96 Medical Group, Eglin AFB, Florida.
Naval Medical Research Unit San Antonio, San Antonio, Texas.
J Surg Educ. 2021 Jul-Aug;78(4):1275-1279. doi: 10.1016/j.jsurg.2020.12.002. Epub 2020 Dec 14.
Military-civilian partnerships for the maintenance of trauma readiness skills will be required to maintain skills in preparation for future combat casualty care operations. There is little data describing relative worth of potential partnerships. This study aims to demonstrate that quantitative and qualitative differences are prevalent between trauma centers.
A combat casualty care relevant case (CCC-RC) was determined to be one that was open, urgent, and required a blood transfusion. Total number of urgent trauma cases and number of cases requiring transfusions between January 1, 2017 and January 1, 2019 were tallied at Saint Louis University Hospital (ACS Level 1), San Antonio Military Medical Center (ACS Level 1), Madigan Army Medical Center (Washington Level 2), and William Beaumont Army Medical Center (Texas Level 3). At the participating level 1 trauma centers, cases were segregated by surgeon.
Saint Louis University Hospital (SLU), San Antonio Military Medical Center (SAMMC), Madigan Army Medical Center (MAMC), and William Beaumont Army Medical Center (WBAMC).
All general surgery/trauma cases at participating hospitals between January 1, 2017 and January 1, 2019.
A total of 267 of 721 trauma cases performed by trauma/general surgeons at SAMMC were CCC-RCs, at SLU 213 of 342, MAMC, 5 of 13, and at WBAMC 1 of 33. While SAMMC had the most cases, SLU had the highest ratio of cases that were CCC-RC (p < 0.0001). The average number of CCC-RCs of the top 5 surgeons at each level 1 institutions were 15.7 cases/year (60.5%) at SLU and 10.3 cases/year (33.6%) at SAMMC (p < 0.0001).
The CCC-RC definition is easily used to distinguish the value and relevancy of trauma centers to general surgeon combat casualty care readiness. The volume and proportions of relevant trauma are significantly different between trauma centers. The military trauma designated hospitals are currently inadequate to support all general surgeon readiness needs. Embedding surgeons at centers with high volumes or relevant cases is the optimum solution.
为了在未来的作战伤员救治行动中保持技能，需要建立军民合作关系来维护创伤准备技能。目前几乎没有数据可以描述潜在伙伴关系的相对价值。本研究旨在表明，创伤中心之间存在明显的数量和质量差异。
将一个与战伤救治相关的病例（CCC-RC）定义为开放性、紧急性和需要输血的病例。2017 年 1 月 1 日至 2019 年 1 月 1 日期间，圣路易斯大学医院（ACS 1 级）、圣安东尼奥军事医疗中心（ACS 1 级）、马迪根陆军医疗中心（华盛顿 2 级）和威廉·比姆陆军医疗中心（德克萨斯 3 级）记录了紧急创伤病例总数和需要输血的病例数。在参与的 1 级创伤中心，病例按外科医生进行分类。
圣路易斯大学医院（SLU）、圣安东尼奥军事医疗中心（SAMMC）、马迪根陆军医疗中心（MAMC）和威廉·比姆陆军医疗中心（WBAMC）。
2017 年 1 月 1 日至 2019 年 1 月 1 日期间，参与医院所有普外科/创伤外科病例。
在 SAMMC，由创伤/普外科外科医生进行的 721 例创伤病例中，共有 267 例为 CCC-RC，在 SLU 中，有 342 例中的 213 例为 CCC-RC，MAMC 中有 13 例中的 5 例，WBAMC 中有 33 例中的 1 例。尽管 SAMMC 的病例最多，但 SLU 的 CCC-RC 病例比例最高（p < 0.0001）。每个 1 级机构中排名前 5 的外科医生的 CCC-RC 平均病例数为：SLU 为 15.7 例/年（60.5%），SAMMC 为 10.3 例/年（33.6%）（p < 0.0001）。
CCC-RC 定义可用于区分创伤中心对普外科外科医生作战伤员救治准备的价值和相关性。各创伤中心的创伤相关病例数量和比例存在显著差异。目前，军事创伤指定医院还不足以满足所有普外科外科医生的战备需求。在高容量或相关病例的中心派驻外科医生是最佳解决方案。
