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Former USAISR research fellow takes unique path to becoming a critical care physician

By David DeKunder | 502nd Air Base Wing Public Affairs | Aug. 2, 2019

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas —

The path Natalie Koons, a former research fellow at the U.S. Army Institute of Surgical Research at Joint Base San Antonio-Fort Sam Houston, has followed in studying to become a critical care physician is a unique one.

Koons, who was an intern and then a research fellow at USAISR from 2017-18, is going to medical school at the University of New England College of Osteopathic Medicine in Maine, where she is working towards her doctorate in osteopathic medicine.

“I had an interesting pathway to science,” Koons said. “I actually started as a dance major (in college). I was heavily into ballet.”

Koons, 23, attended Mercyhurst University, a private Catholic college of more than 2,700 students located in Erie, Pennsylvania, on a dance scholarship and was a member of the school’s dance department. However, during her freshman year, an injury forced her to give up dancing, an activity she had been involved in since the age of eight.

“I tore up my hip labrums,” Koons said. “It was an overuse injury. I had double hip surgery; it all occurred within six months.”

Her experience as a dancer made her become interested in the physiology of the human body and it was because of this that Koons had a goal of becoming a doctor, even before her injury that ended her dancing career.

“As a dancer, I was always attuned to my body,” Koons said. “I have always been interested in the scientific aspect of it, the movement, the muscles. The way the human body moves. I believe there is a science to that. All of those things are connected to dancers.”

By her junior year in college, Koons decided she wanted to learn and gain experience in medical research. She applied for a handful of internships, including with USAISR. In February 2017, she was one of 13 students nationwide selected for a summer internship with USAISR, out of a pool of 1,500 applicants.

During her internship, Koons was assigned to the Blood and Coagulation task area under the direction of Dr. Daniel Darlington and Dr. Xiaowu Xu, USAISR research physiologists. Koons and the other interns were able to shadow the physicians at the USAISR Burn Center and participated in a weekly journal club. In addition, the interns volunteered at the Warrior and Family Support Center.

Koons worked on a research project to evaluate the effectiveness of intracellular mechanisms controlling aggregation in platelets that could lead to a resuscitative strategy to mitigate coagulopathy, an abnormality in the clotting process of the blood. Her findings were put on a poster presentation in one of the rooms at USAISR, along with those of other interns, for USAISR instructors and personnel to view.

In addition, Koons helped initiate and conduct several other collaborative research projects as an intern at USAISR.

Koons said one of the important things she learned during her internship is how the findings of each of the research projects at USAISR are brought together to improve treatment of combat casualties.

“We were doing small aspects of one big picture,” she said.

After graduating from Mercyhurst, Koons came back to USAISR and did a nine-month stint as a research fellow, from July 2018 to April 2019, in the Battlefield Health and Trauma Center for Human Integrative Physiology. She worked under the guidance of Dr. Victor Convertino, USAISR Senior Scientist for Combat Casualty Care and Director, Battlefield Health & Trauma Center for Human Integrative Physiology.

As a research fellow, Koons authored two research papers that were published in medical journals on blood volume in humans and hemorrhagic shock. Convertino said Koons’ paper on hemorrhagic shock was groundbreaking because she was able to establish that the critical delivery of oxygen that initiates the point an individual goes into shock is 5.3 milliliters of oxygen per kilogram per minute.

“Natalie was the first one to define that,” Convertino said. “Using this data, the paper outlines that we can provide a way for clinicians to resuscitate patients who have lost blood with accurate blood transfusions.”

Koons was involved in the writing of eight articles that were published in medical journals, three as the first author and five as the co-author.

Following up on her research of hemorrhagic shock, Koons was a lead investigator of a study conducted with combat medics at JBSA-Fort Sam Houston to determine if they would intervene early in prohibiting blood loss among casualties.

Convertino said in order to improve clinical outcomes of casualties on the battlefield, it is critical that combat medics recognize an unstable patient and perform early prevention of blood loss from the body.

When Koons tested combat medics who had information on the patient’s compensatory reserve measurement, a new technology for measuring an individual’s ability to compensate for blood loss, she showed having access to this data helped the medics to decrease their amount of time to recognize an unstable patient by more than 40 percent.

Convertino said Koons is a skilled researcher.

“It’s not just intelligence, but it’s having the ability to synthesize and integrate information and think about the big picture,” Convertino said. “Basically, to see the big picture, to take information and put it into a context where there is a thinking process involved is key, and she has that gift. That’s really the essence of research.”

Koons said working with researchers such as Darlington, Xu and Convertino convinced her that medical research was the field she wanted to get in.

“I was able to spend a year with Dr. Convertino,” Koons said. “Just working with him alone, he is an accomplished researcher for the Army and listening to his expertise and his advice in general, that made me want to pursue research as a career in the medical field.”

Koons said she is working on her doctorate with the goal of becoming a physician investigator in the field of critical care medicine. She wants to work in the critical care field because she wants to help improve care for wounded servicemembers and veterans.

“The mission of the Army has really resonated with me,” Koons said. “That was a huge development for my love of research. I’m hoping to continue this passion and to serve the U.S. Army and combat casualty population through research.”