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Vincent Y, Baltazard C, Pfister G, Pons F, Poichotte A, Goudard Y, Hornez E, Malgras B, Boddaert G, Balandraud P, Avaro JP, de Lesquen H. Effectiveness of a specific trauma training on war-related truncal injury management: A pre-post study. Injury 2024; 55:111676. [PMID: 38897902 DOI: 10.1016/j.injury.2024.111676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Non-Compressible Torso Hemorrhage (NCTH) is the leading cause of preventable death in combat casualty care. To enhance the French military surgeons' preparedness, the French Military Health Service designed the Advanced Course for Deployment Surgery (ACDS) in 2008. This study evaluates behavioral changes in war surgery practice since its implementation. METHODS Data were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2003 to 2021. All patients treated in French Role 2 or 3 Medical Treatment Facilities (MTFs) deployed in Afghanistan, Mali, or Chad requiring emergency surgery for NCTH were included. The mechanism of injury, severity, and surgical procedures were noted. Surgical care produced before (Control group) and after the implementation of the ACDS course (ACDS group) were compared. RESULTS We included 189 trauma patients; 99 in the ACDS group and 90 in the Control group. Most injuries were combat-related (88 % of the ACDS and 82 % of the Control group). The ACDS group had more polytrauma (42% vs. 27 %; p= 0.034) and more e-FAST detailed patients (35% vs. 21 %; p= 0.044). Basics in surgical trauma care were similar between both groups, with a tendency in the ACDS group toward less digestive diversion (n= 6 [6 %] vs. n= 12 [13 %]; p= 0.128), more temporary closure with abdominal packing (n= 17 [17 %] vs. n= 10 [11 %]; p= 0.327), and less re-operation for bleeding (n= 0 [0 %] vs. n= 5 [6 %]; p= 0.046). CONCLUSION The French model of war trauma course succeeded in keeping specialized surgeons aware of the basics of damage control surgery. The main improvements were better use of preoperative imaging and better management of seriously injured patients.
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Affiliation(s)
- Yohann Vincent
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France.
| | | | - Georges Pfister
- Department of Orthopaedic, Trauma and Reconstructive Surgery, HIA Percy, Clamart, France
| | - François Pons
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | - Antoine Poichotte
- French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France
| | - Yvain Goudard
- Department of Visceral Surgery, Laveran Military Teaching Hospital, French Military Health Service, Marseille, France
| | - Emmanuel Hornez
- Digestive surgery, Percy Military teaching hospital, 1 rue Raoul Batany, 92140, Clamart, France; École du Val-de-Grâce, French Military Medical Service Academy, Paris, France
| | - Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France; French Military Health Service Academy, Ecole du Val de Grace, Paris, France
| | | | - Paul Balandraud
- Department of Visceral Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France
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Remondelli MH, McDonough MM, Remick KN, Elster EA, Potter BK, Holt DB. Refocusing the Military Health System to support Role 4 definitive care in future large-scale combat operations. J Trauma Acute Care Surg 2024; 97:S145-S153. [PMID: 38720205 DOI: 10.1097/ta.0000000000004379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
ABSTRACT The last 20 years of sustained combat operations during the Global War on Terror generated significant advancements in combat casualty care. Improvements in point-of-injury care, en route care, and forward surgical care appropriately aligned with the survival, evacuation, and return to duty needs of the small-scale unconventional conflict. However, casualty numbers in large-scale combat operations have brought into focus the critical need for modernized casualty receiving and convalescence: Role 4 definitive care. Historically, World War II was the most recent conflict in which the United States fought in multiple operational theaters, with hundreds of thousands of combat casualties returned to the continental United States. These numbers necessitated the establishment of a "Zone of the Interior," which integrated military and civilian health care networks for definitive treatment and rehabilitation of casualties. Current security threats demand refocusing and bolstering the Military Health System's definitive care capabilities to maximize its force regeneration capacity in a similar fashion. Medical force generation, medical force sustainment and readiness, and integrated casualty care capabilities are three pillars that must be developed for Military Health System readiness of Role 4 definitive care in future large-scale contingencies against near-peer/peer adversaries.
