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Sellier A, Beucler N, Joubert C, Julien C, Tannyeres P, Anger F, Bernard C, Desse N, Dagain A. Emergency Cranial Surgeries Without the Support of a Neurosurgeon: Experience of the French Military Surgeons. Mil Med 2024; 189:598-605. [PMID: 35906867 DOI: 10.1093/milmed/usac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/03/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Unlike orthopedic or visceral surgeons, French military neurosurgeons are not permanently deployed on the conflict zone. Thus, craniocerebral war casualties are often managed by general surgeons in the mobile field surgical team. The objective of the study was to provide the feedback of French military surgeons who operated on craniocerebral injuries during their deployment in a role 2 surgical hospital without a neurosurgeon. MATERIALS AND METHODS A cross-sectional survey was conducted by phone in March 2020, involving every military surgeon currently working in the French Military Training Hospitals, with an experience of cranial surgery without the support of a neurosurgeon during deployment. We strived to obtain contextual, clinical, radiological, and surgical data. RESULTS A total of 33 cranial procedures involving 64 surgeons were reported from 1993 to 2018. A preoperative CT scan was not available in 18 patients (55%). Half of the procedures consisted in debridement of craniocerebral wounds (52%, n = 17), followed by decompressive craniectomies (30%, n = 10), craniotomy with hematoma evacuation (15%, n = 5), and finally one (3%) surgery with exploratory burr holes were performed. The 30-day survival rate was 52% (n = 17) and 50% (n = 10/20) among the patients who sustained severe traumatic brain injury. CONCLUSIONS This survey demonstrates the feasibility and the plus-value of a neurosurgical damage control procedure performed on the field by a surgeon nonspecialized in cranial surgery. The stereotyped neurosurgical techniques used by the in-theater surgeon were learned during a specific predeployment training course. However, the use of a live telemedicine neurosurgical support seems indispensable and could benefit the general surgeon in strained resources setting.
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Affiliation(s)
- Aurore Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Christophe Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Clément Julien
- Department of Visceral Surgery, Laveran Military Hospital, Marseille 13384, France
| | - Paul Tannyeres
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Florent Anger
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Cédric Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
- French Military Health Service Academy, École du Val-de-Grâce, Paris Cedex 5 75230, France
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Shabhay AA, Shabhay ZA, Mwami AS, Massaga FA. Do Urban City Trauma Centers Suffice as Pre-Deployment Training and Post-Deployment Skills Retaining Centers? Disaster Med Public Health Prep 2023; 17:e526. [PMID: 37946536 DOI: 10.1017/dmp.2023.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Ahmed Ali Shabhay
- Institute of Infectious Diseases and Research, Lugalo Military College of Medical Sciences (MCMS) and General Military Hospital (GMH), Dar es Salaam, Tanzania, Africa
- Military Hospital, Mwanza, Tanzania, Africa
| | | | - Amri Salim Mwami
- Institute of Infectious Diseases and Research, Lugalo Military College of Medical Sciences (MCMS) and General Military Hospital (GMH), Dar es Salaam, Tanzania, Africa
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Borg TM, Cavale N, Abu-Sittah G, Ghanem A. Plastic and Maxillofacial Training for War-Zones - A Systematic Review. Craniomaxillofac Trauma Reconstr 2023; 16:154-162. [PMID: 37222978 PMCID: PMC10201192 DOI: 10.1177/19433875221083416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design Injuries sustained in war-zones are variable and constantly developing according to the nature of the ongoing conflict. Soft tissue involvement of the extremities, head and neck often necessitates reconstructive expertise. However, current training to manage injuries in such settings is heterogenous. This study involves a systematic review. Objective To evaluate interventions in place to train Plastic and Maxillofacial surgeons for war-zone environments so that limitations to current training can be addressed. Methods A literature search of Medline and EMBase was performed using terms relevant to Plastic and Maxillofacial surgery training and war-zone environments. Articles that met the inclusion criteria were scored then educational interventions described in included literature were categorised according to their length, delivery style and training environment. Between-group ANOVA was performed to compare training strategies. Results 2055 citations were identified through this literature search. Thirty-three studies were included in this analysis. The highest scoring interventions were over an extended time-frame with an action-oriented training approach, using simulation or actual patients. Core competencies addressed by these strategies included technical and non-technical skills necessary when working in war-zone type settings. Conclusions Surgical rotations in trauma centers and areas of civil strife, together with didactic courses are valuable strategies to train surgeons for war-zones. These opportunities must be readily available globally and be targeted to the surgical needs of the local population, anticipating the types of combat injuries that often occur in these environments.
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Affiliation(s)
- Tiffanie-Marie Borg
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
- Department of Surgery, Queen’s Hospital, London, UK
| | | | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
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Stern CA, Glaser JJ, Stockinger ZT, Gurney JM. An Analysis of Head and Neck Surgical Workload During Recent Combat Operations From 2002 to 2016. Mil Med 2022; 188:usac402. [PMID: 36574225 DOI: 10.1093/milmed/usac402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION In battle-injured U.S. service members, head and neck (H&N) injuries have been documented in 29% who were treated for wounds in deployed locations and 21% who were evacuated to a Role 4 MTF. The purpose of this study is to examine the H&N surgical workload at deployed U.S. military facilities in Iraq and Afghanistan in order to inform training, needed proficiency, and MTF manning. MATERIALS AND METHODS A retrospective analysis of the DoD Trauma Registry was performed for all Role 2 and Role 3 MTFs, from January 2002 to May 2016; 385 ICD-9 CM procedure codes were identified as H&N surgical procedures and were stratified into eight categories. For the purposes of this analysis, H&N procedures included dental, ophthalmologic, airway, ear, face, mandible maxilla, neck, and oral injuries. Traumatic brain injuries and vascular injuries to the neck were excluded. RESULTS A total of 15,620 H&N surgical procedures were identified at Role 2 and Role 3 MTFs. The majority of H&N surgical procedures (14,703, 94.14%) were reported at Role 3 facilities. Facial bone procedures were the most common subgroup across both roles of care (1,181, 75.03%). Tracheostomy accounted for 16.67% of all H&N surgical procedures followed by linear repair of laceration of eyelid or eyebrow (8.23%) and neck exploration (7.41%). H&N caseload was variable. CONCLUSIONS H&N procedures accounted for 8.25% of all surgical procedures performed at Role 2 and Role 3 MTFs; the majority of procedures were eye (40.54%) and airway (18.50%). These data can be used as planning tools to help determine the medical footprint and also to help inform training and sustainment requirements for deployed military general surgeons especially if future contingency operations are more constrained in terms of resources and personnel.
