Chancellor McRaven Addresses TexMed 2017 Physicians

our first opening general session speaker is Chancellor Admiral William McRaven a retired US Navy four-star Admiral and leader of one of the nation's largest and most respected systems of higher education the University of Texas since he became Chancellor and January 2015 Admiral McRaven has recommitted the UT System and its institutions to improving the lives of Texans and people all over the world through education research and health care in his previous life Admiral McRaven was the commander of US Special Operations Command he led a force of 69 thousand men and women it was responsible conducting counterterrorism operations worldwide as I was going through my introductory comments last night my husband a former Vietnam era Navy Submariner was most impressed by Admiral McRaven status bullfrog and I'll leave it up to the animal to clarify that Admiral McRaven has also recognized national authority on foreign policy and has advised presidents George W Bush and Barack Obama as well as other US leaders on defense issues his book Special Ops case studies on special operations warfare theory and practice has been published in several languages and is considered a fundamental text on special operations strategy Admiral McRaven has been recognized for his leadership numerous times by national and international publications and organizations in 2011 he was the first runner-up for Time magazine's Person of the Year and was named Texan of the year by the Dallas Morning News in 2012 foreign policy magazine named him one of the nation's top ten foreign policy experts and one of the top 10 100 global thinkers in 2014 Politico magazine named Admiral McRaven one of the politico 50 citing his leadership is instrumental in cutting through Washington bureaucracy which as we all know is not an easy task Chancellor Admiral McRaven graduated from the University of Texas in Austin in 1977 with a degree in journalism and received his master's degree from the Naval Postgraduate School in 1991 in 2012 the Texas Exes honored him with a Distinguished Alumni Award and now it is my pleasure and honor to welcome our first opening general speaker Chancellor Admiral Willem H McRaven [Applause] thank you thank you very much for the comms folks back there I'm going to go straight with the podium mic well first Karen thank you very much for that kind introduction and and this afternoon just to let you know I'm really not going to talk a lot about the University of Texas health care system because frankly we've got too many Doc's from from UT here I'm really going to kind of focus more on the tactical side I got let me start off by telling you that my mother god rest her soul would be thrilled to see me standing in front of a group of doctors and caretakers my mother always wanted me to be a doctor my grandfather was a doctor he had served in both World War one and World War two graduated from from medical school in 1910 and of course so was old enough to make World War one and then as World War two rolled around he was still young enough to make World War two my great-grandfather was one of the first docs in that generation actually graduate from medical school as most you know back then all you had to do really was kind of put out a shingle in order to be a doctor so she always wanted me to be a doctor but unfortunately these are my aptitude for science nor my attitude for studying so hard was going to ever let me be a doctor so I followed my father's footsteps and went into the military and I think both my mother and my father would be very surprised by my good fortune in life but while my mother's dreams of a physician son were dashed I can't tell you that my career in the military has intertwined with the medical profession time and time and time again particularly during the post 9/11 years as America's been at war I have had a front-row seat a front row seat to the bravery and the courage of our great combat surgeons our Doc's our nurses our medics our corpsman and it has been absolutely spectacular I have seen miracles I saw a man a great CLI new name Mike day who had been shot 27 times 27 times and he essentially walked away from it and is today a motivational speaker and talks about how he survived not only the initial shots but addiction afterwards and a lot of other issues and I've seen an awful lot of heartbreak breathtaking advances and frankly in some cases profound frustration and today what I'd like to do is share some of what I've seen some of the lessons we've learned over the past 16 years of fighting and how I think some of those lessons would apply to the work that many of you are doing today so let me start off by talking about a unit with whom I have worked very very closely the 75th Ranger Regiment we have a couple of Rangers in the audience with us today and as they well know the Ranger motto is Rangers lead the way Rangers lead the way and that certainly was true with respect to the battlefield trauma care the Rangers are one of the most elite fighting units in the world to say that the work they do is dangerous would be really the height of understatement airborne assault jumping out of airplanes and into the fight infiltrations behind enemy lines hostage rescues urban raids on high-value targets on a typical mission providing care to a fellow ranger who is wounded is very difficult among other challenges you may be operating