NARRATOR: Imagine for a moment that you're on a battle- field. You are wounded. And a medic is carrying you from the madness, to safety.

As you are whisked to the field hospital, he returns to the battlefield to bring more wounded out. Military doctors, medics and nurses expect to face hazardous working conditions and to encounter great challenges under fire, but this is only part of their job. These men and women may also be part of a new movement in medical care.

Today on "AMERICA'S DEFENSE MONITOR," we take a look at military medicine and its potential impact on the new civilian medical system of the 21st Century.

["AMERICA'S DEFENSE MONITOR" program introduction.]

Admiral EUGENE CARROLL, Jr.: Welcome once again to "AMERICA'S DEFENSE MONITOR."

In past wars the special problems of providing effective medical care on the battlefield to American servicemen have always presented special challenges to the doctors and nurses who come into military medicine directly from civilian hospitals and clinics. Now the services are providing a special form of training for these people which promises to be a solution to the problem of battlefield medicine.

Today, "AMERICA'S DEFENSE MONITOR" takes you into the field for a realistic exercise of these new techniques which will enable our doctors and nurses to provide first class medical care for America's fighting men and women.

NARRATOR: In every war the effectiveness of the army depends on the health of its troops. Soldiers may march to the front lines, but in their shadows march another corps, the military doctors, medics and nurses who keep the troops healthy before the battle and minister to them in combat.

Unlike the army they support, a military doctor's enemies never change. These enemies are the wounds caused by the increasingly horrendous weapons of war. They are also diseases and bacteria that strike with equal fervor, no matter the color of a soldier's uniform. Until World War I, if a wounded soldier made it off the battlefield, the field hospital was often far more hazardous.

Dr. ROBERT JOY: Disease has always been the major cause of death in American armies until World War I. In World War I, for the first time in an American army, died-of-wounds equalled died-of-disease.

NARRATOR: Dr. Robert Joy was the first commandant of the country's only federal medical school, the Uniformed Services University of the Health Sciences, or USUHS, for short. He is currently serving as chairman of the Medical History Department at the school.

Dr. JOY: The American Army, Navy and then, of course, after World War II, its air forces always had physicians with it. George Washington was the first commander to introduce immuniza-tion, in this case against smallpox, by command fiat.

NARRATOR: Throughout the 20th Century, as men learned to kill and maim in more gruesome and efficient ways, military doctors struggled to keep pace. The machine gun, artillery, poison gas, airplane, tank and atom bomb increased the damage that men could do to other men, women and children.

Medical personnel serving in the military face unique challenges unknown in civilian life.

Dr. JOY: Military medicine, in my view, is two things: It's dealing with diseases and injuries that are either not found, like malaria, or uncommon, high velocity gunshot wounds, in civil life.

And the other part of military medicine is the require-ment for understanding the infrastructure of it. How is it put together in the field? You cannot call Baxter and get a shipload of drugs. You cannot just turn on a water tap.

Dr. JAMES ZIMBLE: One mosquito is worth about a hundred mortar rounds.

NARRATOR: Dr. James Zimble is currently the president of the Uniformed Services University. He has a long and distin- guished career as a military doctor. Prior to assuming his present post, Dr. Zimble served as the 30th surgeon general of the Navy.

Dr. ZIMBLE: Hygiene. You know, it's easy to have good hygiene when you have indoor plumbing. It's not so easy to main-tain good hygiene when you have large numbers of troops suddenly coming to a desolate area in which there are none of the abili-ties to be able to take care of disposing of human waste.

NARRATOR: Despite the increasingly difficult challenges facing military doctors, no special training school -- a medical West Point, for example -- existed in this country until after Vietnam. Military doctors learned what they had to on the battle-field, where real casualties demanded immediate care.

Dr. CRAIG LLEWELLYN: I'd had no specific medical training for the job I had in Vietnam.

NARRATOR: Dr. Craig Llewellyn was chief surgeon for Army Special Forces in Vietnam from 1965 through 1966. He describes his experiences in the field.

Dr. LLEWELLYN: The physicians who were working for me also had no specific medical training for the things they were going to deal with. ...And made a number of mistakes, both in the management of injuries, combat and non-combat injuries, but also in disease cases, in knowing how to assess threats and work with our line commander bosses.

