL 119 Service Medal. o
4 NAVY MEDICINE
Commander Seventh Fleet
Conducts First Medical
Symposium
M edical care throughout the for Surgeons General is a very signifi 62) and in the Seventh Fleet Flagship,
world varies as much as the cant initiative. The fact that nations USS Blue Ridge (LCC-19); toured
culture, customs, and the are sending such senior medical per Naval Hospital Yokosuka and Sagami
foods it eats. For sailors and troops sonnel is indicative of the importance Army Contingency Hospital; and
deployed overseas, finding this quality they attach to it, and we certainly con received briefings on the mission of
care in unfamiliar parts of the globe cur," continued V ADM Wright. U.S. Seventh Fleet and the Navy's
can be a life or death search. Attending Seventh Fleet's Western future outlook defined in". . . From
In an effort to identify medical care Pacific Medical Symposium for Sur the Sea."
facilities in the western Pacific and to geons General were senior medical Commander in Chief Pacific Fleet
exchange medical information and officers from Indonesia, Malaysia, Surgeon, CAPT James H. Black and
expertise, Commander, U.S. Seventh Philippines, Thailand, and Japan. In Japan Maritime Self-Defense Force
Fleet recently held its first-ever addition to the opportunity to ex Surgeon General, RADM Hiromichi
Western Pacific Medical Symposium change professional information and Oiwa also attended the symposium
for Surgeons General from regional background on each nations' medical and made remarks to the multina-
nations on 6-8 April 1993. service, symposium attendees toured tiona! force surgeons general.
"It was another step in the growing shipboard medical facilities in the air CAPT M. Hollis Tanksley, Seventh
cooperation between the United States craft carrier USS Independence (CV- Fleet Surgeon, says he initiated the
and the nations of the Asia-Pacific
region. I think a Jot of goodwill came
from sharing ideas and concerns," said
VADM Tim Wright, Commander,
U.S. Seventh Fleet.
One of the greatest concerns for the
Seventh Fleet is identifying medical
facilities within its 52-million-square
mile area of responsibility which can
be accessed in a medical evacuation or
contingency situation. Although all
U.S. Navy ships have trained medical
personnel and facilities, shipboard
capabilities can only, in most cases,
stabilize patients with serious injuries
and illnesses until they can be trans
ported to modern hospitals for defini
tive treatment.
"We sometimes have to rely on the
indigenous facilities (of some coun
tries) as some of our ships transit
through, particularly the combatants
and smaller ships which don't have USS Independence's senior medical officer, CDR Dennis
extensive medical capabilities. The Deakins, shows the aircraft carrier's medical facilities to
Western Pacific Medical Symposium senior medical personnel.
May-June 1993 5
\J
f'
z
"'
::::>
~
0
0
0. ,
~
;;;:
a:
0
()
~
B
0
&~~~~~~~~~~~~~~~~~-
Surgeons General from Malaysia, Indonesia, Thailand,
Japan, and the United States gather In the operating room of
USS Blue Ridge.
conference because it was apparent to Charron, organizing and hosting a ing sailor prompt medical attention.
him, during visits to nations in the medical symposium at the U.S. Navy's Because the Seventh Fleet flagship
western Pacific with the Fleet Com forward-deployed base in Yokosuka, visited Madras, India, several months
mander, that the U.S. Navy's medical Japan, required a little more advance earlier and medical facilities within
role and responsibility in that area was planning than just compiling a sched India were explored by CAPT
not well understood. Additionally, the ule of events. Obtaining the required Tanksley during that visit, it was deter
medical capabilities of those nations country clearance for the multina mined that quality treatment was
were not well known to the U.S. Navy, tional medical officers required liaison available in the area.
explained CAPT Tanksley, and a with the Japan Maritime Self-Defense "We had to medevac that person
common ground was needed. With Force, Commander U.S. Forces ashore and because we were familiar
that goal in mind, the first Western Japan, and Commander, Naval with the nearby medical facilities, we
Pacific Medical Symposium was or Forces Japan. were able to get her to a hospital where
chestrated. "No small share of the credit goes to she underwent surgery, did very well,
"To have interoperability, you have our Japanese hosts who have been and is now fully recovered," recalled
to have a beginning point and I hope very gracious and took an active role VADM Wright.
