部署军医的临床利用。

Clinical utilization of deployed military surgeons.

机构信息

From the Department of Surgery, 96 Medical Group (A.B.H., C.M.), Eglin AFB, Florida; Naval Medical Research Unit San Antonio (I.Q.); Joint Trauma System (J.G.), Defense Center of Excellence; Joint Trauma System (J.G., S.S.), Defense Health Agency, San Antonio, Texas; US Africa Command, Germany (J.T.), HQ Unit AFRICOM; Expeditionary Medical Facility-Djibouti (S.T.); William Beaumont Army Medical Center (A.W.), El Paso, Texas; and Department of Medicine (R.W.), Uniformed Services University, Bethesda, Maryland.

出版信息

J Trauma Acute Care Surg. 2021 Aug 1;91(2S Suppl 2):S256-S260. doi: 10.1097/TA.0000000000003095.

DOI:10.1097/TA.0000000000003095

PMID:33496548

Abstract

BACKGROUND

Combat casualty care has been shaped by the prolonged conflicts in Southwest Asia, namely Afghanistan, Iraq, and Syria. The utilization of surgeons in austere locations outside of Southwest Asia and its implication on skill retention and value have not been examined. This study hypothesizes that surgeon utilization is low in the African theater. This lack of activity is potentially damaging to surgical skill retention and patient care.

METHODS

Military case logs of surgeons deployed to Africa under command of Special Operations Command Africa between January 1, 2016, and January 1, 2020, were examined. Cases were organized based on population served, general type of procedure, current procedural terminology codes, and location.

RESULTS

Twenty deployment caseloads representing 74% of the deployments during the period were analyzed. In 3,294 days, 101 operations were performed, which included 45 on combat/terrorism related injuries and 19 on US personnel. East and West African deployments, combat, and noncombat zones, respectively, were compared. East Africa averaged 4.1 ± 3.8 operations per deployment, and West Africa, 7.3 ± 8.0 (p = 0.2434). In East Africa, 56.1% of total operations were related to combat/terrorism, compared with 29.6% of total operations in West Africa (p = 0.0077). West Africa had a significantly higher proportion of elective (p = 0.0002) and humanitarian cases (p = <0.0001).

CONCLUSION

Surgical cases for military surgeons were uncommon in Africa. The low volumes have implications for skill retention, morale, and sustainability of military surgical end strength. Reduction in deployment lengths, deployment location adjustments, and/or skill retention strategies are required to ensure clinical peak performance and operational readiness. Failure to implement changes to current practices to optimize surgeon experience will likely decrease surgical readiness and could contribute to decreased retention of deployable military surgeons to support global operations.

LEVEL OF EVIDENCE

Economic/decision, level III.

摘要

背景

战斗伤员救治受到了在西南亚（阿富汗、伊拉克和叙利亚）持续冲突的影响。在西南亚以外的艰苦地区使用外科医生及其对技能保留和价值的影响尚未得到检验。本研究假设在非洲战区外科医生的利用率较低。这种活动的缺乏可能会对手术技能的保留和患者护理造成损害。

方法

对 2016 年 1 月 1 日至 2020 年 1 月 1 日期间在非洲特种作战司令部指挥下部署的外科医生的军事病例记录进行了检查。病例根据服务人群、手术类型、当前程序术语代码和地点进行了分类。

结果

分析了 20 个部署病例量，占该期间部署的 74%。在 3294 天中，进行了 101 次手术，其中 45 次与战斗/恐怖主义相关的伤害有关，19 次与美国人员有关。比较了东非和西非的部署、战斗和非战斗区。东非每部署平均进行 4.1 ± 3.8 次手术，而西非为 7.3 ± 8.0 次（p = 0.2434）。在东非，总手术中有 56.1%与战斗/恐怖主义有关，而在西非，总手术中有 29.6%与战斗/恐怖主义有关（p = 0.0077）。西非的择期手术（p = 0.0002）和人道主义手术（p = <0.0001）比例明显更高。

结论

在非洲，军事外科医生的手术病例并不常见。数量较少对技能保留、士气和军事外科手术人员可持续性产生影响。需要减少部署长度、调整部署地点和/或采用技能保留策略，以确保临床表现达到峰值和保持行动准备状态。如果不实施改变当前做法的措施来优化外科医生的体验，外科手术准备工作可能会下降，可能导致可部署的军事外科医生数量减少，无法支持全球行动。