WarDocs - The Military Medicine Podcast

   Four years after his death, COL (Ret) Anthony Johnson, MD, is still teaching. WarDocs is releasing again a 2021 interview recorded by his colleagues Gary Legault, MD, and Grant Justin while Johnson was living with stage 4 cancer, and his voice carries the same clarity, humor, and conviction that defined three decades in Army medicine. A cornea and refractive surgeon, Tony traces a path into medicine that began with a chance conversation during a third-year OB rotation and grew into a career spent perfecting the art of suturing. He credits mentors Doyle Stolte and George Waring for the technique he ultimately published in a textbook chapter, a knot-splicing method he adapted from a sailing manual called Ashley's Book of Knots, and he recalls the astonished phone call from cornea specialist Marilyn Mackiewicz after her own fellow used the technique successfully for the first time.      In 2003, Johnson deployed to Operation Iraqi Freedom as the only operating ophthalmologist for the 47th and 28th Combat Support Hospitals, performing more than 400 surgical procedures in theater, many of them alone, in an open-air combat support hospital, refining ruptured-globe repairs he would spend the rest of his career teaching to residents. He describes the chaos of the first Scud missile alarm, sleeping in a converted morgue for lack of space, and the 36 straight hours he spent operating after the bombing of United Nations headquarters in Baghdad sent eight ruptured globes into his care at once. A decade later, at a humanitarian mission in Burkina Faso, he ran into one of those patients entirely by chance, still able to see out of the eye he had rebuilt. Tony returned to Brooke Army Medical Center as a residency director and Chief of Ophthalmology, founded the Army's first Eye Trauma and Vision Restoration Research Unit, and spent his final working years teaching residents he came to think of as his own children. He reflects candidly here on marriage, faith, and fatherhood, and on receiving a terminal diagnosis with gratitude rather than regret. WarDocs is bringing this conversation back because the surgeons Johnson trained are still practicing today, and still teaching what he taught them. That is what a legacy actually looks like. Chapters (00:00-07:43) Becoming a Physician and Choosing Ophthalmology (07:43-16:41) A Mentor's Suturing Technique and the Road to Deployment (16:41-27:49) Deploying to Iraq: Chaos, a Vestibule Clinic, and the First Cases (27:49-32:58) The Only Ophthalmologist in Theater (32:58-44:15) The UN Bombing, 36 Hours of Surgery, and a Reunion Years Later (44:15-58:55) Legacy: Teaching, Fatherhood, Faith, and a Life Without Regret Chapter Summaries (00:00-07:43) Becoming a Physician and Choosing Ophthalmology Tony describes a childhood pull toward medicine, choosing West Point despite its two-percent medical school quota, and stumbling into ophthalmology during a third-year OB rotation when an ophthalmology technician talked up the specialty for hours. He credits the camaraderie of "cooperate and graduate" at West Point for shaping how he later led and mentored. (07:43-16:41) A Mentor's Suturing Technique and the Road to Deployment During his cornea fellowship, he learns a suturing philosophy built on speed and efficiency from his mentors, then invents a technique for splicing a broken running suture, borrowed from a sailing knots manual, that he publishes and that a leading cornea specialist adopts after seeing it work. (16:41-27:49) Deploying to Iraq: Chaos, a Vestibule Clinic, and the First Cases Tony recounts arriving in Kuwait as part of an eight-person eye surgical team, the confusion of the first scud missile alarm, and being reassigned solo to Iraq to support the 47th and 28th Combat Support Hospitals with the only ophthalmology equipment in theater. (27:49-32:58) The Only Ophthalmologist in Theater By the fall of 2003, attrition leaves him as the sole surviving member of his surgical team, and he becomes the only ophthalmologist treating eye trauma in the entire Iraq theater of operations for roughly six months. (32:58-44:15) The UN Bombing, 36 Hours of Surgery, and a Reunion Years Later He describes performing ruptured-globe surgery for 36 straight hours after the United Nations headquarters bombing in Baghdad, then, years later, unexpectedly reuniting with two of those patients an ocean apart, both still able to see. (44:15-58:55) Legacy: Teaching, Fatherhood, Faith, and a Life Without Regret He reflects on his return to Brooke Army Medical Center, building a teaching career and the Army's first Eye Trauma and Vision Restoration Research Unit, and closes with reflections on marriage, fatherhood, faith, and facing a terminal cancer diagnosis without regret. Take Home Messages Shared Struggle Builds Lasting Bonds: A demanding institution's culture of "cooperate and graduate" can turn competition into lifelong camaraderie. Helping classmates succeed, rather than outcompeting them, built a network of trust that paid off for decades afterward. The Right Conversation at the Right Moment Can Redirect a Career: A specialty that never appeared on a young clinician's radar can become a life's calling after a single unplanned conversation. Staying open during rotations, even ones that seem to have nothing to teach, leaves room for that moment to happen. Constraint Forces Mastery: Operating alone, with limited equipment, in an austere combat environment forced a level of technical self-sufficiency that no routine practice would have required. Real skill often gets built under exactly the conditions nobody would choose. A Career's Impact Outlives the Moment It Happened: Patients treated in the chaos of a mass-casualty event can resurface years and continents later, their outcomes intact. The full measure of a surgeon's work is often not visible until long after the operating room lights go off. Facing Mortality Can Sharpen Gratitude Instead of Regret: A grim prognosis did not produce bitterness but a clear-eyed inventory of a life spent on family, faith, and service. Looking back with no desire to change anything is itself a kind of victory. Episode Keywords Cornea Surgeon, Refractive Surgery, Brooke Army Medical Center, Ophthalmology Residency, Operation Iraqi Freedom, Combat Support Hospital, Ruptured Globe Repair, Military Medicine, West Point, Uniformed Services University, Eye Trauma Research, Suturing Technique, Humanitarian Mission, Burkina Faso, UN Bombing Baghdad, Army Colonel, Military Ophthalmologist, Mentorship in Medicine, Faith and Fatherhood, Legacy in Medicine #WarDocs, #MilitaryMedicine, #MilMed, #Ophthalmology, #CorneaSurgeon, #IraqWarVeteran, #ArmyMedicine, #MedEd Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the "What We Are For" Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

