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Haverkamp FJC, Van Dongen TTCF, Edwards MJR, Boel T, Pöyhönen A, Tan ECTH, Hoencamp R. European military surgical teams in combat theater: A survey study on deployment preparation and experience. Injury 2024; 55:111320. [PMID: 38238119 DOI: 10.1016/j.injury.2024.111320] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Adequate (predeployment) training of the nowadays highly specialized Western military surgical teams is vital to ensure a broad range of surgical skills to treat combat casualties. This survey study aimed to assess the self-perceived preparedness, training needs, deployment experience, and post-deployment impact of surgical teams deployed with the Danish, Dutch, or Finnish Armed Forces. Study findings may facilitate a customized predeployment training. METHODS A questionnaire was distributed among Danish, Dutch, and Finnish military surgical teams deployed between January 2013 and December 2020 (N = 142). The primary endpoint of self-perceived preparedness ratings, and data on the training needs, deployment experiences, and post-deployment impacts were compared between professions and nations. RESULTS The respondents comprised 35 surgeons, 25 anesthesiologists, and 39 supporting staff members, with a response rate of 69.7 % (99/142). Self-perceived deployment preparedness was rated with a median of 4.0 (IQR 4.0-4.0; scale: 1 [very unprepared]-5 [more than sufficient]). No differences were found among professions and nations. Skills that surgeons rated below average (median <6.0; scale: 1 [low]-10 [high]) included tropical disease management and maxillofacial, neurological, gynecological, ophthalmic, and nerve repair surgery. The deployment caseload was most often reported as <1 case per week (41/99, 41.4 %). The need for professional psychological help was rated at a median of 1.0 (IQR 1.0-1.0; scale: 1 [not at all]-5 [very much]). CONCLUSIONS Military surgical teams report overall adequate preparedness for deployment. Challenges remain for establishing broadly skilled teams because of a low deployment caseload and ongoing primary specializations. Additional training and exposure were indicated for several specialism-specific skill areas. The need for specific training should be addressed through customized predeployment programs.
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Affiliation(s)
| | | | | | - Thomas Boel
- Danish Armed Forces, Medical Command, DK-8220 Brabrand, Denmark
| | - Antti Pöyhönen
- Finnish Defence Forces Health Services, Centre For Military Medicine, FI-11311 Riihimäki, Finland
| | - Edward C T H Tan
- Department of Surgery, Radboudumc, 6500 HB Nijmegen, Netherlands; Defence Healthcare Organization, Ministry of Defence, 3584 AB Utrecht, Netherlands
| | - Rigo Hoencamp
- Defence Healthcare Organization, Ministry of Defence, 3584 AB Utrecht, Netherlands; Department of Surgery, Alrijne Hospital, 2353 GA Leiderdorp, Netherlands; Division of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, Netherlands; Department of Surgery, Erasmus MC, 3015 GD Rotterdam, Netherlands
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Wolf K, Bowyer M, Bradley M, Franklin B, Weissbrod E, Dinnen R, Andreatta P. Clinical Readiness: Can Providers Learn to Perform Lower Leg Fasciotomy Through a Tablet-based Augmented Reality Surgical Training Environment? Mil Med 2024:usae103. [PMID: 38554272 DOI: 10.1093/milmed/usae103] [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: 12/07/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION The uses of on-demand, interactive tablet-based surgical training environments are of interest as potential resources for both the acquisition and maintenance of rarely performed, critical procedures for expeditionary surgical care. This study examined the effectiveness of a tablet-based augmented reality (AR) procedural training environment for lower leg fasciotomy with a cohort of novice surgical trainees in (1) procedural knowledge, (2) tablet-based procedural skills, (3) tablet-based procedural time, and (4) procedural performance on a cadaver. We hypothesized that engaging with the AR procedural training would increase procedural knowledge and tablet-based skills and procedural time. We hypothesized that the tablet-based AR training environment would be insufficient to acquire the ability to perform lower leg fasciotomy on a cadaver. MATERIALS AND METHODS This study was approved as exempt by the Institutional Review Board at USU. Surgical interns, sub-interns, and independent duty corpsman (n = 30) with no prior lower leg fasciotomy experience voluntarily participated. Tablet-based training activities included pre-training assessment, engagement with instruction, interactive procedural practice, and post-training assessment. Tablet-based knowledge assessment included 17 multiple choice questions covering concepts, reasoning, and judgment associated with the procedure. Tablet-based procedural completion and time were assessed within the training environment. Within 1 week of completing the tablet activities, participants were assessed by fellowship-trained trauma surgeons while performing cadaver-based lower leg fasciotomy. Statistical analysis included paired t-tests and effect size (Cohen's d). Statistical significance was set at P < .05. RESULTS