Where the heroes are: A tribute to military MLTs

Dec. 1, 2003
When medical personnel marched off to the Civil War, most had only a couple of years worth of education. (Harvard Medical School did not even own a single stethoscope or microscope!) A working knowledge of what caused diseases was foreign to them. For every soldier who died in battle, two died of disease. These grossly archaic conditions are lightyears away from todays cutting-edge medical scientific and technological advances. Military men and women rely on the fact that their medical teams are well-educated and well-prepared to care for them wherever they might serve. Among these teams are highly educated medical laboratory technicians (MLTs) whose training might well have been received at the Armys top-notch training facility, the U.S. Army Medical Department Center and School (AMEDD C&S) at Fort Sam Houston in Texas. Both the Navy and the Air Force have smaller-scale versions of this MLT program, according to Maj. Michael D. Miller, MS and its chief of education and training.In June 2001, Miller arrived at the AMEDD C&S. I became interested in the laboratory field when I was in the 10th grade, Miller says.My medical Explorer troop in South Carolina met biweekly at Lexington County Hospital. We did our rotation through the laboratory and morgue, then had a forensic pathologist come to deliver a talk. I was hooked. The Army was not my first career choice. I knew that I wanted to go to college, and the Army offered me a scholarship. My intent was to spend the mandatory four years for the scholarship, and then leave. Here I am, 14 years later. Youre in the Army now Miller heads up a team that coordinates the students initial MLT program entry and serves as their administrative staff to the end of their training and beyond. A student applicant must achieve an aptitude score of over 107 on the military exam and a C or higher in algebra and chemistry.If these two courses have not been taken or the required GPA has not been met, applicants are not allowed into the program and, says Miller,on average annually, 35 to 40 are not.Enlisted and officer MLTs and MTs complete a training program to become instructors, staying for an average of 3.5 years. We do have some civilians that teach within the program, says Miller, with post-graduate degrees in microbiology, chemistry and parasitology. As education coordinator, Miller sits in on instruction, notes deficiencies, furnishes critiques to instructors, assigns mentors when instructor issues exist, trains department members on mentorship and teamwork, and updates issues, such as HIPAA and CLIA, and the effects of those on the program.No time for sergeants?Five or six classes of 116 students simultaneously attend the MLT program for 52 weeks. Balanced between hands-on practical exercises and lecture, Phase I (focused on didactic), consists of 26 weeks: nine in chemistry and urinalysis; eight in hematology, coagulation and blood bank; and nine in microbiology, immunology and parasitology.
Students are then sent for Phase II clinical rotations for 26 weeks at one of 21 sites within the United States at someplace as glamorous as Hawaiis Tripler Army Medical Center or as grassroots as Fort Polk, LAs Bayne Jones Army Community Hospital, Miller says. Every three years, all sites are visited under an NAACLS accreditation agreement.
Once students complete Phase II, they are 12 credit hours shy of an associates degree from George Washington University (GWU). They can either take the 12 combined hours of English, higher math, and specified electives at a community college and transfer them to GWU, or sit for the CLEP exams, to get that degree.If I had to cite the major difference between ours and a civilian program, says Miller, it is the level of discipline required to succeed in the military. Our students awake at 0430 daily, conduct physical training until 0615, shower, dress and eat until 0745, begin classes at 0815, get dismissed at 1700, eat dinner and perform barracks duties until 1930, and study until lights out at 2200. Did I mention that while at Phase I they still belong to a drill sergeant? That makes it even tougher! Miller cites the militarys MLT program advantages: The attrition rates in civilian MLT schools can be as high as 50% because of financial issues, commitment problems, lack of maturity and so on.In the military, this is your job for one full year.You are paid to learn.You dont have to balance academics and two part-time jobs.The active-duty military is not experiencing a shortage of people entering the MLT field, Miller notes.Our class sizes have grown over the past two years. People get into this field so they can have a skill and a job when they exit the service.The current Army contract provides over $70,000 in tuition payback and $50,000 additional tuition assistance while in the service through the GI bill. The MLTs also get a bonus of over $5,000 once they complete Phase II training.Uncle Sam wants you, tooMiller highlights the variety of jobs available in medical centers and community hospitals vs. those that are in highly deployable field units.There are positions in research we have some research currently going on in Kenya, Thailand, Iraq and Afghanistan at Walter Reed and other research facilities, as well as opportunities in the other branches of military service and positions outside of the MLT arena. I look at medical technology as a