When military surgeon Dustin Zierold arrived at the Kirkuk Air Base in Northern Iraq and got a look at the sick bay, he knew he had a challenge on his hands.

"The way they managed trauma was disorganized," recalls Zierold, an Air Force major who was stationed at Kirkuk for six months in 2005. "A lot of the technicians and nurses didn't have roles, and the doctors were doing everything."

Zierold knew a better way. A medical resident at the David Grant Medical Center at California's Travis Air Force Base from 1997 to 2003, he had done his trauma training at UC Davis Medical Center in Sacramento. There, he had learned the importance of organization when faced with a patient who has stopped breathing or is in danger of bleeding to death.

"UC Davis is very good at organizing trauma resuscitation," said Zierold, referring to the process of getting a patient stabilized so that they survive long enough to be operated on. "It's a global team effort where everybody knows what they're supposed to do and how to do it."

'The Davis system'

Zierold quickly went about implementing what people in Kirkuk were soon calling "the Davis system."

"I gave everyone roles, and the time between when a patient came in the door and when they were in the operating room went down significantly," Zierold said.

The greater efficiency drew the attention of the Air Force's Forward Surgeon General at the time, who sent Zierold an e-mail praising him and the rest of the Kirkuk medical crew.

"I'm proud people took to the Davis system," said Zierold, who is pursuing additional training through a trauma surgery fellowship at UC Davis.

Ready for combat surgery

When surgeon Jay Grove of the Naval Medical Center San Diego was tending to wounded soldiers overseas, he also applied lessons he had learned at UC Davis, where he was a resident in general surgery from 1994 to 2000.

Deployed twice — in late 2001 during the conflict in Afghanistan and in 2004, when there was intense fighting in Falluja, Iraq — Grove was treating injuries of a severity he had never imagined. Nonetheless, he found that UC Davis had prepared him surprisingly well for the intensity of combat surgery.

"The severity of injuries in combat is multisystem. Nothing stateside prepares you for that. But the high volume (of trauma patients) at UC Davis was similar and that helped a lot," said Grove, a commander in the Navy.

The Naval Medical Center and Travis Air Force Base have been sending their resident surgeons to UC Davis for trauma training for several years now.

UC Davis assistant professor Lynette Scherer, program director for the surgical residency-training program at UC Davis, said that, at any one time, a dozen or more residents from the Navy Medical Center and Travis AFB are receiving trauma training through the UC Davis Medical Center.

About 85 percent of the people rushed to the emergency room at the medical center have "blunt" type of injuries – meaning they were hurt in car wrecks, falls, diving accidents or some other type of mishap, Scherer said. The remaining 15 percent have "penetrating" wounds, "which means they were either stabbed or shot."

Scherer acknowledged that such injuries differ profoundly from the often-devastating wounds inflicted on soldiers from machine gun fire or shrapnel from high explosives. In that sense, there is no way to prepare military surgeons for the types of wounds they'll have to deal with in a combat situation.

However, Scherer said, "What's more important than the type of injuries they see here is that we teach them ways to think.

"You have to be well-trained in broad-based general surgery and be comfortable operating just about everywhere in the body, and we provide that training," Scherer said. "But to be successful as a trauma surgeon you also have to be willing to make decisions with limited information because there's often simply not enough time to fully research all the options," she continues. "That's where the thinking comes in."

Military surgeon Jon Perlstein, a former David Grant resident from Travis AFB, who, like Zierold, received his trauma training through UC Davis, puts it this way: "You learn the basics (at UC Davis), how to initially evaluate someone, how to resuscitate them, how to do the operations that you need to know how to do on trauma patients. Then, when you get into a combat situation, you apply those same basic principles to wartime trauma patients.

"The wounds are different," he said, "but the principles are the same."

A Beneficial Partnership

It sometimes seems that everything changed after 9-11. Take the David Grant Air Force Medical Center at Travis Air Force Base in Fairfield.

Before the terrorist attacks, and the invasions of Afghanistan and Iraq that they spawned, the military medical center's surgical residents received three to four months of emergency room training over the five years of their residency. Now, with young surgeons facing the prospect of having to care for wounded soldiers once their residency is up, they are receiving up to 12 months of such training.

"We wanted to make sure our residents had an appropriate volume of training in trauma critical care," said Perlstein, chief of trauma and critical care at Travis' medical center."We wanted to make it more intense."

Because the center's resources — both human and otherwise — have been shifted overseas, the increased emphasis on trauma training would not have been possible had it not been for something that happened in the summer of 2005: The merging of David Grant's entire residency program with the UC Davis Medical Center residency program.

Perlstein and Scherer were the driving forces behind the merger. Scherer said 13 Travis residents are currently rotating through UC Davis Medical Center and other hospitals in the Sacramento area.

Kevin Easthouse, a freelance writer, wrote this story for the spring 2007 issue of UC Davis Medicine magazine.