Tablet-based AR procedural training significantly improved procedural knowledge (P < .001), tablet-based procedural skills (P < .001), and reduced tablet-based procedural time (P < .002). Effect sizes were very large for tablet-based procedural knowledge (d = 1.75) and skills (d = 3.2) and small (d = 0.42) for procedural time. There were no significant effects of procedural knowledge, tablet-based procedural skills, or time on cadaver-based performance. No participant was able to accurately and independently complete lower leg fasciotomy procedure on a cadaver. CONCLUSIONS Tablet-based AR procedural training improved procedural knowledge and tablet-based skills; however, those gains did not transfer to the ability to perform the procedure on a cadaver. The tablet's limited AR interface did not support the acquisition of requisite surgical technique, tissue handling, and decision-making in novice surgical trainees. Experienced surgeons may have different outcomes because their mature understanding of surgical constructs would allow extrapolation of abilities to other procedural contexts. Further investigation of the tablet-based training environments for surgical care is necessary before distributing such resources to support clinical readiness.
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Affiliation(s)
- Kieran Wolf
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Mark Bowyer
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Matthew Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Brenton Franklin
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Elizabeth Weissbrod
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Ryan Dinnen
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Pamela Andreatta
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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Gendler S, Gelikas S, Talmy T, Nadler R, Tsur AM, Radomislensky I, Bodas M, Glassberg E, Almog O, Benov A, Chen J. Predictors of Short-Term Trauma Laparotomy Outcomes in an Integrated Military-Civilian Health System: A 23-Year Retrospective Cohort Study. J Clin Med 2024; 13:1830. [PMID: 38610595 PMCID: PMC11012665 DOI: 10.3390/jcm13071830] [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] [Received: 01/06/2024] [Revised: 02/03/2024] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Trauma laparotomy (TL) remains a cornerstone of trauma care. We aimed to investigate prehospital measures associated with in-hospital mortality among casualties subsequently undergoing TLs in civilian hospitals. Methods: This retrospective cohort study cross-referenced the prehospital and hospitalization data of casualties treated by Israel Defense Forces-Medical Corps teams who later underwent TLs in civilian hospitals between 1997 and 2020. Results: Overall, we identified 217 casualties treated by IDF-MC teams that subsequently underwent a TL, with a mortality rate of 15.2% (33/217). The main mechanism of injury was documented as penetrating for 121/217 (55.8%). The median heart rate and blood pressure were within the normal limit for the entire cohort, with a low blood pressure predicting mortality (65 vs. 127, p < 0.001). In a multivariate analysis, prehospital endotracheal intubation (ETI), emergency department Glasgow coma scores of 3-8, and the need for a thoracotomy or bowel-related procedures were significantly associated with mortality (OR 6.8, p < 0.001, OR = 48.5, p < 0.001, and OR = 4.61, p = 0.002, respectively). Conclusions: Prehospital interventions introduced throughout the study period did not lead to an improvement in survival. Survival was negatively influenced by prehospital ETI, reinforcing previous observations of the potential deleterious effects of definitive airways on hemorrhaging trauma casualties. While a low blood pressure was a predictor of mortality, the median systolic blood pressure for even the sickest patients (ISS > 16) was within normal limits, highlighting the challenges in triage and risk stratification for trauma casualties.
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Affiliation(s)
- Sami Gendler
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
| | - Shaul Gelikas
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Department of Medicine, Sheba Medical Center, Tel-Hashomer 5262504, Israel
| | - Tomer Talmy
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
| | - Roy Nadler
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
| | - Avishai M. Tsur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Department of Medicine, Sheba Medical Center, Tel-Hashomer 5262504, Israel
| | - Irina Radomislensky
- The National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 5262100, Israel
| | - Moran Bodas
- The National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 5262100, Israel
- Department of Emergency & Disaster Management, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo 6139001, Israel
| | - Elon Glassberg
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
- The Uniformed Services, University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ofer Almog
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem 9112102, Israel
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 5290002, Israel
| | - Jacob Chen
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan 5262504, Israel (J.C.)
- Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
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Cant MR, Naumann DN, Swain C, Mountain AJ, Baden J, Bowley DM. Acquisition and retention of military surgical competencies: a survey of surgeons' experiences in the UK Defence Medical Services. BMJ Mil Health 2024; 170:117-122. [PMID: 35649691 DOI: 10.1136/bmjmilitary-2022-002112] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The 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. METHODS A 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. RESULTS There 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. CONCLUSIONS There 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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Affiliation(s)
| | - D N Naumann
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - C Swain
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - A J Mountain
- Department of Military Trauma and Orthopaedics, Royal Centre for Defence Medicine, Birmingham, UK
| | - J Baden
- Department of Military Plastic and Reconstructive Surgery, Royal Centre for Defence Medicine, Birmingham, UK
| | - D M Bowley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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Lammers D, Uhlich R, Rokayak O, Manley N, Betzold RD, Hu P. Comparison of military and civilian surgeon outcomes with emergent trauma laparotomy in a mature military-civilian partnership. Trauma Surg Acute Care Open 2024; 9:e001332. [PMID: 38440096 PMCID: PMC10910416 DOI: 10.1136/tsaco-2023-001332] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Medical readiness is of paramount concern for active-duty military providers. Low volumes of complex trauma in military treatment facilities has driven the armed forces to embed surgeons in high-volume civilian centers to maintain clinical readiness. It is unclear what impact this strategy may have on patient outcomes in these centers. We sought to compare emergent trauma laparotomy (ETL) outcomes between active-duty Air Force Special Operations Surgical Team (SOST) general surgeons and civilian faculty at an American College of Surgeons verified level 1 trauma center with a well-established military-civilian partnership. Methods Retrospective review of a prospectively maintained, single-center database of ETL from 2019 to 2022 was performed. ETL was defined as laparotomy from trauma bay within 90 min of patient arrival. The primary outcome was to assess for all-cause mortality differences at multiple time points. Results 514 ETL were performed during the study period. 22% (113 of 514) of patients were hypotensive (systolic blood pressure ≤90 mm Hg) on arrival. Six SOST surgeons performed 43 ETL compared with 471 ETL by civilian faculty. There were no differences in median ED length of stay (27 min vs 22 min; p=0.21), but operative duration was significantly longer for SOST surgeons (129 min vs 110 min; p=0.01). There were no differences in intraoperative (5% vs 2%; p=0.30), 6-hour (3% vs 5%; p=0.64), 24-hour (5% vs 5%; p=1.0), or in-hospital mortality rates (5% vs 8%; p=0.56) between SOST and civilian surgeons. SOST surgeons did not significantly impact the odds of 24-hour mortality on multivariable analysis (OR 0.78; 95% CI 0.10, 6.09). Conclusion Trauma-related mortality for patients undergoing ETL was not impacted by SOST surgeons when compared with their civilian counterparts. Military surgeons may benefit from the valuable clinical experience and mentorship of experienced civilian trauma surgeons at high volume trauma centers without creating a deficit in the quality of care provided. Level of evidence Level IV, therapeutic/care management.
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Affiliation(s)
- Daniel Lammers
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rindi Uhlich
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Omar Rokayak
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nathan Manley
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard D Betzold
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Parker Hu
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lee J, Roberson L, Garner R, Kim E, Glaser J, Choi P, Vicente D. Trauma and Critical Care Military-Civilian Publications Increased After the COVID-19 Pandemic: A Literature Review. J Surg Res 2023; 292:97-104. [PMID: 37603939 DOI: 10.1016/j.jss.2023.06.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION There continues to be a growing demand for military-civilian partnerships (MCPs) in research collaborations developing medical trauma care in domestic and international affairs. The objective of this comprehensive review is to investigate the difference in the quantity of MCP trauma and critical care publications before and after the COVID-19 pandemic. METHODS A systematic literature review was performed for the calendar years 2018 and 2021 utilizing MEDLINE, Cochrane, and EMBASE databases. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a three-tiered review of 603 English language articles to identify trauma-related military and/or civilian partners and describe the changes in geographical relationships. RESULTS A total of 96 (2018) and 119 (2021) articles met screening criteria for trauma and critical care studies and were used for final data extraction. Ultimately, 59 (2018) and 71 (2021) papers met the inclusion criteria of identifying trauma/critical care MCPs and identified both military and civilian partners. There was also an increase from 10 (2018) to 17 (2021) publications that mentioned advocacy for MCP. Using the author affiliations, four regional MCP types were recorded: of 2018 articles, locoregional (3.4%), US-national (47.5%), single international country (42.4%), and between multiple countries (6.8%); of 2021 articles, locoregional (15.5%), US-national (38%), single international country (29.6%), and between multiple countries (16.9%). There has been an increase in the number of locoregional and multinational MCPs and an overall increase in the number of collaborative trauma publications and MCP advocacy papers. A national geographical heat map was developed to illustrate the changes from 2018 to 2021. CONCLUSIONS There has been an increase in the number of recorded trauma and critical care MCP publications post-pandemic. The growth in the number of manuscripts in more regions post-pandemic suggests an increase in the recognition of collaborations that contribute not only to conflict readiness but also advancements in trauma and surgical care.
