Vermeulen Christine F W, Keijzers Peter J, Fredriks Erik H W M, van der Hee Peter, Van Waes Oscar J F, Hoencamp Rigo
Institute of Collaboration Defense and Relation Hospitals (IDR), Ministry of Defense, Utrecht, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Vascular Section, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Institute of Collaboration Defense and Relation Hospitals (IDR), Ministry of Defense, Utrecht, the Netherlands; Department of Anaesthesiology, MST Enschede, Enschede, the Netherlands.
Injury. 2019 Jan;50(1):215-219. doi: 10.1016/j.injury.2018.11.001. Epub 2018 Nov 3.
The Combined Joined Task Force - Operation Inherent Resolve is the military intervention of Iraq and Coalition Forces in the battle against Islamic State of Iraq and Syria (ISIS). Al Assad Airbase (AAAB) is one of the key airbases. It contains a Role 2 Medical Treatment Facility, primarily to perform Damage Control Surgery in Coalition Forces, Iraqi National Security Forces and Local Nationals. We present a six month medical exposure in order to provide insight into the treatment of casualties and to optimize medical planning of combat operations and (pre-/post-) deployment training.
This is a cohort study of casualties that were admitted to the Role 2 Medical Treatment Facility AAAB from November 2017 to April 2018. Their mechanisms and types of injury are described and compared to those sustained in Uruzgan, Afghanistan between 2006-2010. Additionally, they are compared to the caseload in the Dutch civilian medical centers of the medical specialist team at AAAB.
There were significant differences in both mechanism and type of injury between Coalition Forces and Iraqi Security Forces (p = 0.0001). Coalition Forces had 100% disease and non-battle injuries, where Iraqi Security Forces had 86% battle injuries and 14% non-battle casualties. The most common surgical procedures performed were debridement of wounds (38%), (exploratory) laparotomy (10%) and genital procedures (7%). The surgical caseload in Uruzgan, Afghanistan was significantly different in aspect and quantity, being 4.1 times higher. When compared to the workload at home all team members had at least a tenfold lower workload than in their civilian hospitals.
The deployed surgical teams were scarcely exposed to casualties at AAAB, Iraq. These low workload deployments could cause a decline in surgical skills. Military medical planning should be tailormade and should include adjusting length of stay, (pre-/post-)deployment refresher training and early consultation of military medical specialists. Future research should focus on optimizing this process by investigating fellowships in combat matching trauma centers, regional and international collaboration and refresher training possibilities to maintain the expertise of the acute military care provider.
联合特遣部队——坚定决心行动是伊拉克和联军对伊拉克和叙利亚伊斯兰国（ISIS）作战的军事干预行动。阿萨德空军基地（AAAB）是关键空军基地之一。该基地设有二级医疗救治机构，主要为联军、伊拉克国家安全部队和当地民众实施损害控制手术。我们呈现为期六个月的医疗情况，以便深入了解伤亡人员的治疗情况，并优化作战行动及（部署前/部署后）训练的医疗规划。
这是一项队列研究，研究对象为2017年11月至2018年4月期间入住AAAB二级医疗救治机构的伤亡人员。描述了他们的受伤机制和损伤类型，并与2006 - 2010年在阿富汗乌鲁兹甘受伤的情况进行比较。此外，还将其与AAAB医疗专家团队在荷兰 civilian 医疗中心的病例数量进行了比较。
联军和伊拉克安全部队在受伤机制和损伤类型上均存在显著差异（p = 0.0001）。联军有100%为疾病和非战斗损伤，而伊拉克安全部队有86%为战斗损伤，14%为非战斗伤亡。最常见的外科手术为伤口清创术（38%）、（探查性）剖腹术（10%）和生殖器官手术（7%）。阿富汗乌鲁兹甘的外科病例数量在方面和数量上有显著差异，高出4.1倍。与国内所有团队成员的工作量相比，他们在AAAB的工作量至少比在 civilian 医院低十倍。
部署到伊拉克AAAB的外科团队很少接触到伤亡人员。这些低工作量的部署可能导致手术技能下降。军事医疗规划应量身定制，应包括调整住院时间、（部署前/部署后）进修培训以及尽早咨询军事医疗专家。未来的研究应通过调查战斗创伤中心的进修项目、区域和国际合作以及进修培训可能性来优化这一过程，以保持急性军事护理提供者的专业知识。
