Fuenfer Michael M, Spinella Philip C, Naclerio Anne L, Creamer Kevin M
Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
Mil Med. 2009 Sep;174(9):887-91. doi: 10.7205/milmed-d-02-2308.
Over 3,500 infants and children, many critically ill and injured, have been admitted to military combat support hospitals (CSH) in Afghanistan and Iraq, which are not doctrinally staffed or equipped to provide their care. This report details how the military medical system is adapting to create a data driven and comprehensive response to optimize the medical and surgical pediatric care being provided.
Information from multiple sources was used over time to craft the military medical response to the pediatric wartime mission. Pediatric data from both the Joint Theater Trauma Registry (JTTR) and the Patient Administration Systems and Biostatistics Activity (PASBA) database were utilized extensively. The resulting educational, supply, and personnel adaptations implemented by the U.S. military will be highlighted, and innovations currently under development will also be described on the basis of this demonstrated need.
This information helped drive pediatric-specific, just-in-time education for CSH personnel, modified CSH equipment and supply lists, inspired the 24/7 pediatric critical care teleconsultation service, and resulted in new initiatives in the predeployment training for CSH personnel.
Military physicians are routinely asked to perform outside their traditional scopes of practice while deployed. Given this reality, military pediatric specialists in medicine and surgery have initiated several successful multidisciplinary programs designed to improve in-theater care of injured children. These innovative efforts include drafting a pediatric addendum to the Army's "Emergency War Surgery" manual, development of instructional compact discs, augmenting and refining the pediatric portion of the Joint Forces Combat Trauma Management course, formation of a pediatric augmentation team to the CSH, and a comprehensive hyperlinked Web-based pediatric critical care and trauma educational platform.
在阿富汗和伊拉克，超过3500名婴幼儿及儿童被收治到军事战斗支援医院（CSH），其中许多人病情危急或受伤严重，而这些医院在人员配备和设备配置上并不符合提供此类救治的标准教义要求。本报告详细阐述了军事医疗系统如何进行调整，以建立一个基于数据的全面应对机制，从而优化所提供的小儿内科和外科护理。
随着时间推移，综合利用来自多个来源的信息，制定针对小儿战时任务的军事医疗应对措施。广泛使用了联合战区创伤登记处（JTTR）以及患者管理系统和生物统计学活动（PASBA）数据库中的儿科数据。将重点介绍美国军方在教育、物资供应和人员方面所做出的适应性调整，同时也将基于已证明的需求描述目前正在开发的创新举措。
这些信息推动了针对CSH人员的小儿专科实时教育，修改了CSH的设备和物资清单，催生了全天候小儿重症监护远程会诊服务，并促成了CSH人员部署前培训的新举措。
军事医生在部署期间经常被要求在其传统执业范围之外开展工作。鉴于这一现实情况，军事儿科医学和外科专家启动了多个成功的多学科项目，旨在改善战区内受伤儿童的护理。这些创新举措包括为陆军的《紧急战争外科》手册起草儿科附录、开发教学光盘、扩充和完善联合部队战斗创伤管理课程中的儿科部分、组建一支前往CSH的儿科增援团队，以及搭建一个基于网络的全面超链接儿科重症监护和创伤教育平台。