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Affiliation(s)
- Joseph Lee
- Department of Surgery, Naval Medical Center San Diego, San Diego, California
| | - Laura Roberson
- Department of Surgery, Naval Medical Center San Diego, San Diego, California
| | - Reid Garner
- Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland
| | - Eungjae Kim
- Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland
| | - Jacob Glaser
- Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland; Surgery, Providence Regional Medical Center, Everett, Washington
| | - Pamela Choi
- Department of Surgery, Naval Medical Center San Diego, San Diego, California; Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland
| | - Diego Vicente
- Department of Surgery, Naval Medical Center San Diego, San Diego, California; Surgery, Uniformed Services University of The Health Sciences, Bethesda, Maryland.
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Hefley J, Talbot LA, Metter EJ, Lorenz ME, Shattuck H, Romito K, Heyne RE, Bradley DF. Advancing Readiness Through Military Programs: An Evidence-Based Practice Perspective. Mil Med 2023; 189:31-38. [PMID: 37956329 DOI: 10.1093/milmed/usad230] [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: 02/23/2023] [Revised: 04/24/2023] [Accepted: 06/14/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Military nurses comprise the largest percentage of military health care providers. In the current military health care system, they have two roles: (1) Patient care in military treatment facilities (MTFs) and (2) patient care during combat operations. Although in MTFs, the military nurse's roles are similar to those of their civilian counterpart, their roles are unique and varied in the combat operational environment. These combined roles lead to questions regarding readiness training to ensure that nurses are proficient in both MTFs and combat operational settings where treatment requirements may differ. The purpose of this paper is to (1) present the current state of educational readiness programs to maintain a ready medical force that entail formal teaching programs, military-civilian partnerships, and joint exercises of combat simulations, and (2) identify gaps as presented in an evidence-based practice educational panel. METHODS On March 11, 2022, TriService Nursing Research Program hosted the virtual First Military Evidence-Based Practice Summit from the Uniformed Services University of the Health Sciences in Bethesda, MD. As part of the summit, an evidence-based practice education panel discussed the availability of current evidence-driven military medical readiness programs and identified gaps in the integration of military readiness for nursing personnel into the Defense Health Agency and Armed Services. RESULTS The panel participants discussed the separate requirements for training within the MTFs and in combat operational settings. The available training programs identified by the panel were primarily those developed in local MTF settings to meet local needs. Although these programs support the MTFs' peacetime mission, competing roles, limited time, and limited funds contributed to limited preparation of nursing personnel in skills associated with combat-related injuries and illnesses. Prolonged casualty care has become an important focus for the Department of Defense as greater considerations are directed to wartime operations in austere expeditionary environments. Although there is some training available that is specific for prolonged casualty care, the focus has been the adaptation of combat casualty care during contingency operations. A keynote here was the concept that combat casualty care training must include both development of individual skills and integration of the team since maximal care can be achieved only when the individual and the team operate as a unit. A key point was the utility of central repositories for storing information related to training a ready medical force at individual and unit levels and that these repositories could also be used to collect and facilitate the accession of current evidence-based information. DISCUSSION Optimal patient care at all levels of the military health system requires training that maximizes individual and unit skills specific to the environment at an MTF or in a combat operational setting. Training must be designed to incorporate evidence-driven knowledge in all military settings with guidance that is specific to the environment. CONCLUSION Enhanced communication of evidence-based training and knowledge is an important component of maintaining a ready medical force for broader medical support of combat contingency operations.
