“This time, let’s make sure we remove the neck brace, since last time we did it too late, and missed critical information,” calls out Lieutenant Rachel Robek, PA, a physician assistant in the Division of Trauma. The rest of the group, an Emergency Department physician, an anesthesiologist, and three nurses, nod in agreement.
The group stands in a circle around the patient, a manikin in shorts and a polo shirt, with gashes on his right arm and foot, which have been created with moulage, or special effects makeup.
“The patient was in a waterskiing accident and has had a lot of blood loss. He has a wound on his right arm and right ankle,” Commander Mary Decoteau, MD, a general surgeon reads from a stack of papers as the rest of the group listens. “Ready? Go.”
The team snaps into action around the mannequin, cutting off his clothes, and assessing his vital signs.
“Sir— can you hear me? What’s your name?” asks Lieutenant Commander Gu Feel Kang, MD, an anesthesiologist.
The manikin groans in response.
As the team continues to try to stabilize the “patient,” his vital signs on a nearby screen respond in real time. A blood pressure cuff is administered, and his blood pressure appears on the screen, followed by his oxygen levels after a sensor is placed on his finger.
Lieutenant Joanne Mamie, RN, an Emergency Department nurse, darts across the room and grabs a cooler, which is full of units of fake blood, to help replenish what the patient would have lost prior to arriving at the hospital. At the same time, LT Robeck applies a tourniquet to the patient’s right arm.
While the team works on the patient, Commander Christine Deforest, DO, an Emergency Medicine physician, stands at the foot of the bed, calling out updates on the patient’s vital signs, and updating the team on each other’s progress.
Eventually, the case wraps up, and the team simulates how they would pass the patient along to the operating room, summarizing his injuries, which medications he was given, and what procedures they performed to stabilize him.
They will continue to a classroom to review video footage of the case, and talk through how they handled it, identifying areas to improve on for next time.
This isn’t a typical group of Trauma medical staff. They are all sailors in the United States Navy, and train with Penn Medicine’s Trauma Division as part of an expanded and extended partnership that aims to provide military medical staff with the skills they need for deployment.
The first phase of the partnership was considered so successful by both Penn Medicine and the Navy that they launched the second phase of the partnership this month. The new program will triple the number of Navy teams trained at Penn Medicine, double the length of the program, and incorporate even more specialized training for each team, focusing on the specific challenges of providing medical care during combat.
Growing importance of military-civilian partnerships
The first Navy team with the Ben Franklin statue on campus in 2021.
Penn Medicine’s Trauma Division completed the first phase of a pilot partnership with the United States Navy in June 2024. The three-year program embedded eleven Navy medical staff— four physicians, three nurses, a physician assistant, a surgical technician, and a Search and Rescue Corpsman— into the Level I Trauma Center at Penn Presbyterian Medical Center to train as a team and further develop their skills prior to deployment.
This partnership arose after a 2017 report led by C. William Schwab, MD, the founding chief of Penn Medicine’s Trauma Program, a professor emeritus of Trauma Surgery, and a veteran of the Navy himself, found that in times of relative peace, the level of skills and ability of the medical community to meet the needs of injured war fighters goes down, a decline known as the “Walker Dip.”
To combat this, Schwab and colleagues outlined a need for civilian-military trauma system partnerships that would allow Navy medical staff to build and maintain skills needed for rapid deployment. Supported by the 2016 Mission Zero Act from the National Academy of Medicine, Schwab and Jeremy Cannon, MD, a professor of Surgery in the Division of Trauma at Penn Medicine, and U.S. Air Force veteran, developed a proposal for a revolutionary three-year pilot partnership with the U.S. Navy, which launched in 2021.
“These military-civilian medical partnerships are not only important during times of conflict; the skills and systems that lead to expert care during deployment are also crucial for rapidly responding to disasters and mass casualty events,” said Cannon, the Surgeon Champion of the Penn Medicine-Navy partnership. “Partnerships like Penn’s with the U.S. Navy make sure our military medical units are prepared to care for Americans wherever and whenever they are needed.”
Recently, Penn Medicine and the Navy launched the second phase of the partnership, which will last six years and train multiple teams simultaneously. Unlike the first phase of the partnership, in this phase, each team will train at Penn Medicine for a year, deploy as a team in the second year, and then return to Penn Medicine for the third and final year.