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Affiliation(s)
- Mason H Remondelli
- From the School of Medicine (M.H.R., M.M.M.) and Department of Surgery (K.N.R., E.A.E., B.K.P., D.B.H.), Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Saberi RA, Parker GB, Mohsin N, Gilna GP, Cioci AC, Urrechaga EM, Buzzelli MD, Schulman CI, Proctor KG, Garcia GD. Advanced Surgical Skills for Exposure in Trauma (ASSET) course improves military surgeon confidence. Am J Disaster Med 2024; 19:45-51. [PMID: 38597646 DOI: 10.5055/ajdm.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Active duty military surgeons often have limited trauma surgery experience prior to deployment. Consequently, military-civilian training programs have been developed at high-volume trauma centers to evaluate and maintain proficiencies. Advanced Surgical Skills for Exposure in Trauma (ASSET) was incorporated into the predeployment curriculum at the Army Trauma Training Detachment in 2011. This is the first study to assess whether military surgeons demonstrated improved knowledge and increased confidence after taking ASSET. DESIGN Retrospective cohort study. SETTING Quaternary care hospital. PATIENTS AND PARTICIPANTS Attending military surgeons who completed ASSET between July 2011 and October 2020. MAIN OUTCOME MEASURE(S) Pre- and post-course self-reported comfort level with procedures was converted from a five-point Likert scale to a percentage and compared using paired t-tests. RESULTS In 188 military surgeons, the median time in practice was 3 (1-8) years, with specialties in general surgery (52 percent), orthopedic surgery (29 percent), trauma (7 percent), and other disciplines (12 percent). The completed self-evaluation response rate was 80 percent (n = 151). The self-reported comfort level for all body regions improved following course completion (p < 0.001): chest (27 percent), neck (23 percent), upper extremity (22 percent), lower extremity (21 percent), and abdomen/pelvis (19 percent). The overall score on the competency test improved after completion of ASSET, with averages increasing from 62 ± 18 percent pretest to 71 ± 13 percent post-test (p < 0.001). CONCLUSIONS After taking the ASSET course, military surgeons demonstrated improved knowledge and increased confidence in the operative skills taught in the course. The ASSET course may provide sustainment of knowledge and confidence if used at regular intervals to maintain trauma skills and deployment readiness.
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Affiliation(s)
- Rebecca A Saberi
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Graham B Parker
- Department of Medicine, Los Angeles General Medical Center, Los Angeles, California. ORCID: https://orcid.org/0000-0002-0446-3446
| | - Noreen Mohsin
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Gareth P Gilna
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Alessia C Cioci
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Eva M Urrechaga
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Mark D Buzzelli
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - Carl I Schulman
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida; Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth G Proctor
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; United States Army Trauma Training Detachment, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
| | - George D Garcia
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; United States Army Trauma Training Detachment, University of Miami/Ryder Trauma Center at Jackson Memorial Hospital, Miami, Florida
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Sellier A, Beucler N, Joubert C, Julien C, Tannyeres P, Anger F, Bernard C, Desse N, Dagain A. Emergency Cranial Surgeries Without the Support of a Neurosurgeon: Experience of the French Military Surgeons. Mil Med 2024; 189:598-605. [PMID: 35906867 DOI: 10.1093/milmed/usac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/03/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Unlike orthopedic or visceral surgeons, French military neurosurgeons are not permanently deployed on the conflict zone. Thus, craniocerebral war casualties are often managed by general surgeons in the mobile field surgical team. The objective of the study was to provide the feedback of French military surgeons who operated on craniocerebral injuries during their deployment in a role 2 surgical hospital without a neurosurgeon. MATERIALS AND METHODS A cross-sectional survey was conducted by phone in March 2020, involving every military surgeon currently working in the French Military Training Hospitals, with an experience of cranial surgery without the support of a neurosurgeon during deployment. We strived to obtain contextual, clinical, radiological, and surgical data. RESULTS A total of 33 cranial procedures involving 64 surgeons were reported from 1993 to 2018. A preoperative CT scan was not available in 18 patients (55%). Half of the procedures consisted in debridement of craniocerebral wounds (52%, n = 17), followed by decompressive craniectomies (30%, n = 10), craniotomy with hematoma evacuation (15%, n = 5), and finally one (3%) surgery with exploratory burr holes were performed. The 30-day survival rate was 52% (n = 17) and 50% (n = 10/20) among the patients who sustained severe traumatic brain injury. CONCLUSIONS This survey demonstrates the feasibility and the plus-value of a neurosurgical damage control procedure performed on the field by a surgeon nonspecialized in cranial surgery. The stereotyped neurosurgical techniques used by the in-theater surgeon were learned during a specific predeployment training course. However, the use of a live telemedicine neurosurgical support seems indispensable and could benefit the general surgeon in strained resources setting.
