Q&A: Major General Ronald D. Silverman
Desert Doc
Ensuring Full Spectrum Medical Care Throughout Iraq
Major General Ronald D. Silverman
Commander 3rd Medical Command
and Task Force 3
Major General Silverman was born in Philadelphia, Pa., in 1947. He graduated from the University of Wisconsin in Madison with a B.A. in history in 1969, and subsequently received a commission in the United States Army as a Medical Service Corps officer through the Reserve Officer Training Corps Program. He then graduated from Temple University School of Dentistry with a DDS degree in dentistry in 1972. Since 1976 Silverman has practiced dentistry in Alexandria, Va., and has served as a parttime instructor and student mentor at local university dental programs. In addition, he assists local, state and federal law enforcement agencies in forensic dentistry when called upon.
Upon graduation from Temple School of Dentistry, Silverman received a commission as a Dental Corps officer and entered active duty in the United States Army. He served on active duty from 1972-1975 as a general dental officer at Fort Belvoir, Va. After leaving active duty, he joined the United States Army Reserve in 1976 and has held numerous prestigious positions. His assignments have included service as a Dental Corps officer with 2290th United States Army Hospital, Rockville, Md.; action officer and chief of the technical branch, Office of the Deputy Chief of Staff, Logistics, Pentagon; special projects officer, Dental Corps Branch, United States Army Personnel Command, Alexandria, Va.; and senior dental staff officer and chief, Army Dental Corp, Office of the Surgeon General, Falls Church, Va. He is a 1994 graduate of the United States Army War College, Carlisle, Pa. From October 1998 through September 2002 he served as commander of the 804th Medical Brigade, Devens, Mass.
Silverman’s decorations include the Distinguished Service Medal, Legion of Merit with One Oak Leaf Cluster, Meritorious Service Medal, Army Commendation Medal, Army Achievement Medal, National Defense Service Medal, Armed Forces Reserve Medal (with Bronze Hourglass Device) and the Army Service Ribbon.
Interviewed by MMT Editor Jeff McKaughan
Q: Good morning Major General Silverman. Could we start with an overview of your command and its in-theater responsibilities?
A: I command Task Force 3, a multi-service force of more than 3,000 soldiers and airmen assigned to 30-plus medical units. Our footprint consists of three Army combat support hospitals, each one operating in a split base configuration and one Air Force theater hospital. We also have clinics, multi-functional medical battalions with blood product storage and distribution and dental, mental health, veterinary medicine and preventive medicine capabilities.
TF3 provides full-spectrum medical care throughout Iraq. We take care of everything from treating the common cold to performing trauma surgery in our hospitals. The only care we don’t provide is routine care for soldiers in the combat divisions. Each combat division brings with it basic medical capabilities. In military lingo, we provide care at echelons above division.
Q: Looking at both the working and living conditions, how are your people holding up? Are there steps you are taking—or want to take—to make those conditions better?
A: TF3’s troops are holding up very well. We remain very busy with our critical mission of saving lives and preserving health, but we make time to have some normalcy in our daily lives. Every base has a gym where soldiers and airmen can work out. One base even has its own theater and two swimming pools.
Every base has a post exchange, a morale welfare and recreation center, activities to participate in such as organized sports, various clubs are offered, and various religious services are offered to servicemen and women wherever they may be. Most bases have an education center. So, even though we work very hard to care for those who do the fighting, we are keeping a sense of normalcy to some extent in our daily lives.
Q: What is the command’s role in working with the local civilian health care system? Are you working with their physicians and staff to improve the care provided locally and how much of your time and effort is directly towards treating civilians?
A: We treat all persons who have injuries or conditions that threaten life, limb or eyesight. We provide one standard of care to all patients. Our hospitals have liaisons who work directly with Iraqi health care and social support institutions when Iraqi patients are ready for discharge or need follow-up care that the Iraqi system can provide.
TF3 established a medical training program for both military and civilian health care providers. This program will continue long after TF3 is replaced. TF3’s civil-military operations section facilitates community and provincial medical outreach operations through its working relationship with its counterparts in the Iraqi Ministry of Defense.
Q: Similarly, do you work with the Iraqi military health care system providing either direct care or training?
A: We have established strong working relationships with the surgeon generals in the Iraqi Ministry of Defense. As stated previously, if any Iraqi soldier or policeman suffers an injury that threatens life, limb or eyesight, we evacuate, treat and manage each case.
Our soldier-medics live with and train Iraqi counterparts in the Iraqi fighting forces.
We already mentioned our training program for both civilian and military health care professionals.
Q: From recovering a casualty on the battlefield, through the in-theater system and on to Landstuhl, are you satisfied with the medical evacuation system and components? Is there a link that needs more attention than the others?
A: The flight crews and medics that pick up and deliver to our hospitals U.S. servicemen and servicewomen, our coalition partners and injured Iraqis do a fantastic job. The medevac crews are held in deep respect.
The Air Force casualty staging facility has performed magnificently throughout its tenure.
Q: Would it be a reasonable option to build a Landstuhl-like facility in- theater to reduce that long evacuation flight? Then, once a patient is stabilized, fly them from theater to the states directly?
