“Emergency Care for America's Heroes”

Brigadier General (R) Andre Ognibene’s earliest impact on military emergency medicine was the revolution of the Fort Sam Houston EMS system.  He transformed the antiquated system of empty ambulances that were unable to provide en route care into a functioning EMS system with trained responders and the ability to provide critical care en route.  

GSACEP: Take us through the call to go to Vietnam. 

DR. OGNIBENE: I got orders to go be a medical consultant to the US Army in Vietnam. I went there in 1969. I had a great experience. I put it all in the book. It took 10 years to write. I was an editor in chief of developing that. I got a helping hand from Colonel William Barrett who worked with me. It's called Internal Medicine in the Vietnam War.

 

GSACEP:  Do you believe the experience in Vietnam influenced emergency physicians and departments moving forward?

DR. OGNIBENE: I'm not sure. One problem we had in Vietnam, and when I was there I wrote a program for it, the hospitals were geared more toward war and war injuries and little by little as the division was clearing they were sending a lot of patients to the hospital with rashes, with pneumonia, with bloody nose, with hemorrhoids, with diarrhea, just clogging up a hospital that really had no emergency room. They didn't have an emergency room area, and these had to be built up. I developed a program, Have Specialty, Will Travel. We got dermatologists to go out to various clearing stations in this area and see the skin problems, see them right there so they didn't have to be flown in and flown out and lose time from duty. Same thing with the neurologist. We had a program to go out and look at some of the patients that were going to be coming in for neurologic problems, headaches, and “I'm weak, I can't fight,” and all that crap. The psychiatrists, too. Whenever you needed a specialty in a division, you could make arrangements for a specialist to come to the patient and be seen on site because you wanted to save combat man-days. That was the issue, combat man-days. So it's different thing than we can do in the community now. We don't take the emergency medicine doctor or the interns or the surgeon and fly them to the patient's house. That doesn't fit the civilian format, but we were saving combat man-days.  We didn't free up rooms, we freed up time. We didn't have doctors who were overwhelmed with sick hospital patients and trauma from having to run down to a room somewhere to see somebody who had a boil on his rear end.

 

 

GSACEP: What were the key issues you faced at Walter Reed?

DR. OGNIBENE: One of the big issues was the VIP ward. All eyes were on you. You couldn't make a mistake up there because you could lose a congressman. You could lose a four-star general. I took care of King Hussein when he came in, and you don't want to make a mistake. I had General Westmoreland and Maxwell Taylor as my patients. It was a great experience, but there was tremendous pressure on that VIP ward. Also tremendous pressure in making sure the residents were being trained properly. 

 

GSACEP:  Why do you suppose military medicine does not make it into the spotlight often?

DR. OGNIBENE: It's something like you have two stovepipes on your stove, and one is putting out smoke on one stovepipe, and one from the other, and the smoke from the two comes out the chimney and hardly ever blends anywhere in the stovepipe. Emergency medicine in the military goes up one channel, and it doesn't cross-reference with what's going on in the civilian. It's like two separate structures.  I believe it is due to the isolation of the patient populations. They don't cross over. It's starting more and more now as military hospitals are pushing patients into the community. They haven't got the room or they're not funded enough to take a large population, so doctors in one section are talking to patients who've been treated in the other section. Cross communication in the past has been zero. Now it's getting better. So you really don't know what's going on in the other community. 

 

GSACEP: Tell me about your first meeting with Barry Wolcott. How did that come about?

DR. OGNIBENE:  I'll tell you one brilliant move he made at BAMC.  I was having problems as the commanding general with the fact that we still had 35 or 36 cracker box ambulances. They were not ambulances. They were industrial. They were a big cracker boxes with nothing in them. People would call them and come in with a sore finger, a headache, and I thought, I’ve got to stop this. I need intensive care ambulances. I need ambulances that are built like ICUs, what we know now to be EMT ambulances. We didn't have them. I said, but if I take this away from the community and the generals, also, on the post, there's going to be an uproar. I don't know how we go about it. One of Barry's ideas was fantastic. It turned out to be brilliant. He said, “Let's get rid of them. Let's get the new ambulances, and then we go on a program saying BAMC improves ambulance service. Get this out all over. Posters, everywhere. Then when you call an ambulance, give them an ambulance.” This is what we meant. First call we got with the new ambulances was a soldier with a headache who wanted to come by ambulance. Well, we strung out a gurney, put a neck brace on him, rolled him in on a gurney. He was just flabbergasted. We did the same to some lieutenant colonel who had a little cut on his finger. Soon the word got around, Jesus, don't call an ambulance. You know, they send this damn thing, and put you on the gurney. It worked like a charm.

 

 

GSACEP: I have to ask, what these early ambulances before you got what we consider modern-day ambulances, what were they like inside? What deficiencies were there?

DR. OGNIBENE: They had basically stretchers in the back, you had a driver and an aide who was either poorly trained or passably trained. They would go about and put you in the back and drove you to the hospital.  It was barebones. 

 

This was before the word EMT was en vogue. The new ambulances were ICUs in the back. I had trained individuals in that ambulance. The reason we had to do that, if you came in with a myocardial infarction to the emergency room, we had to put you in the back of the ambulance to take you to Beach Pavilion and drive over a mile, so we had to start your CCU care in the ambulance. We had to start your ICU care in the ambulance, so our ambulances, they traveled back and forth between Beach and Main, were state of the art even today.

 

I'll give you a little anecdote that'll make you laugh. We had at one time two cardiac arrests in the ambulances going to Beach Pavilion, and that was intolerable. We tried to figure it out. We investigated what's happening because we checked the records. Patients were stable. Nobody seems to come up to why that occurred, and one day I was at the ambulance talking to people, one guy who wasn't even an EMT, he was an assistant in the ambulance. He said to me, “I know why they arrested.” I said, “What do you mean, you know why they arrested?” He said, “Yeah, it's the bump.” I said, “What do you mean the bump?” He said, “Going into Beach Pavilion, there's a bump, and the ambulance, we have to go over a speed bump, and that's when they arrested.” Sure enough, he was right.  We got rid of the speed bump, and the incidence of arrests in the ambulance went to zero. In this investigation, nobody talked to the little guy. You got to talk to folks at every level. I went out every day somewhere and talked to the little guy. You got the information many times that you couldn't get from all the top brass looking into things.