What can a small nation with a fierce warrior tradition teach the world's largest militaries about keeping wounded soldiers alive? Brig. Gen. Petter Iversen, M.D., Surgeon General of the Norwegian Armed Forces and Chair of the NATO Committee of the Chiefs of Military Medical Services, sat down with WarDocs at the Defense Strategies Institute Operational Medicine Symposium in San Antonio to answer it. An orthopedic trauma surgeon with deployments to Afghanistan, Chad, and anti-piracy operations in the Indian Ocean, Brig. Gen. Iversen brings a frontline surgeon's view of war surgery and the future of Allied military medicine. His central concern is capacity, not competence. Twenty-five years of expeditionary warfare gave NATO air supremacy, controlled evacuation routes, and constrained battlespace. Large-scale combat operations will offer none of that. Treatment and evacuation will happen close to a long, contested front line, and Brig. Gen. Iversen states plainly that the Alliance does not have enough military medical troops to sustain that fight. That capacity problem reframes what military medicine is for. Modern forces are small and highly specialized, with no bench of spare soldiers. Deployment itself costs health — people get sick, exhausted, and mentally worn. Brig. Gen. Iversen cites the fifteen percent of Ukrainian recruits trained in Europe who return to the front with mental health problems, and the two-thirds of them who can go back to duty when treatment is available nearby. Return to duty, in his framing, is not a personnel metric. It is combat power. He is equally direct about training. Norway has required a war surgery course of every general surgery trainee for more than fifty years, precisely because a specialized hospital system does not produce clinicians who are comfortable with an open belly and limited consumables. Resilience, he argues, is generalist competence — and the curriculum debate now underway in Norway is a debate every Allied medical service is having. Brig. Gen. Iversen also walks through the Norwegian aeromedical evacuation enterprise built with Scandinavian Airlines: a civil airliner reconfigured into a medical evacuation platform in roughly twenty hours, flying near-weekly missions since 2022, more than thirty-five hundred patients moved out of Ukraine, and no fatal outcomes en route. The hard part, he says, was never the aircrew. It was patient selection, cross-border communication, and knowing where a nation's wounded ended up. He closes with a message aimed squarely at American listeners: prepare mentally for something much bigger than you have imagined, on more than one front at once. Chapters (01:08-05:25) The Capacity Gap in Large-Scale Combat Operations (05:25-09:12) Return to Duty as Combat Power (09:12-13:35) Resilience, Generalist Surgery, and the Technology Trap (13:35-18:15) Flying the Wounded Out of Ukraine (18:15-22:08) The Arctic, and a Direct Message to America Chapter Summaries (01:08-05:25) The Capacity Gap in Large-Scale Combat Operations Brig. Gen. Iversen names insufficient military medical troop strength as his single greatest concern for a large-scale fight. He contrasts twenty-five years of expeditionary warfare — air supremacy, controlled evacuation routes, constrained geography — with a long contested front line where treatment and evacuation must happen forward and under threat. (05:25-09:12) Return to Duty as Combat Power Modern forces are small and specialized, with no redundancy, so every clinician who returns a soldier to the line adds combat power. He cites the fifteen percent of Ukrainian recruits trained in Europe who develop mental health problems at the front, and the two-thirds who can return with treatment delivered nearby. (09:12-13:35) Resilience, Generalist Surgery, and the Technology Trap Norway has required a war surgery course of every general surgery trainee for more than fifty years. Brig. Gen. Iversen argues that resilience is generalist competence, and that surgeons trained inside highly specialized systems are measurably less comfortable with open surgery than a decade or two ago. (13:35-18:15) Flying the Wounded Out of Ukraine A partnership with Scandinavian Airlines, built after the tsunami, converts a civil airliner into a medical evacuation platform in about twenty hours. More than thirty-five hundred patients have moved out of Ukraine on near-weekly missions since 2022 with no fatal outcomes en route. The hard part is patient selection and cross-border coordination, not the flying. (18:15-22:08) The Arctic, and a Direct Message to America Cold changes the math on combat casualty care: the protocols are known, but the resource cost and training burden rise sharply, and the same wound is more likely to be fatal. Brig. Gen. Iversen closes by telling American listeners to prepare mentally for a conflict far larger than they have imagined, potentially in Europe and the Pacific at once. Take Home Messages Capacity is the binding constraint, not clinical skill: Allied military medicine knows how to treat combat casualties. What it lacks is enough medical troops to do it along a long, contested front line without air supremacy. Treating this as a force-structure problem rather than a training problem is the first honest step. Return to duty is combat power: Specialized forces carry no bench. Every soldier treated forward and returned to the line is worth more than a replacement who does not exist. Primary care and mental health care delivered near the front are operational capabilities, not welfare services. Mental health treatment near the front works: Fifteen percent of Ukrainian recruits trained in Europe return to the front with mental health problems and must be withdrawn within weeks. Two-thirds of them go back to duty when treatment is available close by. Proximity is what makes the difference. Resilience is generalist competence: Surgeons trained inside highly specialized, well-resourced hospital systems are less comfortable with open surgery and austere conditions than they were fifteen years ago. A mandatory war surgery course for every general surgery trainee, sustained for fifty years, is one answer to that drift. Strategic evacuation is a coordination problem: A civil airliner can be reconfigured into a medical evacuation platform in about twenty hours, and aircrew integrate with military medical teams easily. The hard parts are selecting the right patients, communicating across national borders, and letting a nation keep track of its own wounded. Episode Keywords military medicine, NATO COMEDS, Norwegian Armed Forces, surgeon general, large scale combat operations, LSCO, combat casualty care, war surgery, aeromedical evacuation, medevac, Ukraine, Arctic medicine, cold weather casualty care, TCCC, return to duty, military medical readiness, trauma surgery, orthopedic trauma, allied medical support, Article 5, military health system, deployed medicine, military mental health, Defense Strategies Institute, OpMed TV, WarDocs podcast Hashtags #MilitaryMedicine, #WarDocs, #NATO, #CombatCasualtyCare, #LSCO, #Medevac, #ArcticReadiness, #WarSurgery More from the Operational Medicine Symposium This episode is part of the WarDocs and OpMed TV interview series recorded at the Defense Strategies Institute Operational Medicine Symposium in San Antonio, March 2026. Watch the full set of DSI OP MED videos here: https://hubs.li/Q04jRhjP0   Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called “Docs” as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

Gerard R. Cox, MD, a retired Navy captain, emergency physician, former White House physician, and senior VA leader, shares a remarkable career spanning presidential protection, Middle East operations, and healthcare reform. He explores objective accountability, just culture, high reliability, speaking up, military-to-VA transitions, and the personal boundaries that sustain demanding leadership.

