Nessen Shawn C, Cronk Daniel R, Edens Jason, Eastridge Brian J, Blackbourne Lorne H
Department of Surgery, US Army Institute of Surgical Research, San Antonio, Texas, USA.
Am J Disaster Med. 2009 Nov-Dec;4(6):321-9.
U.S. Army "split"forward surgical teams (FST) currently provide most of the resuscitative surgical care for combat patients in Afghanistan. These small units typically comprised 10 personnel and two surgeons each, who frequently encounter mass casualty (MASCAL) situations in geographically isolated regions. This article evaluates the effectiveness of one split FST managing 43 MASCAL situations in two separate locations for more than a 14-month period in Afghanistan.
An Institutional Review Board-approved review of all admission data of the 541st FST was conducted. Comparison was made between patients treated in MASCAL situations to those of patients treated in non-MASCAL events.
Split-based US Army forward surgical elements in a combat environment in Afghanistan.
Two hundred eighty-two patients were treated during MASCAL events and 479 in non-MASCAL situations.
The primary endpoint was survival outcomes among trauma patients when 5 or more patients arrived simultaneously or if3 or more patients required immediate surgery.
Four patients (1.70 percent) died in the MASCAL group compared with 12 (3.30 percent) in the non-MASCAL group. The mortality of patients receiving surgery at the FST was 2.73 percent and the mortality was 0.93 percent in those transferred without surgery. In the MASCAL group, 41 patients (14.5 percent) were critically injured and the critical mortality rate was 6.25 percent. In MASCAL events, 39 percent of patients required surgery compared with 44.9 percent in the non-MASCAL group. The average Injury Severity Score (ISS) of the most severely injured patient was 21.19 and ISS rapidly decreased to scores consistent with mild injury suggesting over triage at the scene.
Despite very limited resources, the split FST can achieve, with appropriate triage, acceptable mortality outcomes in MASCAL situations. Over triage at the wounding scene is common and surgical intervention is frequently required.
美国陆军“拆分式”前方外科手术队（FST）目前为阿富汗的战斗伤员提供了大部分复苏性外科护理。这些小单位通常每组由10名人员和两名外科医生组成，他们经常在地理上孤立的地区遇到大规模伤亡（MASCAL）情况。本文评估了一支拆分式FST在阿富汗两个不同地点超过14个月的时间里处理43起MASCAL情况的有效性。
对第541前方外科手术队的所有入院数据进行了机构审查委员会批准的审查。对在MASCAL情况下治疗的患者与在非MASCAL事件中治疗的患者进行了比较。
阿富汗战斗环境中基于拆分式的美国陆军前方外科手术分队。
在MASCAL事件中治疗了282名患者，在非MASCAL情况下治疗了479名患者。
主要终点是当5名或更多患者同时到达或3名或更多患者需要立即手术时创伤患者的生存结果。
MASCAL组中有4名患者（1.70%）死亡，而非MASCAL组中有12名患者（3.30%）死亡。在前方外科手术队接受手术的患者死亡率为2.73%，未经手术转移的患者死亡率为0.93%。在MASCAL组中，41名患者（14.5%）受重伤，重伤死亡率为6.25%。在MASCAL事件中，39%的患者需要手术，而非MASCAL组为44.9%。最严重受伤患者的平均损伤严重度评分（ISS）为21.19，ISS迅速降至与轻度损伤一致的评分，表明现场存在过度分诊。
尽管资源非常有限，但拆分式前方外科手术队在MASCAL情况下通过适当的分诊可以实现可接受的死亡率结果。创伤现场的过度分诊很常见，并且经常需要手术干预。
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