Leading the Largest Military-Civilian Partnership in the Country
Air Force Lt. Col. Jeremy Kilburn, a doctor specializing in pulmonary and critical care medicine, is an associate professor of medicine at the Kirk Kerkorian School of Medicine at UNLV as well as the school’s director of the Office of Military Medicine. Here, he provides insight into a unique military-civilian partnership that he says is the most complex in the United States.
In 2011, I was fresh out of my pulmonary critical care fellowship and had no idea what my Air Force career had in store for me. The only thing I was certain of was that I would be in Las Vegas for a few years performing clinical duties at Nellis Air Force Base (AFB). The Air Force frequently moves personnel after four years and military-civilian partnerships (MCP) weren’t common at the time, and growing up in Buffalo, New York, I was not a natural desert dweller. That being said, here I am 11 years later, still in Las Vegas, still in the Air Force, still at Nellis AFB, and leading the largest MCP in the country.
My colleagues and I fully describe the Las Vegas MCP in the article, “The Las Vegas Military-Civilian Partnership: An Origin Story and Call to Action,” which was published in the August Military Supplement of the peer-reviewed Journal of Trauma and Acute Care Surgery. We detail how the Las Vegas MCP is not just the largest in the country, it’s also the most complex – with the Kirk Kerkorian School of Medicine at UNLV featured prominently as our academic affiliate. Other key partners include the Veterans Administration Hospital (VA), University Medical Center of Southern Nevada (UMC), local ground and air ambulance companies, and multiple Air Force organizations including the Air Force School of Aerospace Medicine, the Mike O’Callaghan Military Medical Center (MOMMC), and Air Force Special Operations.
While other MCPs have traditionally focused on embedding military trauma personnel into civilian hospitals or accepting civilian patients into military hospitals, the Las Vegas MCP does both. We also prominently include non-trauma medicine and operate a ground and air ambulance program. In military medicine, we need more than just trauma teams. This has been evidenced through the COVID-19 pandemic, as hundreds of military medical personnel were mobilized domestically in support of pandemic operations. Even in combat operations, there are a high number of casualties, both trauma and non-trauma, that require the treatment of medical personnel not part of a trauma team. While previous MCPs have focused solely on trauma, from the very beginning we decided to be much more expansive. Our goal was to meet as much of the future needs of the Air Force, and country at large, as possible.
While taking Air Force medical personnel and embedding them into civilian hospitals or ambulances is vital to keeping their medical skills current, it’s not the complete answer. For the Air Force to succeed in getting all of its members ready for expeditionary operations, Air Force hospitals need to be busier – not all military medical personnel can go to a civilian hospital to train. With this in mind, the O’Callahan MCP was selected by the Air Force to participate in a special program to take civilian ambulance patients. This allows MOMMC to function much like a civilian hospital in that regard. This was greatly aided by pre-existing relationships in the community, and I found myself very excited to do everything I could to make this successful.
While all this was coming together, my days were busy with trying to keep everything organized as the program grew. In 2018, the Air Force surgeon general visited, and I, with no small amount of trepidation, proposed the concept of the Office of Military Medicine (OMM) to organize and grow what I called the Las Vegas MCP. At the conclusion of my presentation, she looked at me with an intense stare, and I could literally hear my own heartbeat. Then she queried, “What is the ask?” I hoped this meant that she supported the concept and was willing to resource it. Indeed, that was what she meant and the Office of Military Medicine was off and running, with dedicated personnel and a mission to facilitate the Las Vegas MCP, with myself as director.
There are approximately 40 physicians serving as Kirk Kerkorian School of Medicine faculty working at UMC. The faculty teach residents, fellows, and medical students in multiple specialties including trauma and general surgery, emergency medicine, obstetrics and gynecology, and pulmonary and critical care medicine, among others. These faculty attendings work side-by-side with their Kirk Kerkorian School of Medicine colleagues and lead teaching rounds, give lectures to medical students and residents, and participate in scholarly activities and research. In addition, the Air Force sponsors 38 residents and fellows per year in general surgery, obstetrics and gynecology, and pulmonary and critical care medicine. As a level III trauma center, MOMMC is fully integrated into the Las Vegas medical system by accepting ambulance patients. The Las Vegas MCP continues to grow and be successful because it offers advantages to everyone. Air Force medical personnel get the experience they need and enjoy coming to UMC and working with the residents and fellows. It’s hard not to be influenced by their enthusiasm, and the patients at UMC are from a very different demographic than typically is seen in a military hospital, and frequently being uninsured or under-insured, with complex medical problems requiring urgent care.
A consequence of expanding our MCP in this way was unprecedented in terms of the synergy, with Air Force medical personnel taking care of civilian patients with Kirk Kerkorian School of Medicine at UMC, at MOMMC, and on ambulances taking patients to both hospitals. With the Las Vegas MCP, we are more involved in our local community, can help the community, and are an important part of the local medical infrastructure. On October 1, 2017, several of us responded to the mass shooting and reported to UMC to help, including Lt. Col. (Dr.) Stephanie Streit, who in addition to being a trauma surgeon working with the Kirk Kerkorian School of Medicine, was instrumental in the development of the Las Vegas MCP and my education as a physician leader.
It felt very natural to go to UMC to assist with the treatment of patients from the October 1 shooting, or the hundreds of patients we took care of during the COVID-19 pandemic. It just made sense to medically serve our community, which is frequently underserved medically, and at the same time to keep our skills sharp. Those skills have been utilized in hundreds of deployments across the globe and here domestically. There is no doubt that the skills we have sustained and advanced in the Las Vegas MCP have saved lives. This idea of keeping our military medical personnel ready to save those lives while serving our community is what energizes me and drives the Las Vegas MCP.