Last week, we got a chance to visit the Brooke Army Medical Center (BAMC, pronounced “bam see”), located in San Antonio, Texas. BAMC is one of the U.S. military’s primary hospitals and a major medical research facility: the 450-bed hospital features a level-one trauma center, graduate medical education, and military’s only American Burn Association-verified Burn Center. The ABA verification means that all burn victims from Iraq and Afghanistan arrive at BAMC, after a stopover in Landstuhl, Germany, about two days after the injury on the battlefield. The hospital-based U.S. Army Institute of Surgical Research (USAISR) Burn Flight Team has transported to the hospital hundreds of casualties using specially modified C-17 transport planes. Once on site, patients receive full-time physical and mental therapy, while clinical researchers have a lab-to-animal-to-clinical-trial facility to improve the care provided. Although it is a Department of Defense facility, the hospital accepts civilian patients from the surrounding region, and the research scientists publish in clinical journals and share their knowledge with the world.
Burns to the face create a special treatment challenge because applying pressure with a bandage, like in the cases of burns to torso or limbs, is impossible. In order to make individualized plastic masks that perfectly fit the patient, the center has built its own system to digitize the face in 3D, mill a mold, and press the plastic into shape.
Here’s our editor Gene Ostrovsky’s face being laser-scanned, just like a new patient:

Once the scan is complete, a technician cleans up the 3D model, smoothes it out, and sends it to the mill where a special hard foam is used to make the mold:

Once the mold is complete, it is sent to a vacuum forming machine that produces the final product – simply clip on some straps you’ve got a perfectly fitting mask in a matter of three hours.

The burn center also has a SnowWorld virtual reality video game system, that we reported on a few years ago, for patients to play during bandage changes. The system was developed at the University of Washington, and a clinical study at BAMC have shown a significant reduction in perceived pain while playing in the snowy, cold world. Here’s a link to a short NPR report about the use of SnowWorld at BAMC.

Other interesting research going on at the Institute of Surgical Research includes the use of ketamine for PTSD patients, stem cell therapies, regenerative medicine, and a blood coagulation research program. A lot of the research is done for conditions often ignored by the private industry, like severe trauma care, malaria, and Japanese Encephalitis. Here the researchers are also involved in battlefield clinical trials for such things as tourniquets and new gauze material. We also saw a Nintendo Wii being used for rehab sessions. Even though there’s a considerable amount of research being done already, the institute will soon double in size. The new building is already built and equipment is starting to flow in, generating a lot of excitement from the current staff who will get a lot more space, and thanks to the design, a lot more sunlight in their labs and offices. Here’s an animation of the new facility…
The clinicians referenced the strong attention that evidence-based medicine is given, the great interest in technology that “the command” has in improving care, and a singular focus of the entire place on the quality of life of the wounded.
For longer-term rehabilitation of wounded warriors, right nearby there’s the Center for the Intrepid, a three year old facility built purely with donated money. The Center has climbing walls, a surfing pool, all kinds of rehabilitation technology, and lots of virtual reality video games to make a difficult recovery considerably more fun and productive. Sadly, we didn’t get a chance to visit the center due to the tight schedule.
As for preparedness training, battlefield doctors and nurses learn from experience by setting up a field hospital in the local woods nearby and actually taking in real patients who don’t mind an unusual clinical setting. Medics that expect to be rescuing casualties from the battlefield even get training in a cadaver lab to help prepare for the shock of seeing terribly injured and fatally wounded people.
Because this is a military hospital, there’s very little paperwork to deal with regarding payment and insurance, something the doctors and nurses were really excited about. There’s also a fully implemented EMR system and nutritionists, for example, use it to program patient diets so that heart patients don’t get a BLT for breakfast. The facility also has an InTouch robot, camouflaged of course, for remote consultations with specialists in other hospitals.
The Army doctors and nurses we were with spoke a lot about constant forced career progression, training outside the military, and new mentors and leaders to work with. We spoke with folks that started their careers launching mortars during Desert Storm and are now providing advanced nursing care to the severely injured. One interesting thing we noticed is how close civilians and contractors work together with the uniformed team members. However, the uniformed were proud of the elite training they receive, the ability to perform their work in limited resource, dangerous environments, and a real mission that motivates everyone to succeed.
The Army was kind enough to sponsor the transportation and lodging for this one day visit, and we’d like to truly thank them for this opportunity and for the work they do in treating our wounded heroes.