On a recent Friday night in the trauma unit of Stroger Hospital, a public teaching hospital in Chicago, Navy hospital corpsman Michael Soto stood at a woman's side, watching intently as a surgeon treated her for a leg injury, ready to help in any way he could.
The woman, whose leg had been fractured, writhed in pain on her bed as the surgeon drilled. Surrounded by first-world equipment and a team of personnel, Soto was a world away from the battlefield, where he last had to deal with such gruesome trauma.
The Lake Villa, Illinois, native had deployed as a "doc" with a Marine Corps platoon to Afghanistan in 2011, where all he possessed to treat injuries on the battlefield were his training and the supplies he carried.
"Combat is, like, 'OK, here's your med bag, go take care of some Marines,'" the 24-year-old petty officer 2nd class said. "You don't have a physician, you don't have a nurse next to you. You're it."
Currently stationed stateside, Soto is part of a new partnership between Stroger and the Lovell Federal Health Care Center in North Chicago that exposes Navy medical personnel to the civilian side of trauma care.
Only the second such program in the country, the initiative allows sailors such as Soto to work shifts at Stroger — a Cook County-run hospital that handles hundreds of trauma cases each month. There, they learn about injury treatment at a level above the battlefield while keeping their existing skills sharp. Hospital staff also benefit from the knowledge of those who have seen and treated war zone injuries firsthand.
Navy corpsmen perform a variety of jobs at facilities like Lovell or the adjacent Great Lakes Recruit Training Command, everything from lab technician to physical therapist and administrator. Those who deploy with combat units learn to stop the bleeding and open airways amid war zone chaos until a medevac chopper flies in to whisk a casualty away. But those are skills they rarely get to flex here.
Such "perishable skills" inevitably grow dull if they are not used regularly, according to Dr. Faran Bokhari, chairman of Stroger's pre-hospital services and trauma resuscitation division and an architect of the partnership. These skills must remain honed for whatever the future holds, he said. Soto and the other Navy personnel working at Stroger could again be deployed to Afghanistan, humanitarian missions or other tasks.
The corpsmen are treated as a hybrid of a senior medical student, a nurse and a paramedic during the program, Stroger officials said.
"Some of them are very experienced," Bokhari said. "They're not green medical students out of la-la land. They've seen the blood and guts."
Stroger's civilian staff benefits from hearing about war zone trauma care and cases not regularly seen at Chicago hospitals, according to Dr. Andrew Dennis, a Stroger trauma surgeon and chair of the pre-hospital and emergency services division.
"We don't see many explosive injuries," Dennis said. "We don't see that many high-velocity rifle injuries, where they do. It is certainly great to have that expertise come back from the military theater and bring back those lessons in education to us."
The program, just a few months old, will also be useful training for Navy personnel who have not deployed, according to Lt. Cmdr. Stan Hovell, a Navy nurse who oversees staff training at Lovell and is wrapping up his own Stroger rotation. A corpsman hesitating at the first sight of blood in a deployed environment could prove costly, he said.
"It's important to get them this kind of training here, so they can see how to stop that bleeding and save that life," Hovell said. "They pick up those skills and carry it back to the Navy."
Lovell's proximity to Cook County, and the fact that the county has one of the country's highest rates of "penetrating injuries" such as gunshot wounds and stabbings, made it an ideal partner for the Navy, said Dr. Jared Bernard, a lieutenant commander and surgeon who helps run the program from the Navy side.
Although the similarities between Stroger staff and Navy medical personnel may not be immediately apparent, trauma treatment involves the same adrenaline-filled, regimented protocols in Chicago as it does in a military hospital in Afghanistan, he said.
Such care in a war zone just involves less technology and other first-world amenities, said Bernard, 37, an Afghanistan veteran who will work one week a month as a surgeon at Stroger during his three-year assignment at Lovell. Civilian trauma care often flows from war zone innovation, he said, with everything from tourniquets to helicopter transports originating out of battlefield necessity.