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Affiliation(s)
- Caryn A Stern
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Jacob J Glaser
- Naval Medical Research Unit, 3650 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, Texas 78234, USA
| | - Zsolt T Stockinger
- Naval Hospital Jacksonville & Navy Medicine Reediness and Training Command, 2080 Child St, Jacksonville, Florida 32214, USA
| | - Jennifer M Gurney
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base San Antonio, Fort Sam Houston, Texas 78234, USA
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Haverkamp FJC, van Leest TAJ, Muhrbeck M, Hoencamp R, Wladis A, Tan ECTH. Self-perceived preparedness and training needs of healthcare personnel on humanitarian mission: a pre- and post-deployment survey. World J Emerg Surg 2022; 17:14. [PMID: 35248111 PMCID: PMC8898429 DOI: 10.1186/s13017-022-00417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Humanitarian healthcare workers are indispensable for treating weapon-wounded patients in armed conflict, and the international humanitarian community should ensure adequate preparedness for this task. This study aims to assess deployed humanitarian healthcare workers’ self-perceived preparedness, training requirements and mental support needs. Methods Medical professionals deployed with the International Committee of the Red Cross (ICRC) between October 2018 and June 2020 were invited to participate in this longitudinal questionnaire. Two separate questionnaires were conducted pre- and post-deployment to assess respondents’ self-perceived preparedness, preparation efforts, deployment experiences and deployment influence on personal and professional development. Results Response rates for the pre- and post-deployment questionnaires were 52.5% (114/217) and 26.7% (58/217), respectively. Eighty-five respondents (85/114; 74.6%) reported feeling sufficiently prepared to treat adult trauma patients, reflected by predeployment ratings of 3 or higher on a scale from 1 (low) to 5 (high). Significantly lower ratings were found among nurses compared to physicians. Work experience in a high-volume trauma centre before deployment was associated with a greater feeling of preparedness (mean rank 46.98 vs. 36.89; p = 0.045). Topics most frequently requested to be included in future training were neurosurgery, maxillofacial surgery, reconstructive surgery, ultrasound, tropical diseases, triage, burns and newborn noncommunicable disease management. Moreover, 51.7% (30/58) of the respondents regarded the availability of a mental health professional during deployment as helpful to deal with stress. Conclusion Overall, deployed ICRC medical personnel felt sufficiently prepared for their missions, although nurses reported lower preparedness levels than physicians. Recommendations were made concerning topics to be covered in future training and additional preparation strategies to gain relevant clinical experience. Future preparatory efforts should focus on all medical professions, and their training needs should be continuously monitored to ensure the alignment of preparation strategies with preparation needs. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00417-z.
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Wild H, Stewart BT, LeBoa C, Stave CD, Wren SM. Pediatric casualties in contemporary armed conflict: A systematic review to inform standardized reporting. Injury 2021; 52:1748-1756. [PMID: 34006405 DOI: 10.1016/j.injury.2021.04.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children represent a significant percentage of casualties in modern conflict. Yet, the epidemiology of conflict-related injury among children is poorly understood. A comprehensive analysis of injuries sustained by children in 21st-century armed conflict is necessary to inform planning of local, military, and humanitarian health responses. METHODS We conducted a systematic search of databases including PubMed, Embase, Web of Science, World Health Organization Catalog, and Google Scholar to identify records that described conflict-related injuries sustained by children since 2001. RESULTS The search returned 5,264 records. 9 eligible reports without potentially duplicative data were included in analysis, representing 5,100 pediatric patients injured in 5 conflicts. Blast injury was the most frequent mechanism (57%), compared to 24.8% in adults. Mortality was only slightly higher among children (11.0% compared to 9.8% among adults; p <0.05). Non-uniform reporting prevented pooled analysis and limited the conclusions that could be drawn. CONCLUSIONS Children sustain a higher proportion of blast injury than adults in conflict. Existing data do support the conclusion that child casualties have higher mortality than adults overall; however, this difference is slighter than has been previously reported. Specific subpopulations of children appear to have worse outcomes. Overall, non-uniform reporting renders currently available data insufficient to understand the needs of children injured in modern conflict.
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Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, Seattle, WA USA.
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA USA; Global Injury Control Section, Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | | | - Christopher D Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, CA, USA
| | - Sherry M Wren
- Stanford University School of Medicine, Stanford, CA, USA
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Sellier A, Beucler N, Desse N, Julien C, Tannyeres P, Bernard C, Joubert C, Dagain A. Evaluation of neurosurgical training of French military surgeons prior to their deployment. Neurochirurgie 2021; 67:454-460. [PMID: 33766563 DOI: 10.1016/j.neuchi.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A specific training course was formalized in 2007 in order to facilitate the management of cranio-encephalic injuries by French military general surgeons during deployment, within the Advanced Course for Deployment Surgery (ACDS). The objective is to evaluate the neurosurgical pre-deployment training course attended by the military surgeons. METHODS From June 2019 to September 2019, we conducted a cross-sectional survey in the form of a digital self-completed questionnaire, addressed to all graduated military surgeons working in the French Military Training Hospitals. The survey included: (1) a knowledge assessment; and (2) a self-assessment of the training course. The participating surgeons were classified into two groups according to their participation (group 1) or not (group 2) in the neurosurgical module. The main outcome was the score received on the knowledge assessment. RESULTS Among the 145 military surgeons currently in service, 76 participated in our study (53%), of which 49 were classified in group 1 (64%) and 27 in group 2 (36%). Group 1 surgeons had a significantly higher score than Group 2 at the knowledge assessment (mean 21.0±7.1 vs. 17.8±6.0, P=0.041). The most successful questions were related to TBI diagnosis and surgical technique, while the least successful questions dealt with "beyond emergency care" and surgical indications. CONCLUSION The French pre-deployment neurosurgical training course provides a strong neurosurgical background, sufficient to perform life-saving procedures in a modern conflict situation. However, neurosurgical specialized advice should be solicited whenever possible to assist the in-theatre surgeon in surgical decisions.