steppingstone into health informatics, health administration, and research, he says. I believe that is the way to market our profession. A military lab careerNoel R. Webster, Col., MS, is the laboratory program manager/clinical laboratory program manager for the Army Medical Command and the clinical laboratory consultant to the Surgeon General. It is indeed an honor and privilege, says Webster of his current positions. After completing an ROTC scholarship program with an undergraduate degree in microbiology, Webster attended the one-year clinical laboratory officer course certification program at Walter Reed Army Medical Center and became a certified MT. Since joining the Medical Service Corps, he has received masters degrees in both hospital administration and biology, plus a one-year fellowship in immunohematology, becoming a certified specialist in blood banking.Webster has served as a medical platoon leader, a medical company commander, a lab manager, a commander-blood detachment, a director-blood donor center and a deputy director-Armed Services blood program office.The most unusual situation was my six-month lab management rotation to Honduras, Webster reminisces. I tested for some parasitic diseases I would have never seen in the United States. I worked with some Honduran civilian hospital laboratories, and flew to remote sites to help people in need of medical care. It was very educational and enlightening to visit many different countries, working with scientists around the world.Career challenges and opportunitiesAs the Armys top clinical laboratory technologist, Websters career is a prime example of the diversity of duties a military laboratorian can experience. He currently provides guidance and expertise to the commanders and staffs of the medical, regional medical and other major subordinate commands and other major subordinate commands, and to 65-plus hospitals and health clinic laboratories throughout the world. He coordinates staff actions and develops laboratory policies. Webster says clinical laboratory service is a great starting point for high school or college students interested in medical science. My advice is that the Army affords them a great education, as well as fantastic opportunities to be leaders at a very young age. They may not have the chance to do the same job in a civilian career. Military lab techs face a very good chance of being deployed throughout the world. They get to contribute great scientific work in areas where disease identification is different and exciting, demanding and very rewarding. Young clinical laboratory officers may pursue fully funded masters and PhD programs. Enlisted personnel may pursue their undergraduate degrees for promotion potential. The same holds true for the Air Force and the Navy. According to Webster, the Army also has some of the most state-of-the-art clinical laboratory capabilities available with which to work. Soldiers firstAmong Websters duties is reviewing files for new officer accessions for the Army as the clinical laboratory consultant. The basic requirement is to have an undergraduate degree in MT, as well as a one-year MT internship (usually built into the program) from an accredited school or a degree in a related scientific field, take and pass a national MT examination and be certified by that accrediting agency recognized by the Surgeon Generals office. For those without the internship but with a degree in a related science, he may join Medical Service Corps as a field medical assistant, then apply for the MT program at Walter Reed, just as I did, suggests Webster. For those young adults with a masters or PhD in microbiology or chemistry, they can apply to become microbiologists or chemists. As members of the Army, they must realize they are soldiers first, says Webster.Websters view is that military lab techs are at no more increased risk than civilians when it comes to bioterrorism. Where personnel may come in contact with agents such as anthrax and smallpox, staff may be protected with vaccinations. Most of our labs are sentinel labs, and we have some medical centers with biosafety level 3 capabilities to confirm biothreat agents, he continues. We work closely with the local public health labs when dealing with biothreat agents. Military lab techs may likely see unique diseases as they serve at hospitals around the world. I am proud of every one of them for their hard work and patriotism.One such soldier in IraqM
aj. Martin E. Rusty Tenney, MEDCOM-HQ, Websters comrade, volunteered for duty in Iraq. Tenney arrived last July and brought 21 years of experience as an Army med lab tech with him. Tenney is officer in charge, laboratory services, at a combat support hospital (CSH, pronounced cash) lab. An Army CSH can support 164 beds with the capability to split the staff, equipment and shelters to allow two separate hospital operations. Currently, three Army CSHs support troops in Kuwait and Iraq: the 47th CSH, Fort Lewis, WA, in Kuwait; the 21st CSH, Fort Hood, TX, Mosul and Balad, Iraq; and the 28th CSH (pictured), Fort Bragg, NC, in Tikrit and Baghdad, Iraq.The portable CSH lab resembles a cargo container, and typically has two isoshelters, which store and transport lab equipment and serve when unfolded as the lab. All equipment and workbenches can be disconnected, placed in the isoshelters center section and secured, then towed via a five-ton truck to a new location. One