Perspectives on competencies for care in austere settings

Abstract

Austerity in surgical care may manifest by limited equipment/supplies, deficient infrastructure (power, water), rationing/triage requirements, or the unavailability of specialty surgical or medical expertise. Some settings in which surgeons may experience austerity include the following: military deployed operations (domestic and foreign), humanitarian surgical missions, care in rural or remote settings, mass-casualty events, natural disasters, and/or care in low-and some middle-income countries. Expanded competencies beyond those required in routine surgical practice can optimize the quality of surgical care in such settings. The purpose of this expert panel review is to introduce those competencies.

Irregular warfare must combine good medicine, with both good tactics and good strategies: Position paper by the French Special Operations Forces Medical Command

“…This includes critical care skills for the extended management of combat casualties in the preoperative and postoperative stages, advanced soft tissue coverage procedures for the management of complex lower extremity trauma to keep patients alive and save their limbs, the use of telemedicine when deployable, methods for managing limited resources (e.g., drugs, blood products, personnel, and equipment), and more. 19,40 Finally, as illustrated by the Russo-Ukrainian War, the deliberate targeting of health care facilities has become a common tactic in irregular warfare within conflict zones, subjecting medical and surgical teams deployed in operations to an elevated level of danger. 41 Hybrid warfare-defined as a mix of conventional warfare, irregular warfare, terrorism, criminality, and different types of other hybrid threats such as cyberattacks and drone technology-also poses threats to medical and surgical teams.…”

“…To meet these new medical challenges, new special predeployment training of medical and surgical teams is required. This includes critical care skills for the extended management of combat casualties in the preoperative and postoperative stages, advanced soft tissue coverage procedures for the management of complex lower extremity trauma to keep patients alive and save their limbs, the use of telemedicine when deployable, methods for managing limited resources (e.g., drugs, blood products, personnel, and equipment), and more 19,40 …”

“…16 Given the shift toward irregular warfare, some authors have highlighted the need for medical support to adapt to these new modes of military operations. [17][18][19] However, these authors have focused primarily on the tactical level of care on the battlefield within dedicated organizations. Furthermore, the French Military Medical Service has a long tradition of sending medical teams to the casualty as close as possible at the point of injury, which derives from the French civilian standard of care that includes prehospital critical-care teams.…”

“…Given the shift toward irregular warfare, some authors have highlighted the need for medical support to adapt to these new modes of military operations 17–19 . However, these authors have focused primarily on the tactical level of care on the battlefield within dedicated organizations.…”