Skill sets required for the management of military head, face and neck trauma: a multidisciplinary consensus statement

Abstract

The identification of those skill sets required for deployment is in keeping with the General Medical Council's current drive towards credentialing consultants, by which a consultant surgeon's capabilities in particular practice areas would be defined. Limited opportunities currently exist for trainees and consultants to gain experience in the management of traumatic head, face, neck and eye injuries seen in a kinetic combat environment. Predeployment training requires that the surgical techniques described in this paper are covered and should form the curriculum of future military-specific surgical fellowships. Relevant continued professional development will be necessary to maintain required clinical competency.

Acute neurosurgical management of traumatic brain injury and spinal cord injury in French armed forces during deployment

“…9 This procedure can be associated with another damage control surgical act. 6,9 Neurosurgical damage control guarantees a medevac as safe as can be expected between the conflict zone and a homeland hospital. 4,18 Its objective is to directly control intracranial pressure elevations, particularly when neuromonitoring is lacking due to limited resources.…”

How are we currently training and maintaining clinical readiness of US and UK military surgeons responsible for managing head, face and neck wounds on deployment?

“…The skill sets believed to be required for UK surgeons to adequately manage high energy transfer injuries to the HFN in the deployed military environment are now well established 14. Multiple specialties of surgeon seen in the civilian environment are unlikely to be present, necessitating the development of extended competencies.…”

“…It was widely recognised by both countries that a single specialty of surgeon could not manage all of these types of injuries. Multidisciplinary teams similar to that seen in civilian level 1 trauma centres in the USA or major trauma centres (MTCs) in the UK with all these specialties present was the ideal strived for 14. However, in practice, this almost never occurred for either country, and instead a small group of two or three surgeons with HFN skills generally worked together 15.…”

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

“…The US and UK adopted different approaches to the specialty mix of surgeons responsible for treating patients with HI 14–21. The US deployed neurosurgeons to specific Role 3 MTF 4 15.…”

“…The second in May 2007 to Camp Bastion Hospital, Afghanistan, in response to concerns raised following review of several neurosurgical cases 16. Specialist neurosurgical capability was not maintained as these concerns were felt to be mitigated by policy to retain neurosurgical skill training for non-neurosurgeons and TACEVAC selected patients to the Role 3 MTF at Kandahar 14 16 18…”