How to Train War Surgery Specialists: Part II

Abstract

Since 1950 the peacetime practice of civilian and military surgery has been characterized by increasing specialization and subspecialization. The surgical management of war wounds continues to require a solid foundation in general surgery training and experience, plus additional specific training in war surgery. Even the trauma specialist will face significant differences and difficulties treating war wounds in field hospitals. Neither military nor civilian surgical programs provide this training. This two-part essay identifies major characteristics of war surgery and explores the essential training and education required to prepare civilian and military surgeons for the practice of war surgery.

Colon and Rectal Injuries During Operation Iraqi Freedom: Are There Any Changing Trends in Management or Outcome?

“…30,31,35 Differences between civilian and military trauma must always be considered and may account for diverse management strategies seen in the present series. [36][37][38] Examples include the higher velocity weapons used in combat, which result in more destructive injury patterns, and the need to transport patients without continuous physician attention, making a Bconservative^option, such as diversion, more attractive. In addition, the combat surgeon must consider not only the anatomic injuries and patient physiology but also the number and severity of other incoming casualties, the available resources, such as blood products, the amount of postoperative observation before evacuation to the next level of care, and the amount of monitoring and observation that will be available during that evacuation process.…”

The French mobile neurosurgical unit

“…This training can be supported and updated by specialized military illustrated manuals or other publications. 6,14,15 Nevertheless, this training is often limited to the treatment of some chronic subdural hematomas, open cranial wounds, and/or a few acute extradural hematomas, in conditions in which complete neurosurgical facilities are available. The situation is different in remote areas.…”

“…General surgeons are supposed to be trained for neurosurgical emergencies, but in practice, the time devoted to specific education is relatively short. 14,15 This can be partially explained by the fact that there is no mandatory course in neurosurgery during the education of military general surgeons in France. Specific workshops are held only occasionally, although a significant effort was recently begun in 2007 to implement regular specialized neurosurgical training for general and orthopedic surgeons.…”

Current US Military Operations and Implications for Military Surgical Training

“…Although many surgeons have learned surgery and gained great operative skill in the management of combat wounded, the modern era of predeployment surgical education began with the first appearance of the topic in the modern literature in 1990 with the publication of an article by Rignault, a French general and surgeon, in Military Medicine. 8 In his article, General Rignault advocated the rotation of military surgeons in busy civilian trauma centers for 3 to 6 months at a time in order to immerse the surgeon in the care of the trauma patient. In addition, he advocated that military surgical training be a dynamic model, with analysis of caseloads encountered in current military operations, accompanied by training curriculum modification to reflect deployed injury patterns.…”