Hahn Christina, Staudt Amanda M, Brockmeyer Joel, Mann-Salinas Elizabeth A, Gurney Jennifer M
772 FST Commander, 6390 Desert Storm Ave, Fort Campbell, KY.
U.S. Army Institute of Surgical Research, 3698 Chambers Road, Joint Base San Antonio-Fort Sam Houston, TX.
Mil Med. 2019 Mar 1;184(Suppl 1):301-305. doi: 10.1093/milmed/usy392.
The combat experience during the re-entry stages of Operation Inherent Resolve was distinct from other recent operations, but there is no published literature regarding these "initial entry operations" experiences among forward surgical teams (FSTs) deployed to Role 2 facilities A descriptive analysis of patients treated by FSTs may provide valuable information for Role 2 surgical teams preparing to deploy in support of initial entry operations. The purpose of this analysis was to describe injury mechanism, wounding patterns and interventions performed by a small FST in the re-entry phase in Iraq.
From July 17, 2015 to January 31, 2016, a split surgical team with two surgeons and an ER physician documented care for all patients treated by their FST located in Iraq. Given their austere environment, FSTs have limited holding capacity, blood supply, and ability to triage and perform advanced procedures. Patients, who arrived to the Role 2 in asystole, were ineligible for the study. The patient population was Iraqi Security Forces as well as Iraqi civilians. No follow-up data were obtained. Using descriptive statistics, we described the basic demographics, health status, blood utilization, injury severity, and injury pattern of the patient population.
The final study population included 300 Iraqi casualties. The majority of patients (96%) were discharged alive. Many patients were 16 years or older (96%), male (96%), Iraqi soldiers (86%), and injured during battle (96%). Over one-third of patients (35%) had a form of metabolic acidosis, 7% were hypothermic, and 18% were in shock at admission. The median amount of blood products used was 6 (interquartile ranges (IQR) = 2-12) units, while the median red blood cells:fresh frozen plasma ratio was 1.2:1. Six or more units of blood were given to 67 (22%) patients. The top three diagnoses were laceration (n = 197, 21%), penetrating injury (n = 185, 19%), and fracture (n = 174, 18%). A high number of injuries occurred in the extremities/pelvis and buttocks (n = 360, 38%) and in the abdomen and pelvic contents (n = 145, 15%). Over a quarter of patients (26%) had critical injuries (i.e., military injury severity score ≥25).
Given the Role 2 configuration, these results demonstrate FSTs must be capable of managing critically ill patients with markedly limited resources. This management will include general operations in both adult and pediatric patients, resuscitation with a limited blood supply, and patient assessment with minimal to no diagnostic tools. This analysis can inform resident training, pre-deployment training, as well as sustainment training for surgeons after residency.
“坚定决心行动”重返阶段的战斗经历与近期其他行动不同，但目前尚无关于部署到二级医疗机构的前方外科小组（FST）这些“初始进入行动”经历的公开文献。对FST治疗的患者进行描述性分析，可能为准备部署以支持初始进入行动的二级外科小组提供有价值的信息。本分析的目的是描述伊拉克重返阶段一个小型FST的损伤机制、伤口类型和所采取的干预措施。
2015年7月17日至2016年1月31日，一个由两名外科医生和一名急诊医生组成的分阶段外科小组记录了其位于伊拉克的FST治疗的所有患者的情况。鉴于其环境简陋，FST的收容能力、血液供应以及分诊和实施高级手术的能力有限。到达二级医疗机构时已无心跳的患者不符合本研究要求。患者群体包括伊拉克安全部队人员和伊拉克平民。未获取随访数据。我们使用描述性统计方法描述了患者群体基本人口统计学特征、健康状况、血液使用情况、损伤严重程度和损伤类型。
最终研究群体包括300名伊拉克伤亡人员。大多数患者（96%）存活出院。许多患者年龄在16岁及以上（96%），为男性（96%），是伊拉克士兵（86%），且在战斗中受伤（96%）。超过三分之一的患者（35%）存在某种形式的代谢性酸中毒，7%体温过低，18%入院时处于休克状态。使用血液制品的中位数为6单位（四分位间距（IQR）=2 - 12），而红细胞与新鲜冰冻血浆的中位数比例为1.2:1。67名（22%）患者接受了6单位及以上的输血。前三位诊断分别为撕裂伤（n = 197，21%）、穿透伤（n = 185，19%）和骨折（n = 174，18%）。四肢/骨盆和臀部受伤人数较多（n = 360，38%），腹部和盆腔脏器受伤人数为145人（15%）。超过四分之一的患者（26%）有重伤（即军事损伤严重程度评分≥25）。
鉴于二级医疗机构的配置，这些结果表明FST必须有能力在资源明显有限的情况下管理重症患者。这种管理将包括成人和儿童患者的普通手术、有限血液供应下的复苏以及使用极少或无诊断工具进行患者评估。本分析可为住院医师培训、部署前培训以及住院医师毕业后外科医生的维持性培训提供参考。
