C-STARS prepares medics for expeditionary duties

(Editor’s Note: The program at Baltimore Shock Trauma Center is one of three C-STARS programs helping the Air Force train and maintain the highest caliber trauma medics.  A division of the U.S. Air Force School of Aerospace Medicine, the Air Force Expeditionary Medical Skills Institute that runs the Baltimore program also operates C-STARS training platforms at the hospital trauma centers of St. Louis University and the University of Cincinnati. )

By Col. Michael Restey
89th Surgical Operations Squadron Commander
Andrews AFB, Md.

On any given day you will find U.S. Air Force health care professionals providing world-class trauma care at the nearby Baltimore Shock Trauma Center.

These Air Force physicians, nurses and medical technicians are indistinguishable from the rest of the University of Maryland School of Medicine and Medical Center staff that work at the Shock-Trauma Center except for their identification badges that have the five letters "C-STARS".

C-STARS, the Center for the Sustainment of Trauma and Readiness Skills, is a program that rotates active-duty Air Force health care providers through the state-of-the-art Baltimore Shock Trauma Center.  The center admits more than 7,000 trauma patients and performs more than 8,000 surgical procedures annually.

The C-STARS program was developed as a result of studies performed after the first Gulf War that indicated military medicine was not as prepared as it should have been to successfully treat a large number of combat casualties.

Recent base closures, medical force restructuring and institution of TRICARE all led to a reduction in the number of critically ill/injured patients that are treated at Air Force medical facilities, diminishing our provider currency in trauma care.

At the same time experience was decreasing, Air Force medical teams were being called upon to provide a high level of trauma care while deployed around the world as expeditionary medical support system and critical care air transport team members.

Coincident with the establishment of C-STARS, the Air Force surgeon general developed a program to define skill requirements for all deployable medical personnel. Analogous to the currency program for a pilot that requires a specific number of takeoffs, landings and approaches over a specified time period, the Readiness Skills Verification Program requires performance of a specific number of clinical procedures for medics.

For example, a general surgeon is required to perform at least five cardiothoracic and 25 abdominal/pelvic surgical procedures annually, in addition to other surgical skills, critical care and trauma patient management. Each specialty has its own set of requirements. 

The Baltimore C-STARS program brings Air Force health care providers together for a month-long trauma immersion experience.  While at C-STARS the participants provide hands-on care for actual trauma patients under the supervision of military and civilian staff.

The Air Force has 13 health care providers assigned to the Shock Trauma Center for their primary duty. These individuals provide the core academic instruction and on-site administration of the program under the auspices of the USAF School of Aerospace Medicine.

The permanent Air Force faculty includes three trauma (general) surgeons, an orthopedic trauma surgeon, anesthesia provider, critical care physician, four nurses (two critical care, one trauma and one operating room) and two medical technicians.

The faculty is fully integrated with the Shock Trauma staff and they hold equivalent teaching appointments at the University of Maryland School of Medicine.  They also provide the Air Force surgeon general with a core of highly trained and experienced trauma medics that can be utilized for special readiness and disaster missions.

As an example, the C-STARS orthopedic staff trauma surgeon was deployed to Landstuhl Army Medical Center, Germany, during the height of the Iraqi War to support the staff with care of casualties with orthopedic injuries.

Rotating personnel are selected for attendance based upon currency requirements developed by each specialty consultant and the individual's assignment to a specific EMEDS/CCATT readiness team and AEF window.

During any given month a significant number of Malcolm Grow Medical Center staff may be TDY to Baltimore Shock Trauma.

For example, two operating room nurses, an OR technician and a nurse anesthetist form the Surgical Operations Squadron all spent the month of January at Baltimore.

While staff attendance at the program may sometimes adversely impact our productivity and access to care at the Medical Group, the benefits for training and trauma currency far outweigh the costs.

By all measures the C-STARS Program has been a success in sharpening and refreshing the trauma care currency, knowledge base and confidence of our Air Force medics.

Attendees become more competent and confident in their ability to care for trauma.

During the month long TDY many of the rotators have the opportunity to accomplish the majority of their Readiness Skills Verification tasks through the care of actual patients.

Overall, C-STARS has been a win-win partnership for the Air Force Medical Service and the Baltimore Shock Trauma Center.

The Air Force community can be assured that their expeditionary medics are ready to meet the challenges of providing the best care possible for our deployed troops in the most forward and austere environments.

The outstanding performance of our EMEDS and CCATT medics during Operations Enduring and Iraqi Freedom has validated the training and currency programs that have been instituted over the last several years.

The C-STARS Program has played a major role in that success.