A Perfect Storm: 2019 Scudder Oration on Trauma

How to maintain the readiness of forward deployed caregivers

“…The AAST panel consensus was that MCP will not only be integral to military caregiver readiness (Box 2) but they will also continue to enrich civilian providers and institutions as well. 4,5,8,26,27 The three general types of available military-civilian partnership agreements that exist are for providers or teams to embed full time in civilian institutions, receive Just-In-Time clinical experience in trauma care just before a deployment, or they can spend time at regular intervals in civilian institutions augmenting their MTF practice. When existing MCP were initially created 20 years ago, MTF were clinically more active than today.…”

Military-Civilian Partnerships to Expand Emergency Obstetric Care for Both Civilian and Military Mothers-to-Be

“…Military-civilian partnerships in trauma care have existed since the early 2000s and allow for the exchange of lessons learned on the battlefield among military and civilian health care professionals while keeping combat casualty teams prepared for deployment. 4 These partnerships are particularly important to avoid the peacetime consequences of decreased exposure to patients with severe injuries. A landmark report by the National Academies of Sciences, Engineering, and Medicine 5 estimated that a comprehensive US military-civilian trauma system using MTFs would provide access to timely trauma care for an additional 45 million people who currently live in underserved areas, with the potential to save 20 000 to 30 000 lives each year.…”

Assessing Clinical Readiness

“…In a joint effort with the American College of Surgeons, the DoD has developed the Clinical Readiness Program (CRP) to answer the question "Is this physician 'ready' to deliver the relevant KSAs necessary to care for casualties?" [2][3][4] The CRP includes 4 key elements: (1) periodic assessment of knowledge aligned with a relevant curriculum; (2) assessment of key expeditionary procedural skills; (3) an appropriate train/retrain cycle focused on areas of need by the above assessments; and (4) development of a measurable "readiness" value of an individual physician's clinical practice when not deployed. 3,4 The latter may include partnering with civilian centers to provide continued exposure to the care of injured and ill patients to address the well-described decreasing surgical volumes in military hospitals.…”

“…3,4 The latter may include partnering with civilian centers to provide continued exposure to the care of injured and ill patients to address the well-described decreasing surgical volumes in military hospitals. 2 This approach has been multidisciplinary by design, incorporating all physicians who care for combat patients including anesthesiologists, emergency medicine professionals, surgical specialists, and critical care physicians.Assessing clinical readiness through KSAs is a part of a multistep process designed to be both scalable and reproducible across medical specialties and is applicable to both military and civilian health care professionals alike. The process starts with defining a "Scope of Practice" followed by formulation of a KSA blueprint developed from Clinical Practice Guidelines, case records, and relevant literature.…”