in extreme weather at high altitudes it is likely dark outside because most the missions the Rangers run or at night you are far from any kind of military or medical facility I don't by the way the bad guys are generally shooting at you nevertheless Rangers must overcome these challenges because nine out of ten nine out of ten combat related deaths that are potentially preventable happen before a casualty gets to the care of a surgeon nine out of ten combat related deaths are preventable before they get to the care of a surgeon given the nature and the tempo of the Rangers work casualties are inevitable it's a fact of war and yet the 75th Ranger Regiment has achieved the lowest incident of preventable deaths ever documented in a combat unit let me repeat that the lowest incident of preventable deaths ever in a combat unit so how is that possible well it's possible because nearly 20 years ago a young Colonel the Ranger regimental commander named Stan McChrystal issued a directive acting on the advice of his superb ranger medical personnel he made carrying for the Rangers wounded in combat one of his big four priorities he said first as Rangers we need to be able to shoot so marksmanship was one of them physical training obviously as a ranger you're humping up and down mountains it's long patrols physical training was next small unit tactics and medical readiness one of the big for every Ranger was going to have to be an expert marksman physically fit understand small unit tactics and have the medical readiness necessary to take care of their comrades in the field it was understood from that point on that every Ranger was going to be engaged in casualty care so every ranger received training in tactical combat casualty care or tc3 as a result the Rangers achieved the lowest incident of preventable death in their wounded members in the history of modern warfare now tc3 what is it well tc3 is a set of evidence-based best practice pre-hospital trauma care guidelines customized for useful and battlefield continuously updated over the last decade and have their profound departure from both traditional military and civilian pre-hospital care practices tc3 was developed in the mid 90s by Special Operations medicine with a great assist from the uniformed services University our country's military medical school tc3 was innovative it was different and it was ahead of its time and because it was ahead of his time unfortunately it was slow to be adopted by the military in the years before Iraq and Afghanistan use of tc3 was initially limited to just the Rangers some Navy SEALs and a few other elite military units but it has now become the standard throughout the US military as well as many of our allies the goal of TC 3 is provide all operators since they all soldiers within that unit medical and non-medical personnel with the skill needed to save lives on the battlefield when their teammates are wounded and to do so under fire if necessary so what makes tc3 so different and why does it work so much better than the old approach before I get to that I need to take you back to 2004 the war in Afghanistan was well underway and we were losing a lot of young men and women on the battlefield captain Frank Butler former Navy SEAL ophthalmologist was the command surgeon at the US Special Operations Command at the time and he had two critically important questions he wanted answered first specifically what were our special operations operators dying of what were those combat casualties that were taking lives and second what if anything could be done to prevent those deaths now one might reasonably assume that the Department of Defense has always performed performed preventable death reviews on its combat fatalities but unfortunately as of 2004 there were no formal processes to review our combat deaths Frank Butler called on a young colonel named John Holcomb the commander of the US Army Institute of surgical research to help answer those questions many of you may know John is now working at Memorial Hermann this Army Laboratory is quite possibly the final finest battlefield trauma care research facility in the world and I'm pleased to note of course that it's just down the road from us in San Antonio what we learned once the study was performed was frankly beyond disturbing simply put we learned that a lot of special operators had died preventable deaths from preventable deaths and some of those deaths might have been prevented with very simple tc3 measures like a tourniquet seems a little unthinkable special operators America's best warriors getting shot in the arm or the leg and bleeding to death but it was happening over and over US Special Operations Command and soon after the entire US military realized that we needed a dramatic departure from our traditional methods of caring for our combat wounded tc3 was that departure the most important and the son the most controversial thing we started doing differently was to immediately start using tourniquets to stop extremity bleeding now the use of extremity tourniquets undoubtedly has been the most effective life-changing life-saving change in pre-hospital combat casualty care in the 40 years since I joined the military and maybe ever and yet as I'm sure you all know tourniquets aren't something new they've been around for at least for centuries but have until recently been completely Anantha to the words to the worlds of both military and civilian