NARRATOR: Until the end of Vietnam, military doctors were obtained through the so-called "doctor draft." When the military draft ended, however, so did the doctor draft and the military had to ensure a supply of proficient military doctors.

Dr. LLEWELLYN: It was in anticipation of the doctor draft stopping that Congress passed the bill which both initiated this university, the Uniformed Services University of Health Sciences, and also the health profession scholarship program.

NARRATOR: The Uniformed Services University of the Health Sciences, located in a suburb of Washington, D.C., graduated its first class of military doctors in 1980. Its purpose was to train doctors for careers in the armed forces and the US Public Health Service.

The list of courses taught at the school is compre-hensive. The school was recently fully reaccredited and the Princeton Review rated it one of the best medical schools in America.

Dr. ZIMBLE: We're unique. Now I have a bias when I say that -- I'm the president, you would expect that -- but I'm not the only one that says that. The AMA says that. The American Association of Medical Colleges says that. The Association of Academic Health Centers says that. And many elements of organized medicine also say we are serving a sector that is essential.

NARRATOR: Competition to attend the school is stiff. There are 15 applicants for every available slot. USUHS is the only federally-run medical school in the country and the only one that teaches the basics of military medicine.

Dr. ZIMBLE: We have a high focus on the preventive medicine aspects. We have 160 contact hours in infectious disease and tropical medicine; the average medical school has 13. We teach combat casualty care. We teach the logistics of deployment medicine. How do you plan to move a hospital of 500 beds from point A to point B?

NARRATOR: One of the core aspects of this training is teaching preventive medicine -- keeping troops healthy.

Dr. JOY: Military medicine should focus and does focus on preventive aspects and on keeping people healthy and free from disease from a whole variety of diseases and methodologies, as well as on what everybody thinks military medicine is, which is MASH and surgeons with blood up to their elbows.

Dr. ZIMBLE: Everybody thinks of a weapons system in terms of airplanes, and ships, and submarines, but at the end of a trigger of a rifle is a rifleman's finger. And then from there on back is the responsibility of the medical department to make sure that that is maintained.

Dr. LLEWELLYN: You have to understand that it can be life-threatening to many people in the unit if the principal medical adviser can't recognize threats to that unit.

NARRATOR: Dr. Llewellyn is currently serving as chairman of the Department of Military and Emergency Medicine at the Uniformed Services University. He oversees an innovative and unique training exercise for medical students at the school.

Dr. LLEWELLYN: It's training that I know I would have benefitted from if I had had it before I was assigned to Vietnam and was trying to do the best I could based on my civilian medical instruction.

NARRATOR: During their fourth year at the university, students must complete a field exercise called "Operation Bush-master," which challenges both their medical knowledge and their ability to function in realistic and austere field conditions. Dr. Llewellyn describes the course:

Dr. LLEWELLYN: Bushmaster was developed as an intensive simulation where students were required to function in medical leadership, medical command positions doing clinical, administra-tive and other kinds of work simultaneously under a very demand-ing and changing scenario.

NARRATOR: "AMERICA'S DEFENSE MONITOR" traveled to San Antonio, Texas, to Fort Sam Houston to witness Operation Bushmaster. Although it was cold, rainy and miserable, the exercise proceeded as planned. As in war, the treatment of casualties doesn't stop for bad weather.

Students must apply the knowledge they have learned over four years. They are graded on their performance. In this 72-hour round-the-clock exercise, students live and work in harsh environments.

This is the first day. In addition to pitching tents and coping with unfamiliar radio equipment, students must also quickly organize their medical supplies and prepare to receive their first patients.

STUDENT 1: Okay, so we have one patient that needs Evac. Okay?

STUDENT 2: Priority is?

STUDENT 1: Priority is routine.

NARRATOR: Operation Bushmaster is directed from here, at the Tactical Operations Center, and by instructors who accompany the students in the field. The instructors question and debrief the students on what they do wrong and what they do right.

INSTRUCTOR: Well, he's going out to some undisclosed area to find casualties, correct?