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Affiliation(s)
- A Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France.
| | - N Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - N Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Julien
- Department of Visceral Surgery, Sainte-Anne Military Hospital, Toulon, France
| | - P Tannyeres
- 9th Army Medical Center, 144th medical unit, French Military Health Service, Canjuers, France
| | - C Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - A Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France; French Military Health Service Academy - École du Val-de-Grâce, Paris, France
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Jensen G, van Egmond T, Örtenwall P, Peralta R, Aboutanos MB, Galante J. Military civilian partnerships: International proposals for bridging the Walker Dip. J Trauma Acute Care Surg 2020; 89:S4-7. [DOI: 10.1097/ta.0000000000002785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Thoracic surgery constitutes 2.5% of surgical procedures performed in theater, but the skills required are increasingly foreign to military surgeons. This study examines thoracic surgical workload in Iraq and Afghanistan to help define surgical training gaps. METHODS Retrospective analysis of Department of Defense Trauma Registry for all role 2 (R2) (forward surgical) and role 3 (R3) (theater) military facilities, from January 2002 to May 2016. The 95 thoracic surgical International Classification of Diseases-9th Rev.-Clinical Modification procedure codes were grouped into 10 categories based on anatomy or endoscopy. Select groups were further stratified by type of definitive procedure. Procedure groupings were determined and adjudicated by surgeon subject matter experts. Data analysis used Stata Version 15 (College Station, TX). RESULTS Of the total procedures, 5,301 were classified as thoracic surgical procedures and were included in the present study. The majority of thoracic surgical procedures (4,645 [87.6%]) were recorded as being performed at R3 medical treatment facilities (MTFs). The thoracic surgical procedures groups with the largest proportions were: bronchoscopy (39.1%), thoracotomy (16.9%), diaphragm (15.6%), and lung (11.4%). The most common lung procedure subgroup, aside from not otherwise specified, was segmentectomy (28.8%). The R3 MTFs recorded nearly five times the number of lung procedures compared with R2 MTFs; with R3 MTFs recording more than eight times the number of lobectomies compared with R2 MTFs. Thoracic workload was variable over the 15-year study period. CONCLUSION Thoracic surgical skills are necessary in the deployed environment to manage combat-related injuries. Given the current trends in training and specialization, development and sustainment of thoracic surgical skills is challenging in the deployed US trauma system and likely for other nations, and humanitarian surgical care as well. Current training and practice paradigms pose both training and sustainment challenges for surgeons who deploy to a combat zone. LEVEL OF EVIDENCE Therapeutic/Care Management IV.
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Coventry CA, Dominguez L, Read DJ, Trelles M, Ivers RQ, Montazerolghaem M, Holland AJA. Comparison of Operative Logbook Experience of Australian General Surgical Trainees With Surgeons Deployed on Humanitarian Missions: What Can Be Learnt for the Future? J Surg Educ 2020; 77:131-137. [PMID: 31451427 DOI: 10.1016/j.jsurg.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE General surgical training in Australia has undergone considerable change in recent years with less exposure to other areas of surgery. General surgeons from many high-income countries have played important roles in assisting with the provision of surgical care in low- and middle-income countries during sudden-onset disasters (SODs) as part of emergency medical teams (EMTs). It is not known if contemporary Australian general surgeons are receiving the broad surgical training required for work in EMTs. DESIGN Logbook data on the surgical procedures performed by Australian general surgical trainees were obtained from General Surgeons Australia (GSA) for the time period February 2008 to February 2017. Surgical procedures performed by Médecins sans Frontières (MSF) surgeons during 5 projects in 3 SODs (the 2010 Haiti earthquake, the 2013 Philippines typhoon and the 2015 Nepal earthquake) were obtained from previously published data for 6 months following each disaster. SETTING AND PARTICIPANTS This was carried out at the University of Sydney with input from MSF Operational Centre Brussels and GSA. RESULTS Australian general surgical trainees performed a mean of 2107 surgical procedures (excluding endoscopy) during their training (10 6-month rotations). Common procedures included abdominal wall hernia repairs (268, 12.7%), cholecystectomies (247, 11.8%), and specialist colorectal procedures (242, 11.5%). MSF surgeons performed a total of 3542 surgical procedures across the 5 projects analyzed. Common procedures included Caesarean sections (443, 12.5%), wound debridement (1115, 31.5%), and other trauma-related procedures (472, 13.3%). CONCLUSIONS Australian general surgical trainees receive exposure to both essential and advanced general surgery but lack exposure to specialty procedures including the obstetric and orthopedic procedures commonly performed by MSF surgeons after SODs. Further training in these areas would likely be beneficial for general surgeons prior to deployment with an EMT.
