Complete Story
05/18/2025
History of Military Emergency Medicine
Lt Col (ret.) Torree McGowan
GSACEP commissioned this interview with Dr. David Munter as part of its history of military Emergency Medicine project. Dr. Munter is a partner in Emergency Physicians of Tidewater. He founded the U.S. Navy’s Emergency Medicine residency in Portsmouth, VA, and served as its chairman of Emergency Medicine from 1997-1999. He served as the intern and Emergency Medicine specialty leader for the Navy. He was named director of medical services for the Naval Medical Center at Portsmouth in 1999. In 2001 he became the director of Tricare Region 2 before retiring in 2003. His story begins in 1978, when he was accepted to the third-ever class at the United States University of Health Sciences medical school.
GSACEP: How did you draw an interest in the Emergency Department?
DR. MUNTER: In my third year, I did family practice down in South Carolina, placed at Charleston. They took call in the Emergency Department. That was my first taste of that, and I really liked it. I did my internship in surgery. In that year, as part of your surgical internship, you did a month in the Emergency Department. Now, this was 1982. In the Emergency Department rotation, you would work 24-hour shifts. You would work from 6 AM till 6 AM the next day. From 10 PM till six in the morning, that Emergency Department was staffed by an intern and nobody else.
Here’s the advice that was given to you: if somebody really sick comes, [call in] a code, because if you call a code the junior resident in medicine and the junior resident in surgery will come and everything will be okay. That’s just the way things were back then.
GSACEP: Are there stories that stand out for you?
DR. MUNTER: When you work 120 hours a week, it all blurs together. You don’t remember that much. After you were an intern, you had to apply again for the surgery residency, but I told them I wasn’t going to apply. And that was the famous day. I was in the ICU making rounds on a patient. The chief of surgery – now you’ve got to understand that it was the chief of surgery at Bethesda, Dr. Cochran, and that [name] strikes fear in everybody’s hearts – came into the ICU and screamed at me for what seemed to like two days – it was probably 15 or 20 minutes – [he] screamed at me in front of everybody. What I remember from that is the comment that I had the chance to be a real doctor and I was throwing it away for this Emergency Medicine bullshit. I remember those words very clearly. I’ll never forget that day ever in my life.
GSACEP: It’s amazing to realize the depth of venom against emergency physicians. What do you think was in Dr. Cochran’s mind? What was the antipathy against this?
DR. MUNTER: Well again, nobody thought of Emergency Medicine as a specialty. It had no respect. This is spring of 1983. At that point even in the civilian world, the Emergency Departments [which] were places where people who had been fired, or suspended, or lost their license, or couldn’t hack it in anything else. It was a dumping ground for incompetence.
GSACEP: What about Emergency Medicine made you push forth in that direction? It must’ve been something stronger on this end to sort of trump that.
DR. MUNTER: To this day I just like the intellectual challenge. You never know when you walk in what’s going to happen. You never know what the day’s going to be like. You never know what you’re going to see. You see everything. I talked to doctors all the time who are just frightened of things, and there’s nothing I’m scared of. There’s just nothing. Anything can roll through the door any day.
GSACEP: What’s your next step at this point?
DR. MUNTER: Well, at that point, the norm was for Navy physicians to do what’s called a GMO tour—general medical officer, and so I went out to sea on the USS Seattle. I had a really great tour. I learned a lot, did a great job, and then I went to be the general medical officer at the branch medical clinic at Oceana, which was in Virginia Beach at the naval air station.
I wrote a letter to the commander there, and I asked if I could be in the Emergency Department. I found out later that when they got that letter it was met with astonishment because that was the place nobody wanted to go. They must have laughed when they read it. So I arrived and I was placed in charge of the Emergency Department.
It’s busy as hell. And you know, cuts and broken bones, and sick kids and fevers, but once in a while really sick people, and here I am running the whole place. By the end of my second year I was actually in charge of all the ERs for all the branch clinics, seven of them, and ran the committee that ran all the things that set all the policies.
