Military trauma training at civilian centers

Abstract

In the late 1990s, a Department of Defense subcommittee screened more than 100 civilian trauma centers according to the number of admissions, percentage of penetrating trauma, and institutional interest in relation to the specific training missions of each of the three service branches. By the end of 2001, the Army started a program at University of Miami/Ryder Trauma Center, the Navy began a similar program at University of Southern California/Los Angeles County Medical Center, and the Air Force initiated three Centers for the Sustainment of Trauma and Readiness Skills (C-STARS) at busy academic medical centers: R. Adams Cowley Shock Trauma Center at the University of Maryland (C-STARS Baltimore), Saint Louis University (C-STARS St. Louis), and The University Hospital/University of Cincinnati (C-STARS Cincinnati). Each center focuses on three key areas, didactic training, state-of-the-art simulation and expeditionary equipment training, as well as actual clinical experience in the acute management of trauma patients. Each is integral to delivering lifesaving combat casualty care in theater. Initially, there were growing pains and the struggle to develop an effective curriculum in a short period. With the foresight of each trauma training center director and a dynamic exchange of information with civilian trauma leaders and frontline war fighters, there has been a continuous evolution and improvement of each center's curriculum. Now, it is clear that the longest military conflict in US history and the first of the 21st century has led to numerous innovations in cutting edge trauma training on a comprehensive array of topics. This report provides an overview of the decade-long evolutionary process in providing the highest-quality medical care for our injured heroes.

Enhancing Military--Civilian Medical Synergies: The Role of Army Medical Practice in Civilian Facilities

“…At the end of the training, the entire 20-person FST runs the entire trauma center together for 48 hours (Thorson et al, 2012). By 2012, approximately 2,300 Army personnel (95 FSTs) had rotated through the program (Thorson et al, 2012). The program operates with ten military instructors who rotate through the program every two years.…”

“…The Army sends forward surgical teams (FSTs) to this trauma center for a two-week training prior to deployment (Schulman et al, 2010). At the end of the training, the entire 20-person FST runs the entire trauma center together for 48 hours (Thorson et al, 2012). By 2012, approximately 2,300 Army personnel (95 FSTs) had rotated through the program (Thorson et al, 2012).…”

“…Skilled medical trauma teams are essential for providing effective combat care to the warfighter. Following a 1996 report to Congress on military trauma training in civilian facilities, the military services undertook seven new partnership agreements (see Thorson et al, 2012).…”

“…Skilled medical trauma teams are essential for providing effective combat care to the warfighter. Following a 1996 report to Congress on military trauma 36 Enhancing Military-Civilian Medical Synergies training in civilian facilities, the military services undertook seven new partnership agreements (see Thorson et al, 2012).These trauma training military-civilian partnerships provide another mechanism for military personnel to augment or maintain proficiency for combat care. They differ substantially from early militarycivilian partnership programs in that they tend to be short and systematic, with an emphasis on training rather than cost.…”

Does the Declining Lethality of Gunshot Injuries Mask a Rising Epidemic of Gun Violence in the United States?

“…In fact, many of the recent advances in the management of civilian gunshot injury have been learned from military experiences in the battlefields of Iraq and Afghanistan, where improvements in field hemostasis, 5 endovascular repair of vascular injury, and neuro-critical care have occurred. 6,7 For example, aggressive intracranial pressure monitoring and frequent neurosurgical intervention among victims of battlefield blast and penetrating injury has been demonstrated to improve mortality, a practice which has translated to civilian care. 8 Similarly, early and even preemptive correction of coagulopathy (e.g., through use of recombinant factor VIIa) in battlefield victims has been demonstrated to result in fewer transfusions with no increase in thrombosis, providing valuable information for civilians suffering gunshot injury.…”