Navy Emergency Medicine: An Interview with LCDR Ann Long

Lieutenant Commander Anne Long, an active duty emergency medicine physician in the U.S. Navy, shares her journey from joining the military for financial reasons to discovering a passion for military medicine during her operational roles, including a challenging deployment with the 11th Marine Expeditionary Unit. She describes her experiences in military emergency medicine, emphasizing preparedness through training and partnerships with civilian medical centers to maintain skills despite the evolving nature of military operations and the drawdown of large-scale conflicts. She highlights the greatest reward of her military career as the relationships and connections she's formed with colleagues and other military personnel.

Transcript

1:03

Hello, I'm Matthew Turner and welcome to another episode of the GSA Sub podcast. Today we're interviewing Lieutenant Commander Anne Long. Lieutenant Commander Anne Long is an active duty EM physician for the U.S. Navy. She graduated from Toro College of Osteopathic Medicine in New York in 2013. She completed an operational medicine tour as a naval flight surgeon before completing her training in emergency medicine at Navy Medicine Readiness Training Command in San Diego. She deployed with the 11th Marine Expeditionary Unit in 2021-2022 and is currently stationed with 1st Medical Battalion in Camp Pendleton, California. And without any further ado, let's get to it. All right, so what inspired you to become both a physician and a member of the military? I think for becoming a physician that was kind of more less glamorous. I think it was just the right intersection of science and helping people. And so I think that's what kind of drew me towards it. And then just in med school, I fell in love with anatomy and physiology. And honestly, I joined the military for financial reasons. I liked the financial benefits. But once I joined, I really found that there's a lot of great people in the military. And it's got such a great history for military medicine. And it was just cool being part of something bigger than myself. So I always told myself, oh, it's just going to be like a three year stint and then I'm going to get out. But here I am 12 years later. So it's been fun. Nice. I like that. I feel like that's a reason that a lot of us came in initially for the finances, but then you kind of fall in love with the whole process itself. Could you share your journey into emergency medicine and how it really intersected with your military service? Yeah. So I got into emergency medicine probably in like third year of medical school. I did a rotation at NYU. I went to med school in New York at Toro College. And I really, I really liked the fast pace of the ER, like that there was a mix of pretty much all the different specialties from medicine, you know, like internal med, OBGYN, ortho, just like a little bit of everything. Plus like, you know, procedures, the like excitement of, you know, getting to see like the critical patients when they first come in. And then, so then when I, when I applied for residency or intern year, that was actually the first year that they had EM breakthrough internships for the Navy. So it was super competitive. So I ended up getting a transitional year spot, which I actually really liked. I did my transitional year at Naval Hospital Portsmouth. I had a great time and it actually allowed me to do a lot of electives in emergency medicine. So I actually got to rotate at a hospital in Newport News, which didn't have any EM residents at the time. So I got to do like all the procedures, like, you know, just basically by myself. And it was, it was really cool. And then after that, I went into flight surgery because, you know, I was really burnt out from intern year and I really, you know, I didn't have a chance to like study abroad, like in college. And so I really wanted, and I really wanted some like fleet experience before going back to residency. So I did a flight surgery tour out at Naval Station North Island, which is out at Coronado out here in San Diego. And so that was really cool because it allowed me to go to flight school in Pensacola for six months, you know, learn how to fly a T-6, which is like the single prop plane. And then also like the, the trainer helicopter and then end up getting to fly with my helicopter squadron basically whenever. It was, it was such a great job. Eventually I had to go back to residency. So I was like, okay, I'll apply for emergency medicine at either San Diego or Portsmouth. And then I had just gotten married to my husband who's also in the Navy and he was stationed in San Diego. So I was like, okay, I'll apply to San Diego to see if I get picked up. If I don't, I'll just apply to Portsmouth next year. And then I ended up getting selected for San Diego. So that's how I ended up here for residency. And then after that, I got stationed with CLB-11 out of Camp Pendleton. And then I ended up being with, going out on deployment with the 11th Marine Expeditionary