What I mostly learned back in that tour, I’ll be honest with you, was about bureaucracies and how they work. The best book I ever read was called Up the Organization. I was focusing on the job that we did and how many patients we saw, and they didn’t care. What they cared more about was policies and procedures, and manuals, and instructions. When I changed the focus to what policies we had written and procedures we had done, they were real happy. Then I could focus my team on process improvement and patient care, and we could do what we wanted.
GSACEP: You are beginning to move up the ranks. Take me through some of the next steps in the timeline.
DR. MUNTER: I was interviewed at the San Diego residency, which was the only residency the Navy had, and the interview went very poorly. I took all this as kind of as a sign that that wasn’t really the place I was supposed to go.
Then I get this phone call from the selection board. They said, “Well listen, would you go out to an Army residency in Texas, in Killeen, Texas?”
I said, “Sure, I guess so.” They said, “Okay, we’ll probably do that.” The next thing I know, we get this phone call that says, “All right, we picked you for a residency in Fort Hood, Texas.” I was the first and only Navy person ever to go to Darnell to that residency program.
GSACEP: We’re at Fort Hood now, right?
DR. MUNTER: Yeah. So I go out to Fort Hood. I’m the only naval officer in an ocean of 70,000 Army troops. It was confusing, a little bit. I got frocked to lieutenant commander, so I actually outranked many of the faculty.
The residency program—it was the last of the two-year residency programs. We worked like crazy. Those were the old days, the old cowboy days of ER. No faculty at night, you were on your own. You could call them, but they weren’t in the hospital. It was considered a sign of weakness to call them.
GSACEP: How many residents were there?
DR. MUNTER: There were six a year. It was very busy. Most of the codes would come to us from the civilian world. I saw more snake bites than I’ll probably ever see again. The swimming pool at the Officer’s Club had this bizarre chlorination system where it had this piping system where it would pipe in chlorine gas to chlorinate the pool. Every once in a while, it would accidentally release these huge chlorine bubbles, and so we’d get all these chlorine gas inhalation people. During the summer, we’d get four or five at a time. We were probably the world’s experts on chlorine gas inhalation.
All Hell Night is the most vivid story that I can remember from my residency. There was one night it was in June of my junior year, so that’s June of ’87. What happened was the National Guard was in town, so there were 20,000 extra troops in town. It was just myself and a senior resident there. All these people in the National Guard were in town, and about three days later all their medical problems sort of evolved. All the people that had seizures were seizing. All the alcoholics who were now in the field with no alcohol were withdrawing. We had three in every bed space. We had 30 cots lined up on the floor. We had so many ambulances coming in from the field that we had to put MPs out front to direct traffic, and we had to put a nurse out front to triage the ambulances. We had four or five medicine admissions a night. We had 33 admissions to medicine that night.
I was going from cot to cot to cot. One guy came in and he goes, “Oh, my stomach’s swollen,” and he had two bottles of lactulose. His doctor from New York had sent him to the field with lactulose because he’s a liver failure patient.
I had this kid, 23 years old, who came in with abdominal pain. He had a rigid abdomen. I thought he had appendicitis until he peed and his urine was black. What he had was rhabdomyolysis from all the terrible physical training he was doing. He was in acute renal failure. He ended up on dialysis.
Then at one in the morning, two tanks shot each other, and we had a 12-man mass casualty with three deaths. Thank God it was only a practice round. One tank captured the spotter, you know it’s the guy out front who’s spotting the other guy. He was spotting with infrared light, so they thought it would be fun to shine the infrared light at the other tank. Well, that’s how they aim, so the tank went do, do, do, do, do and aimed at the infrared light and shot the practice round, right into the group of 12 people. I’ve got casualties everywhere with shrapnel. Three of them died in the ER. It was unbelievable. I’ll never forget that night my entire life. They don’t remember it there, because what they remember now is the Luby’s cafeteria [incident] the following year, and then they remember, of course, the gunman, the most recent thing. That experience has been supplanted by those two.
