Page 70 - JSOM Winter 2017

Experience With Prehospital Damage Control Capability in Modern Conflict

Results From Surgical Resuscitation Team Use

Joseph J. DuBose, MD *; Daniel Martens, PAC ; Colin Frament, PAC ;
2
2
1
2
Imad Haque, MD ; Simon Telian, MD ; Peter Benson, MD 2
3

ABSTRACT
Background: Early resuscitation and damage control surgery The SRT is capable of expediently and effectively facilitating
(DCS) are critical components of modern combat casualty delivery of both resuscitation and damage control surgery
care. Early and effective DCS capabilities can be delivered in (DCS) within 1 hour from point of injury (POI) in austere
a variety of settings through the use of a mobile surgical re- environments.
suscitation team (SRT). Methods: Twelve years of after-action
reports from SRTs were reviewed. Demographics, interven- Methods
tions, and outcomes were analyzed. Results: Data from 190
casualties (185 human, five canine) were reviewed. Among A comprehensive review was conducted of deidentified data
human casualties, 12 had no signs of life at intercept and did collected from 12 years of after action reports (AARs) from
not survive. Of the remaining 173 human casualties, 96.0% casualty episodes of care by a multidisciplinary surgical team.
were male and 90.8% sustained penetrating injuries. Interven- All AAR reviews were performed by an experienced team-
tions by the SRT included intravascular access (50.9%) and certified physician assistant and a board-certified trauma/vas-
advanced airway establishment (29.5%). Resuscitation in- cular surgeon.
cluded whole blood (3.5%), packed red blood cells (20.8%),
and thawed plasma (11.0%). Surgery was provided for 63 of Data abstracted from AARs included how the team was used,
the 173 human casualties (36.4%), including damage control patient demographics, mechanism of injury, and interventions
laparotomy (23.8%) and arterial injury shunting or repair before team intercept. Interventions conducted by the multi-
(19.0%). SRTs were effectively used to augment an existing disciplinary team and the outcomes were also recorded and
medical treatment facility (70.5%), to facilitate casualty trans- analyzed.
port (13.3%), as an independent surgical entity at a forward
ground structure (9.2%), and in mobile response directly to Team and Capabilities
the point of injury (6.9%). Overall survival was 97.1%. Con- The multidisciplinary SRT consists of an appropriately trained
clusion: An SRT provides a unique DCS capability that can be surgeon, an emergency medicine physician, a certified regis-
successfully used in a variety of flexible roles. tered nurse anesthetist, and a physician assistant. Members
of this team undergo specialized recruitment, assessment, and
Keywords: resuscitation; damage control surgery; combat selection, with new members participating in an initial skills
casualty care; mobile surgical resuscitation team pipeline including team-centric, advanced, austere and far-
forward medical and surgical training. Every team member
performs advanced training continually to maintain readiness
and proficiency.
Introduction
Recent experiences in modern regions of conflict have dem- The primary role of the SRT is to provide damage control re-
onstrated a continued need to develop and effectively use suscitation and surgery as close to the POI as tactically feasible
strategies to mitigate the risk for hemorrhagic death on the and to facilitate subsequent transfer to definitive care. This
battlefield. 1–10 Contemporary experience, however, suggests mission requires flexibility of team response to contingencies
that medical support in present and future theatres of military ranging from POI casualty collection to critical care transport
conflict may be faced with significant challenges to meet this of casualties. Team composition and equipment are designed to
requirement. 11–13 facilitate bridging the treatment gap between unit medic TCCC
interventions and an established medical treatment facility
We describe the experience of a mobile surgical resuscitation (MTF) while maintaining the ability to effectively augment the
team (SRT) designed specifically for its flexibility and abil- entire care spectrum based on mission and casualty needs.
ity to rapidly respond to support emerging contingencies of
the modern battlefield. This unit effectively bridges the gap SRT Uses
between tactical combat casualty care (TCCC) and further Over the study period, the SRTs were used in various roles and
damage control or definitive surgical care in various settings. settings (Figure 1). They were predominantly used in strategic

*Address correspondence to jjd3c@yahoo.com
1 Dr DuBose is at David Grant Medical Center, 60th MDG Department of Surgery, 101 Bodin Circle, Travis Air Force Base, CA. Messrs Martens
2
and Frament are at Womack Army Medical Center, Fort Bragg, NC. Dr Haque is at Madigan Army Medical Center, Fort Lewis, WA. Drs Telian
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2
and Benson are at Womack Army Medical Center, Fort Bragg, NC.
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