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Affiliation(s)
- Justin Hefley
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Laura A Talbot
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Megan E Lorenz
- Landstuhl Regional Medical Center, Unit 33100, APO, Landstuhl 66849, Germany
| | - Heather Shattuck
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Kenneth Romito
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rebecca E Heyne
- Lackland Airforce Base, Science and Technology, Center for Clinical Inquiry, JBSA Lackland, TX 78236, USA
| | - David F Bradley
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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McDonough MM, Benoit PJ, Jarman MP, Remick KN. Geospatial Assessment to Improve Time to Treatment (GAITT). J Surg Res 2023; 291:653-659. [PMID: 37556877 DOI: 10.1016/j.jss.2023.07.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Geographic information systems (GIS) can optimize trauma systems by identifying ways to reduce time to treatment. Using GIS, this study analyzed a system in Maryland served by Johns Hopkins Suburban Hospital and the University of Maryland Capital Region Medical Center. It was hypothesized that including Walter Reed National Military Medical Center (WRNMMC) in the Maryland trauma system in an access simulation would provide increased timely access for a portion of the local population. MATERIALS AND METHODS Using ArcGIS Online, catchment areas with and without WRNMMC were built. Catchment areas captured Johns Hopkins Suburban Hospital, University of Maryland Capital Region Medical Center, and WRNMMC at 5-, 10-, 15-, 20-, 25-, 30-, 45-, and 60-min. Various time conditions were simulated (12 am, 8 am, 12 pm, and 5 pm) on a weekday and weekend day. Data was enriched with 19 variables addressing population size, socioeconomic status, and diversity. RESULTS All catchment areas benefited on at least one time-day simulation, but the largest increases in mean population coverage were in the 0-5 (10.5%), 5-10 (12.3%), and 10-15 min (5.7%) catchment areas. These areas benefited regardless of time-day simulation. The lowest increase in mean population coverage was seen in the 20-25-min catchment area (0.1%). Subgroup analysis revealed that all socioeconomic status and diversity groups gained coverage. CONCLUSIONS This study suggests that incorporating WRNMMC into the Maryland trauma system might yield increased population coverage for timely trauma access. If incorporated, WRNMMC may provide nonstop or flexible coverage, possibly in different traffic scenarios or while civilian centers are on diversion status.
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Affiliation(s)
- Matthew M McDonough
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Patrick J Benoit
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Molly P Jarman
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Kyle N Remick
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Sheldon RR, Bozzay JD, Brown SR. Case Volume and Readiness to Deploy: Clinical Opportunities for Active-Duty Surgeons Outside of Military Hospitals. J Am Coll Surg 2023; 237:221-228. [PMID: 36999735 DOI: 10.1097/xcs.0000000000000697] [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] [Indexed: 04/01/2023]
Abstract
BACKGROUND The Military Health System (MHS) uses a readiness program that identifies the knowledge, skills, and abilities (KSAs) necessary for surgeons to provide combat casualty care. Operative productivity is assigned an objective score based on case type and complexity and totaled to assess overall readiness. As of 2019, only 10.1% of surgeons met goal readiness threshold. At one tertiary military treatment facility (MTF), leadership has taken an aggressive approach toward increasing readiness by forming military training agreements (MTAs) and allowing Off Duty Employment (ODE). We sought to quantify the efficacy of this approach. STUDY DESIGN Operative logs from 2021 were obtained from surgeons assigned to the MTF. Operations were assigned CPT codes and processed through the KSA calculator (Deloitte; London, UK). Each surgeon was then surveyed to identify time away from clinical duties for deployment or military training. RESULTS Nine surgeons were present in 2021 and spent an average of 10.1 weeks (19.5%) abroad. Surgeons performed 2,348 operations (Average [Avg] 261 ± 95) including 1,575 (Avg 175; 67.1%) at the MTF, 606 (Avg 67.3; 25.8%) at MTAs, and 167 (Avg 18.6, 7.1%) during ODE. Adding MTA and ODE caseloads increased KSA scores by 56% (17,765 ± 7,889 vs 11,391 ± 8,355). Using the MHS threshold of 14,000, 3 of 9 (33.3%) surgeons met the readiness threshold from MTF productivity alone. Including all operations, 7 of 9 (77.8%) surgeons met threshold. CONCLUSIONS Increased use of MTAs and ODE significantly augments average caseloads. These operations provide considerable benefit and result in surgeon readiness far exceeding the MHS average. Military leadership can maximize the chances of meeting readiness goals by encouraging clinical opportunities outside the MTF.