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Affiliation(s)
- Aurore Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Christophe Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Clément Julien
- Department of Visceral Surgery, Laveran Military Hospital, Marseille 13384, France
| | - Paul Tannyeres
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Florent Anger
- Department of Orthopedic surgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Cédric Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Nicolas Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, Toulon Cedex 9 8800, France
- French Military Health Service Academy, École du Val-de-Grâce, Paris Cedex 5 75230, France
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Fawaz R, Dagain A, Pons Y, Haen P, Froussart F, Caruhel JB. Head Face and Neck Surgeon Deployment in the New French Role 2: The Damage Control Resuscitation and Surgical Team. Mil Med 2023; 188:e2868-e2873. [PMID: 36308315 DOI: 10.1093/milmed/usac329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION High-intensity conflict is back after decades of asymmetric warfare. With the increase in the incidence of head, face, and neck (HFN) injuries, the French Medical Military Service has decided to deploy HFN surgeons in the new French Role 2: the Damage Control, Resuscitation, and Surgical Team (DCRST). This study aims to provide an overview of HFN French surgeons from their initial training, including the surgical skills required, to their deployment on the DCRST. MATERIALS AND METHODS The DCRST is a tactical mobile medico-surgical structure with several configurations depending on the battlefield, mission, and flux of casualties. It represents the new French paradigm for the management of combat casualties, including HFN injuries. RESULTS The HFN's military surgeon training starts during residency with rotation in the different subspecialties. The HFN surgeon follows a training course called "The French Course for Deployment Surgery" that provides sufficient background to manage polytrauma, including HFN facilities on modern warfare. We have reviewed the main surgical procedures required for an HFN military surgeon. CONCLUSION The systematic deployment of HFN surgeons in Role 2 is a specificity of the French army as well as the HFN surgeon's training.Currently, the feedback from an asymmetric conflict is encouraging. However, it will have to innovate to adapt to modern warfare.
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Affiliation(s)
- Rayan Fawaz
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte Anne Military Teaching Hospital, Toulon Cedex 83000, France
| | - Yoann Pons
- Department of ENT and Maxillo Facial Surgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Pierre Haen
- Department of Maxillo Facial Surgery, Laveran Military Teaching Hospital, Marseille Cedex 13384, France
| | - Françoise Froussart
- Department of Ophthalmology, Percy Military Teaching Hospital, Clamart Cedex 92140, France
| | - Jean Baptiste Caruhel
- Department of ENT and Maxillo Facial Surgery, Percy Military Teaching Hospital, Clamart Cedex 92140, France
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Borg TM, Cavale N, Abu-Sittah G, Ghanem A. Plastic and Maxillofacial Training for War-Zones - A Systematic Review. Craniomaxillofac Trauma Reconstr 2023; 16:154-162. [PMID: 37222978 PMCID: PMC10201192 DOI: 10.1177/19433875221083416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design Injuries sustained in war-zones are variable and constantly developing according to the nature of the ongoing conflict. Soft tissue involvement of the extremities, head and neck often necessitates reconstructive expertise. However, current training to manage injuries in such settings is heterogenous. This study involves a systematic review. Objective To evaluate interventions in place to train Plastic and Maxillofacial surgeons for war-zone environments so that limitations to current training can be addressed. Methods A literature search of Medline and EMBase was performed using terms relevant to Plastic and Maxillofacial surgery training and war-zone environments. Articles that met the inclusion criteria were scored then educational interventions described in included literature were categorised according to their length, delivery style and training environment. Between-group ANOVA was performed to compare training strategies. Results 2055 citations were identified through this literature search. Thirty-three studies were included in this analysis. The highest scoring interventions were over an extended time-frame with an action-oriented training approach, using simulation or actual patients. Core competencies addressed by these strategies included technical and non-technical skills necessary when working in war-zone type settings. Conclusions Surgical rotations in trauma centers and areas of civil strife, together with didactic courses are valuable strategies to train surgeons for war-zones. These opportunities must be readily available globally and be targeted to the surgical needs of the local population, anticipating the types of combat injuries that often occur in these environments.
