From the Department of Surgery (P.B.A., M.W.B., C.H.R., E.A.E.), Uniformed Services University of the Health Science; Department of Surgery (P.B.A., M.W.B., C.H.R., E.A.E.), Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Trauma (J.C.G., J.M.G.), San Antonio Military Medical Center; and Joint Trauma System (J.C.G., J.M.G.), DHA Combat Support, San Antonio, Texas.
J Trauma Acute Care Surg. 2024 Aug 1;97(2S Suppl 1):S119-S125. doi: 10.1097/TA.0000000000004381. Epub 2024 May 13.
All military surgeons must maintain trauma capabilities for expeditionary care contexts, yet most are not trauma specialists. Maintaining clinical readiness for trauma and mass casualty care is a significant challenge for military and civilian surgeons. We examined the effect of a prescribed clinical readiness program for expeditionary trauma care on the surgical performance of 12 surgeons during a 60-patient mass-casualty situation (MASCAL).
The sample included orthopedic (four) and general surgeons (eight) who cared for MASCAL victims at Hamad Karzai International Airport, Kabul, Afghanistan, on August 26, 2021. One orthopedic and two general surgeons had prior deployment experience. The prescribed program included three primary measures of clinical readiness: 1, expeditionary knowledge (examination score); 2, procedural skills competencies (performance assessment score); and 3, clinical activity (operative practice profile metric). Data were attained from program records for each surgeon in the sample. Each of the 60 patient cases was reviewed and rated (performance score) by the Joint Trauma System's Performance Improvement Branch, a military-wide performance improvement organization. All scores were normalized to facilitate direct comparisons using effect size calculations between each predeployment measure and MASCAL surgical care.
Predeployment knowledge and clinical activity measures met program benchmarks. Baseline predeployment procedural skills competency scores did not meet program benchmarks; however, those gaps were closed through retraining, ensuring all surgeons met or exceeded the program benchmarks predeployment. There were very large effect sizes (Cohen's d ) between all program measures and surgical care score, confirming the relationship between the program measures and MASCAL trauma care provided by the 12 surgeons.
The prescribed program measures ensured that all surgeons achieved predeployment performance benchmarks and provided high-quality trauma care to our nation's service members.
Prognostic and Epidemiological; Level IV.
所有军事外科医生都必须保持创伤能力，以适应远征护理环境，但大多数人都不是创伤专家。为创伤和大批伤员护理保持临床准备状态，是军事和民用外科医生面临的重大挑战。我们研究了一个规定的远征创伤护理临床准备计划对 12 名外科医生在 60 名大批伤员情况下（MASCAL）的手术表现的影响。
样本包括在 2021 年 8 月 26 日在阿富汗喀布尔哈马德·卡尔扎伊国际机场照顾大批伤员受害者的骨科（4 人）和普通外科（8 人）医生。一名骨科医生和两名普通外科医生有以前的部署经验。规定的计划包括三个临床准备的主要措施：1、远征知识（考试成绩）；2、程序技能能力（绩效评估成绩）；3、临床活动（手术实践概况指标）。从样本中每位外科医生的计划记录中获得数据。对每个病例进行了审查和评分（绩效评分），由联合创伤系统的绩效改进分部进行，这是一个全军事范围的绩效改进组织。所有分数都经过归一化处理，以便使用效果大小计算在每次部署前的测量值和大批伤员护理之间进行直接比较。
部署前的知识和临床活动测量值符合计划基准。基线部署前的程序技能能力评分未达到计划基准；然而，通过再培训缩小了这些差距，确保所有外科医生在部署前达到或超过了计划基准。所有计划措施与手术护理评分之间存在非常大的效果大小（Cohen's d），证实了计划措施与 12 名外科医生提供的大批伤员创伤护理之间的关系。
规定的计划措施确保所有外科医生达到了部署前的绩效基准，并为我们国家的军人提供了高质量的创伤护理。
预后和流行病学；四级。
