NAVY MEDICINE July-August 1993 Suqeoo Geaeral of the Navy Chief, BUMED NAVY MEDICINE VADM Donald F. Hagen, MC, USN Vol. 84, No. 4 July-August 1993 Deputy Surgeon General Deputy Chief, BUMED Chief, Medical Corps RADM Richard I. Ridenour, MC, USN Department Rounds 1 Autotransfusion Technique Saves Navy Hospital a Bundle Editor Jan Kermeth Herman A. Marechal-Workman Assistant Editor Interview Virginia M. Novinski 4 Flight Surgeon on the Spot: Aboard USS Franklin 19 March 1945 J.K. Herman Editorial Assistant Nancy R. Keesee Features 10 Risk-Taking: Analysis and Intervention J. Lark NAVY MEDIONE. Vol. 84. No. 4. (ISSN 089S-8211 USPS 316-070) 11 publisbed bimonlhly by lhc Dcpanmenl of lhc Navy, Bureau of Medicine and 5ur&crY (BUM ED 14 Medicine in the Tropics Course: Preparing Navy Doctors for 09H). WuhiiiJIOII, DC 20372-5300. Second-elisa poat­ Global Medical Challenges qe paid II WuhiiJI(on, DC. and ldditional mailiq offic:cs. CDR J.M. Crutcher, MC, USNR POSTMASTER: Send lddrcssc:banps10Novy Medi­ CAPT H.J. Beecham III, MC, USN mw care of Naval Pubhellions and Forms Dim:tora~e. A1TN. Code 10363.5801 Tabor Avemae. Philadelpbia, PA 19120. POLICY: Navy Mtdirow is lhc official publicllion of 21 Chronology--World War II: Navy Medicine July-August 1943 die Navy Medical Depanmenl. It is illlalded for Medieal J. Mitchum DqJartmcat ~and coatainl professiooal iafonna­ liOII rdlliYe 10 mediciae, dc8istry. IDd die allied bealth ICJeDCa. Opioi-e&praiCd are diose ofdie audlon and Notes do IMJl IICCICIIUIIy repraeal die official position of die Dcparancnl of die Navy. die Bureau of MedicJDC IDd 28 Naval Medical Research and Development Command Highlights SuraerY. oraay olberJO¥-'clcpu1medor aacncy. Tndc --are IIICd for idealification only and do not rcpracniiD ClldoiiiCIIICIIl by die Depanmcm of die Navy Professional or die Bureau of MediCIIIC and 5urJery. Allboulb Navy Mtdicuw may cne or elllael from directives. aulhonty for 29 IV Antibiotic Self-Infusion for Active Duty Personnel IICbolllbould be obtained from die ciled reference. LT K. Summers, NC, USN DISTRIBUTION: Navy Medirow is diltributed 10 acave duty Medical Depanrncnl penonncl via die Stan­ dard Navy Dilcr1but1011 List. Tile fotlowina distribution is A Look Back audlorized: one copy for each Medical, Denial. Medieal ServiCe. and Nurse Corps ofr~eer; one copy for eacb 10 33 Navy Medicine 1922 enlisted MediCI! Dcpal'llllenl memben. Requests 10 m­ creue or decreue lhc number ofalloued copies lbould be forwarded 10 Navy Mtdicuw via die local command. NAVY MEDICINE 11 publisbed from appropriated rundl by alllhor!ly of die Bureau of Medicine and Suqery m -*nee Mlh Navy Publtcations IDd Prialina Reau­ lationl P-35. Tile Secretary of die Navy bas decermincd lhat dill pubiiCiliOII II nc:ccssary ID die UII1SIClioa of business reqwred by law of the Dcpartmenl of the Navy. COVER: One of the most gripping stories to come out of World War Fuads for pnlllliiJ IIIII pubiiCiliOII have been approved by die Navy l'llblicalionJ and PrilllliiJ Policy COIIIIIIiaee. II is the account of USS Franklin (CV-13). While conducting flight An~elcs. leacn. and lddress cbanccs may be forwarded 10 operations off the Japanese coast, a single Japanese bomber turned the the Ednor. Novy Mftllcilll!, Dcpal'llllenl of die Navy. Bureau of MediCine and SwJcry (BUM ED 09H). Wuh- carrier into a blazing inferno. LCDR Samuel R. Sherman, MC, 1111'011. DC20372-5300. Tclcpllonc(AreaCode202)6S3- USNR, was on the flight deck that day and won the Navy Cross for 1237. 653-1'1!¥7: DSN 294-1237. 294-1'1!¥7. C0111ribulions from die fidel are welcome and w111 be published as space his heroism. Story on page 4. Photo courtesy National Museum of pcnnill, subjectiO edllill& and possible abrid&JDCIII. American Jewish Military History. For sale by the Supcri111cndcm of Documcnll, U.S. Govcmmcn1 Printma Office. Wuhina10n. DC 20402. NA VMED P·SOII Department Rounds Autotransfusion Technique Saves Navy Hospital a Bundle LCDR Paul Potter hooks up the suction on the Cell saver 111. WHEN LCDR PaulS. Potter, MC, originally trained on." the surgery; clean the red cells and USNR, became a staff anesthesiolo­ That was 20 years ago. Since then, reinfused them back into the patient. " gist at Oak Knoll, CA, in 1991, he after getting out of the Navy in 1977, Using this method, the autotransfuser saved the command $175,000 in 1992 Potter started medical school on a operator can give back up to 80 cc's and $173,000 for the first 6 months of health professional scholarship and from every 100 cc 's of blood lost -- a 1993. He was able to cut thousands of worked with Dr. Malcolm Orr, the recovery of 80 percent. dollars from his department's budget physician who "invented all these sys­ According to LCDR Potter, use of by revising the autotransfusion sys­ tems. " Orr