Combat surgical workload in Operation Iraqi Freedom and Operation Enduring Freedom

Turner, Caryn A.; Stockinger, Zsolt T.; Gurney, Jennifer M

doi:10.1097/ta.0000000000001496

Cited by 50 publications

(38 citation statements)

References 24 publications

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“…Similar to the findings in other studies, a large proportion of casualties went directly from point of injury to Role 3 [9]. Orthopedic and soft tissue represented 60% of all procedures, consistent with previous findings [25]. This emphasizes the need for orthopedic surgeons in deployed MTFs [18].…”

Section: Discussionsupporting

confidence: 90%

Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided

Schweizer

Janak

Stockinger³

et al. 2019

Military Med Res

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Background Since 2001, the French Armed Forces have sustained many casualties during the Global War on Terror; however, even today, there is no French Military trauma registry. Some French service members (SMs) were treated in US Military Medical Treatment Facilities (MTFs) and were recorded in the US Department of Defense Trauma Registry (DoDTR). Our objective was to conduct a descriptive analysis of the injuries sustained by French SMs reported in the DoDTR and subsequent care provided to them to assist in understanding the importance of building a French Military trauma registry. Methods Using DoDTR data collected from 2001 to 2017, a retrospective descriptive analysis was conducted. We identified 59 French SMs treated in US MTFs. The characteristics of the SMs’ demographics, injuries, care provided to them, and discharge outcomes were summarized. Results Among the 59 French SMs identified, 46 (78%) sustained battle injuries (BIs) and 13 (22%) sustained nonbattle injuries (NBIs). There were 47 (80%) SMs injured in Afghanistan ( Opération Pamir) , while 12 (20%) were injured in Opération Chammal in Iraq and Syria. Explosives accounted for 52.5% of injuries, while 25.4% were due to gunshot wounds; all were BIs. The majority of reported injuries were penetrating (59.3%), most of which were BIs (71.7%). The mean Injury Severity Score for BIs was 12 (SD = 8.9) compared to 6 (SD = 1.7) for NBIs. Around half of SMs ( n = 30; 51%) were injured in Afghanistan between the years 2008–2010. Among a total of 246 injuries sustained by 59 patients, extremities were the body part most prone to BIs followed by the head and face. Four SMs died after admission (6.8%). Conclusions The DoDTR provides extensive data on trauma injuries that can be used to inform injury prevention and clinical care. The majority of injuries sustained by French SMs were BIs, caused by explosives, and predominantly occurring to the extremities; these findings are similar to those of other studies conducted in combat zones. There is a need to establish a French Military trauma registry to improve the combat casualty care provided to French SMs, and its creation may benefit from the DoDTR model.

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Section: Discussionsupporting

confidence: 90%

Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided

Schweizer

Janak

Stockinger³

et al. 2019

Military Med Res

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“…Follow-on studies, as well as validation of these methods, will continue to be informative; a broad analysis of all level 1 and level 2 trauma centers using Trauma Quality Improvement Program (TQIP) data further helps elucidate suitable TS-MCPs. Additional analyses could also examine operative case categories at TS-MCPs compared with the anatomic case type and operative workload distribution seen during deployment 12. The caveat to further trying to predict and require specific case types will be inherently longer than the current estimates presented in this study.…”

Section: Discussionmentioning

confidence: 97%

“…A definition of an adequate number of cases for a general surgeon to be ‘proficient’ in trauma is undefined and ambiguous at best; there are little objective data to answer this question. Although arbitrary, and difficult to correlate with trauma readiness for deployment operations, 10-operative trauma was selected as an initial target for this to objectify a starting point, but expanded to include other possible totals 10–12. Despite being the number mandated by the ACGME for residency graduation, it is unlikely that this is the case volume which would result in a trained surgeon (in non-trauma practice) retooled for deployment.…”

Section: Discussionmentioning

confidence: 99%

“…For each surgical specialty examined, seasonality was tested for each institution and, where appropriate, further analysis was done to determine the anticipated number of days required to experience a certain number of cases and to estimate how many cases would be experienced during a specified number of days. Given there are little data to discern adequate case volume for a general surgeon to be ‘proficient’ in trauma, we chose 10 operative trauma cases as an initial benchmark, the number mandated by Accreditation Council for Graduate Medical Education (ACGME) for general surgery graduation, but considered other possible case volumes above and below this number 10–12. Additional case volume scenarios were analyzed, defining competency as exposure to ‘X’ cases per year, where ‘X’=5, 10, 12, or 20 cases, respectively.…”