medicine thanks to tc3 the military has done a 180 on tourniquets and a sea change has begun in the civilian world as well if you can put yourself in the place of a young Army Ranger coming to the aid of a bleeding comrade it's hard to hold pressure on a wound while you're being shot at it's even more difficult to return fire while applying pressure you also can't apply pressure while moving the casualty out of the line of fire and you can't take care of another casualty while you were holding that direct pressure tourniquets a simple tourniquet change that equation dramatically along with hemostatic dressings another tc3 initiative tourniquets have helped prevent hundreds if not thousands of warriors from bleeding to death on the battlefield I know some doctors still believe that tourniquets aren't worth the risk of tissue damage but that notion is easily dispelled by both the routine use of tourniquets during orthopedic surgery by the fact that the US military put on many many thousands of tourniquets in Iraq and Afghanistan without causing any loss of limbs and most importantly by the countless men and women who are alive and well today because of tourniquet quickly and decisively stop the hemorrhage that might have cost that life still on the topic of blood another way we have completely changed our approach the trauma relates to the way we resuscitate a casualty who has gone into shock another part of tc3 as with tourniquets the idea is it novel but as we all know even the most common sense solution to a problem sometimes has to overcome the power of habit for many years the way we did things was to replace the blood spilling out of people's body with crystalloid fluid Chris Lloyd is inexpensive easy to make and it's become a tradition but we have learned that whenever possible someone who is bleeding blood ought to be given blood to replace it whole blood preferably not just red cells studies again from the Army Institute of surgical research have shown that transfusing whole blood helps us to save even more of our casualties lives and the sooner you get this life-saving blood the better tc3 recommends giving whole blood is the best way to treat shock on the battlefield and blood products are now routinely given during casually evacuations before they reach the hospital pre blood hospital blood products are now starting to be used in some parts of the US civilian sector as well here in Houston for example if you are a trauma patient shock and get picked up by the UT EMS system you will get pre-hospital blood products thanks to John Holcomb in the military we Revere tradition but outdated tradition can cost lives and cost pain to survivors hard as it is to believe the US military was until recently using the same primary medication for Battlefield pain relief that it did 150 years ago tactically speaking and for muscular morphine makes sense up to a point intramuscular morphine is fast and easy to administer but slower to work while intravenous pain medications work faster starting an IV on the battlefield takes time and is often impractical especially at night I remember as a young Navy SEAL one of the we all had to learn basic battlefield trauma and how to deal with patients and we were always giving IVs it was the first thing you learn as young ensign first thing you learn as a young seaman recruit seal is how to give an IV in all matters of weather day and night etc plus opioids like morphine can kill someone who has gone into gone into shock as we found out there one or two at the start of the war in Afghanistan however the military was still using intramuscular morphine almost exclusively but a plan developed by special operations Doc's came up with an alternative what tc3 now calls the triple option analgesic plan without going into great detail the first breakthrough is a fentanyl lozenge that gives you the rapid pain relief of a strong narcotic without having to start an IV lozenge goes between your cheek and your gum and works within just a few minutes the second breakthrough is the addition of a low dose k2 mine to the medics analgesic options it treats pain just as well as narcotics and is much safer to use for casualties at risk of shot this pain relief without it doesn't cause a drop in blood pressure the new approach the pre-hospital pain management has swept through the military and was reflected last year a new policy statement by the American College of Emergency Physicians in the last decade and a half we have profoundly changed profoundly improve the way we deliver trauma care on the fields of war death by extremity hemorrhage has dropped by two-thirds all units that have trained all their members in TC 3's best practices have documented the lowest incident of preventable D deaths in the history of modern warfare the statistics paint a very very good picture but the difference between knowing the stats and knowing the men and women who make up those stats is the letters you don't have to write to the families that's part of what it means to me but what does any of this mean to all of you there's no quote you've heard it before that says that the only winner in war is medicine and some of you probably know there are multiple efforts to translate the hard-won lessons of the post 9/11 conflicts and the better trauma care in the civilian sector the hartford consensus is an ongoing study effort by the American College of Surgeons to determine what can