this symposium is the first step. This in the presentations," stated V ADM Seventh Fleet's first-ever Western
gives us the opportunity to start or Wright. Pacific Medical Symposium for Sur
continue a dialogue with those nations The importance of understanding geons General has opened the door for
we interact with," said CAPT the medical capabilities in regions further discussions to understand the
Tanksley. where soldiers, sailors, airmen, and medical care facilities and practices in
CAPT Tanksley hopes that more marines operate is vital to force sub the region where the Seventh Fleet
medical symposia will be conducted in stainability and survivability. This was operates. With a solid foundation
the future to explore deeper areas of most apparent during a recent medical established, quality medical care for
the medical profession dealing with evacuation of a woman sailor aboard U.S. sailors, marines, airmen, and
equipment, infectious diseases, USS Cape Cod who suffered from an soldiers is quickly becoming avail
medevac procedures, and possibly acute appendicitis. With the ship able- wherever they operate. o
combined medical exercises. steaming toward the Persian Gulf and
-LT James E. Brooks and CDR Norris
According to Assistant Seventh the nearest land being India, quick Jones, Commander Seventh Fleet Public
Fleet Surgeon's, HMCS William decisions were required to get the ail- Affairs Office.
6 NAVY MEDICINE
Naval Medical Research and
Development Command Highlights
Bethesda, MD
• New Submarine Rescue Manual equivalent" model development by NAMRL a series of
The Naval Submarine Medical Research Laboratory irradiation tests will measure specific absorption rates
(NSMRL) provided undersea medical officers and sub (a measure of energy absorption within the human
marine crew rescue teams with a valuable resource, the body}. Reliable RFR protective suits are products that
Pressurized Submarine Rescue Manual (NSMRL have been long-awaited and anticipated by industries
Report No. 1178, 22 June 1992), to assist in rescuing that use radiofrequency technology. The principal
survivors of a disabled submarine. NSMRL scientists investigator for NAMRL will be Dr. Richard G. Olsen,
conducted extensive pulmonary oxygen toxicity and Head, Bioengineering Division. For more information
decompression research to establish the safe procedures contact CDR J.R. Beddard, MSC, NMRDC Research
outlined in the manual. Various methods of safe decom Area Manager for Fleet Occupational Health, DSN
pression from 132 fsw were explored and researchers 295-0885 or Commerical 301-295-0885.
developed decompression tables for air, nitrox, and
* * *
trimix gas mixtures. Further work on decompressing
with a trimix gas led to a 1.5 day decrease in decompres
sion time when compared to standard saturation rates. • Genetics of Motion Sickness
The manual reviews concepts of pressure, hypoxia, Motion sickness and disorientation are significant oper
hyperoxia, and atmosphere contamination. Factors ational concerns for the Navy and Marine Corps. Cur
affecting the decision of a crew to either escape to the rent studies have documented an unacceptably high
surface or await rescue are examined. Included are incidence of motion sickness in aircrew and shipboard
algorithms (decision trees) which when incorporated personnel. Studies also have recognized that, in the
with decompression procedures could be useful under a underwater environment, sensory conflicts, body fluid
variety of rescue scenarios. The information in the redistribution, and nitrogen narcosis make Navy divers
manual represents a synthesis of material from many highly susceptible to motion sickness. Researchers at
sources. The manual is intended to supplement the the Naval Health Research Center, San Diego, CA; the
Submarine Rescue Manual ATP 57 and the Search and Wayne State University School of Medicine, Detroit,
Rescue Instructions ATP IO(d), Chapter 8. For more Ml; and the University of Michigan Medical School,
information contact CDR B. Schibly, MC, NMRDC Ann Arbor, MI, are investigating a new approach to the
Research Area Manager for Submarine and Diving problem of motion sickness. They are focusing on the
Medicine, DSN 295-0879 or Commercial301-295-0879. cellular and molecular physiology of gene expression to
determine if a predisposition to motion sickness is an
* * *
inherited trait. Genetic differences in the complement of
receptors on autonomic neurons of the central and
• Radiofrequency Radiation peripheral nervous system could explain the differences
Protective Suits in an individual's susceptibility to motion sickness. Pre
The Naval Aerospace Medical Research Laboratory liminary findings suggest that a genetic polymorphism
(NAMRL), Pensacola, FL, has entered into a Coopera of the alpha-2 adrenergic receptor (encoded by chromo
tive Research and Development Agreement (CRDA) some 10) is associated with development of motion
with Maxwell Safety Products, Ltd., of Smithtown, sickness. This approach can also be used to understand
NY. This action is taken under the authority of the the variations in human responses to other physical
Federal Technology transfer Act of 20 Oct 1986, as stresses in the operational environment, such as a pre
amended. Under CRDA, Maxwell and the Bioengi disposition to heatstroke or gravity-induced loss of
neering Division of NAMRL will work together to consciousness. For more information contact Ms.