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Affiliation(s)
- Tiffanie-Marie Borg
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
- Department of Surgery, Queen’s Hospital, London, UK
| | | | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School of
Medicine and Dentistry, Queen Mary University of London, London,
UK
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Maj BC, Col MS, Capt MA. The Orthodontist's Role in Post-Battlefield Craniomaxillofacial Trauma Reconstruction. Mil Med 2022; 188:usac102. [PMID: 35415744 DOI: 10.1093/milmed/usac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/06/2022] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In modern conflicts, deployed members are more vulnerable to craniomaxillofacial (CMF) injury than in previous conflicts. Patients presenting with CMF trauma are susceptible to post-trauma dental malocclusion and may require lengthy rehabilitation to achieve pre-injury function. This study surveyed military health care professionals who are potential contributors to CMF trauma rehabilitation teams to evaluate the orthodontist's inclusion in treating to the final outcome. METHODS Following approval from the Defense Health Agency Information Management Collections Office (Control Number: 9-DHA-1031-E) and the Air Force 59th Medical Wing Institutional Review Board (Reference Number: FWH20210061E), a survey study was conducted from April 2021 to July 2021. Volunteer participants were recruited from orthodontists, oral maxillofacial surgeons, medical specialists, and other dental specialists who have worked in military healthcare. Respondents reported their current practice treating CMF trauma, self-evaluated their knowledge of different aspects of the process, and submitted their perceptions on system and patient-limiting factors which affect outcomes. Descriptive statistics were conducted for ordinal data and chi-square tests for categorical data. Kruskal-Wallis analyses of variance compared cohorts with further Mann-Whitney U tests to distinguish the difference in cohorts. RESULTS Valid responses were collected from 171 participants. The responses were mostly from active duty military (93%) and well distributed among orthodontists, oral maxillofacial surgeons, other dental specialists, and medical specialists. When reporting current CMF trauma treatment practices, the majority of dental specialists stated they most commonly participate in a multidisciplinary team that addresses any CMF trauma case (68.4%) whereas medical specialists most commonly act as solo independent provider practice (53.6%). Dental specialists reported follow-up with post-trauma patients greater than 1 year and medical specialists reported the shortest post-trauma follow-up time with a median of 0 to 3 months. The majority of participants selected at least one system factor limiting CMF trauma care (78.7%) and at least one patient factor limiting CMF trauma care (86.3%). When asked about orthodontic participation in multidisciplinary teams, the responses showed a great range with orthodontists never included in CMF trauma care 23.1% of the time and always consulted regarding trauma cases 10.7% of the time. Other survey data collected allows the investigators to draw conclusions regarding specific limitations to treatment and recommendations for improvement, along with qualitative responses from survey participants. CONCLUSIONS Orthodontics, while available in the military, is underutilized in treating post-warfare or other CMF trauma. There are both system- and patient-limiting factors in the treatment of battlefield and non-battlefield CMF trauma. In addition, there are limitations to the inclusion of orthodontists in CMF trauma care which include the physical distance from primary treating specialists and the absence of standard referral protocols. Oral maxillofacial surgeons reported the highest understanding of the military orthodontist's contribution to a CMF trauma treatment team and medical specialists reported the lowest understanding. Advanced technology tools could help improve outcomes and multidisciplinary interactions. Further research is needed to study the complete CMF trauma rehabilitation process in military treatment facilities, evaluate the efficiency of cross-specialty referrals, and highlight best practices and protocols of functioning multidisciplinary teams.