Unit, which is basically like the conglomeration of, so CLB is Combat Logistics Battalion, which is like the logistics arm of the Marine Expeditionary Unit. There's a ground unit, there's an aviation unit, and then there's logistics. So that's, that was us. That includes like the medical service piece. And then, and then, yeah, after I went on deployment, I came back and then I'm now stationed with 1st Medical Battalion again out of Camp Pendleton. But yeah, I continue to do ER shifts over at Naval Medical Center San Diego. So yeah, that's kind of my, that was my journey through military emergency medicine. And yeah, it's been great. I got great training at Naval Medical Center San Diego. Great to continue to be able to work with the residents and then also like corpsmen and the nurses from 1st Medical Battalion. Do a lot of training exercises, them to, to get, keep everybody, you know, ready for deployment. So yeah, it's cool. That's quite a journey you've had. That's a, that's really cool. I didn't know you were flying helicopters and everything. That's awesome. Flew a lot when I first joined the squadron. And they let you sit like in the front seat, the back seat, like wherever you want. So like when I first joined, I was like, all gung ho about sitting in the front seat the whole time. And then, you know, later on I was like, oh, you know, I just, I'll sit in the back. It's okay. So before you entered like military emergency medicine, what were your like expectations and ultimately how did reality really compare to that? Oh my goodness. Yeah. So I think when I first got or first heard about military emergency medicine, you know, I, I think it was still kind of like peak Afghanistan years. So like back in like 2013, you know, we were still pretty involved in Afghanistan and like, you know, probably winding down from Iraq. So that's what I imagined military emergency medicine was going to be like, you know, all trauma all the time, just like, you know, traumatic amputations, you know, penetrating injuries, all that kind of stuff. But yeah, it just wound down a lot during my residency. And so I think a lot of the, the medicine and the injuries like really changed to reflect, you know, the, the drawdown and, you know, kind of the, just the return back to garrison. So that's just a lot of like, you know, the typical like medical issues, just like non, non-trauma, like disease, non-battle injury, as we say. So that was, that was really different than what I expected from when I joined. So I guess kind of bouncing off of that question, kind of in more of like a deployed or operational setting, what does military emergency medicine look like right now? I think it's mostly about preparation, right? So in military emergency medicine, we always talk about the Walker gap. Basically the Walker gap is it's like an expected degradation of skills that we've learned on the battlefield that, you know, we basically like naturally go through because we're just not seeing all of the same injury patterns or patients or acuity that we would be seeing during like wartime. So really I think military emergency medicine right now is like trying to bridge that gap or trying to prevent further degradation as much as possible, you know, trying to stay prepared for whatever's going to come next. So with that, it's like a lot of training exercises, a lot of simulation activities, a lot of trying to develop civilian partnerships in order to, you know, be, to be able to see those patients. So like, for example, like for the Navy, we have a partnership with, you know, LA County and Los Angeles. It's at the Navy Trauma Training Center, you know, First Medical Battalion has relationships with UC Irvine and UCLA where we send groups of like ER doctors, anesthesiologists, corpsmen and nurses, you know, for like a couple weeks at a time to like rotate through the ER so that they can get this experience. So yeah, I think, I think that's really what our job is now is really trying to keep our skills up for whatever's coming next. So did you ever have any like specific moment in your career that really kind of defined what military emergency medicine means to you? Sort of, I think it was while I was on pretty much like any sort of like actual emergency while I was out on deployment. So with the Marine Expeditionary Unit, you're out at sea, you know, with on a ship with a bunch of Marines, kind of waiting for your next mission, whether that's like humanitarian or something actually like, like combat related, although, you know, it was during COVID. So none of that happened, fortunately, but there were actual like medical emergencies that happened on our ship. The one that was like most memorable to me was this girl had given herself an open globe injury on accident. I know, it was crazy. It was like we had, we were on our way home from deployment. We were, we had just left Hawaii and we're in between Hawaii and California, which is like, you know, over 500 nautical miles. And we had just left the point where we were too far from