    Bleeding is what kills people after injury. In this companion conversation to their earlier episode, host and vascular surgeon Dr. Wayne Causey asks Dr. John Pavlus, Chief of Interventional Radiology at Brooke Army Medical Center, to do the thing most medical conversations skip. He walks step by step through exactly how a bleeding trauma patient is treated without major surgery.   The tools are small. A needle, a short hollow tube called a sheath placed in the artery at the groin, wires thinner than a strand of spaghetti, and catheters steered by live X-ray to the one vessel that is leaking. The patient leaves with a bandage instead of an incision. The decisions behind those tools are what make the difference.    It starts with the CT scan. Contrast is injected and images are captured at three different moments, and the timing of those pictures decides what the doctor believes he is looking at. A scan done for a different purpose at an outside hospital can make a patient look like an arterial bleeder when the bleeding is coming from a vein instead, and veins are not something a catheter can easily fix. Getting the timing right is the difference between the right treatment and the wrong one.     From there the conversation turns to the system. At Brooke Army Medical Center, a trauma activation commits the interventional team to having a needle in the artery within sixty minutes of the call, at any hour. That standard was not bought with equipment. It was built on years of trust with the trauma surgeons, to the point that when a trauma surgeon calls a bleed, nobody argues about the pictures. Everyone moves, including anesthesia.    Then come the organs. The liver is complicated because it carries two separate blood supplies, and one of them cannot be reached easily from the inside. The spleen is the favorite, shut down with a metal coil placed at a precise landmark, sometimes in fifteen minutes. And the conversation closes on thrombin, a clotting agent injected through the skin under ultrasound, no X-ray required. It is cheap, it is simple, and it is the one tool a military interventional radiologist would want in his pack if told to deploy tomorrow.     The thread running through all of it is not equipment. It is repetition. Do the same thing the same way every time, and the mind is free to solve the problem that actually matters. Chapters (01:12-07:15) What Endovascular Care Actually Is and What the CT Scan Shows (07:15-12:23) The Sixty-Minute Clock and Activating the Trauma Interventional Radiology Pathway (12:23-20:49) A Bleeding Liver with Two Blood Supplies and Why Access Comes First (20:49-28:59) A Bleeding Spleen with Microcatheters Coils and Knowing When Good Enough Is Enough (28:59-35:51) Thrombin and the Simple Tool Worth Carrying Far Forward Chapter Summaries (01:12-07:15) What Endovascular Care Actually Is and What the CT Scan Shows    Dr. Pavlus defines his specialty in the plain language he uses with patients. Minimally invasive, image guided procedures done through pinholes in the skin, either plugging up an artery that is bleeding or lining the inside of an injured one with a small tube. The discussion then turns to the CT scan, where contrast dye is imaged at three separate moments, and how the timing of those pictures determines whether the bleeding is arterial, venous, or a contained pocket of blood called a pseudoaneurysm. (07:15-12:23) The Sixty Minute Clock and Activating the Trauma Interventional Radiology Pathway   A trauma surgeon standing at the scanner calls a bleed and the pathway fires. A single alert reaches the interventional radiologist, the nurse, the technologist, and the resident at the same time, and everyone drives in. The standard is a needle in the artery within sixty minutes of the call, and the guest is direct that the only way to hold that standard is to remove every point of debate from the process. Anesthesia is activated at the same moment, because these patients are rarely stable enough for anything less. (12:23-20:49) A Bleeding Liver with Two Blood Supplies and Why Access Comes First   The liver is harder than most people assume because it carries two separate incoming blood supplies, and the second one cannot be reached quickly from inside a catheter. That is why a certain grade of liver injury belongs in the operating room with a surgeon rather than in the radiology suite. The guest then walks through his access routine in detail, from ultrasound guided puncture of the artery at the groin to the specific wire and catheter he uses every single time, and explains why keeping the hole in the artery as small as possible matters in a patient who may receive thirty units of blood. (20:49-28:59) A Bleeding Spleen with Microcatheters Coils and Knowing When Good Enough Is Enough Splenic bleeding can be shut down with a metal coil placed at a precise landmark between two small pancreatic arteries. Dr. Pavlus explains why he abandoned one widely used technique after it tore an artery early in his career, and why he now threads a much smaller catheter inside his working catheter to reach the target safely. He is also candid that in an unstable patient at two in the morning, the goal is not a perfect result. It is a live patient who can be handed back to the trauma team. (28:59-35:51) Thrombin and the Simple Tool Worth Carrying Far Forward    Thrombin is a clotting agent injected directly through the skin with a needle, guided by ultrasound rather than X-ray. It is the standard repair for a pseudoaneurysm in the groin, but the guest has extended it to bleeding inside solid organs and small vessels in soft tissue that would be difficult or impossible to reach with a catheter. Because it requires no X-ray suite and almost no equipment, he names it as the single technique he would most want available in a far forward combat setting. The episode closes on consistency, repetition, and adapting a fixed base technique to whatever the patient in front of you presents. Take Home Messages Timing of the Contrast Changes the Answer: A CT scan is not one picture. Contrast dye is imaged before it arrives, as it fills the arteries, and again after it has spread, and comparing those three moments is what separates arterial bleeding from venous bleeding from an old finding that was never bleeding at all. A scan ordered for a different purpose at an outside hospital can point a team toward the wrong treatment entirely. Trust Is Built Long Before the Emergency: The sixty minute standard from phone call to needle in the artery is not achieved with faster equipment. It is achieved by removing every point of debate from the pathway, which only happens after years of a trauma service and a radiology service learning to rely on each other. When the trauma surgeon calls a bleed, nobody re-argues the pictures. Everyone moves. Access Is the Whole Game: You can perform the most elegant procedure in the world inside a patient, and if the puncture in the artery is mishandled, that is the only part anyone will remember. Ultrasound guidance takes no meaningful extra time, and