STUDENT: Right.

INSTRUCTOR: But what does he have marked right here?

STUDENT: He's got his -- He's got his BAS marked.

INSTRUCTOR: Okay. So if he gets captured by the enemy?

STUDENT: They've got his map.

INSTRUCTOR: They've got the map and they know exactly where to come back to get the rest of your BAS.

NARRATOR: This tent was pitched over a fire ant colony. The students have to move it.

And, of course, the patients keep coming. Some of them have bullet wounds. Others have ailments that are not so obvious, but still degrade their ability to function as part of their unit.

PATIENT: I have diarrhea.

INTERVIEWER: I'm sorry.

PATIENT: So, am I. (Laughing.)

INTERVIEWER: How chronic is it?

PATIENT: It's not as bad as it seems. It's just __ They had me sitting and they had an IV in, which they were out of at the time, so they simulated that. And then they had me laying on the litter to make sure no fainting or dizzy spells.

INTERVIEWER: Have you ever been hurt for real?

PATIENT: No.

INTERVIEWER: What do you think of the care that they're giving you here?

PATIENT: It's pretty good. I didn't think that they would do this good, but they've done a lot of things better than I thought they would.

NARRATOR: The patients are young volunteers temporarily stationed at Fort Sam Houston. In a process known as moulage, reminiscent of Central Casting in Hollywood, or Halloween, young healthy privates become mock casualties with very realistic looking wounds, wounds the student doctors will treat as real.

Back in the field, a call comes in to a battalion aid station.

STUDENT: And the information that I have is that they're right in this area here. So, if we leave the BAS, there's this tank...

NARRATOR: Our crew went with the students to locate the patients. Even though the map is unmarked and the terrain unfami-liar, the students show initiative in planning the evacuation. In this case, they capitalize on the ambulance driver's previous experience of the area.

STUDENT: Cowsgills Road. Is that right?

AMBULANCE DRIVER: Yes, sir.

STUDENT: You're familiar with this area, aren't you?

AMBULANCE DRIVER: Yes, sir.

STUDENT: There it is, big.

NARRATOR: They succeed in locating and stabilizing the patients.

STUDENT: Charlie three-nine, this is Charlie one-one. Have arrived at the evacuation site. Two patients on site. Estimate return to base camp in 2-zero mikes. Over.

NARRATOR: As the exercise progresses, the situations become more and more complicated.

STUDENT: Medic! We've got mass cal. Call in evacua- tion teams.

NARRATOR: Several situations involve mass casualties. Students must prioritize who gets treatment first. This screen-ing is called triage and ensures that first priority goes only to those who can be expected to survive.

Patient care is routinely interrupted by orders to move camp. On the second day, the students are ambushed while on the move. Most of the students correctly drove through the simulated bombs and gunfire. One group stopped and turned around. If this had been real, their instructors tell them later, they would have been killed.

STUDENT: November 4-5, this is Delta 4-2. Size of enemy is unknown. Break. Activity: sniper fire. Break. Location at our location. Break. Uniform: unknown. Break. Time: 2054 25 January 94. Break. Equipment: small arms. Over.

NARRATOR: One night, the battalion aid station that our crew visited was "attacked" and "overrun." The students had to decide what to do about an ambulance full of patients and an advancing enemy.

Many of the students felt that the exercise helped them understand what they might face in the field.

STUDENT: The biggest part is just getting used to the fact that if this is what a combat environment is like, to get comfortable with it now, so when you really are in combat, you're not trying to learn for the first time what to do, so you can actually best treat the patients and not make it a learning experience on them.

NARRATOR: USUHS is increasingly coming under attack and may be closed down, despite the success of the university and the leadership roles assumed by many of its graduates. Two of Presi-dent Clinton's personal physicians are USUHS graduates, as is Persian Gulf veteran Rhonda Cornum, the first woman prisoner of war.

Critics have dubbed the school "Useless U." They dismiss the uniqueness of the education provided at USUHS. The strongest criticisms, however, focus on the costs of running the school. The US Senate held hearings in March 1994 to evaluate these costs.