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Affiliation(s)
- Charles A Coventry
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - Lynette Dominguez
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, NT, Australia
| | - Miguel Trelles
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Andrew J A Holland
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
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van der Wal H, van Dongen TTCF, Vermeulen CFW, Bruce JL, Bekker W, Manchev V, Kong V, van Waes OJF, Clarke DL, Hoencamp R. Developing a blueprint for a civilian-military collaborative program in trauma training for Northern European countries: A South African experience. Injury 2020; 51:70-75. [PMID: 31400810 DOI: 10.1016/j.injury.2019.07.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/22/2019] [Accepted: 07/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent terrorist attacks and mass shooting incidents in major European and North American cities have shown the unexpected influx of large volumes of patients with complex multi-system injuries. The rise of subspecialisation and the low violence-related penetrating injuries among European cities, show the reality that most surgical programs are unable to provide sufficient exposure to penetrating and blast injuries. The aim of this study is to describe and create a collaborative program between a major South African trauma service and a NATO country military medical service, with synergistic effect on both partners. This program includes comprehensive cross-disciplinary training & teaching, and scientific research. METHODS This is a retrospective descriptive study. The Pietermaritzburg hospital and Netherlands military trauma register databases were used for analysing patient data: Pietermaritzburg between September 2015 and August 2016, Iraq between May and July 2018 and Afghanistan from 2006 to 2010. Interviews were held to analyse the mutual benefits of the program. RESULTS From the Pietermaritzburg study, mutual benefits focus on social responsibility, exchange of knowledge and experience and further mutual exploration. The comparison showed the numbers of surgical procedures over a one-month period performed in Iraq 12.7, in Afghanistan 68.8 and in Pietermaritzburg 152. CONCLUSION This study has shown a significant volume of penetrating trauma in South Africa, that can provide substantial exposure over a relatively short period. This help to prepare civilian and military surgeons and deployable military medical personnel for casualties with blast - and/or penetrating injuries. The aforementioned findings and the willingness to shape the mutual benefits, create a platform for trauma electives, research, education and training.
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Affiliation(s)
- Henk van der Wal
- Institute for Defence and Partner Hospitals, Ministry of Defence, Utrecht, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defence Healthcare Organization, Ministry of Defence, Utrecht, the Netherlands.
| | - Thijs T C F van Dongen
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Division of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Defence Healthcare Organization, Ministry of Defence, Utrecht, the Netherlands
| | - Christine F W Vermeulen
- Institute for Defence and Partner Hospitals, Ministry of Defence, Utrecht, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Vascular Section, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - John L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Wanda Bekker
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Vassil Manchev
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Victor Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Oscar J F van Waes
- Institute for Defence and Partner Hospitals, Ministry of Defence, Utrecht, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Damian L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Division of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defence Healthcare Organization, Ministry of Defence, Utrecht, the Netherlands
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Haverkamp FJC, van Gennip L, Muhrbeck M, Veen H, Wladis A, Tan ECTH. Global surgery for paediatric casualties in armed conflict. World J Emerg Surg 2019; 14:55. [PMID: 31827594 PMCID: PMC6902420 DOI: 10.1186/s13017-019-0275-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background Understanding injury patterns specific for paediatric casualties of armed conflict is essential to facilitate preparations by organizations that provide medical care in conflict areas. The aim of this retrospective cohort study is to identify injury patterns and treatment requirements that are specific for paediatric patients in conflict zones. Methods Characteristics of children (age < 15 years) treated in medical facilities supported by the International Committee of the Red Cross (ICRC) between 1988 and 2014 in Kabul, Kao-i-Dang, Lokichogio, Kandahar, Peshawar, Quetta and Goma were analysed; patient characteristics were compared between treatment facilities and with those of adult patients (age ≥ 15 years). Results Of the patients listed in the database, 15% (5843/38,088) were aged < 15 years. The median age was 10 years (IQR 6–12); 75% (4406/5843) were male. Eighty-six percent (5012/5,843) of the admitted children underwent surgery, with a median of 2 surgeries per patient (IQR 1–3). When compared with adult patients, children were more frequently seen with fragment injuries, burns and mine injuries; they had injuries to multiple body regions more often and had higher in-hospital mortality rates. Conclusions Children more often sustained injuries to multiple body regions and had higher in-hospital mortality than adults. These findings could have implications for how the ICRC and other organizations prepare personnel and structure logistics to meet the treatment needs of paediatric victims of armed conflicts.
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Affiliation(s)
- Frederike J C Haverkamp
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands
| | - Lisanne van Gennip
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands
| | - Måns Muhrbeck
- 2Department of Surgery, Linköping University, Norrköping, Sweden.,3Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.,4Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Harald Veen
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands.,2Department of Surgery, Linköping University, Norrköping, Sweden.,3Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.,4Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Andreas Wladis
- 3Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.,4Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Edward C T H Tan
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid, 9101, 618 Nijmegen, the Netherlands
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Mackenzie CF, Tisherman SA, Shackelford S, Sevdalis N, Elster E, Bowyer MW. Efficacy of Trauma Surgery Technical Skills Training Courses. J Surg Educ 2019; 76:832-843. [PMID: 30827743 DOI: 10.1016/j.jsurg.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Because open surgical skills training for trauma is limited in clinical practice, trauma skills training courses were developed to fill this gap, The aim of this report is to find supporting evidence for efficacy of these courses. The questions addressed are: What courses are available and is there robust evidence of benefit? DESIGN We performed a systematic review of the training course literature on open trauma surgery procedural skills courses for surgeons using Kirkpatrick's framework for evaluating complex educational interventions. Courses were identified using Pubmed, Google Scholar and other databases. SETTING AND PARTICIPANTS The review was carried out at the University of Maryland, Baltimore with input from civilian and military trauma surgeons, all of whom have taught and/or developed trauma skills courses. RESULTS We found 32 course reports that met search criteria, including 21 trauma-skills training courses. Courses were of variable duration, content, cost and scope. There were no prospective randomized clinical trials of course impact. Efficacy for most courses was with Kirkpatrick level 1 and 2 evidence of benefit by self-evaluations, and reporting small numbers of respondents. Few courses assessed skill retention with longitudinal data before and after training. Three courses, namely: Advanced Trauma Life Support (ATLS), Advanced Surgical Skills for Exposure in Trauma (ASSET) and Advanced Trauma Operative Management (ATOM) have Kirkpatrick's level 2-3 evidence for efficacy. Components of these 3 courses are included in several other courses, but many skills courses have little published evidence of training efficacy or skills retention durability. CONCLUSIONS Large variations in course content, duration, didactics, operative models, resource requirements and cost suggest that standardization of content, duration, and development of metrics for open surgery skills would be beneficial, as would translation into improved trauma patient outcomes. Surgeons at all levels of training and experience should participate in these trauma skills courses, because these procedures are rarely performed in routine clinical practice. Faculty running courses without evidence of training benefit should be encouraged to study outcomes to show their course improves technical skills and subsequently patient outcomes. Obtaining Kirkpatrick's level 3 and 4 evidence for benefits of ASSET, ATOM, ATLS and for other existing courses should be a high priority.