was the chairman of the the autotransfusion machine has more tem. Anesthesia Department at the Univer­ than budget-saving significance, how­ Potter was introduced to sity of Texas. Prior to the Bentley, ever. In terms ofdisease transmission, autotransfusion as a corpsman at Na­ Potter explained, "During surgery, as the medical implications are far reach­ val Hospital Portsmouth, VA, where patients bled, the blood was suctioned ing, especially since hepatitis and AIDS he used the Bentley Auto Transfuser. and simply thrown away. It could not came on the scene. This marked the beginning of an era be reused. This meant an awful lot of "If you look at statistics for disease that revolutionized surgical blood trans­ waste, so Dr. Orr, myself, and a lot of transmission from banked blood, there fusionlautotransfusion practices inter­ other people devised a system whereby is 1 in 40 to 1 in 100,000 chances of nationally. the blood could be salvaged and trans­ contracting AIDS and 1 in 400 chances "That was one of the original sys­ fused back into patients, as needed. " for hepatitis and parasitic diseases tems designed during the Vietnam era To describe the procedure briefly, such as malaria and, now, the dreaded to salvage blood from wounds and Potter said, "We collect the surgical HIV," Potter remarked. He added recirculate it to the patient," he said, blood in a sterile container; wash out that the autotransfusion technique -­ referring to the Bentley machine. "It all the fat, bone chips, and debris the ability to pick up the surgical blood had some problems, but this is what I picked up in the vacuum line during during a procedure, filtering it and July-August 1993 1 Front view of the Cell Saver Ill. putting it back into the patient -- has been available nationally since about 1975. "But it wasn't used in anything but major heart cases until the mid- 1980's, when HIV came on the stage and scared everybody. According to statistics from 1988, in the United States, 1. 8 million units of blood were donated and transfused. Of that, .18 million units were from autotransfused blood. This means that only about 10 percent of blood was self-salvaged. It's projected that by the year2000, the percentage should be raised to about 35 to 40 percent." Dr. Potter has been doing his best in this regard since he came to Oak Knoll, first as a resident anesthesiolo­ gist in July 1988, then when he took over as director of the autotransfusion service in October 1991 . He explained that, while he was a resident, the service was provided by a civilian contract group whom he felt was "sort of plus and minus in their abilities." When he became staff, he decided that he could do the job much more effi­ ciently and at greatly reduced cost to the government. So, he "took over the service, organized it, purchased ma­ chines, trained the corpsmen, and started running a technician service." Potter was quick to point out that the salvage technique is being done throughout the world and that the significance of Oak Knoll's contribu­ tion is its prominence in the realm of separate it into the blood components plasma from the blood bank, thus platelet and plasma salvage. "We've that are normally obtained from blood cutting down the risk of disease trans­ revolutionized that," he said. "Prior to banks -- platelets, red cells, serum, mission considerably." [our intervention], the salvage was and fresh plasma. We store those dur­ All of this means that, with the undertaken as a reaction to major ing the surgery and, as they're needed, dedication of the technicians who are blood loss. What we've done is take we return those blood components to trained on a "strictly voluntary basis," the process one step further. the patient. Naval Hospital Oakland's Anesthesi­ "We come into the operating room "This means that, not only have we ology Department has become a lead­ prior to the start of the surgical proce­ cut down the amount of red cells ing authority in autotransfusion. Pot­ dure, hook up our machines, tap into needed because of the bleeding, but ter said that, routinely, he gets re­ the patient, remove the blood, and now we no longer need platelets or quests for information on how they run 2 NAVY MEDICINE HN Sandi Lloyd hooks up the system cisco not only requires use of state-of­ on the Cell saver Ill to start the blood· the-art autotransfusion technology, it cleaning process. demands Oak Knoll-trained techni- cians in their services. " The patient population needs to ated . we can put them in field Jearn about this revolutionary tech­ hospitals, salvage the blood, thereby nique too, Potter concluded, stating greatly reducing the amount of blood that, in accordance with the mandate that would need to be transported to a of the Paul Gann Blood Safety Act, war theater.