isoshelter serves as the blood bank with two plasma freezers, a blood refrigerator and blood unit centrifuge for making blood components in emergencies. The other serves as the main laboratory, equipped with Istats and Piccolos for chemistries and blood gases, MLA and RapidPoint coagulation analyzers, and Coulter ACT 10 Hematology Analyzers.Tenneys CSH, originally set up southeast of Baghdad from March until late August, was moved from the desert to Ibn Sina Hospital at one of Saddams Presidential palace compounds. This fixed facility gave us the ability to operate three intensive care units and two intermediate care wards with a 76-bed capacity, says Tenney. We split off a 32-bed unit to provide medical support outside Tikrit.Humanitarian actsThe majority of our inpatients are Iraqi enemy POWs or civilians severely injured because of attacks on U.S. or coalition forces. Many require very long stays before release to detention camps or to their homes. Whenever possible, we also provide medical care as a humanitarian act, explains Tenney. Soldiers wear helmets and Kevlar vests to protect the head and torso but nothing to protect their arms and legs when attacked on convoys by makeshift bombs. Most arrive with traumatic arm or leg amputations. We also received patients from the U.N. and Al Rasheed Hotel bombings.I am the only medical technologist for this lab, performing the duties of the laboratory director and manager, technical supervisor, and quality control technologist. I also review daily the lab test results, quality control and lab bench work, as necessary. In addition, I consult with the medical staff on laboratory services, serve as the lab staff advisor to the hospital commander and consultant on lab issues for our higher headquarters.We have 12 medical laboratory technicians assigned to the CSH, and three lab techs at the separate hospital location. My most senior technician has six years of lab experience, while a couple of them are right out of the military MLT program. This is their first assignment. Beyond the call of dutyThe Military Health Intelligence Organization prepares medical health information reports for all countries where military operations will be conducted, which list weather conditions, hazardous plants, insects, and animals, common diseases and everything of medical importance. But because of the political climate and Saddams control of the country, not much was known about Iraq, says Tenney. From Gulf War experiences, diseases like Leishmaniasis were known before this deployment. (Leishmaniasis, endemic in the Middle East, is usually spread by the bite of sand flies. American soldiers returning from Iraq are being told not to give blood for up to one year to prevent the possible spread of the parasite responsible for the disease.)The military has equipment for detecting many toxic agents, and every soldier is issued two chemical/biological protective suits and a protective mask to be worn in the event a toxic agent has been detected. The field medical labs, however, are not equipped with analyzers to test soldiers for toxic agent exposure. Any such tests are sent to Landstuhl Regional Medical Center in Germany, where all U.S. soldiers at the CSH are evacuated if they cannot return to duty after local treatment.Tenney and his staff are active in other medical areas of the region, as well. We have provided some short-dated blood to local hospitals, and assistance to the Iraqi Ministry of Health with the identification and determining susceptibilities for a chorea outbreak (a condition featuring involuntary movements of the face muscles and limbs seen in a number of neurological diseases, including Huntington Disease) in Babylon. The medical staff put together medical lectures for the Iraqi healthcare providers, and I give lectures on controlling hospital infections and hospital infection surveillance programs. Sand, showers, sacrificesTenney says dealing with separation from their families, with communication sometimes not available for weeks, is the medical lab technicians biggest challenge; but in Iraq, coping with the heat, which in summer is 140F during the day and 100F at night, is also a major problem. The temperature was so high the power generators or air-conditioning units failed, says Tenney. During the summer, our refrigerated storage MilVan would break down, and all our reagents would be lost. And the sleeping tents were not air-conditioned.
Sand constantly blows during the day, making its way into everything eyes, nose, mouth, food, tents, sleeping bags, the hospital and the instruments. Soldiers use outdoor latrines and burn the waste afterwards. They are only allowed to shower every other day.
Most of these soldiers had been working for almost six months, 12- to 16-hour days, without a day off. At the new hospital location, we re-worked the schedule to eight-hour days, with one day off weekly. Previous deployments to Iraq were about six months long. Tenneys unit arrived in Kuwait the first week of March and may not be coming home from Iraq until April 2004.Until then, we know where the heroes are.Carren Bersch and Dottie Dunham are editor and associate editor, respectively, of MLO. The writers thank Jenny Goellnitz, for permission to use materials she has compiled at her website,
www.civilwarmedicine.aphillcsa.com, as background information in the introductory paragraph.
2003 Nelson Publishing, Inc. All rights reserved.