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Affiliation(s)
- Colin F Mackenzie
- Shock Trauma Anesthesiology Research Center, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland.
| | | | | | - Nick Sevdalis
- Center for Implementation Science, Kings College, London, UK.
| | - Eric Elster
- Department of Surgery, The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Mark W Bowyer
- Department of Surgery, The Uniformed Services University of Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.
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Stern CA, Stockinger ZT, Todd WE, Gurney JM. An Analysis of Orthopedic Surgical Procedures Performed During U.S. Combat Operations from 2002 to 2016. Mil Med 2019; 184:813-819. [DOI: 10.1093/milmed/usz093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Orthopedic surgery constitutes 27% of procedures performed for combat injuries. General surgeons may deploy far forward without orthopedic surgeon support. This study examines the type and volume of orthopedic procedures during 15 years of combat operations in Iraq and Afghanistan.
Materials and Methods
Retrospective analysis of the US Department of Defense Trauma Registry (DoDTR) was performed for all Role 2 and Role 3 facilities, from January 2002 to May 2016. The 342 ICD-9-CM orthopedic surgical procedure codes identified were stratified into fifteen categories, with upper and lower extremity subgroups. Data analysis used Stata Version 14 (College Station, TX).
Results
A total of 51,159 orthopedic procedures were identified. Most (43,611, 85.2%) were reported at Role 3 s. More procedures were reported on lower extremities (21,688, 57.9%). Orthopedic caseload was extremely variable throughout the 15-year study period.
Conclusions
Orthopedic surgical procedures are common on the battlefield. Current dispersed military operations can occur without orthopedic surgeon support; general surgeons therefore become responsible for initial management of all injuries. Debridement of open fracture, fasciotomy, amputation and external fixation account for 2/3 of combat orthopedic volume; these procedures are no longer a significant part of general surgery training, and uncommonly performed by general/trauma surgeons at US hospitals. Given their frequency in war, expertise in orthopedic procedures by military general surgeons is imperative.
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Affiliation(s)
- Caryn A Stern
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base San Antonio, Fort Sam Houston, TX 78234
| | - Zsolt T Stockinger
- Naval Hospital Jacksonville & Navy Medicine Readiness and Training Command, 2080 Child St, Jacksonville, FL 32214
| | - William E Todd
- Naval Hospital Jacksonville & Navy Medicine Readiness and Training Command, 2080 Child St, Jacksonville, FL 32214
| | - Jennifer M Gurney
- Joint Trauma System, DoD Center of Excellence for Trauma, 3611 Chambers Dr, Joint Base San Antonio, Fort Sam Houston, TX 78234
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Vermeulen CFW, Keijzers PJ, Fredriks EHWM, van der Hee P, Van Waes OJF, Hoencamp R. Dutch combat operation experiences in Iraq and Afghanistan: The conundrum of low surgical workload deployments. Injury 2019; 50:215-9. [PMID: 30458983 DOI: 10.1016/j.injury.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Combined Joined Task Force - Operation Inherent Resolve is the military intervention of Iraq and Coalition Forces in the battle against Islamic State of Iraq and Syria (ISIS). Al Assad Airbase (AAAB) is one of the key airbases. It contains a Role 2 Medical Treatment Facility, primarily to perform Damage Control Surgery in Coalition Forces, Iraqi National Security Forces and Local Nationals. We present a six month medical exposure in order to provide insight into the treatment of casualties and to optimize medical planning of combat operations and (pre-/post-) deployment training. PATIENTS AND METHODS This is a cohort study of casualties that were admitted to the Role 2 Medical Treatment Facility AAAB from November 2017 to April 2018. Their mechanisms and types of injury are described and compared to those sustained in Uruzgan, Afghanistan between 2006-2010. Additionally, they are compared to the caseload in the Dutch civilian medical centers of the medical specialist team at AAAB. RESULTS There were significant differences in both mechanism and type of injury between Coalition Forces and Iraqi Security Forces (p = 0.0001). Coalition Forces had 100% disease and non-battle injuries, where Iraqi Security Forces had 86% battle injuries and 14% non-battle casualties. The most common surgical procedures performed were debridement of wounds (38%), (exploratory) laparotomy (10%) and genital procedures (7%). The surgical caseload in Uruzgan, Afghanistan was significantly different in aspect and quantity, being 4.1 times higher. When compared to the workload at home all team members had at least a tenfold lower workload than in their civilian hospitals. DISCUSSION The deployed surgical teams were scarcely exposed to casualties at AAAB, Iraq. These low workload deployments could cause a decline in surgical skills. Military medical planning should be tailormade and should include adjusting length of stay, (pre-/post-)deployment refresher training and early consultation of military medical specialists. Future research should focus on optimizing this process by investigating fellowships in combat matching trauma centers, regional and international collaboration and refresher training possibilities to maintain the expertise of the acute military care provider.
