Humanitarian Surgical Care in the US Military Treatment Facilities in Afghanistan From 2002 to 2013

Weeks, Sharon R.; Oh, John S.; Elster, Eric A.; Learn, Peter A.

doi:10.1001/jamasurg.2017.3142

Cited by 5 publications

(6 citation statements)

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“…Emergencies required significantly more postoperative care and resulted in higher reoperation rates. In 2017, Weeks et al ,18 through a large retrospective series with more than 10 000 patients, reported significantly longer LOS, more procedures and more blood transfusions for patients operated for war-related procedures. The mortality rate was higher for these cases but was not significant.…”

Section: Discussionmentioning

confidence: 99%

The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up

et al. 2018

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Humanitarian surgical care can be provided without compromising the primary mission of the medical forces. Close surveillance and follow-up allowed favourable outcomes with low morbidity and mortality rates. Humanitarian care is responsible for a considerable portion of the workload in such deployed surgical teams. Accounting for humanitarian care is essential in the planning and training for such future medical operations.

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Section: Discussionmentioning

confidence: 99%

The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up

et al. 2018

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“…Cultural competency has gained increasing recognition not only as an essential component of effective global health engagement but also as a key to improving health care disparities domestically . Considering the number of factors that can increase the cultural distance between the deployed military surgeon and local populations and the volume of contact we demonstrated, focused training seems a reasonable prerequisite to deployment, although how best to integrate such training amidst mission-essential requirements will remain a challenge. For an organization that has already prioritized cultural competency in special operations forces training, this is certainly an achievable task if it is valued appropriately.…”

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confidence: 95%

Cultural Sensitivity in Deployed US Medical Personnel—Reply

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Elster

2018

JAMA Surg

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In Reply We read with great interest the letter by Polok et al regarding our article 1 and appreciate their insightful comments, which highlight several challenges in the use of retrospective databases for quality monitoring. However, several key factors deserve further consideration.The initial question prompting our study was whether recent innovations in research and technology translated into actual improvements in patient outcomes from 2005 to 2014. To objectively answer this question, we used the largest longitudinally collected and validated surgical database in the United States, the American College of Surgeons National Surgical Quality Improvement Program. 2 However, as surgical practice has evolved over time, so too have methods of data collection. For example, our study covered trends from 2005 to 2014, during which time the definition of postoperative myocardial infarction was modified twice. 3 In our study, 1 definitions for events were standardized per National Surgical Quality Improvement Program registry definitions and protocols, which is itself constantly evolving to optimize modeling and adjust for complex patient and procedural risk profiles. 4 We acknowledge the challenges in maintaining consistency of myocardial infarction definition across the study period. Yet this point leads to one of our highlighted findings: the Myocardial Infarction and Cardiac Arrest calculator, initially developed and validated prior to the most recent revision of the myocardial infarction definition, 5 was found to consistently underestimate myocardial infarction risk. 1 We agree with Polok et al that higher-quality cohort data with uniform characterization of patient characteristics and adjudication of postoperative events would be ideal for developing and validating future risk assessment tools.Polok et al alluded to the potential prognostic implications of minor troponin elevations. While recent studies may indicate an association between troponin elevations and mortality, 6 the specificity of this biomarker elevation remains an issue of contention. Other conditions, such as congestive heart failure, pulmonary embolism, myocarditis, and sepsis, have all been associated with elevated troponin levels. 3 Currently available evidence does not support the routine use of high-sensitivity troponin panel in the postoperative period because it does not necessarily produce management-altering information.In conclusion, shifting practice norms in our rapidly changing surgical environment inevitably lead to evolving disease definitions in clinical data repositories. This will continue to be an important consideration when evaluating evidence from retrospective studies. Nonetheless, in the whirlwind of disruptive technologies and publications, objectively collected outcomes data remain the best measure by which to evaluate whether actual progress is being made in the delivery of health care, the ultimate goal of all modern medicine.

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“…Previous publications have addressed certain aspects of the US military’s provision of humanitarian surgical care to specific patient populations such as burns, orthopedic injuries, and children 1–6,9–14. No comprehensive descriptive analysis of the overall epidemiologic and workload of humanitarian care performed in US combat zones has been conducted.…”

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confidence: 99%

“…Previous publications have addressed certain aspects of the US military's provision of humanitarian surgical care to specific patient populations such as burns, orthopedic injuries, and children. [1][2][3][4][5][6][9][10][11][12][13][14] No comprehensive descriptive analysis of the overall epidemiologic and workload of humanitarian care performed in US combat zones has been conducted. Understanding the injury patterns and resources required to support humanitarian missions are important considerations for the military given that surgical teams are not staffed or equipped to provide care to the civilian population.…”

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confidence: 99%

Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq

et al. 2022

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Objective: To characterize humanitarian trauma care delivered by US military treatment facilities (MTFs) in Afghanistan and Iraq during combat operations. Background: International Humanitarian Law, which includes the Geneva Conventions, defines protections and standards of treatment to victims of armed conflicts. In 1949, these standards expanded to include injured civilians. In 2001, the Global War on Terror began in Afghanistan and expanded to Iraq in 2003. US MTFs provided care to all military forces, civilians, and enemy prisoners. A thorough understanding of the scope, epidemiology, resource requirements, and outcomes of civilian trauma in combat zones has not been previously characterized. Methods: Retrospective cohort analysis of the Department of Defense Trauma Registry from 2005 to 2019. Inclusion criteria were civilians and Non–North Atlantic Treaty Organization (NATO) Coalition Personnel (NNCP) with traumatic injuries treated at MTFs in Afghanistan and Iraq. Patient demographics, mechanism of injury, resource requirements, procedures, and outcomes were categorized. Results: A total of 29,963 casualties were eligible from the Registry. There were 16,749 (55.9%) civilians and 13,214 (44.1%) NNCP. The majority of patients were age above 13 years [26,853 (89.6%)] and male [28,000 (93.4%)]. Most injuries were battle-related: 12,740 (76.1%) civilians and 11,099 (84.0%) NNCP. Penetrating trauma was the most common cause of both battle and nonbattle injuries: 12,293 (73.4%) civilian and 10,029 (75.9%) NNCP. Median Injury Severity Score (ISS) was 9 in each cohort with ISS≥25 in 2236 (13.4%) civilians and 1398 (10.6%) NNCP. Blood products were transfused to 35% of each cohort: 5850 civilians received a transfusion with 2118 (12.6%) of them receiving ≥10 units; 4590 NNCPs received a transfusion with 1669 (12.6%) receiving ≥10 units. MTF mortality rates were civilians 1263 (7.5%) and NNCP 776 (5.9%). Interventions, both operative and nonoperative, were similar between both groups. Conclusions: In accordance with International Humanitarian Law, as well as the US military’s medical rules of eligibility, civilians injured in combat zones were provided the same level of care as NNCP. Injured civilians and NNCP had similar mechanisms of injury, injury patterns, transfusion needs, and ISS. This analysis demonstrates resource equipoise in trauma care delivered to civilians and NNCP. Hospitals in combat zones must be prepared to manage large numbers of civilian casualties with significant human and material resources allocated to optimize survival. The provision of humanitarian trauma care is resource-intensive, and these data can be used to inform planning factors for current or future humanitarian care in combat zones.

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Humanitarian Surgical Care in the US Military Treatment Facilities in Afghanistan From 2002 to 2013

Cited by 5 publications

References 4 publications

The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up

The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up

Cultural Sensitivity in Deployed US Medical Personnel—Reply

Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq

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