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Affiliation(s)
- B Carter Maj
- Tri-Service Orthodontic Residency Program, Air Force Post-Graduate Dental School and Uniformed Services University of the Health Sciences Postgraduate Dental College, JBSA Lackland AFB, TX 78236, USA
| | - M Speier Col
- Clinical Dentistry, Air Force Medical Readiness Agency and Assistant Professor of Orthodontics, Uniformed Services University of the Health Sciences Postgraduate Dental College, Falls Church, VA 22042, USA
| | - M Anderson Capt
- Tri-Service Orthodontic Residency Program, Air Force Post-Graduate Dental School and Assistant Professor of Orthodontics, Uniformed Services University of the Health Sciences Postgraduate Dental College, JBSA Lackland AFB, TX 78236, USA
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Lee JJ, Hall AB, Carr MJ, MacDonald AG, Edson TD, Tadlock MD. Integrated military and civilian partnerships are necessary for effective trauma-related training and skills sustainment during the inter-war period. J Trauma Acute Care Surg 2022; 92:e57-e76. [PMID: 34797811 DOI: 10.1097/ta.0000000000003477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Joseph J Lee
- From the Department of Surgery (J.J.L., M.J.C., M.D.T.), Navy Medicine Readiness & Training Command, San Diego, California; 96th Medical Group (A.B.H.), US Air Force Regional Hospital, Eglin AFB, Florida; Uniformed Services University of the Health Sciences (A.G.M.), Bethesda, Maryland; and 1st Medical Battalion (T.D.E.), 1st Marine Logistics Group, Camp Pendleton, California
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Breeze J, Gensheimer W, Berg C, Sarber KM. Head Face and Neck Surgical Workload From a Contemporary Military Role 3 Medical Treatment Facility. Mil Med 2021; 187:93-98. [PMID: 34056658 DOI: 10.1093/milmed/usab221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Previous analyses of head, face, and neck (HFN) surgery in the deployed military setting have focused on the treatment of injuries using trauma databases. Little has been written on the burden of disease and the requirement for follow-up care. The aim of this analysis was to provide the most comprehensive overview of surgical workload in a contemporary role 3 MTF to facilitate future planning. METHOD The operating room database and specialty surgical logbooks from a U.S.-led role 3 MTF in Afghanistan were analyzed over a 5-year period (2016-2020). These were then matched to the deployed surgical TC2 database to identify reasons for treatment and a return to theatre rate. Operative records were finally matched to the deployed Armed Forces Health Longitudinal Technology Application-Theater outpatient database to determine follow up frequency. RESULTS During this period, surgical treatment to the HFN represented 389/1989 (19.6%) of all operations performed. Surgery to the HFN was most commonly performed for battle injury (299/385, 77.6%) followed by disease (63/385, 16%). The incidence of battle injury-related HFN cases varied markedly across each year, with 117/299 (39.1%) being treated in the three summer months (June to August). The burden of disease, particularly to the facial region, remained constant throughout the period analyzed (mean of 1 case per month). CONCLUSIONS Medical planning of the surgical requirements to treat HFN pathology is primarily focused on battle injury of coalition service personnel. This analysis has demonstrated that the treatment of disease represented 16% of all HFN surgical activities. The presence of multiple HFN sub-specialty surgeons prevented the requirement for multiple aeromedical evacuations of coalition service personnel which may have affected mission effectiveness as well as incurring a large financial burden. The very low volume of surgical activity demonstrated during certain periods of this analysis may have implications for the maintenance of surgical competencies for subspecialty surgeons.
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Affiliation(s)
- John Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham B15 2TH, UK
| | - William Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Craig Berg
- Department of Neurosurgery, 88th SGC/SGCO, Wright-Patterson Air Force Base, Dayton, OH 45433, USA
| | - Kathleen M Sarber
- Department of Otolaryngology, 96th Medical Group, Eglin AFB, FL 32542, USA
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Boudin L, de Lesquen H, Patient M, Romeo E, Rivière D, Cungi PJ, Savoie PH, Avaro JP, Dagain A, Bladé JS, Balandraud P, Bourgouin S. Role of Cancer Surgery in the Improvement of the Operative Skills of Military Surgeons During Deployment: A Single-Center Study. Mil Med 2021; 186:e469-e473. [PMID: 33135732 DOI: 10.1093/milmed/usaa327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The maintenance of military surgeons' operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons' activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons' operative skills. METHODS Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint). RESULTS Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P < 0.001). Considering the secondary endpoint, cancer surgery was rated higher than specific training by all surgeons, without statistically significant difference (positive mean score of + 2.00; 95% IC: 0.85-3.14). CONCLUSION This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.
