Saving the Military Surgeon: Maintaining Critical Clinical Skills in a Changing Military and Medical Environment

Edwards, Mary J.; Edwards, Kurt; White, Christopher E.; Shepps, Craig; Shackelford, Stacy

doi:10.1016/j.jamcollsurg.2016.03.031

Cited by 59 publications

(37 citation statements)

References 25 publications

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“…While operative experience is not the sole factor in determining the most appropriate TS-MCP, case volume cannot be underestimated as foundational to preparing a team or provider for surgical care of the combat casualty. Many military treatment facilities report low operative and trauma volumes, resulting in military providers that lack exposure to the critical skills needed to care for severely injured combat casualties 6–8. In addition, a model that accurately predicts trauma case volume at an institution would be valuable in establishing TS-MCP courses.…”

Section: Discussionmentioning

confidence: 99%

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

Hall

Qureshi²,

Glaser³

et al. 2019

Trauma Surg Acute Care Open

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BackgroundTrauma readiness is a Department of Defense requirement for military healthcare providers. Surgeons must maintain readiness to optimize surgical care on the battlefield and minimize preventable death. The objective of this study was to validate a predictive model for trauma operative exposure by applying the model prospectively.MethodsThe predictive model for operative trauma exposure was prospectively applied to predict the number of emergent operative cases that would be experienced over predetermined time periods at four separate trauma sustainment military–civilian partnerships (TS-MCP). Notional courses were designed to be 2 or 4 weeks long and consisting of 5 and 12 overnight call periods, respectively. A total of 51 separate 2-week courses and 49 4-week courses were evaluated using the model. The outcome measure was the number of urgent (occurring within a day of arrival) operative trauma cases.ResultsTrauma/general surgery case volumes during call periods of notional courses were within the predicted range at least 98% of the time. Orthopedic volumes were more variable with a range of 82%–98% meeting expectation depending on the course length and institution.ConclusionThe previously defined model accurately predicted the number of urgent trauma/general surgery cases course participants would likely experience when applied prospectively to TS-MCP; however, the model was less accurate in predicting acute orthopedic trauma exposure. While it remains unknown how many cases need to be performed meet a trauma sustainment requirement, having a model with a predictive capability for case volume will facilitate metric development. This model may be useful when planning for future TS-MCP.Level of evidenceEconomic and Value Based Evaluations Level II

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Section: Discussionmentioning

confidence: 99%

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

Hall

Qureshi²,

Glaser³

et al. 2019

Trauma Surg Acute Care Open

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“…Urgent surgical operation in traumatically injured patients was selected as the intervention of interest most closely representing the role of forward-deployed surgeons 1 6–9. The most common scenario for deployed forward surgical teams includes a general and an orthopedic surgeon with a small team consisting of four to eight additional personnel in an austere far-forward, resource-constrained environment with little or no patient holding capacity.…”

Section: Methodsmentioning

confidence: 99%

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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“…[1][2][3][4] However, as operational tempo has decreased, there are concerns that there has been a concomitant decrease in the readiness of the surgical force. [5][6][7] The military's attention has turned towards maintaining surgical readiness and preparing the next generation of surgeons for the conflicts of the future. [8][9] This cycle of care improving over the course of a conflict, followed by a subsequent loss of skills during peacetime, and the need to relearn those skills is known as the "Walker Dip".…”

Section: Introductionmentioning

confidence: 99%

Military civilian partnerships: International proposals for bridging the Walker Dip

Jensen

Egmond

Örtenwall

et al. 2020

J Trauma Acute Care Surg

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The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict. As the operational tempo of the conflicts in Afghanistan and Iraq has declined, concerns have arisen regarding whether US military surgeons are prepared to meet the demands of future conflicts. This problem is not unique to the US military and allied nations have taken creative steps to address the Walker Dip in their own surgical communities. A panel entitled Military and Civilian Trauma System Integration: Where Have We Come; Where Are We Going and What Can We Learn from Our International Partners at the 2018 American Association for the Surgery of Trauma meeting brought together a cadre of civilian and military surgeons with experience in this area. The efforts described involved the creation of a new trauma training program in Doha,Qatar, the military civilian partnership in the Netherlands, and the steps taken to address the deficit of penetrating trauma in Sweden. This article focuses on the lessons that can be learned from our allied partners to assure readiness for deployment amongst military surgeons.

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Saving the Military Surgeon: Maintaining Critical Clinical Skills in a Changing Military and Medical Environment

Cited by 59 publications

References 25 publications

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

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

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

Military civilian partnerships: International proposals for bridging the Walker Dip

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