Testifying at these hearings, William Lynn, Director of Program Analysis and Evaluation in the Office of the Secretary of Defense, stated that closing USUHS would save $207 million over five years. In 1993, Vice President Gore's Reinventing Government Report claimed that closing USUHS would save as much as $300 million over five years.

WILLIAM LYNN (at congressional hearing):

"The Vice President's National Performance Review calls for the closure of the university. The basis of this recommenda-tion was that today USUHS provides less than 10 percent of the services' physicians at a cost much higher than other programs. The Department of Defense supports this recommendation.

"While the university is a valued institution that produces high quality graduates who have service obligations -- excuse me, who have extended service obligations, because of severe budgetary constraints, the National Performance Review and the department have determined that our essential requirements for military physicians can be met through other less costly accession sources."

NARRATOR: Representative Martin Sabo, a distinguished and outspoken congressman from Minnesota, has led the initiative in Congress to cancel funds for the school.

Rep. MARTIN SABO: It serves a useful purpose. It trains doctors. I have no question it does a good job of training doctors. But the question is can we get those same doctors at significantly lower priced at a time of restrained budgets.

NARRATOR: USUHS is expensive. It costs over $500,000 to train each student as a physician prepared to deal with the special demands of military medicine.

Defenders of the school, however, maintain that it is actually cheaper to train doctors at USUHS than at most medical schools.

Dr. ZIMBLE: The cost of medical education in this country today is quite high. If you look at the total cost of medical school, divide that by the number of students that graduate, which is the way we've been looked at, then the cost per capita is $1.2 million for a four-year training program to graduate a physician in this country.

NARRATOR: When Congress created the Uniformed Services University of the Health Sciences, the legislation that created the school also initiated a scholarship program called the Health Professionals Scholarship Program, or HPSP. HPSP provides finan-cial support for students at civilian medical schools. In return for tuition and a stipend, HPSP students must serve in the mili-tary of Public Health Service for four years after graduation. Nine out of ten doctors serving in the military today are products of the HPSP program.

Graduates of the Uniformed Services University, however, serve as commissioned officers while at school, pay no tuition, and must serve for seven years. Many stay longer. Herb Fechter is a fourth year USUHS student.

HERB FECHTER: I personally am looking at at least a 24-year career in the military. And if things are good at 24 years, I'll stick it out to 30 years.

NARRATOR: Some proponents of closing USUHS believe that the scholarship program can provide all the doctors the military needs at a lower cost.

WILLIAM LYNN (same congressional hearing):

"If USUHS is closed, we'll increase the number of scholarships granted by the armed forces' Health Professions Scholarship Program, HPSP, to offset the loss of the currently programmed number of USUHS graduates."

Rep. SABO: We have to make lots of tough choices and most doctors that come into the military come from other medical schools. Most of the people that have provided current military medical leadership currently came from other medical schools. Clearly, that system has worked and, clearly, we get those doctors at a cheaper cost to the federal government than those we train solely at USUHS.

NARRATOR: Supporters of the school and current students like Caroline Holland disagree.

CAROLINE HOLLAND: The HPSP students are usually, with their smaller requirements, thinking beyond their obligation to the military: "Well, when I get through with this, say chore of working for the military, then my real life will begin."

INTERVIEWER: Do you know any HPSP students?

STUDENT at Field Exercise: I know several of them.

INTERVIEWER: And how do you think your experience differs from their experience?

Same STUDENT: They go to a civilian med school where they don't get these same type of courses. So, when they come into the military, they get a week of it during -- or two weeks during their internship year and that's it.

Dr. JOY: We are producing a cadre of people. Will we have the majority of service physicians? No. We're producing new leaders.

NARRATOR: Defenders of USUHS argue that solely by relying on students trained in a civilian environment, those trained through the scholarship program, the military faces a dangerous situation. One in which, come a war, the doctors on the front lines will have no realistic preparation for frontline medical care.

General ALCIDE LaNOUE, Surgeon General, US Army (at congressional hearing):

"I can tell you that in the Army we have a deficit of training in the type of individuals who go into combat with a battalion, and with a brigade, and with a division. And I do get complaints from line officers that we very frequently have physicians in there who aren't ready for that. That's never the case when a USUHS graduate fills that bill."

