Page 155 - Journal of Special Operations Medicine - Fall 2017

Front Line Surgery

A Practical Approach

Martin MJ, Beekley AC, editors. Front Line Surgery: A Practical Approach. New York, NY: Springer Science+Business Media;
2011. Paperback, 554 pages. ISBN: 978-1-4419-6078-8.
Review by COL (Ret) Warner “Rocky” D. Farr, MD, MPH

his book felt like an old friend from the moment I picked this throughput system. In this day of emerging deployments
Tit up! In addition to being edited by two experienced U.S. to faraway places without a golden hour, dedicated surgical
Army war trauma surgeons, the individual chapters read like support, or planned out evacuation routes, anyone could be
a Who’s Who of the Committee on Tactical Combat Casualty the provider on the hot seat with only this book to guide them.
Care (CoTCCC), whose meetings I still at- In Vietnam, we used to talk about performing surgery with a
tend. The forward is by Lorne Blackburn, book open on a mayo stand—this is that book!
“Prehospital Care” is by Ian Wedmore,
“Triage” is by Jamie Riesberg, “Damage Front Line Surgery provides practical insights for surgeons
Control Surgery” is by John Holcomb, to, where quick, best-outcome based, solutions for complex ur-
as they say, name just a few. In addition, gent clinical problems are required. Each chapter has detailed
the book covers freeze-dried plasma and instructions and emergency surgical principles with many il-
field blood collection. lustrations. The focus is clearly surgery, but the authors also
have provided clinical pearls and a “Top Ten Combat Trauma
Clearly, this text is appropriate for anyone Lessons” such as, “1. Patients die in the ER, and 2. Patients die
bound for a Level or Role 2 or 3 surgical in the CT scanner; 3. Therefore, a hypotensive trauma patient
facility, theater hospital, or forward surgical team/element. belongs in the operating room ASAP.” Also “4. Most blown
One of the oldest sayings in military medicine is that only up or shot patients need blood products, not crystalloid. Avoid
young surgeons profit from war. This book is the most com- trying “hypotensive resuscitation”—it’s for civilian trauma. 5.
plete rendition of how surgeons and damage control surgery For mangled extremities and amputations, one code red (4
has grown, profited, and matured over the life of the GWOT. PRBC + 2 FFP) per extremity, started as soon as they arrive.”
Both editors served as active duty officers and surgeons in the
U.S. Army. Martin, a fellowship-trained trauma surgeon, was Chapters that should convince medics to buy this book are
chief of surgery at the 47th Combat Support Hospital (CSH) “Chapter 34: Stabilization and Transfer From the Far For-
in Tikrit, Iraq, in 2005–2006 and then later was chief of ward Environment” and “Chapter 2: Combat Triage and
trauma and general surgery at the 28th CSH in Baghdad, Iraq, Mass Casualty Management.” Another pearl is “Appendix A:
in 2007–2008. He has published multiple peer-reviewed jour- Improvise, Adjust, Overcome: Field Expedient Methods in a
nal articles and analyzed trauma-related deaths in the current Forward Environment.” Two examples: “weight lifting belts
war and the strategies to reduce them. Beekley was the former make good abdominal binders” and “Most disposable sup-
trauma medical director at Madigan Army Medical Center plies can be cleaned and reused; pay attention to what gets
with multiple combat deployments to both Iraq and Afghani- thrown away.”
stan, for various leadership roles with both FSTs and CSHs.
Amazon shows a new, unreleased second edition of this book
This book will keep new, first-time deploying surgeons out of on the way, which I plan to review when I can get my hands
trouble and up to date on current methodologies in theater. on one. This first edition should then be findable on the used
Any surgeon treating trauma patients should have this book. book market for you cheapskates out there. I highly recom-
However, beyond that, it is a great introduction to the medi- mend this book for both for the skilled damage control surgi-
cal battlefield for surgeons and for general medical officers cal practitioner and for the first responder. As I said above,
preparing for deployment. Any provider from first responder as war transitions into immature theaters, no/limited surgical
medic to Walter Reed staff would benefit from seeing how mil- support, and on the fly evacuation, this book can made you
itary trauma casualties are meant to be handled throughout the smartest medical operator out there, wherever there is.

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