be done to save lives and a mass shooting or terrorist attack and I know that the TMA that this particular seminar I've had a chance to get out and see how are you dealing with mass casualties I think anything we can do to take the work that's been learned on the battlefield and translate that to the civilian world would be well worth the effort and the relevance of the military success with tourniquets and hemostatic dressings was immediately apparent and the hartford consensus team concluded that if we want to save more people in the event of an attack we need life-saving external hemorrhage control tools and techniques at the scenes just so as a DS have empowered the lay public to respond to heart attacks the hartford consensus recommends that easily apply tourniquets and hemostatic dressings become just as ubiquitous the same goes for a White House program called stop the bleeding recognizing the controlling severe bleeding external bleeding is something that everyone can do the this initiative hopes to make stop the bleeding kits with tourniquets and hemostatic gauze available at airports train stations stadiums you name it and just as every soldier sailor Airman and marine learn to use them the White House wants every American to be trained and ready to stop the bleeding at a moment's notice imagine the lives saved when that skill becomes as widespread as CPR or the Heimlich maneuver our nation's military men and women count on military medicine to provide them with the best possible care if they are wounded on the battlefield and we must live up to that trust every single day and the civilian sector that nations trust rests in our trauma care systems and we can live up to that trust by constantly searching for ways to improve trauma care and by saving as many as possible of the was 330 thousand injured Americans who die from preventable deaths each year let me leave you with a shocking statistic that may be two final thoughts during the war in Vietnam an estimated 3,400 US troops bled to death from injuries to their upper and lower extremities 3,400 young Americans who because the military was guided by tradition rather than an ongoing process of continuous improvement trauma care died preventable deaths that's shocking but what's more shocking is that between the end of Vietnam and the beginning of the war in Afghanistan nothing changed the papers have been written the evidence was there for all to see but nobody stepped forward asked hard questions demanded answers or drove change the point being we absolutely need well designated clinical research to guide medical practice but new evidence alone will not drive advances in trauma care we need strong leaders and a concerted determination to keep getting better at caring for the injured to make these advances happen I want to tell one final story and go off-script here just a minute I talked about the fact that my mother always wanted me to be a doctor and I wasn't really sure why she knew I probably didn't have the aptitude to be a doctor but in the ensuing a my ensuing 37 years the military I spent a lot of time in combat hospitals and there was one time in particular that will forever be kind of embedded in my memory it was 2009 and we'd had two young seals had been shot and I got the call from my command center that they were coming by medevac to our combat hospital in Afghanistan and the hospital was essentially a couple hundred yards from my command center so I make my way over to the hospital and just as the two casualties are being wheeled into the end of the hospital in the o.r and there's a young Army Major who is the trauma surgeon on duty and they quickly triage the two men we only had one surgeon on duty at the time they realized that one was more serious than the other so immediately go into the operating room and I'm in the operating room and the doc the major is in there he's got a battle-hardened nurse with him two young female corpsman or medics are in there as well and the doctor immediately stripped this young man down he's lay bare on the table and the doc opens up his chest and is trying to stop the bleeding and soon into the effort the two young ladies were probably know no more than 19 or 20 years old they just break down from the from having to watch this the seal get broken open blood everywhere and they they break down and they walk outside and the grizzled old nurse who I always thought of as as Hot Lips Houlihan she was kind of one of these ones been in battle she went outside grabbed those two young ladies said you got a job to do get back in here and to the young lady's credit they came back in unfortunately we couldn't save that young man the doc and I move to the next o-r where the other seal is has been shot as well unfortunately while we wear bulletproof vests beside the seam between the front plate in the back plate a 762 round it hit both these guys different on the same mission but kind of different locations on the mission and 762 is a pretty big round like 30.6 round and cut right through these guys we go into the second or and the young doc again cracks this kid open trying to stop the bleeding but unsuccessful there and and I remember the scene as the floor is covered in blood and the team has tried all that it can and the doc leans up against the wall after about you know 45 minutes trying to save these two guys he leans up against the wall slides down on the floor and weeps