What was your job?

Dr. Danielson was a 61J- general surgeon with a military occupation specialty. He was with a Forward Surgical Team where each unit was sent out with a variety of physicians and nurses with different jobs to carry out different duties. Dr. Danielson's sub-specialty in pediatrics was not taken into consideration as there was no need for pediatric surgery in the Army. 

What do you know about the reserve side of the military?

70% of military medical professions came from the Reserves while the other 30% came from Active duty. The Reserves were mainly combat operations while active was peacetime primary care (sometimes sent to civilian hospitals) but does support combat training exercises and more military focused education.

Peacetime vs. Wartime?

Wartime causes a high volume of trauma with surgery, anesthesia and critical care, as well as the expansion of military medical facilities overseas. During peacetime, primary care and basic subspecialties for military and their family members. Multiple bases overseas and most likely a physician will be sent to a civilian hospital. 
Trauma on the Field?

Dr. Danielson said the military medical force's prime goal was to get the wounded during the Golden Hour of Trauma. This is the hour of the most deaths after injury. The goal is to get more of the wounded during the Golden Hour before they die to a physician to be treated and increase the soldier's survival. 

How does the military get soldiers to hospitals?

Before the Gulf War, the wounded in enemy territory made rescue teams have to go to get the wounded and bring them back which was too long and lots died on the way to the hospital. During the Gulf War, Forward Surgical Teams were made to allow surgeons to perform temporary lifesaving operations and then send the patient to hospitals for surgical treatment. Forward Surgical Team carry out "Damage Control Surgery". Afghanistan had no roads and had to send their doctors out and if situations became dire, already formed surgical teams had to split up and some were put with Special Forces and named GHOST (Golden Hour Surgical Teams). GHOST operated from out of their backpacks in unoccupied buildings. They could only perform 4-5 surgeries before they ran out of supplies. 

Was there a system followed for treatment?

The echelon system was followed for the treatment of the wounded. Level 1 is the immediate care of the patient with combat lifesavers and medics trying to stop the bleeding while in hostile territory. Level 2 is the Forward Surgical Teams that perform lifesaving surgery and sometimes receive enemy fire. Level 3 is the Combat Support Hospital where there are operating rooms and intensive car units to perform more extensive surgery than what was operated by the Surgical Teams. Level 4 is the military medical centers where wounded soldiers are sent to recover like Brooke Army Medical Center, or the nearest one by. 

Were you ever in a hostile situation?

Dr. Danielson faced indirect fire where gunfire and mortars were aimed in the general area of the forward surgical team and in base. Sometime he received direct fire in helicopters. 

Were there any rules you had to follow as a physician in the military?

The Medical Rules of Engagement were a big deal in the military as it made physicians treat all injured. This included enemies, civilians, and any casualties from the war. This was a rule because more civilians are killed in war than soldiers. 

Differences between Civilian Medicine and Military Medicine?

The principles of operating were the same, but war injuries were more variety and complex. High velocity weapons are used to shoot and landmines and IEDs used to blow up. When switching out Forward Surgical Teams, Dr. Danielson recounted that when on the plane the physicians would brief each other what was going on for the next surgeons to be prepared to go downrange. the previous physicians would recall what the next surgeons would most likely see and brush up on how to operate that wound, an example would be IED wounds. Operations for the military depended on the war tempo. Unlike in the civilian world where one patient comes in at a time and you see few major traumas in a day, military medical surgeons would get a ton of patients at once. It could be enemies, American soldiers, or civilians. If the Forward Surgical Teams needed more personnel or supplies because they were out, the teams would have to go dark until resupplied and able to operate to go back online and able to take patients. 

Dr. Danielson's Experience:

Dr. Danielson was in Forward Surgical Teams but he started with the armor unit, moved to the airborne unit, and finally to the Special Forces unit with the Green Berets. As a reservist he only deployed for 3-4 months at a time instead of staying in the desert for long periods of time. This allows other physicians as well as Dr. Danielson to maintain their civilian jobs. Dr Danielson highly suggests the military and reflects positively on his experiences as he saw and was able to do once in a lifetime things, such as being able to operate on blown up victims, operate in a tent, experience explosions/gunfire, fly in the air, boats, but most of all he earned the respect of his fellow military personnel. He had lots of friends in the Special Forces where they would hang out firing machine guns because as the surgeon he got privileges other officers did not. When relations with the Afghan army were tense and no one trusted them, whenever Dr. Danielson went jogging a Special forces soldier would jog with him to protect their surgeon, this went as far as having a buddy to watch his back in the shower and even the latrine! Dr. Danielson had the VIP treatment and everyone thought what he did was cool, but Dr. Danielson would admire what a sniper did but they don't think what they do is cool, it's normal for them. 

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Look to see slides below created by Dr. Danielson and real images from his time in Iraq!