Today we have Dr. Frank Butler, a retired Navy Undersea Medical Officer and an ophthalmologist who served as a Navy SEAL platoon commander prior to attending medical school. Just a few weeks after our interview, President Joe Biden awarded Frank a Presidential Citizens Medal during a White House ceremony. The medal is one of the highest honors a civilian can receive and recognized Frank’s many contributions to civilian and military trauma care. Frank is credited with founding Tactical Combat Causality Care, also known as TC Three, which has transformed battlefield medical care and saved thousands of lives.  TCCC is now used throughout the U.S. military and much of the world. In today’s interview, we talk to Frank about his recent book, “Tell Them Yourself: It’s Not Your Day to Die,” which describes the challenges and improvements TCCC has experienced over the past three decades. Frank spent most of his 26-year career in Navy Medicine supporting the Special Operations community. He served a five-year stint as a Diving Medical Research officer at the Navy Experimental Diving Unit in Panama City, Fla., where he helped develop many of the diving techniques and procedures used by Navy SEALs today. Show notes: [00:03:31] Dawn opens the interview asking Frank what it was like growing up in Savannah, Ga., in the 50s and 60s. [00:04:40] Dawn asks Frank about his father, who was an industrial engineer, and who became director of urban housing in Savannah during a time when the city was developing public housing. [00:05:47] Ken asks Frank if it’s true that most of his family went into the medical field. [00:06:33] Ken asks Frank about his experience attending a Navy SEALs demonstration during his sophomore year of college. [00:08:09] Dawn asks Frank about his experience going through Navy SEAL training, particularly the Basic Underwater Demolition SEALs School. [00:09:29] Dawn asks if it’s true that five people in Frank’s family have become Navy SEALs. [00:10:08] Ken explains that after Frank left the SEALs in 1975, he had to figure out what to do next with his life. Frank talks about what led to his decision to go to medical school. [00:11:14] Ken asks Frank how he ended up at Jacksonville Naval Hospital to do an internship in family medicine. [00:11:46] Dawn explains that after Frank’s internship, he was assigned to the Navy Experimental Dive Unit. She asks him to talk about this experience. [00:12:25] Frank talks about some of the projects he worked on during this period. [00:14:43] Ken asks Frank how he decided on ophthalmology as his surgical specialization. [00:15:47] Dawn asks Frank what his experience as a resident at Bethesda Naval Hospital was like. [00:16:52] Dawn explains that after Frank completed his residency, he was assigned to Pensacola Naval Hospital. Dawn asks Frank how he ended up becoming the biomedical research director for the Navy SEALs. [00:18:48] Ken mentions that Frank worked on several important projects as research director for the SEALs, including battlefield trauma care, a tactical athlete program, improved treatment of decompression sickness, and the Navy SEAL nutrition guide. Ken begins by asking Frank to talk about his work on the tactical athlete program. [00:20:33] Dawn explains that another one of Frank’s projects as research director for the SEALs was the design of the Navy special warfare decompression computer. Dawn asks Frank to explain what a decompression computer does for a diver. [00:21:35] Dawn asks Frank to elaborate on the process of designing this decompression computer and the algorithm as well as the process of getting it approved for the Navy. [00:23:31] Ken asks Frank to talk about a program he worked on to promote refractive surgery. While this program was initially designed to improve combat vision for SEALs, the program has expanded to all active-duty service members, including aviators. [00:26:26] Dawn explains that Tactical Combat Casualty Care (TCCC) has been an incredible transformation in battlefield trauma care, with literature indicating that the protocols have saved thousands of lives. TCCC is now used throughout the US military and much of the rest of the world. Dawn goes on to ask about Frank’s book “Tell Them Yourself: It’s Not Your Day to Die,” which documents how TCCC has evolved over the three decades since it was first introduced, as well as the trials and tribulations the program endured. [00:28:04] Ken asks Frank to elaborate on the