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May 19

Far Forward Safety

Where Leaders Dare to Go…

Dr. Jadick was anxious. It was the evening of November 8th, 2004 and Jadick was the Battalion Surgeon for the 1st Battalion 8th Marine regiment. His Marines, along with other Marines and military personnel would be moving against the strongest insurgence of the war, those holding out in Fallujah. In mere hours he would be treating wounded, seriously wounded. Jadick knew this would probably be the most brutal urban fighting Marines had experienced since Vietnam. As with any medical professional about to be presented with major traumas, Jadick was anxious about his own ability. Would he be able to handle each case, what about his pace of work if there are multiple seriously wounded? How would his Corpsmen do, and did he prepare them well enough? Yet, there was an overarching concern that Jadick had; he worried that his aid station was too far in the rear. It was a 45 minute ambulance ride away. In addition to his other fears, he really thought this time gap, between battlefield wound and professional care, 45 minutes, was too great. The answer to his questions was just hours away.

“Traditional battlefield medicine,” Jadick wrote in his book entitled On Call in Hell, “Was developed over hundreds of years and it made sense for earlier times. The line between KIA (Killed In Action) and WIA (Wounded In Action) was more absolute then. Wounds fell more easily into the categories of lethal or nonlethal. And corpsman or medics with the units served as much to provide comfort to the dying and transport to the dead as to intervene with lifesaving care. Both of those rolls are still an essential part of the job, but today we have more wounds that can go either way. And we have vastly improved higher level care that can help severely injured warriors survive and rehabilitate off the battle field. The interesting thing is that the technology and techniques of battlefield medicine have not changed much since Vietnam.” Jadick’s team received a call early the morning of the 9th, “Marine down.” Jadick didn’t stay in the rear, instead he moved with the ambulance team to help give care to the causality. They pulled up to the injured – – it was a bad wound. Other calls came in and the ambulance team was needed to aid others. In the end, Jadick turned away one less seriously injured Marine, because the ambulance was beyond capacity. The first Marine, who was very seriously injured, didn’t make it, dying on the ride back to the aid station. Jadick’s fears were confirmed. He and his aid station were too far back – – he would move them closer.

It took permission, but once Jadick proved that he and his select corpsman could travel light, they were allowed to move forward and set up a forward aid station – – literally in the middle of the fight. Later, Lt. Col. Mark Winn estimated that without Jadick at the front, the Marines would have lost an additional 30 men. Of the hundreds of men treated by Jadick and his team at the newly established forward aid station, only one died after reaching a hospital. Overall, 53 Marines and Navy SEALs died in the battle. What Jadick led, and what he and his corpsmen did was truly heroic. Not only did they save lives, they set a model that will surely be used moving forward. And, in Jadick’s leadership there are a few lessons for us safety professionals, as well.

Improve your position

Jadick was constantly working to improve his position – – in order to save lives. At the forward aid station, he and his corpsman worked to position sand bags over windows and openings, to protect against sniper fire. They worked to set up latrines. They practiced routines that moved needed medical supplies with great speed and found concrete blocks that could be used as bases for operating tables. In short, they continually looked to improve their position. What do we do to improve our position, to improve safety of our people? We often are caught in the trap of looking for the next big thing instead or major process improvement. I think Jadick would encourage us to pursue them, just as he moved the aid station to the front lines, but he would also suggest that each day we should lead some small change that improves our people’s position (safety).

Define the Golden Hour.

Jadick wrote, “In treating traumatic injuries, there is something known as the golden hour. A badly injured person who gets to the hospital within an hour is much more likely to be saved.” But Jadick knew that in combat the “golden hour” doesn’t exist. Left unaided,” said Jadick, “the wounded could die in 15 minutes, and there are some things that could kill them in six minutes. If they had an arterial bleed, it could be three minutes.” To that end, medicine’s ‘golden hour’ has changed – it is mere minutes to save a life. What is safety’s ‘golden hour’? What is the time between a near miss and an actual injury if the hazard isn’t eliminated? How much time exists between a defective piece of equipment being identified and it causing an injury, if not taken out of service? Or, what is the time gap between an unsafe act and injury? Jadick understood how crucial it was to establish the right care in the right time – – what is our ‘golden hour.’

All Leaders to the front, please

After Fallujah Jadick wrote, “There were real dangers and that raises the issue of whether by going in to establish the FAS (Forward Aid Station) myself that I put an important battalion asset, me, the doctor, needlessly at risk. I think that is looking at it all backwards. By putting me forward I thought we were maximizing our assets. First there was the leadership issue. A battalion surgeon isn’t s just the doctor, he’s also the leading officer of a medical platoon and no selfrespecting platoon leader, anywhere, is going to send his men in to do a job he wouldn’t do himself. There is a big difference between training and experience.” Are our leaders at the front? Do they make a certain number of field observations each month, week or day? Is it required as part of their performance appraisal? If we are going to win the safety battle we need our leaders to establish safety’s equivalent of a FAS. A forward station staffed with leaders who quickly recognize hazards and at risk actions and take corrective action – – no questions asked.

What is your Sphere of Influence

“I couldn’t control who got hit and where but I still had my sphere of influence, and I decided that if it was taking too long to get the wounded out of the city then the only way we could cut the travel time down was to move ourselves in. That would mean in effect setting up an emergency room in the middle of the hot zone,” Jadick reflected. In the workplace, we can’t control who makes a poor choice on a given day, nor what equipment may fail at any one point. But, we can, and must, exercise our ‘sphere of influence’ just as Jadick did. As he moved his care closer to his men, we must move our care, coaching and knowledge even closer to our front line workers. If that means setting up our safety office on the plant floor – – I believe that Jadick would approve.

In the end, Dr. Richard Jadick was honored with a Bronze medal with Combat V for Valor. The Valor distinction denotes “Those individuals who were awarded a decoration in recognition of a valorous act performed during direct combat with an enemy force. It may also denote an accomplishment of a heroic nature in direct support of operations against an enemy force” Later, Winn said of Jadick, “I have never seen a doctor display the kind of courage and bravery that Rich did during Fallujah.” Jadick shakes off the praise and instead puts it all in the category of ‘just doing my job’. But in this ‘just doing my job’ attitude Jadick saved dozens of lives. And, in the process teaches valuable lessons to each of us. Thank you Dr. Jadick!

Matt Forck directs Safestrat, www.safestrat.com

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