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Zhang D, Li Z, Cao X, Li B. Four years of orthopaedic activities in Chinese Role 2 Hospital of eastern Mali peacekeeping area. BMJ Mil Health 2018; 166:156-160. [PMID: 30429291 DOI: 10.1136/jramc-2018-000981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/11/2018] [Accepted: 09/16/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Chinese Role 2 Hospital (CHN-Role 2H) Medical Treatment Facility (MTF) was founded in July 2013 as part of the Chinese commitment to Multidimensional Integrated Stabilization Mission in Mali (MINUSMA). It provides medical care for approximately 5200 personnel of the whole Sector East of MINUSMA including UN military personnel, UN police and UN civilian staff. The aim of this study was to determine the orthopaedic surgical activity over a 4-year period to facilitate the training of future Chinese military surgical teams. MATERIALS AND METHODS Surgical records of all patients operated on at the CHN-Role 2H between 28 March 2014 to 28 March 2018 were identified, and all orthopaedic activity were analysed. RESULTS During this period, 1190 patients underwent 2024 surgical procedures. Orthopaedic procedures represented 961/2024 (47.5%) of all the procedures. Battle injury (BI) represented 43% of patients. Improvised explosive devices (IEDs) were responsible for 15.8 % casualties. Fractures (49%) and soft tissue injures (43%) were the most common injuries, with 61% of the fractures being open. Damage control surgery including debridement (23.52%) and external fixation (17.90%) were the most frequently performed interventions. CONCLUSION Orthopaedic surgery is the most frequently performed surgery in the CHN-Role 2H in Mali. The complexity and severity of injuries demonstrate the urgent need for tailored training and extended skill sets for deploying military orthopaedic surgeons.
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Affiliation(s)
- Dawei Zhang
- Department of Orthopedics and Traumatology, Jinan Military General Hospital, Jinan, China
| | - Z Li
- Department of Orthopedics and Traumatology, Jinan Military General Hospital, Jinan, China
| | - X Cao
- Department of Orthopedics and Traumatology, Jinan Military General Hospital, Jinan, China
| | - B Li
- Department of Orthopedics and Traumatology, Jinan Military General Hospital, Jinan, China
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Haverkamp FJC, Veen H, Hoencamp R, Muhrbeck M, von Schreeb J, Wladis A, Tan ECTH. Prepared for Mission? A Survey of Medical Personnel Training Needs Within the International Committee of the Red Cross. World J Surg 2018; 42:3493-3500. [PMID: 29721638 PMCID: PMC6182760 DOI: 10.1007/s00268-018-4651-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Humanitarian organizations such as the International Committee of the Red Cross (ICRC) provide worldwide protection and medical assistance for victims of disaster and conflict. It is important to gain insight into the training needs of the medical professionals who are deployed to these resource scarce areas to optimally prepare them. This is the first study of its kind to assess the self-perceived preparedness, deployment experiences, and learning needs concerning medical readiness for deployment of ICRC medical personnel. METHODS All enlisted ICRC medical employees were invited to participate in a digital questionnaire conducted during March 2017. The survey contained questions about respondents' personal background, pre-deployment training, deployment experiences, self-perceived preparedness, and the personal impact of deployment. RESULTS The response rate (consisting of nurses, surgeons, and anesthesiologists) was 54% (153/284). Respondents rated their self-perceived preparedness for adult trauma with a median score of 4.0 on a scale of 1 (very unprepared) to 5 (more than sufficient); and for pediatric trauma with a median score of 3.0. Higher rates of self-perceived preparedness were found in respondents who had previously been deployed with other organizations, or who had attended at least one master class, e.g., the ICRC War Surgery Seminar (p < 0.05). Additional training was requested most frequently for pediatrics (65/150), fracture surgery (46/150), and burns treatment (45/150). CONCLUSION ICRC medical personnel felt sufficiently prepared for deployment. Key points for future ICRC pre-deployment training are to focus on pediatrics, fracture surgery, and burns treatment, and to ensure greater participation in master classes.
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Affiliation(s)
- Frederike J. C. Haverkamp
- Department of Surgery (internal postal code 618), Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harald Veen
- World Health Organization, Geneva, Switzerland
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Medical Centre Leiderdorp, Leiderdorp, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Ministry of Defence, Utrecht, The Netherlands
| | - Måns Muhrbeck
- Department of Surgery, Linköping University, Gamla Övägen 25, 603 79 Norrköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Gamla Övägen 25, 603 79 Norrköping, Sweden
| | - Johan von Schreeb
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Andreas Wladis
- International Committee of the Red Cross, 19 Avenue de la paix, 1202 Geneva, Switzerland
- Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Edward C. T. H. Tan
- Department of Surgery (internal postal code 618), Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Turner CA, Orman JA, Stockinger ZT, Hudak SJ. Genitourinary Surgical Workload at Deployed U.S. Facilities in Iraq and Afghanistan, 2002–2016. Mil Med 2018; 184:e179-e185. [DOI: 10.1093/milmed/usy152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/29/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Caryn A Turner
- Joint Trauma System, 3698 Chambers Pass, Ft. Sam Houston, TX
| | - Jean A Orman
- Joint Trauma System, 3698 Chambers Pass, Ft. Sam Houston, TX
| | | | - Steven J Hudak
- San Antonio Military Medical Center, Urology Clinic, 3551 Roger Brooke Drive, Ft. Sam Houston, TX
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Barbier O, Racle M. Has Current French Training for Military Orthopedic Surgeons Deployed in External Operations Been Appropriately Adapted? Mil Med 2018; 183:e411-e415. [DOI: 10.1093/milmed/usy013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/09/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Barbier
- Orthopaedic Department, Begin Military Teaching Hospital, 69, avenue de Paris, Saint-Mandé, France
| | - Maelle Racle
- 1st Military Medical Center, Medical Unit of Vincennes, Cours des Maréchaux, Paris Cedex, France
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20