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Affiliation(s)
- Rowan R Sheldon
- From the Department of Surgery, Womack Army Medical Center, Fort Bragg, NC (Sheldon, Bozzay, Brown)
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD (Sheldon, Bozzay, Brown)
| | - Joseph D Bozzay
- From the Department of Surgery, Womack Army Medical Center, Fort Bragg, NC (Sheldon, Bozzay, Brown)
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD (Sheldon, Bozzay, Brown)
| | - Shaun R Brown
- From the Department of Surgery, Womack Army Medical Center, Fort Bragg, NC (Sheldon, Bozzay, Brown)
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD (Sheldon, Bozzay, Brown)
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10
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Knowlton LM, Butler WJ, Dumas RP, Bankhead BK, Meizoso JP, Bruns B, Van Gent JM, Kaafarani HMA, Martin MJ, Namias N, Stein DM, Tadlock MD, Martin RS, Staudenmayer KL, Gurney JM. Power of mentorship for civilian and military acute care surgeons: identifying and leveraging opportunities for longitudinal professional development. Trauma Surg Acute Care Open 2023; 8:e001049. [PMID: 36866105 PMCID: PMC9972450 DOI: 10.1136/tsaco-2022-001049] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Across disciplines, mentorship has been recognized as a key to success. Acute care surgeons, focused on the care of trauma surgery, emergency general surgery and surgical critical care, practice in a wide variety of settings and have unique mentorship needs across all phases of their career. Recognizing the need for robust mentorship and professional development, the American Association for the Surgery of Trauma (AAST) convened an expert panel entitled 'The Power of Mentorship' at the 81st annual meeting in September 2022 (Chicago, Illinois). This was a collaboration between the AAST Associate Member Council (consisting of surgical resident, fellow and junior faculty members), the AAST Military Liaison Committee, and the AAST Healthcare Economics Committee. Led by two moderators, the panel consisted of five real-life mentor-mentee pairs. They addressed the following realms of mentorship: clinical, research, executive leadership and career development, mentorship through professional societies, and mentorship for military-trained surgeons. Recommendations, as well as pearls and pitfalls, are summarized below.
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Affiliation(s)
- Lisa Marie Knowlton
- Division of General Surgery, Section of Acute Care Surgery, Stanford University, Stanford, California, USA,Stanford University School of Medicine, Department of Surgery, Stanford, California, USA
| | | | | | - Brittany K Bankhead
- Division of Trauma, Burns, and Critical Care, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jonathan P Meizoso
- DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brandon Bruns
- Department of Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Jan-Michael Van Gent
- Division of Trauma and Surgical Critical Care, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Matthew J Martin
- Division of Trauma and Surgical Critical Care, LAC USC Medical Center, Los Angeles, California, USA
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah M. Stein
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew D Tadlock
- 1st Medical Battalion, 1st Marine Logistics Group, US Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
| | - R Shayn Martin
- Department of Surgery, Division of Acute Care Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristan L Staudenmayer
- Division of General Surgery, Section of Acute Care Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer M Gurney
- Department of Trauma Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
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11
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Vasquez M, Edson TD, Lucas DJ, Hall AB, Tadlock MD. The Impact of the Maritime Deployment Cycle on the Surgeon's Knowledge, Skills, and Abilities. Mil Med 2022; 188:usac316. [PMID: 36260423 DOI: 10.1093/milmed/usac316] [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: 07/06/2022] [Revised: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The U.S. Navy routinely deploys aircraft carriers and amphibious assault ships throughout the world in support of U.S. strategic interests, each with an embarked single surgeon team. Surgeons and their teams are required to participate in lengthy pre-deployment shipboard certifications before each deployment. Given the well-established relationship of surgeon volume to patient outcome, we aim to compare the impact of land vs. maritime deployments on Navy general surgeon practice patterns. MATERIALS AND METHODS Case logs and pre-deployment training initiation of land-based (n = 8) vs. maritime-based (n = 7) U.S. Navy general surgeons over a 3-year period (2017-2020) were compared. Average cases per week were plotted over 26 weeks before deployment. Student's t-test was utilized for all comparisons. RESULTS Cases declined for both groups in the weeks before deployment. At 6 months (26 weeks) before deployment, land-based surgeons performed significantly more cases than their maritime colleagues (50.3 vs. 14.0, P = .009). This difference persisted at 16 weeks (13.1 vs. 1.9, P = .011) and 12 weeks (13.1 vs. 1.9, P = .011). Overall, surgeon operative volume fell off earlier for maritime surgeons (16 weeks) than land-based surgeons (8 weeks). Within 8 weeks of deployment, both groups performed a similarly low number of cases as they completed final deployment preparations. CONCLUSIONS Surgeons are a critical component of combat causality care teams. In this analysis, we have demonstrated that both land- and maritime-based U.S. Navy surgeons have prolonged periods away from clinical care before and during deployments; for shipboard surgeons, this deficit is large and may negatively impact patient outcomes in the deployed maritime environment. The authors describe this discrepancy and provide practical doctrinal solutions to close this readiness gap.
