Gurney Jennifer M, Jensen Shane D, Gavitt Brian J, Edson Theodore D, Brown Shaun R, Cunningham Cord W, Drew Brendon G, Eckert Matthew J, Hall Andrew B, Holcomb John B, Knipp Brian S, Lesperance Richard N, Polk Travis M, Schreiber Martin A, Tadlock Matthew D, Shackelford Stacy A
From the U.S. Army Institute of Surgical Research (J.M.G.), Joint Base San Antonio-Fort Sam Houston, Texas; US+UAE Trauma, Burn, and Rehabilitative Medicine Mission (B.J.G.), Abu Dhabi, United Arab Emeritus; 1st Medical Battalion (T.D.E., M.D.T.), 1st Marine Logistics Group, Oceanside, California; Womack Army Medical Center (S.R.B.), Fort Bragg, North Carolina; Joint Trauma System, DoD Center of Excellence for Trauma (J.M.G., S.D.J., C.W.C., S.A.S.), Joint Base San Antonio-Fort Sam Houston, Texas; 1st Marine Expeditionary Force (T.D.E., B.G.D.), Camp Pendleton, California; Division of Acute Care Surgery Joint Medical, University of North Carolina-Chapel Hill (M.J.E.), Chapel Hill, North Carolina; Office of the Command Surgeon (A.B.H.), MacDill AFB, Florida; Professor of Surgery, Department of Surgery, Trauma and Surgical Critical Care, University of Alabama at Birmingham (J.B.H.), Birmingham, Alabama; Naval Trauma Training Center (B.S.K.), NAVMED OTC NEMTI CA, Los Angeles, California; Division of Trauma (R.N.L.), Brooke Army Medical Center, San Antonio Texas; US Army Medical Research and Development Command (T.M.P.), Army Futures Command (AFC), Ft Detrick, Maryland; Professor of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health & Science University (M.A.S.), Portland, Oregon; Force Surgeon, 1st Marine Expeditionary Force; Chair, JTS Committee on Tactical Combat Casualty Care, Naval Hospital Camp Pendleton (B.G.D.), Camp Pendleton, California; and Department of Emergency Medicine (C.W.C.), CRDAMC, Ft Hood, Texas.
J Trauma Acute Care Surg. 2022 Aug 1;93(2S Suppl 1):S6-S11. doi: 10.1097/TA.0000000000003676. Epub 2022 May 23.
Over the last 20 years of war, there has been an operational need for far forward surgical teams near the point of injury. Over time, the medical footprint of these teams has decreased and the utilization of mobile single surgeon teams (SSTs) by the Services has increased. The increased use of SSTs is because of a tactical mobility requirement and not because of proven noninferiority of clinical outcomes. Through an iterative process, the Committee on Surgical Combat Casualty Care (CoSCCC) reviewed the utilization of SSTs and developed an expert-opinion consensus statement addressing the risks of SST utilization and proposed mitigation strategies.
A small triservice working group of surgeons with deployment experience, to include SST deployments, developed a statement regarding the risks and benefits of SST utilization. The draft statement was reviewed by a working group at the CoSCCC meeting November 2021 and further refined. This was followed by an extensive iterative review process, which was conducted to ensure that the intended messaging was clear to senior medical leaders and operational commanders. The final draft was voted on by the entire CoSCCC membership. To inform the civilian trauma community, commentaries were solicited from civilian trauma leaders to help put this practice into context and to further the discussion in both military and civilian trauma communities.
After multiple revisions, the SST statement was finalized in January 2022 and distributed to the CoSCCC membership for a vote. Of 42 voting members, there were three nonconcur votes. The SST statement underwent further revisions to address CoSCCC voting membership comments. Statement commentaries from the President of the American Association for the Surgery for Trauma, the chair of the Committee on Trauma, the Medical Director of the Military Health System Strategic Partnership with the American College of Surgeons and a recently retired military surgeon we included to put this military relevant statement into a civilian context and further delineate the risks and benefits of including the trauma care paradigm in the Department of Defense (DoD) deployed trauma system.
The use of SSTs has a role in the operational environment; however, operational commanders must understand the tradeoff between tactical mobility and clinical capabilities. As SST tactical mobility increases, the ability of teams to care for multiple casualty incidents or provide sustained clinical operations decreases. The SST position statement is a communication tool to inform operational commanders and military medical leaders on the use of these teams on current and future battlefields.
在过去20年的战争中，在受伤点附近对前沿外科手术团队存在作战需求。随着时间的推移，这些团队的医疗覆盖范围有所缩小，各军种对移动单人外科手术团队（SST）的使用有所增加。SST使用增加是出于战术机动性要求，而非因为临床结果已被证明不劣于其他情况。通过一个反复的过程，外科作战伤员护理委员会（CoSCCC）审查了SST的使用情况，并制定了一份专家意见共识声明，阐述了使用SST的风险及提出了缓解策略。
一个由有部署经验的外科医生组成的小型三军工作组，包括有SST部署经验的医生，制定了一份关于使用SST的风险和益处的声明。该声明草案在2021年11月的CoSCCC会议上由一个工作组进行了审查并进一步完善。随后进行了广泛的反复审查过程，以确保高级医疗领导人和作战指挥官能清楚理解预期传达的信息。最终草案由CoSCCC全体成员投票表决。为使 civilian trauma community了解情况，向 civilian trauma leaders征求了意见，以帮助将这种做法置于背景中，并推动军事和 civilian trauma communities的讨论。
经过多次修订，SST声明于2022年1月定稿并分发给CoSCCC成员进行投票。在42名有投票权的成员中，有3人投了反对票。SST声明进行了进一步修订以回应CoSCCC有投票权成员的意见。我们纳入了美国创伤外科协会主席、创伤委员会主席、军事卫生系统与美国外科医师学院战略伙伴关系的医学主任以及一名近期退休的军事外科医生的声明评论，以便将这份与军事相关的声明置于 civilian context中，并进一步阐明在国防部（DoD）部署的创伤系统中纳入创伤护理模式的风险和益处。
SST的使用在作战环境中具有一定作用；然而，作战指挥官必须了解战术机动性与临床能力之间的权衡。随着SST战术机动性的增加，团队应对多起伤亡事件或提供持续临床行动的能力会下降。SST立场声明是一种沟通工具，用于向作战指挥官和军事医疗领导人通报这些团队在当前和未来战场上的使用情况。
