Intensive Care for Emergency Surgeons: Mass Casualties

Pikoulis, Emmanouil; Pikoulis, Andreas; Kalogeropoulos, Athanasios

doi:10.1007/978-3-030-11830-3_19

Cited by 3 publications

(1 citation statement)

References 56 publications

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“…These challenges are accentuated by resource limitations, including the abilities of clinical personnel to provide care beyond the scope of their specialty training and routine clinical practice. Ensuring that there are sufficient surgical personnel to care for these patients may be a challenge, especially in rural, remote, or austere care environments 3 . In 2009, Defense Secretary Robert Gates implemented the Golden Hour policy to ensure that surgical teams were within 60 minutes of any likely possible casualty in Iraq or Afghanistan 4 .…”

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confidence: 99%

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Andreatta,

Graybill,

Bradley

et al. 2024

J Trauma Acute Care Surg

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BACKGROUND The clinical demands of mass casualty events strain even the most well-equipped trauma centers and are especially challenging in resource-limited rural, remote, or austere environments. Gynecologists and urologists care for patients with pelvic and abdominal injuries, but the extent to which they are able to serve as “force multipliers” for trauma care is unclear. This study examined the abilities of urologists and gynecologists to perform 32 trauma procedures after mentored training by expert trauma educators to inform the potential for these specialists to independently care for trauma patients. METHODS Urological (6), gynecological surgeons (6), senior (PGY5) general surgery residents (6), and non-trauma trained general surgeons (8) completed a rigorous trauma training program (ASSET+). All participants were assessed in their trauma knowledge and surgical abilities performing 32 trauma procedures pre/post mentored training by expert trauma surgeons. Performance benchmarks were set for knowledge (80%) and independent, accurate completion of all procedural components within a realistic time window (90%). RESULTS General surgery participants demonstrated greater trauma knowledge than gynecologists and urologists; however, none of the specialties reached the 80% benchmark. Pre-training, general surgery and urology participants outperformed gynecologists for overall procedural abilities. Post-training, only general surgeons met the 90% benchmark. Post-hoc analysis revealed no differences between the groups performing most pelvic and abdominal procedures, however knowledge associated with decision making and judgment in the provision of trauma care was significantly below the benchmark for gynecologists and urologists, even after training. CONCLUSION For physiologically stable patients with traumatic injuries to the abdomen, pelvis or retroperitoneum, these specialists might be able to provide appropriate care; however, they would best benefit trauma patients in the capacity of highly skilled assisting surgeons to trauma specialists. These specialists should not be considered for solo resuscitative surgical care. LEVEL OF EVIDENCE Therapeutic/Care Management, Level III/IV.

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mentioning

confidence: 99%

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Andreatta,

Graybill,

Bradley

et al. 2024

J Trauma Acute Care Surg

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Mass Casualties

Pikoulis

Pikouli

Kalogeropoulos

2023

Textbook of Emergency General Surgery

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Evaluating emergency response at a hospital near the Gaza border within 24 h of increased conflict

Levi,

Givaty,

Ovadia

et al. 2024

BMC Emerg Med

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Background Frontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire. Objectives To describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site. Methods A retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed. Results Patients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation. Conclusion Insights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.

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Intensive Care for Emergency Surgeons: Mass Casualties

Cited by 3 publications

References 56 publications

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Mass Casualties

Evaluating emergency response at a hospital near the Gaza border within 24 h of increased conflict

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