keeping the opening as small as possible protects a patient who may go on to receive massive amounts of blood. Perfect Is the Enemy of Alive: In a stable patient with a low grade injury there is time to chase an ideal result. In a crashing patient at two in the morning there is not. Placing a coil in a good enough position and stopping high flow bleeding so the trauma team can move on is a legitimate and often correct decision, and knowing which situation you are in is a clinical skill of its own. The Simplest Tool May Be the Most Deployable: Thrombin injection needs a needle, an ultrasound probe, and a vial. No X-ray suite, no power injector, no shelf of catheters. That is exactly why it stands out as the technique most likely to work far forward, where the equipment, the imaging, and the logistics that a modern hospital takes for granted simply are not there. Episode Keywords interventional radiology, military medicine, trauma interventional radiology, embolization, splenic artery embolization, liver embolization, solid organ injury, thrombin injection, pseudoaneurysm repair, endovascular hemorrhage control, non compressible torso hemorrhage, angiography, microcatheter, coil embolization, Brooke Army Medical Center, combat casualty care, far forward surgical care, vascular surgery, WarDocs podcast, military trauma care, hemorrhage control, John Pavlus, Wayne Causey Hashtags #MilitaryMedicine, #InterventionalRadiology, #TraumaCare, #HemorrhageControl, #CombatCasualtyCare, #VascularSurgery, #WarDocs, #MilitaryHealth Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called “Docs” as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast    

    Bleeding is what kills people after trauma. That single fact sits at the center of this WarDocs episode, in which host Dr. Wayne Causey, a vascular surgeon, sits down with two military interventional radiologists — Dr. John Pavlus of Brooke Army Medical Center and Dr. Jonathon Schutt, an interventional radiology resident at Yale — to examine one of the fastest-moving areas in modern medicine and what it could mean for the wounded service member. Endovascular care, as they describe it, is deceptively simple to explain and remarkably hard to field: a small stick in the groin or the wrist, image guidance instead of an incision, and wires and catheters small enough to be called straws, threaded through the vascular tree to block a bleeding artery or reline an injured one. As one guest puts it, the patient goes home with a band-aid.    The conversation moves quickly from definition to system. At Brooke Army Medical Center, a trauma activation commits the interventional team to needle-stick access within sixty minutes of the call, day or night. That standard was not bought with equipment. It was built on years of bi-directional trust with the trauma surgeons, to the point that the team now responds without stopping to relitigate the imaging. Both guests are blunt that ownership is the price of admission: if interventional radiology wants a seat on the trauma team, it has to show up at two in the morning for cases that are neither lucrative nor glamorous.   The harder question is how far forward this capability can go. REBOA is scaled today at Role 2, and stent graft and embolization cases in Role 3 remain largely case-reportable events performed by clinicians who brought their own equipment. The limiting factor, both guests argue, is not technique — it is imaging, logistics, and institutional will. Meanwhile, Israeli teams transition to bunker operations within twenty-four hours, and Ukrainian experience with drone-driven injury patterns is already reshaping assumptions about REBOA and embolization that the United States has not yet tested.   The episode closes on people rather than platforms: the case for a military interventional community that crosses Service lines and partners with surgical colleagues, the argument for a skill identifier that lets the system find the right clinician, and a practical inventory of what one interventional radiologist would carry in a backpack if told to deploy tomorrow. Chapters (01:11-06:26) Two Pathways Into Military Interventional Radiology (06:26-10:15) Endovascular Care Explained: A Lot Through a Pinhole (10:15-17:02) The Sixty-Minute Trauma Activation at Brooke Army Medical Center (17:02-26:11) Forward Capability: REBOA, Stent Grafts, and the Role 2 and Role 3 Gap (26:11-35:54) Silos, Superpowers, and the Real Cost Equation (35:54-49:56) Allied Lessons, a Military IR Community, and What Fits in a Backpack Chapter Summaries (01:11-06:26) Two Pathways Into Military Interventional Radiology Both guests trace how they arrived at interventional radiology and at military service — one from the Air Force Academy and a fighter pilot track redirected by a day shadowing an orthopedic surgeon, the other from a childhood spent in a pararescue uncle's uniform and an HPSP commissioning. Each was pulled toward endovascular work by the same realization: that the future of the specialty was in doing more through less. Their training routes differ, one through diagnostic radiology and fellowship, the other through an integrated residency pathway. (06:26-10:15) Endovascular Care Explained: A Lot Through a Pinhole The guests define endovascular care in the language they use with patients: a small poke in the groin or the wrist, image guidance rather than an open field, and catheters threaded through the vascular tree like a plumber working pipes. Roughly ninety-five percent of the work is image guided, most often with fluoroscopy. The host adds the surgeon's framing — always ask what can be fixed through the blood vessel before opening a chest or an abdomen. (10:15-17:02) The Sixty-Minute Trauma Activation at Brooke Army Medical Center A blunt trauma patient arrives, CT shows active extravasation from a high-grade splenic injury, and the trauma activation commits the interventional team to needle-stick access within sixty minutes. The guests describe how that pathway was built on bi-directional trust rather than debate over each scan, and why the team now launches without relitigating the imaging. Both stress that owning trauma call — unglamorous, poorly reimbursed, and at all hours — is what earns interventional radiology its place on the team. (17:02-26:11) Forward Capability: REBOA, Stent Grafts, and the Role 2 and Role 3 Gap The conversation turns to what exists downrange. REBOA is scaled today at Role 2, and endovascular hemorrhage control at Role 3 remains largely a set of case reportable events performed with clinician-supplied equipment. The guests explain stent grafts as simultaneous hemorrhage control and reconstruction, and identify imaging, transport, and packaging — not procedural skill — as the true limiting factors on projecting this capability forward. (26:11-35:54) Silos, Superpowers, and the Real Cost Equation One guest argues that interventional radiology has been siloed by civilian incentives the military has no reason to copy, and that the specialty's real advantage is the fusion of diagnostic reading