Hawaii to fly her back to Hawaii, too far to go to California or just at the border. The story is crazy, too, because like it was like she was she's one of the food prepare, prepare people and she was cutting watermelon and then had gotten the knife stuck in the watermelon and then pulled it out and like poked her eye. Of course, it's always in the middle of the night. And, you know, I'm like, oh, my gosh, like, I think you actually have an open globe. So I call, you know, ophthalmology over at San Diego. And they're like, well, can't you just fly her off? And I was like, we're too far. We're like in the middle of the ocean. And they're like, okay, well, like, just keep her, you know, very still and, you know, keep a shield over her eye, give her some IV antibiotics. And yeah, just, you know, learning how to like make do with what you got. You know, there was there was another guy who had like a fracture dislocated finger from dropping like a metal metal hatch on his finger, you know, and we have x-ray capability, but obviously like no radiology. So, you know, I was like, oh, yep, that's fracture dislocated. And so, you know, I we put it back, I splinted it and, you know, he he got off at the at the next spot and ortho evaluation. But yeah, it's really it, you know, honestly, like in the middle of the ocean, it's very it's, it's austere medicine, like you really don't have, you don't have a lot of capability, depending on the ships, you know, you'll have x-rays, usually most ships will carry an ultrasound, they have like, a VBG kind of for like, labs, or like an eye stat machine for like, basic like CBC and chem and EKG machine, but that's it. And the ship that I deployed on an LHD, which usually goes out with Marines, they have an ICU. So they're a little bit more well equipped. So they'll have like, ventilators, oxygen tanks, stuff like that. But a lot of these like smaller ships destroyers, which is like the more common Navy ships that you'll see running around LCS ships, you know, they don't have like, most of them, they just have just super basic meds and maybe, you know, like an IV capability. But like, it's also been kind of interesting being involved with, you know, trying to get leadership to recognize that, hey, like, we need to beef up the medical capabilities of these smaller ships, you know, for potential future conflicts. Because like, if these ships are stuck out there by themselves, you know, and there's no big ship with an ICU or a surgeon, you know, nearby, like, you know, they're gonna have to be able to take care of casualties on their own. So, you know, trying to game out like what that would look like, or like, what else they need. That's been pretty cool, too. Wow, a globe rupture out in the middle of the Pacific. I was not expecting that. That sounds like, oh, yeah, but it sounds like you handled it really well. Yeah, we ended up flying her now out the next day, because I worked with the, the ship commander, as well as the Marine commander to, to be like, hey, like, this is like, this is an actual emergency. And, you know, so once we got within 500 nautical miles, that was kind of like the border of like, what the flight capability of the Osprey was on the ship. And then we, we could fly her out. At first, you know, like, you know, they were the commanders weren't really sure because it's like, you know, 500 miles over the ocean. When they do that, it actually they have to send out two aircraft to like, they have to accompany each other, you know, in case something happens to one of them. So, you know, it's a big deal to, you know, be like, hey, like, we're doing all of this work just for one, one person. But like, it's her eye, it's her vision. So so we flew her off. She ended up having surgery like the same day, and she got her sight back. So that was good. Good. Glad to hear that. There's a there's an excellent lesson in there about being able to like kind of practice in like the austere, high stress environment that is definitely in the past and the future for the military. Kind of bouncing off of that, in terms of these really stressful moments, especially like you're out in the middle of the ocean, someone has a globe rupture, how do you stay calm and help your team stay calm during these stressful moments? I think it's basically I treat it like a recess, you know, in the emergency department, start with the basics, you know, like, initial, like primary survey, you know, like, what can we what are the interventions that we can do here, you know, knowing your resources. So like, what, like, making sure like, hey, like, what are our medevac capabilities? Like, who do I need to talk to, to make that happen? Do we have like, the particular IV antibiotic that Opto recommends? And then also, like, can we even call ophthalmology? Because like, sometimes the, the, you know, satellite phones not working, or, you know, like, can we send them, like a message or an email? It sounds so archaic, but that's, you know, a lot of these ships, like some ships have Wi Fi nowadays, but