Sussman Matthew S, Ryon Emily L, Urrechaga Eva M, Cioci Alessia C, Herrington Tyler J, Pizano Louis R, Garcia George D, Namias Nicholas, Wetstein Paul J, Buzzelli Mark D, Gross Kirby R, Proctor Kenneth G
Divisions of Trauma, Surgical Critical Care & Burns, Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Ryder Trauma Center, and US Army Trauma Training Center, Miami, FL 33136, USA.
Mil Med. 2021 May 3;186(5-6):571-576. doi: 10.1093/milmed/usaa565.
In peacetime, it is challenging for Army Forward Resuscitative Surgical Teams (FRST) to maintain combat readiness as trauma represents <0.5% of military hospital admissions and not all team members have daily clinical responsibilities. Military surgeon clinical experience has been described, but no data exist for other members of the FRST. We test the hypothesis that the clinical experience of non-physician FRST members varies between active duty (AD) and Army reservists (AR).
Over a 3-year period, all FRSTs were surveyed at one civilian center.
Six hundred and thirteen FRST soldiers were provided surveys and 609 responded (99.3%), including 499 (81.9%) non-physicians and 110 (18.1%) physicians/physician assistants. The non-physician group included 69% male with an average age of 34 ± 11 years and consisted of 224 AR (45%) and 275 AD (55%). Rank ranged from Private to Colonel with officers accounting for 41%. For AD vs. AR, combat experience was similar: 50% vs. 52% had ≥1 combat deployment, 52% vs. 60% peri-deployment patient load was trauma-related, and 31% vs. 32% had ≥40 patient contacts during most recent deployment (all P > .15). However, medical experience differed for AD and AR: 18% vs. 29% had >15 years of experience in practice and 4% vs. 17% spent >50% of their time treating critically injured patients (all P < .001). These differences persisted across all specialties, including perioperative nurses, certified registered nurse anesthetists, operating room (OR) techs, critical-care nurses, emergency room (ER) nurses, licensed practical nurse (LPN), and combat medics.
This is the first study of clinical practice patterns in AD vs. AR, non-physician members of Army FRSTs. In concordance with previous studies of military surgeons, FRST non-physicians seem to be lacking clinical experience as well. To maintain readiness and to provide optimal care for our injured warriors, the entire FRST, not just individuals, should embed within civilian centers.
在和平时期，陆军前沿复苏手术团队（FRST）保持战斗准备状态具有挑战性，因为创伤在军事医院住院病例中所占比例不到0.5%，而且并非所有团队成员都有日常临床职责。军事外科医生的临床经验已有描述，但FRST的其他成员尚无相关数据。我们检验了这样一个假设，即非医师FRST成员的临床经验在现役军人（AD）和陆军预备役人员（AR）之间存在差异。
在三年时间里，对一个民用中心的所有FRST进行了调查。
共向613名FRST士兵发放了调查问卷，609人回复（99.3%），其中499人（81.9%）是非医师，110人（18.1%）是医生/医师助理。非医师组中男性占69%，平均年龄为34±11岁，包括224名陆军预备役人员（45%）和275名现役军人（55%）。军衔从列兵到上校不等，军官占41%。现役军人与陆军预备役人员相比，战斗经验相似：有≥1次战斗部署经历的分别为50%和52%，部署期间与创伤相关的患者负荷分别为52%和60%，在最近一次部署中有≥40次患者接触经历的分别为31%和32%（所有P>.15）。然而，现役军人和陆军预备役人员的医疗经验有所不同：有超过 >15年实践经验的分别为18%和29%，将超过 >50%的时间用于治疗重伤患者工作的分别为4%和17%（所有P<.001）。这些差异在所有专业中都存在，包括围手术期护士、注册护士麻醉师、手术室（OR）技术员、重症护理护士、急诊室（ER）护士、执业护士（LPN）和战斗医疗兵。
这是第一项关于现役军人与陆军预备役人员（陆军FRST的非医师成员）临床实践模式的研究。与之前对军事外科医生的研究一致，FRST的非医师似乎也缺乏临床经验。为了保持战备状态并为受伤的战士提供最佳护理，整个FRST，而不仅仅是个人，应该融入民用中心。
