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

Abstract

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.

Integrated military and civilian partnerships are necessary for effective trauma-related training and skills sustainment during the inter-war period

“…19,34 Potential reasons for this, include that there were likely not enough MCP for the number of surgeons and surgical teams deployed and the often-challenging logistics of moving surgical teams across the country to one of these five just-in-time MCP sites. Furthermore, Hall and colleagues [44][45][46][47]76 demonstrated in their procedural predictive model validated at multiple trauma centers, that operative experiences vary significantly for multiple surgical subspecialties depending on the civilian institution and seasonal variation. Their findings prove that a meaningful operative experience in trauma cannot be guaranteed in a few short weeks prior to deployment.…”

“…Orthopedic surgeons would require 10 to 16 calls (24 hours) and neurosurgeons between 33 and 124 calls to experience 10 operative trauma cases. 45 Finally, between 2001 and 2014, just-in-time MCP were only attended by less than one third of surveyed surgeons prior to deployment. 19,34 No specific data on predeployment MCP utilization for other members of the deployed team are available.…”

Validation of a predictive model for operative trauma experience to facilitate selection of trauma sustainment military–civilian partnerships

“…This study prospectively validates our previously described method for predicting trauma case volume at TS-MCP. Two previous publications used different methodologies that arrived at similar predictions 2 9. The methods demonstrated in this paper are pragmatic, straightforward, and easily applicable.…”

“…A method estimating the number of emergent trauma cases by specialty was designed using 2 years of retrospective trauma data to predict case exposure for the following year 2. The method as described allows for estimating with a 95% level of confidence the estimated number of cases a surgeon would experience after any number of 24-hour shifts or the number of shifts that would be required to reach a minimum number of cases.…”

“…While methods using complicated artificial neural networks have shown limited success, a simpler model is required for practical application 1. This group has previously described straightforward prediction tool to optimize planning at TS-MCP to maximize the operative trauma experience but this model had not prospectively tested 2. The objective of this study is to evaluate the accuracy of this method in a prospective manner, by applying the method’s predictions to planned trauma immersion courses.…”