you know, in 2022, like, I mean, it's just 3.5 megabit internet. So it's, it's not, it's not very much capability there. Yeah, just, you know, trying to stay focused on, you know, the basics and, you know, trying to, to treat it very, like, systematically, like, okay, like, you know, what do we need to do for the patient right now? Where do they need to go? Delegating tasks, getting higher ups involved, you know, as soon as possible. And just, you know, focusing on good communication, sort of just like any recess that you encounter in the emergency department normally. Nice, nice. I like that. Yeah, like, just focus on the basics, take it one step at a time. That's good advice. Just really for anything in general, not even medicine. One of the things I'm always interested in is the future of military emergency medicine, especially like over the next couple years. You hear a lot of stuff about like ELSCO, the like large scale combat operation could be coming back. Where do you think you could see it going in the next couple years? I think it's definitely changing a lot. You know, just, just given the recent everything that's been happening, like, politically, socially, like, whatever. But I do think that, as I mentioned before, a lot of prolonged casualty care, there's going to be a lot of that because I think that in future conflict, there's going to be like more small assets like sent to do like independent operations. So they won't be near any sort of like larger medical capabilities. They're going to need to know how to kind of handle patients for longer periods by themselves with limited resources. And then just, yeah, just like not having like the immediate medevac capability, not having like mature supply lines or logistics, logistics chains getting in for the Navy really to like really building up walking blood bank or really leaning on whole blood transfusion, you know, in the field, because really the only ships that deploy with blood are the Marine ships like the one I deployed on. We deploy with 200 units of frozen cells, big aircraft carriers, like they don't deploy with blood because they're actually not casualty receiving. Yes, yes, they don't have casualty. They're not considered casualty receiving ships, even though they're like the fastest ship because they're nuclear powered, but they're not meant to take casualties. Their medical department is actually smaller than the medical department on my previous ship because with a with a ship that carries Marines, like you're expecting to take casualties. And so there's like a 12 bed ICU. There's, you know, all these operating rooms and all that kind of stuff. But yeah, really, you know, like trying to figure out like how are like how are they going to handle like blood transfusions at sea or like their walking blood bank program. And then I think honestly, like the biggest issues facing military EM now is just retention, retention and also like skill sustainment, especially since, you know, the the military treatment facilities that we work at acuity is really, really not as high as it used to be. And so, you know, how are we going to maintain our skills and continue to to to be sharp, especially like if something spins up really fast and then we need to go out as soon as possible. And then, yeah, retention, trying to incentivize physicians to to stay in the military. Like there's been a lot of my colleagues who gotten out recently. So, you know, just the military, I think, as a whole, like we need to work on trying to figure out ways that we can keep our talent and, yeah, support who we have here and also attract new talent. But, you know, also retaining, retaining, retaining the talent that we have. What do you say has been like the most rewarding aspect from your military service? I think the for sure, like the relationships, all of the relationships that I've built with my friends from intern year, from flight school, from residency, post residency. It's been it's been great. I still keep in touch with some of my friends from intern year. You know, we still we send each other Christmas cards and we'll text each other like randomly, you know, and these are these are people that I never would have met otherwise. And I'm and also I met my husband through the military. So I'm very. Yeah, exactly. So I'm very grateful for all of the people that I've met during my time in service. And that's honestly what keeps me going, you know, like and then working with really, really awesome people on deployment. So like my corpsman and my nurses, you know, just like seeing like how enthusiastic and really just devoted that they are. It's wonderful to see and keeps me going. Yes, ma'am. I totally agree. The people by far, I think, are my favorite part of the military as well. Yes. Well, thank you so much for having this interview. I really appreciate you taking the time and sharing your thoughts. Yeah, I definitely want to do more of these. And yeah, I'd love to. I'd love to interview some people like myself. So thanks for putting this together.