Combat Dermatology: The Role of the Deployed Army Dermatologist
Shortly after completing residency or fellowship, army dermatologists routinely deploy to combat zones as field surgeons. The US Army generally does not deploy dermatologists for their expertise in diagnosing and managing cutaneous diseases; rather, as field surgeons they provide routine, emergency, and trauma care for active-duty soldiers and coalition forces. In this article, we review the various functions of the deployed dermatologist and highlight the importance of maintaining basic emergency medical skills that could be generalized to the civilian population in case of local or national emergencies.
Practice Points
- Army dermatologists routinely deploy to combat zones as field surgeons. In this role, they provide routine, emergency, and trauma care for active-duty soldiers and coalition forces.
- With 5 years of general medical training, army dermatologists often are the most prepared to provide advanced care when compared to co-located physician assistants and combat medics.
- Maintaining basic medical skills would serve any dermatologist in case of local or national emergencies.
To illustrate the value that the properly trained dermatologist can provide in the deployed setting, we will outline field surgeon responsibilities and provide case examples of the first-hand experiences of one of the authors (N.R.M.) as a Role 2 officer in charge and field surgeon. The information presented in the case examples may have been altered to ensure continued operational security and out of respect to US servicemembers and coalition forces while still conveying important learning points.
Sick Call
In the deployed environment, military sick call functions as an urgent care center that is open continuously and serves the active-duty population, US government civilians and contractors, and coalition forces. In general, the physician assistant should treat approximately two-thirds of sick call patients under the supervision of the field surgeon, allowing the field surgeon to focus on his/her ancillary duties and ensure overall medical supervision of the unit. As a safeguard, patients with more than 2 visits for the same concern must be evaluated by the field surgeon. Sick call concerns range from minor traumas and illnesses to much more serious disease processes and injuries (as outlined in Medical Emergencies). As a field surgeon, it is critical to track disease nonbattle illnesses to ensure medical readiness of the unit. In the deployed environment, close quarters and austere environments commonly lend themselves to gastrointestinal illnesses, respiratory diseases, heat injuries, vector-borne diseases, and sexually transmitted infections.
Case Examples
During an 8-month deployment in Afghanistan, one of the authors (N.R.M.) provided or assisted in the care of more than 2300 routine sick call appointments, or approximately 10 patients per day. Epidemiology of disease was tracked, and the condition of the unit was presented daily to the battalion commander for consideration in upcoming operations. The top 5 most common categories of diagnoses included musculoskeletal injuries, gastrointestinal diseases, dermatologic concerns (eg, dermatitis, bacterial infections [cellulitis/abscess], fungal infections, arthropod assault, abrasions, lacerations, verruca vulgaris), respiratory illnesses, and mental health care, respectively. Maintaining a familiarity with general medicine is critical for the military dermatologist, and an adequate medical library or access to online medical review sources is critical for day-to-day sick call.