Section: Methodsmentioning

confidence: 99%

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Objective model to facilitate designation of military–civilian partnership hospitals for sustainment of military trauma readiness

Hall

Qureshi²,

Shackelford

et al. 2019

Trauma Surg Acute Care Open

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BackgroundA major dilemma of the military surgeon is the requirement for battlefield trauma expertise without regular exposure to a traumatically injured patient. To solve this problem, the military is partnering with civilian trauma centers to obtain the required trauma exposure. The main objective of this article is to quantify institutional differences and develop a predictive model for estimating the number of 24-hour trauma shifts a surgeon must be on call at civilian centers to experience urgent trauma cases.MethodsTrauma databases from multiple institutions were queried to obtain all urgent trauma cases occurring during a 2-year period. A predictive model was used to estimate the number of urgent surgical cases in multiple specialties surgeons would experience over various numbers of 24-hour shifts and the number of 24-hour shifts required to experience a defined number of cases.ResultsInstitution 1 had the lowest number of required 24-hour shifts to experience 10 urgent operative cases for general/trauma surgery (10 calls) and orthopedic surgery (6 calls) and the highest number of predicted cases over 12 days, 18.3 (95% CI 11 to 27), with 95% confidence. The expected trauma cases and 24-hour shifts at Institution 1 were statistically significant (p<0.0001). There were seasonal effects at all institutions except for Institution 3.DiscussionThere are significant variabilities in trauma center volume and therefore, the expected number of shifts and cases during a specific period of time is significantly different between trauma centers. This predictive model is objective and can therefore be used as an extrapolative tool to help and inform the military regarding placement of personnel in optimal centers for trauma currency rotations.Level of evidenceEconomic and value-based evaluations, level II.

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“…Penetrating abdominal injuries is common and carries signi cant morbidity and mortality in war zones and in civilian setting (1)(2)(3). Abdominal organs are especially vulnerable to penetrating trauma characterized by numerous injuries to solid organs, gastrointestinal tract and vascular structures.…”

Section: Introductionmentioning

confidence: 99%

Sodium Alginate as Treatment for Penetrating Abdominal Trauma- Feasibility Study.

Barsky

Ya’acov

Avraham

et al. 2020

Preprint

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Introduction: Penetrating abdominal injury is a major cause of death in trauma. It may cause hypovolemia leading to tissue hypoperfusion, direct organ damage and cytokine activation that cause inflammatory damage, all of which lead to death. Alginate is a natural anionic polysaccharide typically derived from brown algae. Sodium alginate hydrogel, a hemostatic agent, offers a platform for targeting both mechanical and biological injuries. The current study assessed the effect of a sodium alginate denoted VLVG (Very Low Viscosity (high) G alginate) following abdominal trauma in a swine model of penetrating abdominal injury. Methods: Seven anesthetized pigs were instrumented with catheters and abdominal trauma was introduced by laparoscopic hepatectomy. Ten minutes after the induction of hypovolemic shock, three animals were intra-abdominally administered with VLVG and four animals with saline (controls). During 8h of continuous monitoring, various hemodynamic and biochemical variables were measured and liver biopsies for histological evaluation were taken. In order to compare the study group to the control in a specific time a-parametric Mann-Whitney test was used, assessment of tendency during time Friedman's test for a-parametric variables was used. In order to compare the effect of the treatment (i.e. normal saline VS VLVG alginate) repeated measures ANOVA model was used, and the p value was calculated based on the Greenhouse-Geiser test. This research was approved by the Hebrew University of Jerusalem ethics Committee number: MD16148533. Results: VLVG-treated animals were more hemodynamically stable vs controls as reflected by their lower heart rate and higher blood pressure. They also had lower levels of liver enzymes and lactate and tissue damage. Conclusions: Our results in this pilot abdominal injury model show that VLVG might be a promising new agent. The superior hemostatic and biocompatibility efficiency along with its tissue preserving properties may turn VLVG in the future to a device that could be used in the pre-hospital setting to improve survival of abdominal trauma injuries.

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Combat surgical workload in Operation Iraqi Freedom and Operation Enduring Freedom

Abstract: Epidemiologic study, level III; Care management, level III.

Cited by 50 publications

References 24 publications

Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided

Description of trauma among French service members in the Department of Defense Trauma Registry: understanding the nature of trauma and the care provided

Objective model to facilitate designation of military–civilian partnership hospitals for sustainment of military trauma readiness

Sodium Alginate as Treatment for Penetrating Abdominal Trauma- Feasibility Study.

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