Ex-SEAL: Battlefield medical techniques needed for civilian shootings

PENSACOLA, Fla. — An eye surgeon and former Navy SEAL who helped transform battlefield medicine is on the front line of a national push to save the lives of civilians targeted in mass shootings and terror attacks.

Frank Butler, 67, of Pensacola was the command surgeon for U.S. special operations when American forces entered Afghanistan after the 9/11 terrorist attacks. Because of his work, all American soldiers deployed in war zones today carry tourniquets as part of their standard-issue equipment — a move credited with saving hundreds of lives.

"Dr. Butler is a very big deal and he is the most unassuming person you will ever meet. He has made a profound, profound, influence on the military and now the civilian side," said Butler's friend Lenworth Jacobs, director of trauma and emergency medicine at Hartford Hospital in Connecticut and a regent for the American College of Surgeons.

"(Butler's) work is incredibly important. The death rate in the military from bleeding went from 7.2 to 2.6 percent, that is a phenomenal drop," Jacobs said.

Butler and Jacobs joined forces after the 2012 Sandy Hook Elementary School shooting in Connecticut that killed 20 children.

The governor of Connecticut asked Jacobs to head a panel of experts that reviewed the medical response and suggest improvements. That work led to the White House's "Stop The Bleed" campaign, which advocates for tourniquets and hemostatic gauze dressings, used to apply pressure and stop the bleeding in torso wounds, to be easily available in public places like airports, schools, night clubs and sporting venues.

Butler is part of the national campaign and its work to train first responders and civilians about what to do in the moments after a mass-casualty attack.

Jacobs said Butler's push for greater use of tourniquets in the military paved the way for better treatment of civilians.

"It is really hard to get people to change, and he got the United States military to change. He is a leader who is a passionate advocate," Jacobs said.

Butler, who is an ophthalmologist at Pensacola Naval Hospital, has for many years shunned publicity about his work or his time with the SEALs. He prefers to let the world know about his work through his many medical papers. When describing his accomplishments, he always includes a lengthy list of the people he worked with to create the medical advances.

He is so unassuming, that many of his longtime hospital coworkers do not know he is a former SEAL platoon commander.

"He will talk about his experiences as a SEAL sometimes, but he doesn't brag about it," said Lt. Cmdr. Gavin McEwan, the hospital's department head for ophthalmology.

Butler shared his story with The News Journal to help spread the message about how to stop bleeding.

"I think there are a lot of things about what SEALs and special forces do that shouldn't be discussed in public, but the medical aspects of what we do, I care very much that any advances we make in learning how to keep SEALs alive are shared," he said.

Butler, a native of Savannah who played basketball at Georgia Tech University, joined the SEALs in 1971.

He was a platoon commander in SEAL Team ONE and deployed to the waters off Southeast Asia.

Four years later, he went to medical school.

"There are a lot of overlaps between the SEALs and the medical community. You have to have good reasoning skills to be a SEAL, and part of SEAL training is learning to think through problems," he said.

Before completing his residency in ophthalmology, he worked as a medical researcher at the Navy's Experimental Diving Unit in Panama City. He helped develop diving equipment and techniques to allow SEALs to stay underwater for longer periods at shallow depths using a lighter-weight oxygen rebreathing system without creating surface bubbles.

Butler's medical interests evolved from a focus on emergency medicine to ophthalmology during the five years he spent at the Experimental Diving Unit.

After joining the ophthalmology staff at Naval Hospital Pensacola in the late 1980s, Butler expected to spend the remainder of his professional career treating local patients.

"But I got an opportunity from the admiral in charge of the Navy SEALS to come back and that was the start of the Naval Special Warfare Biomedical Research Program. We looked at everything that we could do to help SEALs to do their missions and to treat SEALs if they were injured from diving or from combat," he said.

In the years before the 9/11 attacks, Butler worked with other military medical leaders on a major review of U.S. battlefield medicine guidelines. Their research found that many deaths happened because of major blood loss, which could be stemmed with the rapid and proper application of a tourniquet.

The group presented its findings in 1996 but had a tough time overcoming the medical community's strong aversion to tourniquets. The thinking at the time was that tourniquets could do more harm than good by cutting off blood flow to the limb.

"That is true if you put a tourniquet on and leave it on for a long period of time, it is not true if you put it on and leave it on for an hour or two. That gives us enough time to get the casualty to the hospital where surgeons can operate on the leg, fix the bleeding site, take the tourniquet off and restore the blood flow, " he said.

Advances in the speed of moving the wounded off the battlefield and into surgery meant that tourniquets could be removed relatively quickly, but U.S. special forces entered Afghanistan without carrying the tourniquets and hemostatic dressings.

"It was difficult to convince people that the teachings about tourniquets and other aspects of pre-hospital trauma care were incorrect. It was the war that helped us to see that," he said.

A review of the first 82 special forces fatalities in Afghanistan found that 70 could not have been saved because they died in plane crashes, massive explosions and other non-survivable incidents. The review also found that 12 of the dead might have been saved if their bleeding could have been stopped in time.

"We realized that people were bleeding to death because they didn't have a $20 tourniquet. Think of us spending two years to train a Green Beret or SEAL, sending them off to war and then having them get shot in the leg and bleed to death because they didn't have a tourniquet," he said.

After the casualty review, the military awarded $7 million for Butler and others to rapidly supply U.S. special forces with tourniquets and hemostatic dressings and teach them how to uses the tools in the field. Because of the lives saved with that effort, the military began supplying everyone sent to combat zones with the life-saving equipment.

Butler said the golden hour — the critical time to transport a causality off the battlefield for treatment — is actually a "golden five minutes" when it comes to bleeding.

"If you are shot in a major vessel, there is no golden hour. Fortunately it only takes 30 seconds to put on one of these tourniquets," he said, displaying the small, plastic-wrapped device carried by American troops.

The next step in saving lives is ensuring that both first responders and civilians understand how important it is to stop bleeding.

Also important is training police in how to assess a threat while stopping victims from bleeding to death, if possible. Police have been trained in the past to walk over the injured to reach the attacker. Depending on the situation, they can quickly stop bleeding while advancing on the attacker, Butler said.

"You have to think of an active shooting as a military action. The casualties are essentially combat casualties," Butler said.

More difficult is getting the message out to untrained civilians who could be in a position to stop bleeding during an attack.

Butler hopes tourniquet use will eventually become a basic part of first-aid teaching like CPR and the Heimlich maneuver.

"It didn't happen overnight in the military and it isn't going to happen overnight in the civilian world, but we are doing everything we can to make sure it does happen," he said.


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