that was when I knew that was when I knew my mother wanted me to be a doctor why she wanted me to be a doctor so today as you look at the opportunity to take care of anybody out there first let me thank you for the hard work that got you here your patience your drive your care for those under the knife under the anesthesia under the covers for your compassion for all the to do for the patients in Texas and around the world please know that those of us that have the don't wear the white coats appreciate everything you do every single day thank you very much I know this is going to continue to be a great symposium David thank you for for the invitation today Karen thank you for the great introduction introduction again my deepest esteem for everything you do thank you all very very much thank you thank you thank you very much I did I have some time to take a few questions if you have some if they are hard medical questions I have the doc city of Jim you can come up and help answer these questions for me over here I have the command surgeon from 3/4 of this year today so you can answer the hard TV three questions but I am happy to take any other question might have yes sir David tisha orthopedic surgeon on behalf of over 50,000 physicians who serve 28 million Texans thank you for your service thank you for that message you've honored us in so many ways today I was the president of the American Academy where the big surge when Haiti disaster struck January 2010 you'll recall that the hope and the comfort or regular dispensed by the United States Navy it comes out of USAID which is stuck in Secretary of State Office and then they tell the Secretary of Defense get that ship down there and aresty did not want any military personnel on patient soil they immediately called us and said we need 10 orthopedic trauma surgeons we've got all kinds of limbs that are crushed a very difficult situation wanting memorandums of understanding indemnity you know what I'm talking about we immediately tried to supply 10 we got them 10 the hell had to be volunteers it was a messy situation it didn't go well we started a program to try to pre train our civilians just like the pre-training of your military uniform colleague before they went to OIF and OEF we've got a program in place we got the CC Kwas which is the credentialing system so that we were able to actually pre credential civilians in the military system and then the DoD shut us down and we're at an impasse we need some help so I'm going to give you a card and I'm asking for some help with DoD Department of State we're going to have another disaster that America and our Navy and our uniformed service will be asked to participate in overseas we want to respond we want to be helpful but even more importantly you brought up the whole thing about civilian disaster we have to get prepared yeah thanks very much I actually had the Vice Admiral Rakhi bono who is the head of the defense health now so we have a Navy three-star who is in charge of defense health now this is a I think rocky will be able to do some great things but we still have these kind of stovepipe with the surgeons general the Army Navy and the Air Force in terms of making sure we can pull together collectively you know a plan for moving forward but anytime and I know the surgeons generals want to get past the bureaucracy I mean again they are Doc's they want to do right by the patients we sometimes do get stymied by the bureaucracy and I think we can use all the help we we can to figure out how do you how do you probe that how do you assume the risk I mean this is what it always comes down to when you start talking about you know we've got to sign this up in value we got to do this it's all about who's going to accept the liability in the wrist somehow we've got to we got to work with the docs the same way frankly we do with the soldiers you know there are times in conflict when the soldiers make mistakes and people die and obviously if it was a you know if it was an accidental mistake the soldiers not held accountable we've got to figure out how to put ourselves in a position to provide the best care the quickest means possible without having to go through all the red tape and I think rocky Bono can help with that so by all means please leave me your contact Thanks yes sir I'm caisson Tarek I'm a pediatrician from North Texas really appreciate your sincere remarks my question is about how you learn as a culture from the experience of knowing something that you knew decades ago but not bringing it to the front line in a timely fashion how do you change culture to make sure that mistake doesn't happen yeah I tell you terrible to say but war allowed us to do that and I go back to this discussion about doc Frank Butler who again a number of the folks here in the audience know when Frank had Special Operations Command he actually went back and studied all of the casualties in Vietnam and this is where we get these statistics from and of course the the simple tourniquet was one of these ones that was well you know you talk to the docs on one side of the aisle of the other and they had differently different opinions on the use of tourniquets but Frank said hey look we need to move forward with us we beta tested it with the seals the Rangers the Delta Force but when 9/11 happened we said look you know we were losing a lot of guys and initially in Afghanistan in Iraq and so we moved to