Unalaska’s Dr. Murray Buttner has been nationally recognized for his work bringing emergency training to rural Alaska communities.
Buttner, a family medicine doctor and co-medical director of the island’s Iliuliuk Family and Health Services clinic, was named a 2021 Community Star by the National Organization of State Offices of Rural Health. The award went to one health care provider in each U.S. state.
“It was a nice little award because I have been working in rural Alaska since ‘97. And that’s what I consider myself: a rural family doctor,” Buttner said. “I loved the job in Anchorage, but it didn’t feel like me. And then when I got back here, it’s like, this is what I love.”
Buttner received the honor for his work organizing trauma training workshops around the state. Trauma is the leading cause of death in Alaskans age 45 and younger, and overall, Alaskans die from trauma at rates 50% higher than the rest of the U.S.
Buttner said the first 30 minutes after a traumatic event — like an ATV accident or heart attack — are crucial to treat that patient. But most health care providers don’t receive the proper training to respond to initial emergencies.
That’s where the Comprehensive Advanced Life Support classes — or CALS — come in. The classes help train physicians and responders in critical lifesaving care in the most remote and austere environments.
“This course is sort of like a boot camp in paramedic training for physicians and nurses who haven’t done a lot of that first 30 minutes,” Buttner said. “Paramedics get trained in how to take care of someone in the car, in the house, on the side of the river — all that early, quick stabilization stuff. And when you’re in rural Alaska, you actually end up being that person a lot more than you would if you were an internist in New York City or an obstetrician in St. Paul, Minnesota.”
Buttner has found himself in the position numerous times in Unalaska.
The island’s IFHS clinic — located 800 air miles from Anchorage along the Aleutian Chain — sees a larger number of trauma cases than most clinics due to its remote location, extreme weather and busy commercial fishing seasons.
Buttner — who has been working on and off in rural Alaska since the late ‘90s — completed CALS training in the Lower 48 in the fall of 2019. Two weeks later, he was the first to arrive on scene of a plane crash off Unalaska’s runway that killed one person and injured a dozen more.
“I was literally the first person to get on the plane,” he said. “As everyone was jumping off, I was jumping on. Myself and three or four passengers tried to help the young man who was hit by the propeller, and from running to the plane to getting on the plane, and then trying to help him for the next 30, 40 minutes, it was like everything was sort of on automatic from the stuff I had learned in the course. And there is absolutely no way I could have done any of that stuff if I hadn’t taken the course. I might have tried to help, but it would have been more comfort care and shouting for help.”
The CALS course helps responders stay systematic and calm by teaching a step-by-step process for what to do in an emergency, according to Buttner.
“You’re taking the exact same approach to a newborn that’s having trouble breathing or a pregnant lady who’s hemorrhaging or a person who has been in a car accident or someone who’s having a stroke, so that you stay calm, remember the basic steps and then keep working through the algorithm,” he said.
Unfortunately, he said, the reality is that while some people survive, in many traumatic situations, the person doesn’t live. But working through a step-by-step process helps to eliminate the guessing.
“If you’ve been taught what you’re supposed to do, and you do what you’re supposed to do, and you do the best you can, it takes away a lot of the ‘what ifs.’ ‘What if I had known how to do this? What if there had been someone else there instead of me?’” Buttner said. “I think that’s important because this kind of work can really burn people out. And a lot of people do end up leaving the field or leaving the community they’re in because of bad experiences, where they’re traumatized or feel guilty.”
After the plane crash, Buttner started coordinating with other organizations throughout the state — including the Alaska Association of Family Physicians, State Office of Rural Health and Alaska Trauma Review Committee — to bring the Midwest-based training to Alaska.
In May, dozens of health care providers from 16 rural locations throughout the state completed CALS training in Anchorage, and six Alaska providers were mentored as instructors for future courses.
Now, Buttner said, he thinks they’re in good shape to teach a number of the courses throughout the year.
“I think over time we’ll help modify the course so it’s even more relevant to Alaska,” he said. “We’ll have moose stompings and Paralytic Shellfish Poisoning and ATV accidents and snow machine accidents — things that we all see up here that maybe you wouldn’t see in the Midwest.”
Buttner said all of Unalaska’s providers have taken the advanced lifesaving course, along with two of the island’s nurses. He said he hopes to bring the training to subregional hubs to continue to train providers, health aides and responders throughout the state.