From the Department of Surgery, 96 Medical Group, Eglin AFB, Florida (A.B.H., H.M.); Department of Surgery, William Beaumont Army Medical Center (E.D., A.W.), El Paso, Texas; Department of Surgery, Naval Hospital Camp Pendleton (M.V.), Camp Pendleton, California; Department of Surgery, Keesler Medical Center (J.U.), Biloxi, Mississippi; Department of Surgery, Naval Medical Center San Diego (M.D.T.), San Diego, California; Department of Surgery, Naval Medical Research Unit San Antonio (I.Q., J. Glaser), San Antonio, Texas; and Department of Surgery, Joint Trauma System and the US Army Institute of Surgical Research (J. Gurney), Defense Center of Excellence, San Antonio, Texas.
J Trauma Acute Care Surg. 2020 Dec;89(6):1054-1060. doi: 10.1097/TA.0000000000002871.
The management of battlefield trauma requires a specific skill set, which is optimized by regular trauma experience. As military casualties from the prolonged conflicts in the Middle East decrease, challenges exist to maintain battlefield trauma readiness. Military surgeons must therefore depend on the Military Health System. The purpose of the study was to evaluate the frequency of surgical cases relevant to deployed combat casualty care performed at military treatment facilities (MTFs).
Combat casualty care relevant cases (CCC-RCs) were defined as emergent, open surgical cases in which the patient required a blood transfusion. Case logs from four military treatment centers with surgical residency training programs were used. Twenty-four months of case records between January 1, 2017, and January 1, 2019, were included to determine total numbers of CCC-RCs at each institution. The results were compared with San Antonio Military Medical Center's, the Department of Defense's only American College of Surgeons-verified level 1 trauma center.
Fifty-one trauma/general surgeons and six vascular surgeons case logs were examined. Thirty (0.3%) of 10,529 cases performed by trauma/general and vascular surgeons over the 2-year study period were considered CCC-RCs. These results were in contrast to San Antonio Military Medical Center, which had a significantly higher proportion of CCC-RCs (113 of 320 cases, 35.3%, p < 0.0001).
A cross-section of MTF surgical case complexity demonstrates a lack of cases considered to be CCC-RCs. At the MTFs evaluated, surgical case surrogates for combat trauma and combat casualty care is close to zero. These data are potentially representative of other military treatment centers, which focus on beneficiary care. For readiness purposes, MTFs that care primarily for Tricare beneficiaries without a significant trauma population should not be considered meaningful sources of CCC-RCs for trauma/general and vascular surgeons.
Therapeutic/care management study, level V.
战场创伤管理需要特定的技能，而这些技能通过定期的创伤经验得到优化。随着中东长期冲突中军事伤员人数的减少，维持战场创伤准备面临挑战。因此，军事外科医生必须依靠军事卫生系统。本研究的目的是评估在军事治疗设施（MTF）进行的与部署的战斗伤员救治相关的外科手术病例的频率。
将与战斗伤员救治相关的病例（CCC-RC）定义为紧急、开放性外科手术病例，其中患者需要输血。使用具有外科住院医师培训计划的四个军事治疗中心的病例记录。纳入 2017 年 1 月 1 日至 2019 年 1 月 1 日的 24 个月病例记录，以确定每个机构的 CCC-RC 总数。将结果与美国国防部唯一的经美国外科医师学院认证的 1 级创伤中心——圣安东尼奥军事医疗中心进行比较。
检查了 51 名创伤/普通外科医生和 6 名血管外科医生的病例记录。在 2 年的研究期间，10529 例创伤/普通外科医生和血管外科医生进行的手术中，有 30 例（0.3%）被认为是 CCC-RC。与圣安东尼奥军事医疗中心相比，这一结果明显较低，后者 CCC-RC 的比例明显更高（113 例/320 例，35.3%，p <0.0001）。
MTF 外科手术病例复杂性的横断面表明，缺乏被认为是 CCC-RC 的病例。在所评估的 MTF 中，用于战斗创伤和战斗伤员救治的外科手术病例替代物接近于零。这些数据可能代表其他主要为 Tricare 受益人提供医疗服务而没有大量创伤患者的军事治疗中心。出于准备目的，主要为 Tricare 受益人提供医疗服务而没有大量创伤患者的 MTF 不应被视为创伤/普通外科医生和血管外科医生进行 CCC-RC 的有意义来源。
治疗/护理管理研究，5 级。