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Uchino H, Kong VY, Bruce JL, Oosthuizen GV, Bekker W, Laing GL, Clarke DL. Preparing Japanese surgeons for potential mass casualty situations will require innovative and systematic programs. Eur J Trauma Emerg Surg 2017; 45:139-144. [PMID: 29119221 DOI: 10.1007/s00068-017-0871-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/31/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The ongoing state of global geo-political instability means that it is prudent to prepare civilian surgeons to manage major military-type trauma. Japan has enjoyed a prolonged period of peace and consequently it is unlikely that surgeons will have been exposed to a sufficient volume of cases. This study reviews the state of trauma training and preparedness in Japan and reviews the trauma workload of a major Japanese emergency medical center and compared with a major South African trauma center with the intention of quantifying and comparing the time needed to gain adequate exposure to major trauma at the two centers. MATERIALS AND METHODS The literature describing the surgical burden from a number of recent military missions was reviewed and the core surgical skills to manage military-type injuries were identified. We then went on to review all patients admitted to both Kurashiki Central Hospital (KCH) and Pietermaritzburg Metropolitan Trauma Service (PMTS) following trauma between the period September 2015 and August 2016. The burden of trauma at each center was quantified and the number of core surgical competencies or procedures performed at each center was then reviewed. These were then compared with the number of the core procedures which were performed on the reported military missions. RESULTS Three reports on military surgical missions were reviewed. These came from the Dutch, French and British military surgical services. The average number of each core procedures performed on each reported military surgery mission are tabulated in the text. The most common procedures were wound debridement and orthopedic fixation, followed by trauma laparotomy, neck exploration and thoracotomy. During the 12 month study period, 309 trauma patients were admitted to KCH. Of which 206 (67%) were male, and the mean age was 57 years. There were 10 penetrating injuries and 299 blunt injuries. Of the penetrating injuries there were no gunshot wounds. The mechanisms of injury for blunt trauma were as follows: Road traffic accidents (RTAs); 141 (47%), fall; 136 (46%) and other injuries; 22 (7%). In the same period, 2887 trauma patients were admitted by the PMTS. There were 1244 cases (43%) of penetrating trauma and 1644 cases (57%) of blunt trauma in PMTS. The mechanisms of injury for penetrating trauma were as follows: stab wounds (SWs); 955 (77%), gunshot wounds (GSWs); 252 (20%), and other injuries; 37 (3%) and for blunt trauma were as follows: assault; 739 (45%), RTAs; 669 (41%), fall; 166 (10%), and other injuries; 70 (4%). The exposure to all the key competencies required to manage trauma is overwhelmingly greater in South Africa than in Japan. The length of time needed to obtain an equivalent trauma exposure to that achieved in South Africa, working in Japan is prohibitively long. CONCLUSION Trauma training in Japan is hamstrung by a lack of clinical material as well as by systematic factors. Training a trauma surgeon is difficult. Developing a trauma system in the country may help address some of these deficits. South Africa in contrast has a huge burden of trauma and sufficient infrastructure to ensure that surgeons working there have adequate exposure to major trauma. Developing an academic exchange program between Japan and South Africa may allow for the transfer of trauma experience and skills between the two countries.
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Affiliation(s)
- H Uchino
- Kurashiki Central Hospital, Emergency and Critical Care Center, 1-1-1 Miwa, Kurashiki, Okayama, Japan.
| | - V Y Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, 719 Umbilo Rd, Durban, South Africa
| | - J L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, 719 Umbilo Rd, Durban, South Africa
| | - G V Oosthuizen
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, 719 Umbilo Rd, Durban, South Africa
| | - W Bekker
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, 719 Umbilo Rd, Durban, South Africa
| | - G L Laing
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, 719 Umbilo Rd, Durban, South Africa
| | - D L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, 719 Umbilo Rd, Durban, South Africa
- Department of Surgery, University of the Witwatersrand, 7 York Rd, Johannesburg, South Africa
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Uchino H, Kong VY, Oosthuizen GV, Bruce JL, Bekker W, Laing GL, Clarke DL. Can We Train Military Surgeons in a Civilian Trauma Center? World J Surg 2018; 42:26-31. [DOI: 10.1007/s00268-017-4149-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bauhahn G, Veen H, Hoencamp R, Olim N, Tan ECTH. Malunion of Long-Bone Fractures in a Conflict Zone in the Democratic Republic of Congo. World J Surg 2017; 41:2200-6. [PMID: 28488041 DOI: 10.1007/s00268-017-4008-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Malunion is a well-recognized complication of long-bone fractures which accounts for more than 25% of injuries in conflict zones. The aim of this study was to investigate the rate of malunion sustained by casualties with penetrating gunshot wounds in an International Committee of the Red Cross (ICRC) surgical substitution project in the Democratic Republic of Congo (DRC) and compare these results with current literature. METHODS A retrospective cohort study was performed. All patients admitted to the ICRC facility between the periods of 01.10.2014 and 31.12.2015 with long-bone fractures caused by gunshot wound were included, and data were collected retrospectively from the patient's hospital notes. RESULTS A total of 191 fractures caused by gunshot were treated in the DRC at the ICRC surgical substitution project during the study period. On average, the fractures were 3 days old on admission and were all open, with 62% also being comminuted. The ICRC management protocol, which emphasizes debridement, antibiotic prophylaxis and conservative fracture stabilization, was followed in all cases. Forty-eight percentage of the fractures were finally classified as 'union without complication'; however, 17% were classified as 'malunion'. CONCLUSIONS This study indicates that open long-bone fractures that are managed by the ICRC surgical substitution project in DRC may have an increased likelihood of malunion as compared to long-bone fractures treated in developed countries. Patient delay and mechanism of injury may have caused increased rates of infection which are likely behind these increased rates of malunion, alongside the lack of definitive fracture treatment options made available to the surgical team.