and procedural skill he calls a superpower. The host and guests weigh the higher up-front cost of advanced imaging and devices against the dramatically lower recovery burden of a pinhole procedure. The biggest hurdle, one guest says flatly, is people — convincing decision makers the capability is worth funding. (35:54-49:56) Allied Lessons, a Military IR Community, and What Fits in a Backpack Israeli teams shifting hospitals to bunker operations within twenty-four hours and Ukrainian experience with drone-driven injury patterns are held up as evidence the United States is playing catch-up. The guests describe the effort to build a military interventional radiology community across Services and to partner with the American College of Surgeons military chapter. The episode closes with a practical deployment loadout — ultrasound, micropuncture kits, sheaths, a base catheter, coils, and wire — and a walk through current training pathways into the specialty. Take Home Messages Bleeding is the mission. The immediate cause of preventable death after trauma is hemorrhage, which is why endovascular capability belongs in the operational conversation at all. Every argument for pushing this capability forward reduces to stopping the bleeding fast enough, and doing it without creating a second catastrophe. Framing the specialty this way makes its military relevance impossible to dismiss. Trust is the system, not the equipment. A sixty-minute call-to-stick standard at a level one trauma center was not purchased — it was built over years of bi-directional trust between the trauma team and the interventional service. Once that trust exists, the activation launches without relitigating the imaging, and everything else falls into motion. Any unit trying to replicate the capability should build the relationship before it buys the gear. Ownership earns the seat. Trauma call is unglamorous, poorly reimbursed, and inconvenient, which is exactly why some centers have written interventional radiology out of the pathway entirely. Showing up at two in the morning, reviewing imaging alongside the trauma team, and taking responsibility for the patient is what secures a permanent place on that team. Presence before the activation is what makes the activation work. The limiting factor is logistics, not technique. Everything done at a level one trauma center is technically achievable far forward — the constraint is diagnostic imaging, fluoroscopy, packaging, and airlift, not procedural skill. Progress therefore depends on investment decisions and institutional will rather than on new procedures. Convincing leaders that the capability is valuable is the hurdle, and funding follows conviction. Allies are already ahead, and the injury patterns are changing. Israeli teams move a hospital into bunker operations within twenty-four hours, and Ukrainian experience with drone-driven wounding is already reshaping assumptions about balloon occlusion and embolization. Planning for the last war is the fastest way to arrive unprepared for the next one. Learning from partner nations now is cheaper than relearning under fire. Episode Keywords military medicine, interventional radiology, endovascular care, WarDocs podcast, non compressible torso hemorrhage, REBOA, stent graft, embolization, hemorrhage control, combat casualty care, Brooke Army Medical Center, trauma activation, expeditionary interventional radiology, Role 2 care, Role 3 care, military trauma system, vascular surgery, image guided procedures, John Pavlus, Jonathan Schutt, Air Force medicine, Army medicine, military health system, battlefield medicine, damage control #WarDocs, #MilitaryMedicine, #InterventionalRadiology, #EndovascularCare, #CombatCasualtyCare, #HemorrhageControl, #TraumaCare, #MilitaryHealthSystem Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called “Docs” as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

    What does it take to keep wounded Soldiers alive when the next war means hours — not minutes — to the operating table? In this special collaboration between WarDocs and OP MED TV, recorded at the Defense Strategies Institute OP MED Symposium, COL Shaun Brown, MD, Commander of the U.S. Army Institute of Surgical Research, lays out the research agenda that will decide whether the wounded of the next conflict survive. COL Brown's path into Army medicine began with a rejection. Poor eyesight closed the door on the U.S. Naval Academy, so he pursued pre-med as a civilian undergraduate. When 9/11 happened, it solidified both his commitment to medicine and his decision to serve, and he took an Army HPSP scholarship in medical school. He trained in general surgery at William Beaumont Army Medical Center — a program with a long, quiet relationship with the special operations community — where attendings would vanish overnight for operational requirements. He chose colorectal surgery as a fellowship to add technical range he could use in civilian practice and on the battlefield, then joined Joint Special Operations Command at Fort Bragg after a year on staff in El Paso. Now commanding the Army's premier combat casualty care research enterprise, COL Brown is candid about what excites him and what worries him. He is most energized by the Organ Support and Automated Technology department, and he uses a widely shared video of a Ukrainian amputee evacuated by unmanned ground system to make his point: autonomous evacuation without autonomous medical support only moves the walking wounded. Ventilators that read changing physiology and adjust themselves, autonomous IV pumps, and en-route support are the missing half of the capability. His concern is combat wounds. In large-scale combat operations with prolonged evacuation timelines, Dr. Brown expects most damage control surgery to be done for sepsis rather than hemorrhage — the patients who cannot be evacuated become septic extremities. He also walks through the blood problem: whole blood is the standard, low-titer O supply will not be sufficient at scale, and the answer is shelf-stable components, including freeze-dried and spray-dried plasma, freeze-dried platelets, and freeze-dried red cells. The conversation closes on people. Brown details how the Army sustains surgical readiness through a diversified platform of military treatment facilities, civilian partnerships, and untapped Veterans Affairs relationships; how he coordinates with the Reserve consultant to pair complementary skill sets on deploying teams; and why, quoting the Army War College, he still serves: you train for the known and you educate for the unknown. Chapters (00:50-02:16) From Naval Academy Dreams to Army Medicine (02:16-04:33) Colorectal Surgery and the Road to Joint Special Operations Command (04:33-08:06) Commanding the ISR: Autonomous En-Route Care and the Combat Wound Gap (08:06-11:59) Blood, Plasma, and the Shelf-Stable Future of Resuscitation (11:59-18:16) Burn Care, Surgical Readiness, and Partnerships Across Components (18:16-22:22) Forward Surgical Capability Gaps and Why He Still Serves Chapter Summaries (00:50-02:16) From Naval Academy Dreams to Army Medicine Brown describes how bad eyesight ended his plan to attend the U.S. Naval Academy and sent him to a civilian undergraduate program and pre-med coursework. September 11th solidified his decision to pursue both medicine and military service, and he applied for the HPSP scholarship in medical school, choosing the Army's four-year award over the Air Force's three-year option. (02:16-04:33) Colorectal Surgery and the Road to Joint Special Operations Command He explains why he chose colorectal surgery — additional technical skill he could use in civilian practice and on the battlefield — and how residency at William Beaumont Army Medical Center exposed him early to the special operations world. He recounts getting the recruiting call while loading a moving van in New Orleans, then completing assessment and selection before moving to Fort Bragg. (04:33-08:06) Commanding the ISR: Autonomous En-Route Care and the Combat Wound Gap COL Brown identifies the Organ Support and Automated Technology department as the work he is most excited about, using a Ukrainian unmanned-ground-system evacuation video to argue that autonomous platforms without autonomous medical support can only move the walking wounded. He then names his chief concern: combat wound research funding, and his expectation that in large-scale combat operations most damage control surgery will be done for sepsis rather than hemorrhage. (08:06-11:59) Blood, Plasma, and the Shelf-Stable Future of Resuscitation The discussion turns to the evolution from component therapy to 1:1:1 ratios to whole blood, and Dr. Brown's assessment that low-titer O will not be available in sufficient quantity for large-scale combat operations. He details work on freeze-dried and spray-dried plasma, freeze-dried platelets, and freeze-dried red cells, noting that spray-drying is faster, cheaper, and uses equipment roughly the size of two ATMs — a major advantage for distributed manufacturing. (11:59-18:16) Burn Care, Surgical Readiness, and Partnerships Across Components COL Brown addresses the burn casualty problem in a future fight: forward Class VIII resuscitation supply, scaling the Advanced Burn Life Support course for deploying units, and partnerships with civilian burn centers, including placing Army burn surgeons in MILCIV sites. He then lays out the diversified surgical platform — military treatment facilities, community hospitals, and underused VA partnerships — and how he works with the Reserve consultant to pair complementary skill sets on deploying units. (18:16-22:22) Forward Surgical Capability Gaps and Why He Still Serves Asked what a forward surgical team still needs, COL Brown points to an off-the-shelf, infection-resistant biologic vascular conduit as a potential game changer over shunts — with the training investment that would require. He closes with his why, quoting the Army War College maxim that you train for the known and educate for the unknown, and asking who will be left to educate the next generation if experienced leaders walk away during the interwar period. Take Home Messages Autonomous evacuation without autonomous care only moves the walking wounded: Unmanned ground and air systems can pull a casualty off the battlefield, but a platform alone does not sustain a patient who needs a ventilator, a pump, or a transfusion en route. The medical community must be in the ground-maneuver conversation early, because a small design change can turn a logistics platform into a casualty evacuation platform. Autonomous ventilators that read changing physiology and adjust themselves are the missing half of that capability. In the next war, sepsis may drive damage control surgery more than hemorrhage: Prolonged evacuation timelines change the casualty population that reaches a surgeon. Patients in uncontrolled hemorrhage far from a surgical team frequently do not survive the wait, while patients with survivable wounds that cannot be evacuated arrive septic days later. Combat wound research and combat wound solutions deserve renewed funding priority for large-scale combat operations. Shelf-stable blood components are the answer to a cold chain that will not hold: Warm whole blood remains the standard of care, but low-titer O will not be available in the quantities a large-scale conflict demands, and cold chain storage is a logistical vulnerability. Freeze-dried and spray-dried plasma, freeze-dried platelets, and freeze-dried red cells are all in the research pipeline. Spray-drying offers a particular advantage: it is faster, cheaper, and the equipment footprint is small enough to support distributed manufacturing forward. Burn readiness is a supply problem, a training problem, and a partnership problem: Thermal weapons, lasers, fuel, and explosions could produce burn casualty volumes the system has not seen in decades. Resuscitation depends on adequate crystalloid and plasma forward, on teams trained to calculate burn surface area correctly, and on scaling the Advanced Burn Life Support course to deploying units. Long-term capacity also depends on formal relationships with civilian burn centers and on placing military burn surgeons inside those partnerships. Surgical readiness comes from a diversified platform, not from one hospital: Military treatment facility volume alone will not sustain a surgeon's skills, so readiness now depends on layering community hospital partnerships and Veterans Affairs relationships on top of the military caseload. Functional VA hospitals near large installations without strong academic affiliations are ripe for preferred referral partnerships. What surgeons need most is not trauma volume but complexity, which older patients with more complex medical conditions reliably provide. Episode Keywords military medicine, combat casualty care, US Army Institute of Surgical Research, ISR, Shaun Brown, WarDocs, OP MED TV, Army surgeon, damage control surgery, LSCO, large-scale combat operations, whole blood, freeze dried plasma, spray dried plasma, blood products, burn care, Army Burn Center, prolonged casualty care, en route care, autonomous medical systems, trauma surgery, military health system, surgical readiness, Army medicine Hashtags #MilitaryMedicine, #WarDocs, #CombatCasualtyCare, #ArmyMedicine, #TraumaSurgery, #LSCO, #MilitaryHealth, #BurnCare Honoring the Legacy and Preserving the History of Military Medicine   The WarDocs Mission: WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you.   WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called “Docs” as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.   Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

Luke Sciulli, a former Green Beret combat medic who survived a C5 spinal cord injury, recounts becoming the patient and rebuilding through discipline. He discusses MEDEVAC chains, rehab culture shock, and rebuilding purpose. He also covers military-civilian trauma partnerships, medevac and interoperability lessons from Africa and Ukraine, and scaling tactical tech like wearables and automated care.