this because we had to and unfortunately you would like to think you don't have to have a war to drive the change but the reality of the matter is that's exactly what we had to do yeah again medicine always wins in war and we'll be better the next time but the kind of classic golden hour as the docs will tell you no kiddin when Fran I remember Frank used to tell me this when he went back and looked at these studies he said as long as they are absolutely not gonna die they didn't take around the head or around the heart and they are they are savable if we can get them to a combat hospital you know with a surgeon in that golden hour their chance of survival is above 90% that's pretty remarkable and when you see the corpsman and the medics that we are training today and certainly in the Special Operations arena we have a program that the goes through Fort Bragg used to go through Fort Sam Houston I mean these corpsman and these medics are remarkable in trauma care I mean they are light years ahead of where we were in Vietnam Korea world war two so we're doing a great job but again the war drove that you know hopefully we don't have to have a mass casualty so again when you start looking at mass casualties will get better after the next mass casualty we don't want to wait till the next match castle eight we got to figure this out now and people have to accept what our what our options are thing yes sir yes excuse me Dennis apostle palliative care duck from Austin and former hospital corpsman appreciate your coming today but you had mentioned the triple option for analgesia and you said fentanyl Lauzon jizz and ketamine what was the third part of that I'm sorry I couldn't hear what was the third option yeah then third up okay so we talked about the tourniquet the lozenge Jim can help me there the third option of the tc3 he said ketamine in general okay yeah on that that the tourniquet has something to do with pain management yeah so the pain management piece and again I'm a little out of my realm here what I remember what I remember was the the medics would take where the blossoms which was a big thing so we didn't have to in a muscular you know IVs and the the ketamine was the second part Jim can you answer the third for me when the triple option Allen's easy what they did is said hey look I am morphine doesn't doesn't really work in the pre-hospital environment we proven that over a hundred years not a great option and so when they went to triple option they said hey look we gotta use things that work number one was ketamine number two was Sentinel and and then using narcotics appropriately so I can use I IV morphine on other options but I am morphine was taken off the list and so that was a triple option analgesia concept you guys do know that sub-q morphine works pretty well too absolutely yeah yeah so I think it was a little muddled ordinary all but the triple option really was okay continue to use the narcotics if you can if not you got the lozenge M the M ketamine yes sir okay good thank you yes sir it's Steve permit from the AMA board my understanding is that the combat uniforms now have built into them eight tourniquets that can be self-administered is that correct well the guy with guys again I haven't seen that I've been out for three years but I can tell you when I was in Iraq and Afghanistan I mean the tourniquets about yay big guys will carry multiple tourniquets on their body because if you have a Franklin if you have a helicopter crash or you know guys get to hit in combat I mean on a night op you know Rangers you may have three or four guys that are wounded you know with maybe one medic so guys are all doing it so so yeah they carry them but they can put them in a cargo pocket or they you know they put them on their web gear easy to carry and I don't know if the new uniforms actually have better than them or not that was my understanding is that the new uniforms actually have them and have eight of them embedded for each part of the extremities so that they can just crank them up themselves thank you yes sir Chancellor McRaven thank you very much for a very stimulating and very powerful presentation you know you talked a lot about being prepared or optimizing our disaster preparedness now I'm an anesthesiologist actually at governmental schools one of your institutions and one thing that you that you Lou - for example DARPA developed a drug delivery device that could actually make drugs for the field like a portable pharmacy for Afghanistan you mentioned the auto injectables that are being developed right now how how does the process work to actually get these great ideas that can actually reduce time to delivery of care in the civilian world and even not necessarily only in the emergency preparedness it realm but also reduce costs and increase quality of care and increase value of care for the regular civilian world on top of preparing us for disasters how do we get all that that creativity that you me know to harness in the military with those resources and get that to the civilian world faster and please describe that process yeah I think again I'll go back to the point you know in war we have we have regulations and then we follow the regulations and certainly when it comes to life or limb we have to follow them pretty closely but having said that in wartime because it's an all-volunteer service you will find we are able to spend more on a patient because