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Affiliation(s)
- Laurys Boudin
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon 83000, France
| | - Matthieu Patient
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Emilie Romeo
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Damien Rivière
- Head and Neck Surgery Department, Sainte Anne Military Hospital, Toulon 83000, France
| | - Pierre-Julien Cungi
- Department of Anaesthesia and Critical Care, Sainte Anne Military Hospital, Toulon 83000, France
| | - Pierre-Henri Savoie
- Department of Urology, Sainte Anne Military Hospital, Toulon 83000, France.,French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France
| | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon 83000, France.,French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France
| | - Arnaud Dagain
- French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France.,Department of Neurosurgery, Sainte Anne Military Hospital, Toulon 83000, France
| | - Jean-Sébastien Bladé
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Paul Balandraud
- French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France.,Department of Digestive Surgery, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Stéphane Bourgouin
- Department of Digestive Surgery, Sainte Anne Military Hospital, Toulon 83000, Var, France
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Sellier A, Beucler N, Desse N, Julien C, Tannyeres P, Bernard C, Joubert C, Dagain A. Evaluation of neurosurgical training of French military surgeons prior to their deployment. Neurochirurgie 2021; 67:454-460. [PMID: 33766563 DOI: 10.1016/j.neuchi.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A specific training course was formalized in 2007 in order to facilitate the management of cranio-encephalic injuries by French military general surgeons during deployment, within the Advanced Course for Deployment Surgery (ACDS). The objective is to evaluate the neurosurgical pre-deployment training course attended by the military surgeons. METHODS From June 2019 to September 2019, we conducted a cross-sectional survey in the form of a digital self-completed questionnaire, addressed to all graduated military surgeons working in the French Military Training Hospitals. The survey included: (1) a knowledge assessment; and (2) a self-assessment of the training course. The participating surgeons were classified into two groups according to their participation (group 1) or not (group 2) in the neurosurgical module. The main outcome was the score received on the knowledge assessment. RESULTS Among the 145 military surgeons currently in service, 76 participated in our study (53%), of which 49 were classified in group 1 (64%) and 27 in group 2 (36%). Group 1 surgeons had a significantly higher score than Group 2 at the knowledge assessment (mean 21.0±7.1 vs. 17.8±6.0, P=0.041). The most successful questions were related to TBI diagnosis and surgical technique, while the least successful questions dealt with "beyond emergency care" and surgical indications. CONCLUSION The French pre-deployment neurosurgical training course provides a strong neurosurgical background, sufficient to perform life-saving procedures in a modern conflict situation. However, neurosurgical specialized advice should be solicited whenever possible to assist the in-theatre surgeon in surgical decisions.
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Affiliation(s)
- A Sellier
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France.
| | - N Beucler
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - N Desse
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Julien
- Department of Visceral Surgery, Sainte-Anne Military Hospital, Toulon, France
| | - P Tannyeres
- 9th Army Medical Center, 144th medical unit, French Military Health Service, Canjuers, France
| | - C Bernard
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - C Joubert
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France
| | - A Dagain
- Department of Neurosurgery, Sainte-Anne Military Hospital, 1, Boulevard Sainte Anne, BP 600, 8800 Toulon cedex 9, France; French Military Health Service Academy - École du Val-de-Grâce, Paris, France
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12
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France K, Handford C. Impact of military medicine on civilian medical practice in the UK from 2009 to 2020. BMJ Mil Health 2021; 167:275-279. [PMID: 33472811 DOI: 10.1136/bmjmilitary-2020-001691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The positive impact of advances in military medicine and the influence these have had on civilian medical practice have been well documented throughout history: this review will be looking specifically between 2009 and 2020. AIMS Review of innovations that have been implemented or have influenced civilian practice within the areas of trauma, disease outbreak management and civilian systems between 2009 and 2020. This review will also aim to explore the impact that working with or within the military can have on individuals within civilian healthcare systems and the future challenges we face to maintain skills. RESULTS Using a narrative approach to this review, we found that there have been numerous changes to trauma management within the UK, based on military practice and research during conflict, which have improved survival outcomes. In addition, the use of niche military skills as part of a coordinated response, during both internal and international disease outbreaks, are thought to have supported civilian systems enabling an efficient and prolonged response. Furthermore, adaptation of military concepts and their application to the NHS through consultant-led prehospital teams, centralisation of specialties in the form of major trauma centres and the introduction of guidelines to manage 'major incidents and mass casualty events' in 2018 have improved patient outcomes. CONCLUSION From 2009 to 2020, lessons learnt from the British and other nations' militaries have been integrated into UK practice and have likely contributed to improved outcomes in the management of major incidents both nationally and internationally.
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Affiliation(s)
- Katherine France
- General Surgery, James Cook University Hospital, Middlesbrough, UK
| | - C Handford
- Orthopaedics, Queen Elizabeth Hospital, Birmingham, UK
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13
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Breeze J, Gensheimer W, DuBose JJ. Combat Facial Fractures Sustained During Operation Resolute Support and Operation Freedom’s Sentinel in Afghanistan. Mil Med 2020; 185:414-416. [DOI: 10.1093/milmed/usaa159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Facial fractures sustained in combat are generally unrepresentative of those commonly experienced in civilian practice. In the US military, acute trauma patient care is guided by the Joint Trauma System Clinical Practice Guidelines but currently none exists for facial trauma.
