Challenges in the training of military surgeons: experiences from Dutch combat operations in southern Afghanistan

Abstract

The injuries treated at the Dutch Role 2 MTF were often severe, and exposure to pediatric cases was much higher than reported for other combat hospitals in Iraq and in Afghanistan. The current civilian resident training does not equip the trainees with the minimally required competences of a fully trained military surgeon. The recognition in the Netherlands of military surgery as a subspecialty within general (trauma) surgery, with a formal training curriculum, should be considered. The introduction of a North Atlantic Treaty Organization Military (and Disaster) Surgery standard may facilitate the achievement of this aim.

Impact of combat events on first responders: Experiences of the armed conflict in Uruzgan, Afghanistan

“…The first part of the questionnaire (Supplemental data 2) was based on current literature [2,4,5,10,13], and screened for validity and relevance by an expert board of Dutch military medical specialists (Delphi method). It focused on three main topics: (1) participants general background, (2) exposure to combat (casualty) situations, and (3) self-perceived QoC in the pre-hospital phase (QoC was described as the subjective judgment by the participants, and expressed in a numeric variable from 1 [low] to 10 [high]; in this study we defined a score of 7 as average).…”

“…The Netherlands was lead nation in Uruzgan province between 2006 and 2010, deploying Task Force Uruzgan (TFU). During that period, Dutch service members were frequently exposed to high intensity combat [1][2][3][4][5]. The medical support organisation (MSO) in Southern Afghanistan during the ISAF operations was a multinational joint service with a wide range of capabilities, delivering care in a hostile and austere environment.…”

“…This (instinctively contradicting) balance could cause high mental stress for these first responders. Care for battle casualties (BCs) demands special skills from the Dutch deployed service members.The pre-hospital phase seems to be the most substantial opportunity to improve the outcome of BCs, especially the first ''platinum'' 10 min after an injury [3][4][5][6][7][8][9][10][11][12][13].However, there is no objective measurement to evaluate the quality of care (QoC) in the pre-hospital phase and the impact of violent incidents on the first responders or ''the direct circle''. To date, no systematic inventory, using structured questionnaires, has been performed evaluating ''the direct circle'' around battle casualties in the pre-hospital phase and the impact of pre-hospital variables on the post-deployment phase.…”

“…Afghanistan [1][2][3][4][5][6][7]. The Netherlands was lead nation in Uruzgan province between 2006 and 2010, deploying Task Force Uruzgan (TFU).…”

Introduction to the 5th focus-on issue devoted to disaster and military surgery

“…The first two papers deal with educational and training issues. One of them describes current challenges in the training of military surgeons, and reports the experience from Dutch combat operations in Afghanistan [1]. The surgical workload is compared to that of the surgical residents and the pre-deployment medical specialist program.…”