Trauma is a team sport
The new Navy team cares for a patient during a simulation at the Penn Simulation Center. From left: Lieutenant Rachel Robeck, PA, Commander Christine Deforest, DO, Commander Anthony Njoroge, RN, Lieutenant Commander Gu Feel Kang, MD, Lieutenant Joanne Mamie, RN
A main priority of the program is to build a team that works as a cohesive unit, in addition to sharpening individual skills to prepare for combat. The team trains together regularly, and all members of the Navy team are scheduled in the trauma bay at Penn Presbyterian Medical Center every Wednesday.
“Our experience suggests that outcomes improved as the team became more familiar with working together and built trust,” said Commander Jay Yelon, DO, FACS, FCCM, a senior trauma surgeon, during the first phase of the partnership. “At a certain point, the team stopped needing to speak to each other— they could anticipate the next moves without saying a word. Being in sync like that can be the difference between life or death on the battlefield.”
While the Navy team members will go their separate ways for their next assignments, their experience at Penn Medicine positioned them as team leaders, and they will pass along the skills and practices they learned to a new group, multiplying the impact of the partnership.
Building leaders
Commander Mary Decoteau, MD, leads the Navy team in discussion as they debrief after a patient simulation.
Commander Decoteau is using those skills at Penn Medicine, where she will remain for at least another year as Department Head for the Navy Trauma team.
Prior to coming to Penn Medicine in 2021, Decoteau was a junior attending surgeon at the Naval Hospital in Pensacola, Florida.
“I was inexperienced and lacked confidence three years ago,” Decoteau recalled. “At Penn, I was immediately immersed in a fast-paced setting and had amazing mentors who not only helped me improve my skills, but improved my confidence in these stressful and high-stakes situations, and shaped me into a decisive leader.”
Unique training for unique circumstances
Since providing medical care in combat is different from care at a hospital, Penn and Navy leaders had to get creative when planning training for the program.
“We worked with the Navy to determine which skills and competencies should be mastered by all team members, and developed a system to track each individual’s progress,” said Shiloh Kramer, RN, a clinical education coordinator in the Trauma Division, who helps oversee the program.
Not only does the team run patient simulations in the Simulation Center and service in the trauma bays, but cases in both venues are also filmed, so that the team can review them later, and learn how treatment and communication can be improved.
Lieutenant Hyun Kyoung "Sally" Na, RN, a nurse on the Navy team with the PennSTAR helicopter atop Penn Presbyterian Medical Center during her rotation with the Flight Team.
One of the many ways patient care in combat differs from caring for patients in a civilian hospital setting is that in combat, the roles of many Navy team members might expand beyond the skills of a typical nurse or surgical technician. As such, Penn Medicine arranged for rotations across departments for many of the Navy staff.
For example, Lieutenant Hyun Kyoung "Sally" Na, RN, an Emergency Medicine nurse, spent time training in the intensive care unit, the operating room, and with the PennSTAR Flight Team, where she cared for patients being transported to Penn Medicine by helicopter.
“So many staff members at Penn Medicine are veterans, and were able to answer questions about how different procedures could be done when I’m deployed, and don’t have access to all of the hospital or prehospital resources,” Na said.
Despite the extensive resources at Penn Medicine, surveys revealed that the Navy team lacked experience with acute burn treatment and pediatric patients. For the second phase, the team will rotate into a local burn center and at Children’s Hospital of Philadelphia.
Sometimes, the circumstances of combat are quite different from those of Philadelphia: the environment can be loud, dark, dusty or smoky, and specific tools or personnel may not be available. Penn Medicine is in the process of securing funding for immersive environment technology, which uses projectors to transform a simulation training room into a combat zone. The system can reproduce the chaos of combat, using sounds of gunfire or explosions, sirens and civilians, flickering lights, even producing smoke.
Looking ahead to the next phase
Since the teams in the next phase of the partnership should be prepared to deploy after their first year, program leaders have had to adjust the training schedule.
“The program is a lot more condensed in this phase,” said Kramer. “We have a blueprint, but we’re tweaking it to accelerate team building and to get them ready to treat real patients in the trauma bay sooner.”
Encouraged by the success of the first phase of the partnership, Penn Medicine and Navy team members alike are energized and ready for the next six years.
“Everyone is so eager to help us make this partnership successful, and it has a huge impact on both the Navy team and the Penn Medicine staff who interact with them. It’s a huge morale boost all around,” said Schwab, who was recently honored by the American College of Surgeons for his career in trauma surgery and advocacy for military-civilian partnerships.
He added, “It’s truly an honor to be able to play this role in supporting our country.”