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Military doctor finds plenty of bullet wounds in Baltimore

THE BALTIMORE EVENING SUN

Capt. John Bauer, a doctor in the Army Special Forces, had seen the bodies of the maimed and severely wounded coming in at a steady pace all day and into the night.

And the alert on the incoming-patient board announced the imminent arrival of another casualty in critical condition: a young American cut down by bullets in a nasty ambush.

This is what Bauer's training was all about. As a physician for the elite Green Berets, he has served extensively on missions overseas, and he could wind up in the Middle East if war breaks out with Iraq.

But this night Bauer wasn't practicing combat medicine in Honduras, Saudi Arabia or Angola. He was acting as a member of a treatment team at the Shock-Trauma Unit in downtown Baltimore.

Strangely, America's urban centers have become the new killing fields, and military medicine has found a new theater in which to practice its critical skills.

Bauer is part of a project quietly conducted over the past 36 months by the Maryland Institute for Emergency Medical Services and the Army's Special Operations Command, of Fort Bragg, N.C.

Baltimore has joined a growing number of U.S. cities -- New York, Los Angeles and Houston among them -- where military surgeons and other medical professionals are being trained in lieu of a major shooting war.

As Bauer waited at Shock-Trauma for the next victim of urban combat, he sipped a cup of cold coffee and filled out paper work on patients he had treated earlier.

Then, in an electric rush, the young man who had been ambushed was rolled into the admitting area on a gurney. The 20-year-old was full of bullet holes and slipping into darkness.

He had a beeper in his pants pocket and wore a pair of expensive athletic shoes -- one red, the other white.

City paramedics had found him on the sidewalk in the 1500 block of Division St., and he was the 3,063rd patient of 1990 at Shock-Trauma, where every case is a critical one.

Members of Bauer's Team Charlie -- a group of 10 doctors and nurses on call this particular 24-hour period -- went instantly to work, fingers and hands moving in the furious dance of trauma medicine.

At first, the only sound from the victim was a moan through his oxygen mask.

The team made sure he could breathe, placed him on a treatment table, took his blood pressure, checked for nerve damage, cut off his clothes with scissors and removed his shoes and socks.

"What's your name?" shouted one of the doctors. "What's that white powder in your nose?"

The patient mumbled incoherently while the team members, illuminated in the brilliance of four surgery lamps, raced to locate the bullet wounds, stop the bleeding and stabilize the man's vital signs.

He had been shot five times. Each knee had a hole the size of a dime. He also had wounds in the chest, side and back.

Later, police would say the shooting was drug-related and the victim's assailants had used two semiautomatic pistols, a .45-caliber and a 9mm.

A FURIOUS DANCE

The trauma team's furious dance continued: Intravenous tubes were inserted in the man's hand and arm so he could receive essential fluids. Meanwhile, a sample of his blood was rushed to the laboratory for tests, with the results showing up within minutes on the screen of a high-speed computer.

Then it was time to probe inside the man's chest cavity. First he was attached to a heart monitor. A surgeon made an incision in the upper left side of the chest and inserted a tube.

Almost immediately, the clear plastic pipeline began filling with blood. The victim was bleeding internally, and the hurried pace of his saviors quickened.

An X-ray machine on an overhead track swung down, and a technician took pictures of the man's head, torso and limbs. The X-rays would show that one of the slugs tore through his diaphragm, spleen and intestines.

Within minutes, he was being rushed to one of five nearby operating rooms. For him to survive, his abdominal cavity would have to be opened and the internal bleeding stopped.

During four hours of surgery, the patient's spleen and a section of large intestine were removed. A large hole in his diaphragm was repaired and multiple wounds in the small intestine were closed.

The victim later would have to get through a bout of serious infection but would survive.

For the imperturbable Bauer, the case was just one of several challenges during a long night. "Doc" Bauer, 30, is 100 percent Green Beret and is used to crises in far-flung places under strange circumstances.

He is regularly assigned to the 7th Special Forces Group at Bragg, where he is a battalion surgeon, military parachutist and scuba diver. He has served on missions to Panama, Guatemala, Honduras, Ecuador, Bolivia, Peru and Argentina -- assignments he refuses to discuss.

But, until late in November, he will be assigned to the Shock-Trauma Unit in Baltimore.

COMBAT RESEMBLANCE

Because of its clinical success and world-wide reputation -- 92 percent of the patients brought into the facility survive -- Shock-Trauma was selected by commanders at Bragg to train doctors and physician assistants in dealing with a high volume of critical cases, many resembling combat casualties.

Besides Special Forces, other Army units have sent some medical personnel to the Baltimore facility for training, including the Rangers and the hostage-rescue Delta Force.

"I never thought I'd see the level of trauma that I did when I was training there," says Chief Warrant Officer William Donovan, a physician assistant assigned to the 1st Ranger Battalion near Savannah, Ga.

In about two years, the cast of attendees might grow, says Dr. Chris Grande, an originator of the program and an acute-trauma specialist at Shock-Trauma.

Grande says the Navy and Air Force have studied the Army results and are considering sending members of elite units -- Navy SEALS and Air Force paracommandos -- to Shock-Trauma for training.

The Army, in fact, is so pleased with the success of the program that beginning in January Green Beret A-team medics will attend the two-month course at Shock-Trauma.

"There is absolutely no replacement for the real deal as opposed to textbooks, laboratory cadavers or whatever else there is," says one Special Forces sergeant at Bragg.

For now, Special Forces doctors like Bauer return from Baltimore to Bragg and conduct classes for the medics, all of whom are sergeants on the A-teams, which perform classified missions.

The medics -- also specialists in other fields such as weapons, engineering, communications and intelligence -- use the new medical knowledge when they travel to Third World countries to treat and teach, or to win the hearts and minds of the population.

HIGH INTENSITY

Special Forces commanders also believe the high-intensity training received at Shock-Trauma better prepares Green Beret doctors and medics for possible combat situations.

"The top medical commander at Bragg was going to retire but he delayed that move to get this idea going and ultimately get the sergeants up here too," says Dr. Carl Soderstrom, director of physician education at the Maryland Institute for Emergency Medical Services.

"Twenty years ago, in the anti-military climate of the times, we would have met some resistance from the public in conducting this program," Soderstrom says.

"But times have changed and I think the ultimate merit to this is that if you are a parent or the spouse of someone in Special Forces, you want them cared for by the absolute best if they are ever wounded or injured."

Bauer got into Special Forces because his father was career Army, a Green Beret in Southeast Asia. The son took up medicine because it had the intellectual and emotional challenge he craved.

He grew up in Detroit, where in high school he was a halfback in football and a hurdler on the track team. His higher education, including medical school, was paid for by the government, in return for a commitment to Army service.

One of his medical colleagues at Shock-Trauma cringes with envy: "I wish I had laid out a long-range plan like you," he says to Bauer. "Now I have a debt from my college loan of something like $60,000 and I don't know when it will be paid."

A normal work week for Bauer at Shock-Trauma is more than 100 exhausting hours. So when he retires to the loft apartment on West Lombard Street that costs the Army $18,000 a year to rent, it is usually to "crash and burn."

Overall, the Army has sent a total of 15 doctors and physician assistants to Baltimore since the training program began.

Few people at Shock-Trauma know Bauer is a member of the Special Forces.

"He's just like the rest of us," says Lisa Chun, a medical student. "The only distinctive thing about John is his huge taste for M & M's."

TOMORROW: Medics with "one finger on the trigger and another on somebody's pulse."

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