assertion in his book that, save for the use of helicopters in place of horse drawn carriages, pre-hospital battle trauma care was essentially the same as it was during the Civil War prior to TCCC. [00:30:05] Following up on the discussion of tourniquets, Ken mentions his memory of the outright ban of tourniquets in the Navy during his time in the service. [00:31:07] Ken asks Frank how he was able to take his realization that something needed to be done about battlefield trauma care and turn that into a Navy project. [00:32:58] Dawn asks Frank how, as program manager, he approached the conduct of the TCCC research project. [00:35:03] Dawn asks Frank why, even though the TCCC paper came out in 1996, TCCC was still not widely used in the U.S. military at the beginning of the war in Afghanistan. [00:36:14] Frank recalls the first unit to implement TCCC. [00:37:10] Dawn asks what other units followed as early adopters. [00:39:26] Dawn asks Frank how he helped implement TCCC throughout the special operations community. [00:43:11] Ken mentions that some units did particularly well in adopting TCCC and others struggled. Given this, Ken asks if the operational leader’s priority regarding TCCC impacts the implementation of it in the unit. [00:44:31] Ken asks Frank to speak on the adoption and implementation of TCCC in the rest of the military outside of the special operations communities. [00:47:32] Dawn asks Frank how he updated his recommendations for TCCC as new evidence from the war came in. [00:50:31] Ken asks Frank, other than tourniquets, what medical advancements to battlefield trauma care did TCCC usher in. [00:54:31] Ken mentions that while the TCCC innovation of carrying whole blood and performing pre-hospital blood transfusions has saved countless lives, the innovation still is not ubiquitous in the military or for civilian first responders. Ken asks Frank to talk about the complexities of a ubiquitous adoption of this practice, and what can be done to push it forward. [01:00:06] Dawn asks, in addition to tourniquets and whole blood, what are some of the TCCC innovations that are now being widely used in the civilian world. [01:03:19] Ken pivots to a discussion about ketamine. Ken notes that the U.S. military, as well as the militaries in other countries, have used ketamine as an anesthetic, especially since the war in Afghanistan.  Ken notes that the civilian world has been slow to adopt ketamine as a drug for pain relief. Frank gives his thoughts broadly on the use of ketamine as an anesthetic and his belief that it will become more common in civilian EMS units over the next five to 10 years. [01:07:34] For listeners who are interested in learning more about the medical uses of ketamine, Ken recommends Episode 165 with Dr. Jonathan Edwards. [01:09:03] Ken and Frank have a tangential discussion about ketamine as a treatment for suicidal ideation and depression. [01:11:11] Ken asks Frank, given that the TCCC protocols have been widely adopted in every area of the military, what is the basic level of competence in TCCC that every service member should have. [01:14:26] Ken asks Frank to speak to the situation in Ukraine with respect to combat casualty care. [01:17:23] Looping back to Frank’s book “Tell Them Yourself: It’s Not Your Day to Die,” Dawn asks why Frank took up the task of writing it. [01:21:20] Dawn asks Frank about the significance of the book’s title. [01:22:04] Dawn mentions that many people speak about how compelling the first chapter of Frank’s book is. Dawn asks Frank to talk about the writing process for this chapter. [01:25:05] Dawn mentions that one of Frank’s co-authors for his book is Dr. Kevin O’Connor, who is currently the physician to the president. Given that Frank was in the Navy and Dr. O’Connor was in the Army, Dawn asks Frank how the two of them met. [01:26:42] As we near the end of our interview, Ken asks Frank if he has any final insights to share about battlefield trauma care. [01:28:11] Ken comments on the importance of Frank’s book as a marker, so we don’t forget hard won lessons during times of peace. [01:29:47] Dawn closes our interview with Frank by mentioning that he is an avid diver and asks him what his favorite spot to dive is. Links: Frank Butler Presidential Citizens Medal Frank Butler IHMC lecture and bio Learn more about IHMC STEM-Talk homepage Ken Ford bio Ken Ford Wikipedia page Dawn Kernagis bio  

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