Episode Summary     What if a medical career could be built on profound purpose, paid for in full, and shaped by leadership opportunities no civilian path can match? In this episode of WarDocs, COL Danielle Holt, MD, an Army general surgeon and Associate Dean of Admissions and Recruitment at the Uniformed Services University (USU) School of Medicine, lays out exactly what it takes to become a military physician and why the journey is worth it. Drawing on a career that has carried her from broad-spectrum rural surgery at Fort Wainwright, Alaska, to a forward surgical team in Afghanistan, to serving as consultant surgeon for the White House Medical Team at Walter Reed, she offers a candid, insider’s view of the two pathways into uniformed medicine.       The conversation centers on the choice every service-minded pre-med must weigh: the tuition-free USU School of Medicine, the nation’s only fully federally funded medical school, versus the Health Professions Scholarship Program (HPSP) that places students at civilian schools. She explains the trade-offs in plain terms — the seven-year versus four-year service obligation, the roughly $90,000 annual salary USU students earn while in school, the one hundred hours of military-unique curriculum, and the rotations across military treatment facilities worldwide. She is equally direct about the military match, where competitive specialties such as general surgery can be more attainable than many applicants realize.    COL Holt demystifies admissions. Academics are a threshold, not the finish line — a 496 MCAT and 3.0 GPA for regular decision, rising to a 500 minimum, with a class mean near 510. Beyond the numbers, she explains what actually earns an interview and an offer: a clear reason to be a physician, a genuine commitment to military service, and the personal attributes of teamwork, adaptability, and being comfortable when things get uncomfortable. She names the self-inflicted mistakes that sink applicants — turning the application in late, stalling on medical clearance and waivers, retaking the MCAT too often, and failing to engage the admissions team. She closes with the human core of the school: the fire team model, longitudinal faculty coaching, the Military Medical Communities program, and a culture where students and faculty take care of one another in a way civilian medicine rarely sees. Her message to any pre-med on the fence is simple — do not underestimate yourself, reach out for mentorship, and remember that the mission is the point. Chapters (00:00-04:54) A Surgeon’s Journey: ROTC, Alaska, Afghanistan, and the White House (04:55-10:11) What USUHS Is and Why It Is Different (10:12-19:38) USUHS versus HPSP: Obligations, the Military Match, and How to Choose (19:39-27:39) Timelines, Thresholds, and What Earns an Interview (27:40-43:39) Shadowing, Research, Non-Traditional Applicants, and Common Mistakes (43:40-55:30) The Interview, the Fire Team Culture, and Advice for the Fence-Sitter Chapter Summaries (00:00-04:54) A Surgeon’s Journey: ROTC, Alaska, Afghanistan, and the White House Holt traces a twenty-plus-year dual-military-career path from ROTC and HPSP through general surgery training at Tripler Army Medical Center to duty stations spanning rural Alaska and a tertiary academic hospital. She describes deploying to a forward surgical team in eastern Afghanistan in 2012 and learning damage-control surgery, and credits the Army with handing her leadership roles far earlier than a civilian career would.   (04:55-10:11) What USU Is and Why It Is Different She defines the Uniformed Services University as the nation’s only fully federally funded, tuition-free medical school, training physicians for the Army, Navy, Air Force, Coast Guard, and Public Health Service. Students draw full pay and benefits — roughly $90,000 a year — complete about one hundred hours of military-unique curriculum, and rotate at military treatment facilities across the country and overseas.   (10:12-19:38) USU versus HPSP: Obligations, the Military Match, and How to Choose Holt compares the seven-year USU service obligation with the four-year HPSP commitment and argues the difference is small over a full career. She explains the military match, where critically needed specialties like general surgery can be more attainable, and walks through how applicants apply by service, weigh geography and specialty, and decide which pathway fits their long-term goals.   (19:39-27:39) Timelines, Thresholds, and What Earns an Interview The USU medical-school timeline mirrors other allopathic schools through AMCAS, but military commissioning adds a lengthy medical clearance process, with about half of students needing a waiver. Academics are a threshold — a 496 MCAT and 3.0 GPA for regular decision. Above all, she stresses applying early and finishing requirements, because uncleared applicants get skipped as seats fill.   (27:40-43:39) Shadowing, Research, Non-Traditional Applicants, and Common Mistakes She pushes back on the pressure around clinical shadowing, noting USU requires none and that paid work as a phlebotomist or technician offers equal exposure. Research is likewise not required, given USU’s own Capstone program. She details how the school values non-traditional and prior-service applicants, then names the most common self-inflicted mistakes: late applications, stalled clearances, over-testing the MCAT, and downplaying military experience.   (43:40-55:30) The Interview, the Fire Team Culture, and Advice for the Fence-Sitter Holt explains the virtual two-interview format and what makes candidates stand out — genuine commitment, professionalism, and self-knowledge. She describes the fire team model, longitudinal faculty coaching, and the Military Medical Communities program that links applicants, students, and physicians across services. Her closing advice to fence-sitting pre-meds: do not underestimate yourself, seek mentors, and lead with the mission.   Take Home Messages Mindset matters more than a perfect score.: Academic metrics are a threshold, not the finish line. The strongest military physicians are often the applicants who have struggled, adapted, and bounced back — people who value service over a flawless transcript.   The pathway you choose should match the career you want.: The tuition-free, federally funded medical school carries a longer obligation but builds deeper military identity and connections, while the civilian scholarship route offers more independence. Weigh service obligation, specialty goals, and where you see yourself for the long term.   Apply early and finish your requirements.: Rolling admissions reward speed. The single most avoidable mistakes are turning in a late application, stalling on medical clearance and waivers, and waiting too long on the MCAT or letters of recommendation. Uncleared applicants get skipped as seats fill.   Shadowing and research are not gatekeepers.: Required shadowing hours and formal research are not prerequisites. Paid clinical work and life experience count, and the value placed on non-traditional and prior-service applicants means an unconventional background can be a genuine strength.   Camaraderie is the difference, so engage the community.: The fire team model, longitudinal coaching, and military medical community sessions create a culture where students and faculty take care of one another. Do not underestimate yourself — reach out for mentorship and let the mission lead.   Episode Keywords military medicine, USU School of Medicine, Uniformed Services University, Danielle Holt, military doctor, how to become a military physician, HPSP scholarship, military medical school, Army surgeon, premed advice, MCAT, medical school admissions, military match, GME, forward surgical team, Walter Reed, military residency, USUHS, tuition free medical school, military officer physician, WarDocs, military healthcare career, premed shadowing, medical school interview, service obligation Hashtags #MilitaryMedicine, #WarDocs, #USU, #MilitaryMedicalSchool, #HPSP, #FutureMilitaryDoc, #PreMed, #ArmyMedicine Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the "What We Are For" Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

Kimberly Elenberg, retired CAPT and DNP/RN who moved from Army bedside nursing to NIH research and leading DARPA triage work. She recounts early mentorship, building patient education and informatics tools, creating national deployable public health teams after 9/11, partnering with Carnegie Mellon on biosurveillance, and tackling autonomous casualty identification with practical field-first lessons.