STUDENT at Field Exercise: The medicine is pretty basic. It's just adjusting that medicine and using the medicine differently in different situations, based on what the situation dictates: How many casualties you have, or where they are, or where you are, how far away you are from definitive treatment.

Dr. LLEWELLYN: The way we will use military power is to deploy task forces, such as what we sent to Somalia. And it's highly unlikely that we'll ever be able to afford or muster the same kind of force that we sent to the Persian Gulf.

Now when those kinds of task forces are deployed, the built-in medical support is generally very low-ranking young people. As a matter of fact, the only way that the medical force that we sent to the Persian Gulf got ready for the war, with the exception of the USUHS graduates, was by having 4 1/2 months to be trained on the ground over there.

Ms. HOLLAND: We also know that USUHS is a center for such activities and we could always use it as a source for more infor-mation and things that we would need once we were there. We could always call back to the school, which they did throughout Desert Storm.

Mr. FECHTER: Many of our instructors have been to Desert Storm or to Somalia. And part of our curriculum is learning from them their experiences in those environments.

NARRATOR: The majority of doctors who attend USUHS serve in the military, but a small percentage of the students go on to serve in the Public Health Service, which provides doctors who staff the National Institutes of Health and disaster relief agencies.

Dr. Yasky, seen here in Operation Bushmaster, is an instructor at the school. He is also a commander in the Public Health Service. As many instructors at the school have done in national emergencies, he was called to Los Angeles to help with earthquake disaster relief while our crew was filming Operation Bushmaster.

The instructors seem to impart a strong commitment to public service medicine to their students. Between 40 and 50 percent of the students who graduate from USUHS become general practitioners who can treat a broad range of patient needs. Primary care is one of the most needed areas of medical practice in the US today.

Even with a military drawdown, it is conceivable that USUHS could continue to train non-military doctors who are committed to long careers in public health, doctors who would practice in under-served communities, like rural areas and inner cities, where there is a desperate need for doctors.

Mr. FECHTER: We are accustomed to working in austere envir-onments. And we go to a rural community, we won't have all the resources available at a major metropolitan hospital.

NARRATOR: The students' background in preventive medicine and their training in austere environments could make them invaluable contributors to a new American health care system. In fact, preventive medicine and universal access to basic health care are the cornerstones of President Clinton's health care reform package.

Dr. ZIMBLE: I don't think the country can afford not to have the school. This is not the one to close. This one happens to be unique and this one makes for a good paradigm for the way medical schools need to be looking in the future: Integration of skills, and an emphasis on primary care, and an emphasis on community medicine, and health promotion, and wellness. So, I think this school should be used as a model.

NARRATOR: So, as the budget battle wages in Washington, a critical question arises: Could a valuable government program that actually seems to work be sacrificed in the name of efficiency? And will this remarkable school be forced to close its doors forever?

Admiral CARROLL: In the military, as in civilian life, providing first class medical care is costly. But can we afford to provide anything but first class care for the young men and women we send into harm's way? To put this problem in perspec- tive, consider that closing the military medical university will only save about $207 million over five years, and this is less than the cost of two new fighter aircraft.

The Center for Defense Information is not noted for favoring increased military spending, but in this case we strongly favor investing in first class medical care for our fighting men and women. We ask that Congress consider very carefully the question as to whether America will need two new fighter planes more than it needs a functioning military medical school in the year 1999.

Until the next time, for "AMERICA'S DEFENSE MONITOR," I'm Eugene Carroll.

[Over Credits]

NARRATOR (of film clip on military medicine):

"Out of this war came tremendous advances in medical and surgical procedures. New drugs, such as penicillin, and a wide range of other antibiotics that would introduce a whole new dimension to medical practice were tested under the most extreme circumstances.

"Large area insect control through the use of DDT was tested, too. In Naples in 1943 and throughout Europe, the combination of DDT and a new and more effective vaccine greatly reduced the incidence of typhus, the age-old plague of armies. The United States Typhus Commission, a unique military-civilian organization, attacked the problem on a worldwide basis, investi-gating outbreaks of epidemic and scrub typhus wherever they occurred."

[End of broadcast.]