perform highly specialized tests regarding the effective Christine Eisemann, NMRDC Associate Director for
ness of NAPTEXTM radiofrequency radiation (RFR) Research Management, DSN 295-0882 or Commercial
protective suits. Using the uniquely valuable "human- 301-295-0882.
May-June 1993 7
Forum
The Cost of
Avoiding Risk
CDR James A. Brown, MC, USN
isk is inherent to the clinical practice of med quietly translated to not surgically intervening with
R
icine. Every surgical intervention, prescribed out the promise of a predictably safe outcome. Fear
medication, and many diagnostic studies en stalked the corridors of naval hospitals, shadowed by
tail potential hazards. The possibility of errors of a perceived need for perfection, which led to indeci
omission and commission exists whenever patients siveness and professional stagnation. Consequently,
are evaluated and treated, even when the caregiver is complicated cases were sent elsewhere at greater
attentive, highly trained, and conscientious. Physi expense to the patient and taxpayer, often for less
cians constantly weigh the risk/ benefit ratio in liter than or, at best, equal quality of care. Meanwhile,
ally hundreds of daily decisions. The same is true for Navy surgeons' skills atrophied and many qualified
those in leadership positions, where numerous com surgeons left active service to practice the full realm
peting interests must be considered in every manage of their specialty in the civilian sector where they were
ment decision. Effectiveness is dependent upon good most welcome.
judgment and decisiveness. Although risks must be Another costly attempt to eliminate risk is the
minimized, they cannot be completely eliminated. To implementation of restrictive policies after a single
demand such is unrealistic. bad outcome. Certainly every complication should be
"Cast out fear!" is one of the basic tenants of total carefully scrutinized for lessons learned, and policies
quality leadership (TQL), today's management phi to minimize risk should be developed. But extreme
losophy endorsed by Navy leadership in both line and cases rarely make good policies, and the zeal to pre
medical communities. It means to sweep away the vent recurrent complications often results in limita
fear of failure. Yet, this concept requires some clarifi tions upon the entire community in which the
cation. The fear of failure is not necessarily a bad complication occurred. Nonphysician health care
thing; it shields one from the capricious pursuit of providers are particularly vulnerable to such restric
foolish or dangerous acts, and motivates when irre tions. Consequently, policies such as the following
sponsibility or sloth beckon. But the fear from which might be put into effect: independent duty hospital
we need to be free is that which stifles creativity and corpsmen are not allowed to see dependents, physi
moral courage simply because risk is involved. cian assistants are forbidden to order a particular
In the mid-1980's well-trained Navy surgeons were medication, nurse midwives are prohibited from
encouraged to refer many patients who needed high ordering obstetrical ultrasounds without an obstetri
risk operations to CHAMPUS (Civilian Health and cian's approval, or certified registered nurse anesthe
Medical Program of the Uniformed Services) be tists are denied the opportunity to perform pediatric
cause to incur a bad outcome, regardless of the ap anesthesia. While designed to reduce risk, such poli
propriateness of the care rendered, was to place one's cies only reduce availability of patient care and in
professional future in jeopardy. Or, more often, hibit professional satisfaction. In spite of adequate
though not usually spoken, it was to jeopardize the training, a provider may be prohibited from practic
commanding officer's professional future, which ing safely those skills that were arduously obtained.
8 NAVY MEDICINE