   In this episode of WarDocs, Army Deputy Surgeon General Dr. Lance Raney discusses the past, present, and future of military medicine. The conversation begins with Dr. Raney’s early journey from a collegiate scholarship athlete to a Family Medicine physician, exploring how his clinical roots in "small-town" Army medicine established the decision-making framework necessary for high-level strategic leadership. Drawing on his experience as a Brigade Surgeon with the 172nd Stryker Combat Team in Iraq, Dr. Raney emphasizes the life-saving importance of empowering medics at the point of injury and the necessity of critical thinking in the face of unexpected clinical challenges.    The dialogue then shifts to the complexities of the current military healthcare landscape, particularly the transition to the Defense Health Agency and the integration of medical readiness with healthcare delivery. Dr. Raney provides a candid look at the challenges of navigating systemic changes during the COVID-19 pandemic and the implementation of MHS GENESIS, noting that leadership through influence is now more vital than ever. He shares a personal and powerful account of his time at Womack Army Medical Center, discussing how patience and trust in the military justice system reinforced his commitment to servant leadership and organizational resilience.    A major focus of the episode is the Army’s strategic pivot toward Large Scale Combat Operations (LSCO). Dr. Raney details how the "Golden Hour" of evacuation is being replaced by the reality of prolonged field care, requiring a fundamental overhaul of medical training. He explains the expansion of the Army paramedic program and the development of high-tech solutions like Artificial Intelligence for triage and decision support. These innovations are designed to augment the front-line provider's ability to manage casualties in austere, communication-denied environments where resources are strictly limited.    Finally, Dr. Raney offers profound career advice for the next generation of healthcare professionals. He encourages students and young officers to become the experts their patients expect and to seek "Purpose Plus"—the unique fulfillment found in serving the extended family of the American soldier. By focusing on legacy and the impact left in others, Dr. Raney illustrates why military medicine remains one of the most rewarding paths a clinician can choose. Chapters (00:00-06:28) Foundations of a Career in Army Medicine (06:29-11:04) The Clinical Roots of Strategic Leadership (11:05-17:40) Lessons in Combat Casualty Care (17:41-31:35) Command Philosophy and Navigating Systemic Transitions (31:36-45:47) Preparing for Large-Scale Combat Operations and the Role of AI (45:48-50:52) Advice for the Next Generation and Finding Your Purpose Chapter Summaries (00:00-06:28) Foundations of a Career in Army Medicine: Dr. Raney details his path from a lifeguard and ROTC cadet to becoming a Family Medicine physician. He shares how he came to view the Army as his "small town" where everyone shares a common mission and community. (06:29-11:04) The Clinical Roots of Strategic Leadership: The discussion centers on how high-volume primary care at Fort Sill developed the critical decision-making skills needed for senior leadership. Dr. Raney explains how clinical encounters taught him to synthesize information and negotiate solutions under pressure. (11:05-17:40) Lessons in Combat Casualty Care: Reflecting on his deployment to Iraq, Dr. Raney emphasizes the life-saving impact of well-trained medics at the point of injury. He recounts a specific junctional injury save that demonstrated the importance of critical thinking over rote skill repetition. (17:41-31:35) Command Philosophy and Navigating Systemic Transitions: This segment covers Dr. Raney's experience commanding large medical centers and his time as a liaison during the Defense Health Agency transition. He discusses the challenges of separating healthcare from readiness and the personal lessons learned while trusting the system during a difficult investigation. (31:36-45:47) Preparing for Large Scale Combat Operations and the Role of AI: The conversation shifts to the strategic preparations for LSCO, where the traditional "Golden Hour" may no longer exist. Dr. Raney explores the expansion of paramedic training and the potential for AI to assist in triage and clinical decision support on the battlefield. (45:48-50:52) Advice for the Next Generation and Finding Your Purpose: To conclude, Dr. Raney offers career advice focused on achieving clinical expertise and finding "Purpose Plus" within the military. He shares his hope of leaving a legacy through the people he has trained and the lives he has touched. Take Home Messages Master Your Craft: Becoming an expert in your specific clinical field is the fundamental requirement for all military medical professionals. True education happens after residency when you apply your skills to real-world patient outcomes and learn from continuity of care. Lead to Purpose: Leadership should not be about the commander but about enabling others to own their piece of the mission. When a team understands their purpose, they move from just doing a job to providing meaningful interventions that change lives. Prepare for Prolonged Care: In future conflicts, the luxury of rapid evacuation will be limited, requiring medical teams to hold patients for much longer durations. Success will depend on the individual’s ability to think critically and utilize limited resources in the face of unsolvable problems. Embrace Systemic Ownership: Tactical problems are often best solved by those at the tactical level rather than waiting for higher headquarters to provide a solution. Understanding that resources are finite at the strategic level empowers local leaders to take initiative and resolve issues independently. Seek Purpose Plus: Serving in the military provides a unique opportunity to practice medicine on an "extended family" that shares your core values. This sense of shared purpose turns the daily grind into a lifelong mission of service to the nation and its warriors.   Episode Keywords Army Medicine, Dr. Lance Raney, Military Medicine, WarDocs Podcast, LSCO, Large Scale Combat Operations, Combat Casualty Care, Prolonged Field Care, Army Surgeon General, Defense Health Agency, DHA Transition, Medical Readiness, Combat Medic Training, Paramedic Program, TCCC, Leadership Philosophy, Army Family Medicine, Battlefield Trauma, Medical AI, Triage Technology, Military Healthcare, Army ROTC, HPSP, Tactical Medicine, Operational Readiness, Clinical Excellence, MHS Governance. Hashtags #MilitaryMedicine, #ArmyStrong, #WarDocs, #Leadership, #CombatCasualtyCare, #MedicalReadiness, #LSCO, #MedEd   Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast