Military playbook guides stateside lives of Scranton-bred trauma surgeons
By Sandra Snyder / For The Scranton Journal, Fall 2016
Call them battlefield breakthroughs.
An active war zone might not be the most likely place for medical professionals to launch a treatment revolution, but credit life-or-death decisions made under extreme pressure for a much-buzzed-about future on the home front.
Make that back to the future.
That’s how distinguished military trauma surgeon Donald Jenkins describes some landscape-altering discoveries he and fellow combat medics have made in Iraq and Afghanistan that illustrate how often so much that is old becomes new again.
In a generation-uniting twist, what’s new again also happens to link a mentor in Jenkins, ’84, to a mentee in trauma surgeon Daniel Grabo, ’98.
Age represents about the only significant difference between the two friends, who grew up in Luzerne County, a region that, Grabo notes, regularly breeds people who love their country, families and faith above all else and no doubt launched them both down military paths. Their deep love for the University also links the two in a special way, given they share similar reflections on how their Jesuit educations have informed their work.
For Jenkins, the University provided a “fascinating learning environment,” especially considering he lived in a former YMCA that housed freshmen alongside “fantastic graduating seniors.”
“You learned philosophy and religion in the hallways at night,” he said. “I was always encouraged to think and to reason.”
Grabo shared similar sentiments.
“It’s got to come down to cura personalis for me in all I do,” he said.
That Catholic-Jesuit concept of caring for the whole person hits home when he treats potential enemy combatants, Grabo said. Treating friends and foes alike, out of respect for the individual person, he said, may not be easy but is a “no-matter-what” requirement, as important on the battlefields as in civilian life.
For these two doctors, those two distinct worlds have collided in a powerful, positive way that is revolutionizing modern medicine.
Meet the mentor
In 1998, Jenkins first went to San Antonio, Texas, for surgical training. The decade he spent there saw a post-9/11 war begin on two fronts, and Jenkins, who has since returned to the Lone Star State to help lead the Military Health Institute at the University of Texas Health Science Center at San Antonio, eventually deployed to Oman, on the Arabian Peninsula, where he set up the first surgical hospital in 2001. Later, he served in Iraq as chief surgeon for the Air Force theater hospital before moving on to Afghanistan.
The trajectory married a traditional medical past to a “mind-blowing” future and left this surgeon with one overarching thought: “We better have learned something from this war.”
One major eye-opener came in Oman while Jenkins was treating severely injured soldiers who needed blood transfusions. Such patients ordinarily would receive processed donor blood, made up of plasma, platelet and red-blood-cell parts.
“But when I’m on a desert island in Oman,” he said, “I have a fridge with 30 bags of blood. The only other blood products are walking around wearing uniforms with blood pumping through their veins.”
And badly needed were platelets, the key blood-circulating cells that clot to stop bleeding. “The only way we could get platelets,” Jenkins said, “was to draw them from a donor on the spot.”
It was a reactionary method born of necessity, but it delivered shocking results. Trauma victims given two units of whole blood, as opposed to the typical 12 of processed blood, increasingly saw their bleeding stop. Casualties were dramatically lessened.
“It was almost magical,” Jenkins said. “We rekindled this 8-track tape and played some really good music on it.”
Thus was born a team of pioneers into a largely discarded medical past. Given the transition to component therapy began in the 1970s and had become standard practice by 1990, Jenkins and crew had no experience using whole blood in emergencies and could hardly wait to take their findings home.
“Old-school” teachers would need no convincing, he said; contemporary skeptics were a different story.
“They didn’t want to believe there was a better way to do things. If you’ve never heard the music, you wouldn’t know.”
The next old-new frontier?
Tourniquets are another example of old music replaying. The death of Army Corporal Jamie Smith during a 1993 firefight in Somalia – dramatized in the movie “Blackhawk Down” – became a turning point for their re-examination.
“In Vietnam,” Jenkins said, “More than 7,000 of our fellow citizens bled to death in what could have been stopped by a tourniquet.”
He and his crew have recorded many positive outcomes using tourniquets, which are now widely adopted by law enforcement. A 90 percent post-hemorrhage death rate has become a 90 percent survival rate, he said. That means more medical leaders are taking the long view.
Count Grabo among them.
Meet the mentee
A trauma surgeon at the LA County Navy Trauma Training Center who also spent 10 months as chief of trauma in Kandahar, Afghanistan, Grabo is a big believer in Jenkins, who is a key reason Grabo and other younger military surgeons “were already using tourniquets, already using whole blood,” he said.
Jenkins laid the groundwork, and Grabo proudly carries the torch.
“I feel very strongly called to making sure all the hard work Dr. Jenkins did does not get lost,” he said. “After Vietnam, they learned all this stuff but put it on a shelf. So when the Iraq war started, we didn’t know how to do any of it.”
“I’m the guy who keeps this stuff in the forefront, who makes sure that we continue to talk about what he learned, to teach it and to refine it.”
It’s a heady mission for the father of two young sons – and husband of fellow ’98 alum Janet Ramos.
“Ten to 20 years from now, when our children go off to fight the next great war, we hope, there won’t be mass casualties,” he said.
Grabo has implemented Jenkins’ work to great success, often through an evolving concept called damage-control surgery. Its time-saving elements relate to a military system Jenkins established.
In Iraq, Jenkins helped set up a coordinated – and boundary-breaking – trauma system among the Army, Navy and Air Force. Under the old order, a Marine medic would never take an injured Marine to an Army hospital because home base was king, even if it meant “patients were going 90 miles in the wrong direction to get health care that was 20 miles in the other direction,” Jenkins said.
His work to eliminate the blind party loyalty saved many lives.
Time management was equally critical for Grabo, who directed efforts to save the lives of Romanian soldiers injured by an improvised explosive device in Afghanistan in 2014. Every new-old tool from Dr. Jenkins’ kit was used, including tourniquets and fresh whole-blood transfusions, he said.
The humble recipient of a Romanian Medal of Honor for that work continues to use those tools at home in California and sees the difference tourniquets, for one thing, make on trauma patients from the streets of Los Angeles. In such situations, Grabo hears the echoes of cura personalis most strongly.
Caring for drunken drivers, gang members and the like at home can be as difficult as caring for military enemies.
Inner-city youths who could be war heroes “but, due to life situations and choices are in a turf battle in West Philly or East LA, find themselves all shot up and clinging to life, as opposed to the soldier serving his or her country in combat,” he said. “Same injury, same young person, different circumstances. One’s a hero; one’s a thug. That’s where caring for the whole person comes into play.”
The life-saving tourniquet makes no judgments, and neither does Grabo.
As for those tourniquets, “Dr. Jenkins was one of the major leaders on that front,” he said. “I am honored to know him and to look to him as a mentor and a leader.”
Other believers in that mentor and leader are rapidly multiplying, especially when it comes to use of fresh whole blood for transfusions.
“They’ve dusted off the old manuals, they know the science, and they see that this clearly is the way to go,” Jenkins said. “This is the plan for the next decade.”