Materials and methods
All casualties that underwent surgery to facial fractures between January 01, 2016 and September 15, 2019 at a US deployed Military Treatment Facility in Afghanistan were identified using the operating room database. Surgical operative records and outpatient records for local Afghan nationals returning for follow-up were reviewed to determine outcomes.
Results
55 casualties underwent treatment of facial fractures; these were predominantly from explosive devices (27/55, 49%). About 46/55 (84%) were local nationals, of which 32 (70%) were followed up. Length of follow-up ranged between 1 and 25 months. About 36/93 (39%) of all planned procedures developed complications, with the highest being from ORIF mandible (18/23, 78%). About 8/23 (35%) casualties undergoing ORIF mandible developed osteomyelitis, of which 5 developed nonunion. Complications were equally likely to occur in those procedures for “battlefield type” events such as explosive devices and gunshot wounds (31/68, 46%) as those from “civilian type” events such as falls or motor vehicle collisions (5/11, 45%).
Conclusions
Complications Rates from facial fractures were higher than that reported in civilian trauma. This likely reflects factors such as energy deposition, bacterial load, and time to treatment. Load sharing osteosynthesis should be the default modality for fracture fixation. External fixation should be considered in particular for complex high-energy or infected mandible fractures where follow-up is possible.
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Affiliation(s)
- John Breeze
- Royal Centre for Defence Medicine, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - William Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland 20762
| | - Joseph J DuBose
- Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, Maryland 21201
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14
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Choufani C, Barbier O, Demoures T, Mathieu L, Rigal S. Evaluation of a fellowship abroad as part of the initial training of the French military surgeon. BMJ Mil Health 2020; 167:168-171. [PMID: 32015183 DOI: 10.1136/jramc-2019-001303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment. METHODS This study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents' first foreign deployment. RESULTS Sixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10. CONCLUSION A fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees' feedback confirms its relevance.
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Affiliation(s)
- Camille Choufani
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - O Barbier
- Orthopedic and Traumatology, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - T Demoures
- Orthopaedic Surgery, Military Training Hospital Begin, Saint Mande, France
| | - L Mathieu
- Department of Orthopaedic, Trauma and Reconstructive Surgery, HIA Percy, Clamart, France
| | - S Rigal
- Department of Traumatology and Orthopedics, HIA Percy, Clamart, France
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Iacono D, Lee P, Edlow BL, Gray N, Fischl B, Kenney K, Lew HL, Lozanoff S, Liacouras P, Lichtenberger J, Dams-O’Connor K, Cifu D, Hinds SR, Perl DP. Early-Onset Dementia in War Veterans: Brain Polypathology and Clinicopathologic Complexity. J Neuropathol Exp Neurol 2020; 79:144-162. [PMID: 31851313 PMCID: PMC6970453 DOI: 10.1093/jnen/nlz122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 12/27/2022] Open
Abstract
The neuropathology associated with cognitive decline in military personnel exposed to traumatic brain injury (TBI) and chronic stress is incompletely understood. Few studies have examined clinicopathologic correlations between phosphorylated-tau neurofibrillary tangles, β-amyloid neuritic plaques, neuroinflammation, or white matter (WM) lesions, and neuropsychiatric disorders in veterans. We describe clinicopathologic findings in 4 military veterans with early-onset dementia (EOD) who had varying histories of blunt- and blast-TBI, cognitive decline, behavioral abnormalities, post-traumatic stress disorder, suicidal ideation, and suicide. We found that pathologic lesions in these military-EOD cases could not be categorized as classic Alzheimer's disease (AD), chronic traumatic encephalopathy, traumatic axonal injury, or other well-characterized clinicopathologic entities. Rather, we observed a mixture of polypathology with unusual patterns compared with pathologies found in AD or other dementias. Also, ultrahigh resolution ex vivo MRI in 2 of these 4 brains revealed unusual patterns of periventricular WM injury. These findings suggest that military-EOD cases are associated with atypical combinations of brain lesions and distribution rarely seen in nonmilitary populations. Future prospective studies that acquire neuropsychiatric data before and after deployments, as well as genetic and environmental exposure data, are needed to further elucidate clinicopathologic correlations in military-EOD.