frankly we're not concerned overly concerned I mean the docs are concerned you don't want to you don't want health care costs to outrun their the cost of fighting war but but frankly cost in general is not a factor what happens when we are trying to develop you know new new protocols is the military will put the amount of money into it to develop a new protocol or the dc-3 or whatever the device might be and then once we find out whether or not it actually functions on the battlefield and does well because again you hate to say the soldiers are kind of helping beta-tested but if it's going to save lives you're prepared to do that and then you can begin to scale it up a little bit and so it's a little bit I think difficult to compare how we would do things in the military in terms of cost-saving relative to how you might do things in the civilian world I think what happens though is as we move down this path in the military and we hit a price point that works I think that's when the kind of cross pollenization occurs Jim my clothes on it all right desert Michael Levine from Galveston Texas I'm a psychiatrist but I was a general medical officer in Vietnam 1 3 & 2 4 abilities and I want to give a shout out to military psychiatry we didn't have a clue with PTSD and again stress reactions work we just knocked the guys out and if they would wake up we'd give them their m16 deck and send them back and the progress that has been made in recognition in treatment is just astounding and just a shout out to military behavioral health yeah thanks so the comment thank you the comment was really on psychiatry in the you know how today's military really is much better and I think a lot of it has to do with just you know recognizing and as you can see PTSD is not just a function of guys that we're always in hard combat I think anytime you're around kind of trauma for a sustained period of time you know there's always something that lingers I've told that story a number of times hoping that it will get easier to tell it never gets easier to tell but I'll tell you what we have done and this was a you know this required I think the soldiers if you will to excuse the term but to man up and and one of my command sergeant majors so the senior enlisted guy in US Special Operations Command was a sergeant major Chris Farris and Chris had been a young adult operator during the famed Blackhawk down in Mogadishu he had fought in Kosovo and Bosnia in Iraq Afghanistan a highly regarded he had been the Delta Force command sergeant major so a very very well regarded senior enlisted man when he came to work for me initially my three-star and then my four our man but Chris had issues he had seen a lot of combat in his time he struggled with with depression he struggled with relationships he struggled with a lot of things and he and his wife god bless him Lisa when when they came to SOCOM he said sir we have got to get the word out that it's okay for these young enlisted guys to say I got a problem so he and Lisa really went on a road show to meet with all the enlisted guys across the 70,000 folks I had and then eventually he started working with the army and the other services because his story was so powerful and the point was it's okay guys it is okay to come forward and let people know that you've got issues we had a number of issues psychiatric mental health issues PTSD issues that manifest themselves on the battlefield in ways that were horrific because people all the sudden saw shadows were their works at OHS and we had a blue on blue incident one time where a young soldier a soldier killed his very best friend because he thought he was the enemy because he was so terrified because he had been in constant combat so we began a very aggressive approach to dealing with PTSD and every unit that went into the field before they would come back we had what we call the I think it was a third location decompression so instead of taking folks directly from the battlefield back to the continental United States which we used to do you could be literally in a fight one night and 24 hours later you're back with your wife or girlfriend and let me tell you that is not the way to bring people integrate them back into you know a common environment and so we would send them someplace just for a couple days to decompress but we also would get them with the site the dot the chaplain and a counselor and we would do the neck up checkup basically we would say look we need to talk to how you doing they would do a physical checkup they do a mental checkup they would go through all this and they give a chance to kind of have a beer and chill out before we integrated them back into the backend of the homefront so we recognize now in ways that we didn't before the real problems that are that are existing out there with the force not to say all these kids are broken they're not they're great young men and women but we should never and I think frankly I'm going to segue off here for a second all of my dachshund David Lakey is here with me as well my my vice chancellor for Health Affairs we are looking between the presidents at at all of the six health-related institutions I have in the Anderson UT Health Care and Houston and Tyler and San Antonio and Southwestern we are all looking at how do we make sure we are taking care of the caregiver we understand that physician burnout is one of the key issues affecting you know physicians you