Dr. Joshua Tobin has been deployed in Afghanistan since November 2013. “FaceTime makes the separation a little easier,” he says of his time away from home. “But honestly, it’s very hard.”
Joshua Tobin, MD, knows what it’s like to serve on the front lines of medicine — and battle. The assistant professor of anesthesiology at the David Geffen School of Medicine at UCLA and commander in the U.S. Navy Reserve has been on his third overseas deployment, this time serving as head of anesthesia/critical care at the NATO Role 3 Multi-National Medical Unit (MMU) hospital at Kandahar Airfield in Afghanistan.
The Role 3 MMU operates like an intensive care unit, accommodating up to 15 patients with injuries ranging from severe bone fractures to severe wounds and who typically stay nfo more than 24 hours — long enough to undergo surgery and become stabilized before an air-transport team takes them to hospitals in Bagram, Northern Afghanistan, or Germany to recover. “We’re in a forward area, and we want to get the wounded out of here as quickly as possible,” Dr. Tobin says.
Speaking via FaceTime over the Internet from his office in Kandahar, Dr. Tobin appears comfortable and relaxed in his military fatigues, despite the 12-hour time difference and his disappointment over missing his daughter’s first communion earlier in the day. Deployed in November 2013 and not due to return home until the following September, Dr. Tobin uses FaceTime to stay connected with his wife, Nicole Tobin, MD, a pediatric infectious-disease specialist at Children’s Hospital Los Angeles, and their three children, ages 10, 8 and 6.
“I send them postcards and little presents, and they send me pictures that I put up in my room,” Dr. Tobin says. “FaceTime makes the separation a little easier, but honestly, it’s very hard — though probably hardest on my wife because she has to work and take care of three kids and a dog while I’m over here.” A hardened structure with a roof, a floor, walls, plumbing and electricity, the MMU where Dr. Tobin works is “very different from Ronald Reagan UCLA Medical Center, but it’s actually a nice facility,” he says. “I’ve worked out of tents on forward deployments, but here we have X-ray machines and CT scanners. It’s not fully electronic like you’d see back home, but it is pretty darn close.”
The MMU’s adaptable physicians make up for whatever the hospital may lack in equipment. Earlier this year, Dr. Tobin was among six medical-team members who received a Romanian Medal of Honor for the lifesaving treatment they provided a group of Romanian soldiers severely wounded by an improvised explosive device in March 2014.
Before coming to UCLA, in 2012, Dr. Tobin was an assistant professor at the University of Maryland School of Medicine’s R Adams Cowley Shock Trauma Center. Previously, he was an attending anesthesiologist at Santa Clara Valley Medical Center in San Jose, California, and an affiliated clinical instructor in anesthesiology at the Stanford University School of Medicine.
The first member of his family to join the military, Dr. Tobin was in his residency in neurosurgery at the Medical College of Virginia during 9/11, and in 2003 he joined the U.S. Air Force Reserve. “When the war kicked off, I felt very strong that we needed to have good people taking care of our guys over there,” Dr. Tobin says. “Not wanting to argue with my own logic, I said, ‘well, if you feel that strong, you probably ought to join.’”
During the next seven years, Dr. Tobin served as a flight surgeon for the 24th Special Tactics Squadron, completing deployments in the Philippines as team leader of a special-operations critical-care-evacuation team and in Afghanistan as team leader of a critical-care air-transport team that performed 28 combat sorties. “In the Philippines, I worked with the medical civil-action program, and it was great because you really got to interact with the local people, giving clinical aid to those who really needed it,” he says. “When I was in Afghanistan, in 2010, I worked with the critical-care air-transport team, dealing with the aeromedical evacuation of casualties. So I have been able to see firsthand how far we have come since then in relation to trauma and patient care, and it is quite phenomenal.”
In 2010, Dr. Tobin switched to the U.S. Navy Reserve and became a diving medical officer for SEAL Team Seventeen, based at Coronado, California. “Basically, my job with them is taking care of diver fitness and making sure no one gets the bends,” Dr. Tobin says. “I love doing it and consider it an honor to work with the SEALs.”
At UCLA, Dr. Tobin’s research interests are closely aligned with his military experience. He co-authored a checklist for trauma anesthesia and published a paper on a novel critical-care transport approach for evacuating wounded combatants from the battlefield; his methodology, involving the use of trauma bays in evacuation helicopters, has been adapted from Great Britain. “The British have demonstrated better outcomes with sicker patients with the Medical Emergency Response Teams (MERT) method,” Dr. Tobin says. “Some colleagues and I are pushing to have the U.S. military adopt the MERT method of critical-care transport.”
Dr. Tobin says he feels lucky to serve his country and is glad he can apply the knowledge he’s gained from his military service to improve civilian trauma care. “I am very fortunate to be able to see both sides, civilian and military, of the treatment of patients and critical care,” he says. “Advances in medicine have always been at the end of war. The lessons we are learning from war-time medicine will definitely help the overall improvement of trauma care on the civilian side.”
Kim Kowsky is a freelance writer in Los Angeles.