Analysis of Surgical Volume in Military Medical Treatment Facilities and Clinical Combat Readiness of US Military Surgeons

Dalton, Michael K.; Remick, Kyle N.; Mathias, Michael; Trinh, Quoc‐Dien; Cooper, Zara; Elster, Eric A.; Weissman, Joel S.

doi:10.1001/jamasurg.2021.5331

Cited by 58 publications

(64 citation statements)

References 25 publications

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“…The decrease in case volume and case complexity across the military health care system has been well documented 21 . This combined with lack of regular head and neck operations in the average general surgeon’s practice leads to a critical lack of recent experience with the head and neck anatomy and procedures.…”

Section: Discussionmentioning

confidence: 99%

The new face of war: Craniofacial injuries from Operation Inherent Resolve

Neubauer

Camacho

O’Reilly

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:During the last 20 years of conflict in the Middle East, improvements in body armor and the use of improvised explosive devices have resulted in an increased incidence of complex craniofacial trauma (CFT). Currently, CFT comprises up to 40% of all casualties. We present new data from the recent conflict in Iraq and Syria during Operation Inherent Resolve. METHODS:Data were collected for patients treated at role 1, role 2, and role 3 facilities in Iraq and Syria over a 1-year period. During this time, a specialized head & neck surgical augmentation team was deployed and colocated with the central role 3 facility. Data included for this cross-sectional study are as follows: injury type and mechanism, triage category, initial managing facility and subsequent levels of care, and procedures performed. RESULTS:Ninety-six patients sustained CFT over the study period. The most common injuries were soft tissue (57%), followed by cranial (44%) and orbital/facial (31%). Associated truncal and/or extremity injuries were seen in 46 patients (48%). There were marked differences in incidence and pattern of injuries between mechanisms (all p < 0.05). While improvised explosive devices had the highest rate of cranial and truncal injuries, gunshot wounds and blunt mechanisms had higher incidences of orbital/facial and neck injuries. Overall, 45% required operative interventions including complex facial reconstruction, craniotomy, and open globe repair. Mortality was 6% with 83% due to associated severe brain injury. Most patients were local nationals (70%) who required discharge or transfer to the local health care system. CONCLUSION:Complex craniofacial trauma is increasingly seen by deployed surgeons, regardless of subspecialty training or location. Deployment of a centrally located head and neck team greatly enhances the capabilities for forward deployed management of CFT, with excellent outcomes for both US and local national patients.

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Section: Discussionmentioning

confidence: 99%

The new face of war: Craniofacial injuries from Operation Inherent Resolve

Neubauer

Camacho

O’Reilly

et al. 2022

J Trauma Acute Care Surg

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“…The UK Defence Medical Services (DMS) and our allies recognise the difficulties associated with acquisition and retention of militarily relevant surgical knowledge, skills and abilities among their surgical cadres 3–6. Training opportunities have been limited by factors such as the limited penetrating trauma workload in non-deployed roles,4 interruptions to training during the COVID-19 pandemic,7 and reduced deployed experience since the cessation of combat operations in Iraq and Afghanistan. We recently explored the international strategies—such as courses, placements, simulation and fellowships—to mitigate this issue in the subspecialties of General and Vascular Surgery 8.…”

Section: Introductionmentioning

confidence: 99%

Acquisition and retention of military surgical competencies: a survey of surgeons’ experiences in the UK Defence Medical Services

et al. 2022

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IntroductionThe acquisition and retention of militarily relevant surgical knowledge and skills are vital to enable expert management of combat casualties on operations. Opportunities for skill sustainment have reduced due to the cessation of combat operations in Iraq and Afghanistan and lack of military-relevant trauma in UK civilian practice.MethodsA voluntary, anonymous online survey study was sent to all UK Defence Medical Services (DMS) surgical consultants and higher surgical trainees in Trauma and Orthopaedics, Plastic and Reconstructive, and General and Vascular surgical specialties (three largest surgical specialties in the DMS in terms of numbers). The online questionnaire tool included 20 questions using multiple choice and free text to assess respondents’ subjective feelings of preparedness for deployment as surgeons for trauma patients.ResultsThere were 71 of 108 (66%) responses. Sixty-four (90%) respondents were regular armed forces, and 46 (65%) worked in a Major Trauma Centre (MTC). Thirty-three (47%) had never deployed on operations in a surgical role. Nineteen (27%) felt they had sufficient exposure to penetrating trauma. When asked ‘How well do you feel your training and clinical practice prepares you for a surgical deployment?’ on a scale of 1–10, trainees scored significantly lower than consultants (6 (IQR 4–7) vs 8 (IQR 7–9), respectively; p<0.001). There was no significant difference in scores between regular and reservists, or between those working at an MTC versus non-MTC. Respondents suggested high-volume trauma training and overseas trauma centre fellowships, simulation, cadaveric and live-tissue training would help their preparedness.ConclusionsThere was a feeling among a sample of UK DMS consultants and trainees that better preparedness is required for them to deploy confidently as a surgeon for combat casualties. The responses suggest that UK DMS surgical training requires urgent attention if current surgeons are to be ready for their role on deployed operations.

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“…The DOD has also invested in developing the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program, which provides an innovative approach to measuring, evaluating, and sustaining individual clinical proficiency, in collaboration with the American College of Surgeons. 3 The KSA program identifies skills in peacetime medical practice that are similar to those skills a deployed surgeon would need to establish a threshold for battlefield trauma care readiness. In 2016, The National Academies of Science, Engineering and Medicine (NASEM) highlighted the need for bidirectional knowledge translation between the military and civilian sectors with the goal of developing a national trauma care system.…”

mentioning

confidence: 99%

“…), and vary across discipline (subspecialties and profession). The DOD has also invested in developing the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program, which provides an innovative approach to measuring, evaluating, and sustaining individual clinical proficiency, in collaboration with the American College of Surgeons 3. The KSA program identifies skills in peacetime medical practice that are similar to those skills a deployed surgeon would need to establish a threshold for battlefield trauma care readiness.…”

mentioning

confidence: 99%