know around the world and so we are trying to figure out ways what did we learn what did I learn in the military in terms of dealing with burnout of the soldiers who have been in combat for almost 15 16 years how will that apply to the physician and the nurse and the caregiver that has to do the same thing what do we need to do in order to improve our quality of life for the physicians so you should know that the UT systems taking that on headfirst that was a long answer to your question but there's a lot going on in that field yes sir Admiral hi I'm John Scott a anesthesiologist from Dallas Fort Worth I was in the Army for nine years appreciate your speech today was impressive my question is is all of a sudden the physicians have been been attacked or having to take on a battle with it as part of it being the VA because now we have a nurse that is the Surgeon General so the general idea as far as in the VA so how can we as physicians take care of this and I understand with what you said today you get it and so what are we supposed to do when all of a sudden we're being attacked and we're trying to take care of patients but yet we're having to be in Austin and Washington DC trying to defend our patients I appreciate your comments yeah thanks yeah I think I'd have to see all the various issues that you're having to deal with but but I tell you this has got to be a kind of a constant dialogue I think between the Texas Medical Association the physicians are at large with whoever's setting policy we talked early on about the policy and how PMA is trying to influence the top of policy at the Capitol I think you need to continue to make your case but but I will tell you I want to go back to this discussion about my my presidents because it was very enlightening for me one of the very first retreats we had that I attended maybe as the second retreat we we used to hold the retreats in a very kind of sterile environment and we would you know kind of the presidents would come in one day and we'd have this discussion we have briefs all the sort stuff and I said you know what I'd like to do is someone I need to get to know these guys so we're going to start off someplace not in the AT&T Center and we'll meet the night before and we're gonna have drinks in the bar I want to talk through issues where we're not looking at PowerPoint slides and it was interesting those discussions in the bar before the formal event the next day we're probably the most productive of any discussions we had but might take away from these presidents that run these very large multimillion-dollar multibillion-dollar enterprises is that they're still Doc's that they care about their patients and that came through loud and clear we weren't talking about the margin we were talking about the mission of MD Anderson and UT Health and Health Science Center San Antonio and and the Medical School is what we were talking about patient care and when you talk about patient care from dots that are passionate it's really hard to fight that argument yes sir kinematics trauma surgeon Houston thank you sir for being a Texan my pleasure if we look to our right to our left in front of us and behind us the intellectual and experience property in this room is awesome we don't have to go to Rand we don't have to go to Hartford I suggest for us to think together in the positions of authority that are in this room to create a think tank in Texas that consolidates this experience this vision this challenge that overcomes the political arena and has a practical approach to what we do to the challenges you reiterated and the time to start that is today I couldn't agree more then one of the one of the things that I challenged my staff is we began to build our strategic plan and it is right along those lines I said you know we we tend to in the areas of national security and healthcare and pick something I said I want people to start asking what does Texas think what this Texas think on the national security side about terrorism about about immigration about help what this Texas thing stop asking what Harvard thinks and Stanford things asked if you want but asked what's that Texas things so this was kind of a this was a theme of where we wanted to go again if I'm sure there is no greater talent than the talent that's in this room today but I will tell you I think it's true of a lot of other areas across Texas again when I look at UTMB I talk about you know when we look at the Medical Branch in Galveston with with one of the few you know level four biosafety labs and you look at the work they're doing on Zika and in bola and although there is no other institution like that you know maybe one or two others in the entire nation so if you're worried about a pandemic come to Texas that's just what we think you want to know about the order and immigration issues go talk to the folks at El Paso Yukie El Paso or Yuki Rio Grande Valley so we need to ask every everybody out there needs to understand this has become an intellectual center for a whole lot of issues certainly medicine and caregiving ought to be atop that list well thank you all very very much I enjoyed being here today thanks very much [Applause]

Channel: Texas Medical Association

Views: 53,643

Keywords: Texas Medical Association, TMA, patient, physician, patient care, health care, keynote, 2017, texmed

Id: mBmRDmdfwwI

Length: 47min 52sec (2872 seconds)

Published: Mon May 15 2017