A: Patients are stabilized before we move them from theater to Landstuhl or the states directly.
We have aviation assets available to move patients out of theater quickly, and we do an outstanding job to make that happen. We have the medical staff with capabilities to handle trauma injuries and evacuate the patient once he or she is stabilized for travel. Every medical flight to Landstuhl is equipped with the latest technological equipment and a highly trained medical staff to oversee and take care of patients. If necessary, surgeries can be performed on our aircraft as well.
At some point, we will be leaving Iraq. Right now, we are involved in a battle with Al Qaida and insurgents whose threat must be deterred. I’m not convinced this would be a viable option. The evacuation flight system has proven itself as very effective and is working very well.
Q: How much longer can the M113 medical evacuation vehicle keep up with the maneuver force? Can the Stryker MEV completely fill the role or is there a need for a replacement tracked vehicle?
A: Most medical evacuations are performed by air ambulance. Task Force 3 units do not use the M113 so I couldn’t give you a first-hand account of its capabilities. The same with the Stryker—our units don’t have them either, but it’s my understanding that these vehicles are performing well on missions. To better complement our air ambulance platform, I do feel that the Army—and services in general—needs to put more of an emphasis on developing a more suitable and flexible platform for ground evacuation when that type of medevac is necessary. If you asked any medic on the battlefield today what they would like, I’m quite certain they would mention the need for a more efficient and robust platform for ground evacuation in the urban environment in which they fight.
Q: With the prevalence of wounds coming from IEDs, how has that changed the training, types of equipment and supplies on hand? Are there other tools or technologies that would be useful to have farther forward to treat these wounds?
A: Our medical professionals are well trained and have the tools needed to treat severe wounds that occur on the battlefield.
IEDs have caused severe wounds such as traumatic amputations, which can quickly cause the patient to bleed out. This has prompted the fielding of tourniquets to soldiers out in the field. Soldiers are specifically trained to use these tourniquets when faced with life-threatening bleeding.
In addition, many soldiers receive training in combat life saving and receive equipment to use in the field. They don’t have the depth of training as a medic but they do know how to respond to a traumatically injured patient and start life saving first aid to include tourniquets. In addition, IEDs have caused more than just wounds. They can result in traumatic brain injuries and hearing loss. Task Force 3 in partnership with the VA and numerous other agents have developed tools to better screen patients for traumatic brain injuries and to raise awareness of this condition in soldiers and commanders. The high probability of hearing loss from IEDs has prompted Task Force 3 to equip screening audiometers across the theater to better screen soldiers for hearing loss after a blast injury.
Q: What is your take on the current inventory of hemorrhage control agents? Do you see opportunity for other devices or systems?
A: Each soldier has one and our medics carry multiple hemorrhage control bandages, in addition to the new tourniquet. We monitor closely inventory levels. Currently, we have enough of these life-saving hemorrhage control agents to perform the medical mission. The U.S. Army Medical Department is constantly evaluating new technology. When a device or technology proves to be better than what is currently used, we have a rapid fielding program to get it to the troops.
Q: Just wanted to get the picture on the use of telecommunicating for actual health care processes like consultations, second opinions or assistance in actual medical procedures. Is telecommunicating vital to medical care in deployed environments like Iraq and Afghanistan?
A: TF3 sites have and use telemedicine. I mentioned earlier, our split-based hospital configurations. All radiological images, X-rays and CT scans are captured in digital format. The digital images are transmitted to the radiologist and/or pathologist at one of the two sites. Digital photos of skin lesions are transmitted to the theater dermatologist.
If the need arises, digital images can be transmitted back to specialty centers in the U.S.
The Ask a Doctor program makes other specialists back in CONUS available to answer questions from providers in theater.
Our only constraints, found at outlying locations, have been the bandwidth stability of the network. But with the movement of very small aperture satellites into position over the last two months, we’ve greatly reduced transmission times for MEDWEB at our major test sites, for example from 4.5 hours to 15 minutes or less from Mosul to the International Zone in Baghdad.
Q: What are the challenges of training and keeping current with the latest trends and developments in health care with your people deployed in operational conditions?
A: Scheduling many medical professionals for training can be a challenge. As commander, I understand how important it is to have medical staff at their clinics or hospitals to be able to treat patients and save lives.
It’s also important to have them come together and learn from each other. It’s essential that they communicate. Although scheduling training has been challenging, we have managed to facilitate various medical conferences, trauma symposiums and certification courses for medical professionals throughout Iraq. Many training sessions are also transmitted through to information workstations, so if they were unable to make it to the conference, they could still view it on their personal computer.
We have been very diligent to ensure that our medical professionals have the education needed to keep their licenses and certifications up to date.
Q: Is there anything else you would like to add?
A: The servicemen and women who serve under my command embody an ideal we all share: every life is precious and we will do our utmost to preserve it. Every family, friend or acquaintance who has a connection with any member of TF3 can share in the pride we have in serving our brothers and sisters who find themselves in need of medical care.
It is my privilege to serve with these fine soldiers and airmen and a distinct honor to be their commander. As we end every briefing, meeting or gathering of TF3 members, DESERT MEDICS! ♦