Surgery at Sea: Exploring the Training Gap for Isolated Military Surgeons

Nealeigh, Matthew D.; Kucera, Walter B.; Bradley, Matthew John; Jessie, Elliot; Sweeney, W. Brian; Ritter, E. Matthew; Rodríguez, Carlos J.

doi:10.1016/j.jsurg.2018.12.008

Cited by 19 publications

(11 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another explanation is the increase in surface ship deployments during the Iran-Iraq war (1980–1988). An analysis of US Navy surgeon case logs during warship deployments from the 1990s through 2017, found that the average General Surgeon operatively managed one to three orthopedic hand injuries per 7-month deployment, but currently receives no formal training in the management of hand and finger injuries in military residencies 38 . Injuries to the hands and fingers can have a profound impact on individual quality of life and overall military readiness.…”

Section: Discussionmentioning

confidence: 99%

Injury Trends aboard U.S. Navy Vessels: A 50-year analysis of Mishaps at Sea

Benham¹,

Vasquez²,

Kerns

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND Maritime activities have been associated with unique dangers to civilian and military sailors. We performed a retrospective cohort study analyzing injury mechanisms and clinical outcomes of casualties onboard US naval ships to determine common injury mechanisms, trends, and outcomes. We hypothesized there would be a downward trend of injuries and fatalities on US naval ships during the study period. METHODS All mishaps recorded by the Naval Safety Command aboard active service US naval ships from 1970 through 2020 were reviewed. Only mishaps resulting in injury or fatality were included. Over time, injury mechanisms and casualty incidence rates were trended and compared based on medical capabilities. Ships without surgical capabilities were categorized as Role 1, and those with surgical capabilities as Role 2. RESULTS There were a total of 3,127 casualties identified and analyzed, with 1,048 fatalities and 2,079 injuries. The injury mechanisms associated with the highest mortality included electrocution, blunt head trauma, fall from height, man overboard, and explosion. There was a decrease in the trend of mishaps resulting in casualties, fatalities, and injuries over the 50-year study period. The mortality rate for select severe injury mechanisms was higher on Role 1 capable platforms, compared with Role 2 (0.334 vs. 0.250, p < 0.05). CONCLUSION Casualty incidences decreased over 50 years. However, mortality still remains high for certain mechanisms no matter the operational platform. Furthermore, Role 1 capable vessels have a higher overall mortality rate for severe injuries compared with Role 2. The authors propose training, process improvement, and technology-related solutions to improve outcomes on Role 1 capable naval vessels. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.

show abstract

Section: Discussionmentioning

confidence: 99%

Injury Trends aboard U.S. Navy Vessels: A 50-year analysis of Mishaps at Sea

Benham¹,

Vasquez²,

Kerns

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Details on what cases were performed in garrison, on ships, and while deployed were not included in this study, but descriptions on case loads in these environments have previously been published. 7,8,26 In addition, a common weakness in this and in all studies assessing the impact on surgical readiness is the lack of concrete measurement of skill degradation. There is not yet a standard performance metric that exists for military surgeons or studies that measure declines in surgeon performance.…”

Section: Discussionmentioning

confidence: 99%

Military deployment’s impact on the surgeon’s practice

Hall

Qureshi

Vasquez

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND:As the United States withdraws from overseas conflicts, general surgeons remain deployed in support of global operations. Surgeons and surgical teams are foundational to combat casualty care; however, currently, there are few casualty producing events.Low surgical volume and acuity can have detrimental effects on surgical readiness for those frequently deployed. The surgical team cycle of deployment involves predeployment training, drawdown of clinical practice, deployment, postdeployment reintegration, and rebuilding of a patient panel. This study aims to assess these effects on typical general surgeon practices. Quantifying the overall impact of deployment may help refine and implement measures to mitigate the effects on skill retention and patient care. METHODS:Surgeon case logs of eligible surgeons deploying between January 1, 2017, and January 1, 2020, were included from participating military treatment facilities. Eligible surgeons were surgeons whose case logs were primarily at a single military treatment facility 26 weeks before and after deployment and whose deployment duration, location, and number of deployed cases were obtainable. RESULTS:Starting 26 weeks prior to deployment, analyzing in 1-week intervals toward deployment time, case count decreased by 4.8% (p < 0.0001). With each 1-week interval, postdeployment up to the 26-week mark, case count increased by 6% (p < 0.0001). Cases volumes most prominently drop 3 weeks prior to deployment and do not reach normal levels until approximately 7 weeks postdeployment. Case volumes were similar across service branches. CONCLUSION:There is a significant decrease in the number of cases performed before deployment and increase after return regardless of military branch. The perideployment surgical volume decline should be understood and mitigated appropriately; predeployment training, surgical skill retention, and measures to safely reintegrate surgeons back into their practice should be further developed and implemented.

show abstract

“…1,2 Even with this intensive experience, surgeons in isolated localesdcivilian surgeons in underserved and remote hospitals or military surgeons deployed around the globedrequire an expanded skillset beyond standard training. 3 Whether military or civilian, the isolated surgeon must be prepared to treat rarebut-real surgical emergencies until life-threatening conditions are stabilized and transport is arranged. [4][5][6] With each new patient presentation, the isolated surgeon must critically evaluate the health care system's capability for the care that patient requires.…”

Section: Introductionmentioning

confidence: 99%

“…A recent review noted Navy surgeons operating afloat consistently treated urologic, orthopedic, or gynecologic conditions without the aid of an in-person specialty consultant. 3 The need for surgeons in isolated settings continues, both in uniformed and civilian settings, as does the need to train these surgeons for the conditions and procedures their patients require.…”

Section: Introductionmentioning

confidence: 99%

The Isolated Surgeon: A Scoping Review

Nealeigh

Kucera

Artino

et al. 2021

Journal of Surgical Research

Self Cite

View full text Add to dashboard Cite

Background: Surgeons in resource-limited environments often provide care outside the expected scope of current general surgery training. Geographically isolated patients may be unwilling or unable to travel for specialty care. These same patients also present with lifethreatening emergencies beyond the typical breadth of a general surgeon's practice, in hospitals with limited professional and material support. This review characterizes the unique role of isolated surgeons, so individual surgeons and health care organizations may focus professional development resources more efficiently, with the ultimate goal of improved patient care.Methods: We performed a scoping review of the isolated surgeon, reviewing 25 years of literature regarding isolated US civilian and military surgeons. We examined emerging themes regarding the definition of an isolated surgeon, the scope of surgical practice beyond current training norms, and training gaps identified by surgeons in an isolated role.Results: From 904 articles identified, we included 91 for final review. No prior definition exists for the isolated surgeon, although multiple definitions describe rural surgeons, patients, or hospitals; we propose an initial definition from consistent themes in the literature. Isolated surgeons across varied practice settings consistently performed relatively large volumes of cases of, and identified training gaps in, orthopedic, obstetric and gynecologic, urologic, and vascular surgery subspecialties. Life-threatening, "rare-but-real" cases in the above and neurosurgical disciplines are uncommon, but consistent across practice settings.Conclusions: This review represents the largest examination of the isolated surgeon in the current literature. Clarifying the identity, practice components, and training gaps of the

show abstract

Surgery at Sea: Exploring the Training Gap for Isolated Military Surgeons

Cited by 19 publications

References 15 publications

Injury Trends aboard U.S. Navy Vessels: A 50-year analysis of Mishaps at Sea

Injury Trends aboard U.S. Navy Vessels: A 50-year analysis of Mishaps at Sea

Military deployment’s impact on the surgeon’s practice

The Isolated Surgeon: A Scoping Review

Contact Info

Product

Resources

About