When a bomb detonates in Iraq or Afghanistan, the effects reverberate as far as Cincinnati.

Because of a unique trauma skills program at the University of Cincinnati and University Hospital, responders trained in the Tristate are often some of the first people an injured soldier will see on the front lines. The Centers for Sustainment of Trauma and Readiness Skills (CSTARS) program is just one of the many ways Cincinnati is helping the nation's soldiers.

Cincinnati has long been revered for its quality of patient care, but as it turns out, this powerful relationship with the United States Air Force betters the lives of everyone involved.

Joint Benefits

One of only three such programs in the nation, Cincinnati's CSTARS program teaches the mandatory course for Critical Care Air Transport Teams (CCATT), which are essentially portable intensive care units.

"University Hospital and UC have been extremely open to having military come in here and actually train, and we're considered part of the staff whenever we come in," says Col. (Dr.) Todd Carter, an anesthesiologist who works as a CSTARS instructor and staff member at the hospital. "It's more of an openness or an acceptance by Cincinnati to let us come here, because there's not an Air Force base around here."

CSTARS has existed since 2001 and is meant to sustain the training of those who deploy. The mandatory two-week programs are located in Cincinnati (University
Hospital), Baltimore (Baltimore Shock Trauma Center) and St. Louis (St. Louis University Medical Center). In 2007, the surgeon general decided the training would be required every two years.

The training involves several aspects, including classroom lectures, working in the hospital trauma center and practicing in an airplane simulator "” a realistic and stressful environment.

Inside the simulator, the CSTARS team yells over the 80 decibels of airplane engine noise, finding the best strategies for the two patients with multiple traumas on the table. The room is blacked out "” in hostile environments, lights in the sky are essentially moving targets.

The scene could be taking place in any medical aircraft in the Middle East, if it weren't for the cameras on the ceiling recording every move, and the fact that the "patients" are high-tech medical dummies. From a control room, medical technicians challenge the team "” consisting of a doctor, nurse and respiratory technician "” with new issues.

"It's very useful "¢ I think this is the best pre-deployment training at least I have ever been to," says Capt. (Dr.) Dan Brown, who is training for a second time after returning from Iraq. "It's very useful because it tries to not only help you focus on your problems with the equipment, but also the medical problems that are common with critical patients we transport."

But the medical issues aren't just common "” they are actually replicated from real soldiers injured in the Middle East.

Outside the simulator, trainees also learn from an exemplary trauma program in the hospital.

"It's win-win for everybody," says Dr. Timothy Pritts, an associate professor of surgery at UC who presents chest trauma coursework to the teams. "From the Air Force standpoint, especially people who are Air Force-based who don't sit in large-volume trauma centers, (trainees) get the experience of coming through and taking a call with us and seeing a lot of trauma patients.

"We get the experience of working with an active duty Air Force cadre who is very involved in the care of casualties, who deploys on a regular basis and who's able to bring back the cutting-edge techniques that are used in theater back to the United States."

Though Cincinnati has an unfortunately high amount of trauma cases, it makes an ideal training ground for those deploying to heal soldiers. But the injured men and women in uniform aren't the only ones benefiting from the innovative program "” Cincinnatians are rewarded as well for having the training program here.

"With the number of military physicians that we have embedded here in the teaching program, the residency, we're pushing a lot of the war's lessons out early to the community here in Cincinnati. There's no doubt," says Lt. Col. (Dr.) Gerald Fortuna, who is deploying to Afghanistan soon as a trauma surgeon, followed by a CCATT mission in Germany.

"If you look at how we're doing our massive blood transfusion protocol and resuscitation, some of the end points of resuscitation we use "” these are all direct lessons that we've seen come out of the war."

Those wartime lessons directly translate to aiding car accident and gunshot victims here in the Tristate.

"It's really interesting to see something that benefits not only the military community," Pritts says, "but also, really benefits the person who wrecks his ATV out in Clermont County, the person who wrecks his motorcycle out on I-75, (they get) a direct benefit from the expertise here, in part, because of the joint program."

Those benefits should continue to increase, as an Air Force agreement announced in September will fund $24 million for UC's air medical research. The money initially will address evacuation's effects on the body, clinical studies on oxygen and a partnership with local first responders.

Full Circle

When CCATTs pick up injured soldiers and transport them to Germany for treatment, perhaps it shouldn't be surprising that the doctors they see there might be Cincinnatians as well.

Just a few miles south of Ramstein Air Force Base in Germany is the U.S. Army's Landstuhl Regional Medical Center, the largest American hospital outside the U.S. It acts as a major care center for military personnel injured in Operation Enduring Freedom and Operation Iraqi Freedom.

In order to continue advancing its staff's skills, the hospital, in conjunction with the American College of Surgeons, brings in the top doctors from the U.S. for two-week stays caring for soldiers. Last September, University Hospital's Dr. Kenneth Davis Jr. and Dr. Peter Muskat, both trauma surgeons, were invited to join.

"It's almost a forgotten war. Unless you've got somebody over there, it doesn't impact you directly," Davis says. "It's a way of showing them that they're not forgotten; they're appreciated. It's a way of doing something to help out, and that's very important."

And though both doctors had seen their share of trauma in Cincinnati, bombs brought a new meaning to devastation "” Muskat alone saw more double and triple amputations in a week than he had seen in his entire career. Still, the trip was rewarding "” both doctors are considering a second trip.

"It was a wonderful experience when the families look to you and thank you, even though their soldier son has had a devastating injury," Muskat says. "We cannot emphasize enough that what we've seen is nothing compared to what the soldiers have gone through."

While there, the doctors often followed up with patients previously treated by their colleague, Dr. Jay Johannigman, chief of University's trauma division, who was instrumental in developing Cincinnati's CSTARS program. It was also common for Davis and Muskat to run into CCATT members who had trained in Cincinnati.

"It's a good feeling, seeing people that are working there that have been here for their training in the CSTARS program, and perhaps can remember and reminisce about being in Cincinnati and can talk about how great the experience was," Davis says.

That kind of interaction is critical, they explain. When the military and medical communities work together, the health of Cincinnati as a whole will continue to improve.

"The trauma care in this city, in my estimation, is second to none," Muskat says. "In order to stay second to none, this is the kind of thing we need to do. We need to continue to be out there, continue to be visible as senior surgeons because that's how you attract young talent to come here and get trained."

"We're always competing, and I think that's part of why we go and do these things. I want Cincinnati to be on the map. I want us, and the city, to gain from getting young, talented surgeons to come through this place because we provide outstanding care."

With its thriving medical training, Cincinnati can continue to provide unsurpassed care to patients at home and overseas.