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Affiliation(s)
- Diego Iacono
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, Maryland
- Neurodegenerative Clinics, National Institute of Neurological Disorders and Stroke (NINDS), NIH, Bethesda, Maryland
| | - Patricia Lee
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, Maryland
| | - Brian L Edlow
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Neurology, Center for Neurotechnology and Neurorecovery (BLE) and Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging
| | - Nichelle Gray
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, Maryland
| | - Bruce Fischl
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Neurology, Center for Neurotechnology and Neurorecovery (BLE) and Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Boston, Massachusetts
- Harvard-MIT Program in Health Sciences and Technology (HST)/Computer Science & Artificial Intelligence Lab (CSAIL), MIT, Cambridge, Massachusetts
| | - Kimbra Kenney
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland
| | - Henry L Lew
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Scott Lozanoff
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Anatomy, Biochemistry and Physiology, John A. Burns. School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Peter Liacouras
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland
| | - John Lichtenberger
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Rehabilitation Medicine (KD-O) and Department of Neurology (KD-O), Icahn School of Medicine at Mount Sinai, New York City, New York; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Kristen Dams-O’Connor
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
| | - David Cifu
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Veterans Affairs, Chronic Effects of NeuroTrauma Consortium (CENC), Richmond, Virginia
- DoD Brain Health Research Program, Blast Injury Research Program Coordinating Office, Research and Technology United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Sidney R Hinds
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Chronic Effects of NeuroTrauma Consortium (CENC), Fort Detrick, Maryland
| | - Daniel P Perl
- Brain Tissue Repository & Neuropathology Core, Center for Neuroscience and Regenerative Medicine (CNRM), Uniformed Services University (USU), Bethesda, Maryland
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University (USU), Bethesda, Maryland
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Breeze J, Bowley DM, Combes JG, Baden J, Rickard RF, DuBose J, Powers DB. Facial injury management undertaken at US and UK medical treatment facilities during the Iraq and Afghanistan conflicts: a retrospective cohort study. BMJ Open 2019; 9:e033557. [PMID: 31772107 PMCID: PMC6887033 DOI: 10.1136/bmjopen-2019-033557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To perform the first direct comparison of the facial injuries sustained and treatment performed at USA and UK deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan. SETTING The US and UK Joint Theatre Trauma Registries were scrutinised for all patients with facial injuries presenting alive to a UK or US deployed MTF between 1 March 2003 and 31 October 2011. PARTICIPANTS US and UK military personnel, local police, local military and civilians. PRIMARY AND SECONDARY OUTCOME MEASURES An adjusted multiple logistic regression model was performed using tracheostomy as the primary dependent outcome variable and treatment in a US MTF, US or UK military, mandible fracture and treatment of mandible fracture as independent secondary variables. RESULTS Facial injuries were identified in 16 944 casualties, with the most common being those to skin/muscle (64%), bone fractures (36%), inner/middle ear (28%) and intraoral damage (11%). Facial injuries were equally likely to undergo surgery in US MTF as UK MTF (OR: 1.06, 95% CI 0.4603 to 1.142, p=0.6656); however, variations were seen in injury type treated. In US MTF, 692/1452 (48%) of mandible fractures were treated by either open or closed reduction compared with 0/167 (0%) in UK MTF (χ2: 113.6; p≤0.0001). US military casualties who had treatment of their mandible fracture (open reduction and internal fixation or mandibulo-maxillary fixation) were less likely to have had a tracheostomy than those who did not undergo stabilisation of the fractured mandible (OR: 0.61, 95% CI 0.44 to 0.86; p=0.0066). CONCLUSIONS The capability to surgically treat mandible fractures by open or closed reduction should be considered as an integral component of deployed coalition surgical care in the future.
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Affiliation(s)
- John Breeze
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Douglas M Bowley
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James G Combes
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - James Baden
- Royal Centre for Defence Medicine, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Joseph DuBose
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - David B Powers
- Duke University Medical Center, Durham, North Carolina, USA
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Breeze J, Ross D. Dispatches from the editor: Emergency Preparedness, Resilience and Response (EPRR). BMJ Mil Health 2018; 166:3-4. [PMID: 30054371 DOI: 10.1136/jramc-2018-001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Johno Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK .,Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital, Durham, North Carolina, Durham, North Carolina, USA
| | - D Ross
- RAMC, Health Unit, Camberley, Camberley, Surrey, UK
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18
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Breeze J. Dispatches from the editor: highlights of this edition. J ROY ARMY MED CORPS 2018; 164:139. [PMID: 29973383 DOI: 10.1136/jramc-2018-001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Johno Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.,Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital, Durham, North Carolina, USA
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