At Stroger, the corpsmen generally work 12-hour shifts, during which they see a variety of wounded come and go. On that recent Friday night, they helped treat a man struck with a baseball bat and another who came in stabbed and bloody. The corpsmen looked like any other civilian staff member and interacted easily and efficiently with their civilian counterparts.
"Nice job, corpsman," Stroger nurse Lisa Biancalana-Marsh said to one of them as staff crowded around an injured man they had helped treat.
Navy Petty Officer 2nd Class Dwight Koontz stood with fellow corpsman Soto at the side of the woman with the injured leg, telling her "it's almost over" as the surgeon worked on her.
Soto and others said they feel as though they're in a learning environment, where their understanding of trauma care can be taken to the next level.
Corpsmen who deploy with Marines, such as Petty Officer 2nd Class Karl Gieseke, only treat patients on the battlefield and never see them again after the helicopter flies their charge away. Stroger is offering them education on the "fourth dimension" of trauma care, the 28-year-old Wheaton, Illinois, native said.
"It's been really cool to see what goes on after they leave our hands," he said.
Corpsmen working at Stroger said they felt much less pressure at the county hospital than they did while deployed, among other differences. Soto thinks his deployment better prepared him for Stroger. He knows what questions to ask and has felt the work at Stroger to be an "easy transition" from the battlefield, he said.
Through his Stroger rotation, Gieseke said he has seen how various gunshot wounds can differ, with the wounds at Stroger appearing almost tidy compared with what he saw when deployed to Afghanistan in 2011 and treating injured Marines.
Tissue damage can be quite severe and messy when meted out by the high-velocity rifles used on the battlefield, he said. "But a lot of the stuff we saw here was just low-caliber, low-velocity handgun rounds that would come into the body and (produce) a really clean hole," Gieseke said. "It threw me for a loop a little bit."
As a doc in Afghanistan in 2011 and 2012, Soto recalled not only treating gunshot wounds, fractures and amputations but also fielding general medical questions from his Marines during downtime and showing them simple medical fixes that would free him up should he have to treat more than one casualty at a time.
"You're going 100 mph, just kinda doing the best you can," Soto said. "You don't know if another guy is going to get injured, so you're patching up one guy really quick, just to hurry up because something might happen to another guy."
In addition to the pace being slower at Stroger, Soto said he is treating patients with very different backgrounds than the Marines with which he deployed.
"In the Chicagoland area, it's gangs and poverty," he said. "In the military, it's healthy people. Everyone has a good heart rate, everyone has for the most part good blood pressure."
Soto said he could speak more directly and act less touchy-feely with Marines than he can with Stroger's patients. He also shared a more personal bond with his uniformed patients, troops he lived and bonded with in Afghanistan.
Koontz said he did everything his Marine infantry unit did while deployed to the violent Sangin district of Helmand province for eight months in 2011. It was a crazy environment, the 29-year-old father of two said, and the unit's day-to-day missions ranged from security patrols to sweeping for IED's, treating sick villagers and doing "public relations" work with the locals.
"Then, when somebody got hurt, I took care of them," Koontz said. "My job as the corpsman always came first, but if I needed to be a rifleman, I was."
Stroger's trauma unit is a veritable cornucopia of supplies and personnel, amenities that Koontz largely went without while deployed with the Marines.
"Whatever I carried out with me (on missions) is what I had," Koontz said. "If I didn't bring it, we didn't have it."
A corpsman's main battlefield duties are to stop bleeding and establish an airway until the injured can be evacuated, he said, but at Stroger, paramedics have already stopped the bleeding by the time patients arrive.
"Nobody's shooting at you, so it's a lot easier that way," Koontz said of his time at Stroger. "I expected it to be a lot worse."
The Navy-Stroger partnership has also helped civilian staff to better understand the military medical world, according to Biancalana-Marsh. Staff was not entirely sure how much the young sailors would be able to handle, she said, until they learned what Koontz, Soto and Gieseke had done during their deployments.
"After seeing that, we put them to full use," she said. "They suture, they draw blood. It's a much-needed hand and help."
Soto said the civilians didn't really know what a corpsman was when they first showed up.
"You've got to educate them on the (military) branches," he said, smiling. "They're like, 'How's the Army?'"