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Affiliation(s)
- Matthew Vasquez
- 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, CA 92058, USA
- Department of Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Theodore D Edson
- 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, CA 92058, USA
| | - Donald J Lucas
- Department of Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Andrew B Hall
- Department of Surgery, Navy Medicine Readiness and Training Command, CENTCOM, CA 33621, USA
| | - Matthew D Tadlock
- 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, CA 92058, USA
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12
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Ruggero JM, Farnand AW, Roach PB, Starr F, Tadlock MD, Bokhari F. Initial Assessment of a Regional Military-Civilian Partnership on Trauma Surgery Skills Sustainment. Mil Med 2022; 188:usac229. [PMID: 35880592 DOI: 10.1093/milmed/usac229] [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: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Trauma surgery skills sustainment and maintenance of combat readiness present a major problem for military general surgeons. The Military Health System (MHS) utilizes the knowledge, skills, and abilities (KSA) threshold score of 14,000 as a measure of annual deployment readiness. Only 9% of military surgeons meet this threshold. Most military-civilian partnerships (MCPs) utilize just-in-time training models before deployment rather than clinical experiences in trauma at regular intervals (skills sustainment model). Our aim is to evaluate an established skills sustainment MCP utilizing KSAs and established military metrics. MATERIALS AND METHODS Three U.S. Navy active duty general surgeons were embedded into an urban level-1 trauma center taking supervised trauma call at regular intervals prior to deployment. Operative density (procedures/call), KSA scores, trauma resuscitation exposure, and combat casualty care relevant cases (CCC-RCs) were reviewed. RESULTS During call shifts with a Navy surgeon present an average 16.4 trauma activations occurred; 32.1% were category-1, 27.6% were penetrating, 72.4% were blunt, and 33.8% were admitted to the intensive care unit. Over 24 call shifts of 24 hours in length, 3 surgeons performed 39 operative trauma cases (operative density of 1.625), generating 11,683 total KSA points. Surgeons 1, 2, and 3 generated 5109, 3167, and 3407 KSA points, respectively. The three surgeons produced a total of 11,683 KSA points, yielding an average of 3,894 KSA points/surgeon. In total, 64.1% of operations fulfilled CCC-RC criteria. CONCLUSIONS Based on this initial evaluation, a military surgeon taking two calls/month over 12 months through our regional skills sustainment MCP can generate more than 80% of the KSA points required to meet the MHS KSA threshold for deployment readiness, with the majority being CCC-RCs. Intangible advantages of this model include exposure to multiple trauma resuscitations while possibly eliminating just-in-time training and decreasing pre-deployment requirements.
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Affiliation(s)
- John M Ruggero
- Department of Trauma, Cook County Health, Chicago, IL 60612, USA
- Navy Medicine Readiness and Training Command Great Lakes, North Chicago, IL 60064, USA
| | - Alex W Farnand
- Navy Medicine Readiness and Training Command Great Lakes, North Chicago, IL 60064, USA
| | - Paul B Roach
- Navy Medicine Readiness and Training Command Great Lakes, North Chicago, IL 60064, USA
| | - Frederic Starr
- Department of Trauma, Cook County Health, Chicago, IL 60612, USA
| | - Matthew D Tadlock
- 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, CA 92055, USA
| | - Faran Bokhari
- Department of Trauma, Cook County Health, Chicago, IL 60612, USA
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