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van Dongen TTCF, Idenburg FJ, Tan ECTH, Rasmussen TE, Hamming JF, Leenen LPH, Hoencamp R. Combat related vascular injuries: Dutch experiences from a role 2 MTF in Afghanistan. Injury 2016; 47:94-8. [PMID: 26358515 DOI: 10.1016/j.injury.2015.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/25/2015] [Accepted: 08/22/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND In a combat environment, major vascular trauma endures as the leading cause of death. The Dutch role 2 Medical Treatment Facility (MTF), provided supportive care during the mission in Uruzgan, Afghanistan. Aim of this study was to conduct detailed analysis of the admitted major haemorrhages (vascular injuries) and to compare our findings with NATO coalition partners. METHODS Retrospective, descriptive study. Participants eligible for this study came from the role 2 MTF admission database, where they fitted the criteria 'Major haemorrhage (class 2 haemorrhage or more according to the ATLS(®) classification) between 2006 and 2010'. Results were contrasted with studies from coalition partners. RESULTS The query revealed 194 casualties sustaining 208 central (60% abdominal, 40% thoracic/neck), and 99 extremity major haemorrhages leading to 1.6 major haemorrhages per casualty. Survival was significantly better (p<0.05) in the peripheral vascular injuries cohort (96% versus 72%). Primary amputation was needed in 73/84 of lower, and in 8/15 of upper extremity major haemorrhages. Vascular repair or vascular Damage Control Surgery techniques (e.g. shunting) were used in 19/84 cases in the lower, and 7/15 in the upper extremity cohort, with a success rate of 69.2 percent. Amputation rates of coalition partners, using different inclusion and exclusion criteria, ranged from 5 to 60 percent. CONCLUSIONS Only in a few cases genuine peripheral vascular surgery was needed (<1%). This limited number of reconstructions does not demonstrate the need for extensive skills in all areas of vascular surgery. Achieved success rate until discharge was almost 70%. Vascular damage control surgery seems effective as initial limb saving skill in a role 2 MTF. The difference in usage of definitions concerning vascular injuries in current literature warrants further assessment. For optimal analysis there is need for detailed (NATO wide) registration with uniform definitions for vascular injuries. LEVEL OF EVIDENCE Level IV--Epidemiologic study.
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Affiliation(s)
- Thijs T C F van Dongen
- Department of Trauma, Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Floris J Idenburg
- The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden - Bronovo, The Hague, The Netherlands.
| | - Edward C T H Tan
- Royal Netherlands Army and Department of Surgery-Trauma, Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Todd E Rasmussen
- United States Air Force and The Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Science, Bethesda, United States.
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Luke P H Leenen
- The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden - Bronovo, The Hague, The Netherlands.
| | - Rigo Hoencamp
- The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden - Bronovo, The Hague, The Netherlands.
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Alvarado O, Trelles M, Tayler-smith K, Joseph H, Gesline R, Wilna TE, Mohammad Omar MK, Faiz Mohammad NM, Muhima Mastaki J, Chingumwa Buhu R, Caluwaerts A, Dominguez L. Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured? International Orthopaedics (SICOT) 2015; 39:1901-8. [DOI: 10.1007/s00264-015-2781-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/29/2015] [Indexed: 10/23/2022]
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Hoencamp R, Idenburg FJ, Vermetten E, Tan E, Plat MC, Hoencamp E, Leenen LPH, Hamming JF. Impact of combat events on first responders: experiences of the armed conflict in Uruzgan, Afghanistan. Injury 2015; 46:863-9. [PMID: 25548112 DOI: 10.1016/j.injury.2014.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/18/2014] [Accepted: 12/07/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Care for battle casualties demands special skills from medics, nurses, and tactical commanders. To date, no inventory has been performed evaluating the first responders (medics, nurses and tactical commanders) around battle casualties. METHOD This observational cohort study was conducted amongst the first responders (n=195) who were deployed to Southern Afghanistan (2009-2010) in three Marine companies. The survey focused on four main topics: (1) participants general background, (2) exposure to combat (casualty) situations, (3) self-perceived quality of care (1 [low]-10 [high]) in the pre-hospital phase, and (4) the effects of combat stressors on professional skills and social environment using the Post Deployment Reintegration Scale (PDRS) and the Impact of Event Scale-Revised (IES-R). RESULTS 71% of the eligible Dutch tactical commanders, medics, and nurses participated in this survey. Most (14/16) medics and nurses scored their pre-deployment training as sufficient The overall self-perceived quality of care score was above average (7.8). Most (80%) of the participants were exposed to battle casualties. There were no significant differences regarding rank, gender, age and military task using the impact of event scale and PDRS, except for a worse score on the work negative, family positive and personal positive subscales (p<0.05) in the PDRS for the first responders in comparison to the armed forces norm score. CONCLUSION The quality of care in the pre-hospital phase was considered adequate, symptoms of post-traumatic stress in this group was low. Active involvement of co-combatants and the social support network are essential in adaption after exposure to combat events. Further research is necessary to identity predisposing preventable high stress factors, and to compose a "waterproof" aftercare programme.
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Affiliation(s)
- Rigo Hoencamp
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Floris J Idenburg
- Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands.
| | - Eric Vermetten
- Leiden University Medical Centre; Military Mental Health Research, Utrecht, The Netherlands.
| | - Edward Tan
- Department of Surgery-Trauma surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Marie-Christine Plat
- Force Health Protection, Expert Centre Force Health Protection Ministry of Defense, The Netherlands.
| | | | - Luke P H Leenen
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
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Turégano F, Lennquist S. Introduction to the 5th focus-on issue devoted to disaster and military surgery. Eur J Trauma Emerg Surg 2014; 40:419-20. [PMID: 26816236 DOI: 10.1007/s00068-014-0428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/20/2014] [Indexed: 11/24/2022]
Affiliation(s)
- F Turégano
- Gregorio Marañón Hospital, Madrid, Spain.
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