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A unique selection and training regimen is required for the References
development of this capability. Our data demonstrate the wide 1. Eastridge BJ1, Mabry RL, Seguin P, et al. Death on the battlefield
range of skills implemented effectively by a SRT. Team mem- (2001–2011): implications for the future of combat casualty care.
bers must able to provide appropriate TCCC interventions, J Trauma Acute Care Surg. 2012;73(6 suppl 5):S431–437.
the benefit of which has been demonstrated in several large 2. Sauer SW, Robinson JB, Smith MP, et al. Saving lives on the bat-
tlefield (Part II)–one year later. A Joint Theater Trauma System
reports. 3,16–18 In addition, the multidisciplinary SRT maintains and Joint Trauma System review of prehospital trauma care in
currency in the effective use of a wide variety of resuscitative Combined Joint Operations Area-Afghanistan (CJOA-A) final
adjuncts, including the ability to secure an advanced airway, report, 30 May 2014. J Spec Oper Med. 2015;15(2):25–41.
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clusion of the aorta. Finally, the SRT can transition rapidly 1,003 combat wounded. J Trauma Acute Care Surg. 2012;73(2
8
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to providing surgical intervention in the pre-Role 2 setting for 4. Freel D, Warr BJ. Surgical and resuscitation capabilities for the
emergent indications, including cranial decompression, con- “next war” based on lessons learned from “this war.” US Army
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restore distal perfusion. 5. Nessen SC, Eastridge BJ, Cronk D, et al. Fresh whole blood use
by forward surgical teams in Afghanistan is associated with im-
Our experience demonstrates that an SRT can be effective in a proved survival compared to component therapy without plate-
lets. Transfusion. 2013;53(suppl 1):107S–113S.
variety of roles—from augmentation of a Role 2 facility dur- 6. Cap AP, Pidcoke HF, DePasquale M, et al. Blood far forward:
ing mass casualty events, to independent action, or even to time to get moving! J Trauma Acute Care Surg. 2015;78(6 suppl
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The small size and flexible capabilities of the SRT may pro- 7. Hooper TJ, Nadler R, Badloe J, et al. Implementation and ex-
vide a useful life-saving capability in response to contingency ecution of military forward resuscitation programs. Shock. 2014;
operations that require speed and mobility of medical support 41(suppl 1):90–97.
execution. In this context, the SRT can rapidly and effectively 8. Russo RM, Williams TK, Grayson JK, et al. Extending the golden
hour: partial resuscitative endovascular balloon occlusion of the
support both resuscitation and DCS within 1 hour of POI in aorta in a highly lethal swine injury model. J Trauma Acute Care
austere military environments, with the goal of delivering op- Surg. 2016;80(3):372–378; discussion 378–380.
timal casualty care as close as feasible to the POI. 9. Welch A. “Golden hour” policy saved hundred of U.S. troops.
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Our report does have important limitations that must be ac- /golden-hour-policy-decreased-combat-deaths-among-u-s-troops/.
Accessed 15 October 2017.
knowledged, including those inherent to retrospective review. 10. Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden
The AARs from which these data were abstracted do not con- hour policy on the morbidity and mortality of combat casualties.
stitute a formal casualty care database. Although these docu- JAMA Surg. 2016;151(1):15–24.
ments accurately recorded team roles and interventions, the 11. Childers R, Parker P. The cost of deploying a Role 2 medical asset
granularity of data available was not consistent with an a priori to Afghanistan. Mil Med. 2015;180(11):1132–1134.
database designed explicitly for the purpose of comprehensive 12. Malgras B, Barbier O, Petit L, et al. Surgical challenges in a new
data collection. Some variables, including specific vital signs theater of modern warfare: the French role 2 in Gao, Mali. Injury.
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at delivery to the next echelon of care, were not consistently 13. Malgras B, Barbier O, Pasquier P, et al. Initial deployment of the
available for review. As such, caution should be taken when 14th Parachutist Forward Surgical Team at the beginning of the
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with those in other care settings or capability configurations. 180(5):533–538.
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Conclusion Shock. 2013;40(1):5–10.
15. Morrison JJ, Oh J, DuBose JJ, et al. En-route capability from
A mobile SRT provides a unique resuscitative and DCS capa- point of injury impacts mortality after severe wartime injury. Ann
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is required to determine optimal SRT use in conflicts. 16. Tien HC, Jung V, Rizoli SB, et al. An evaluation of tactical com-
bat casualty care interventions in a combat environment. J Spec
Disclaimer Oper Med. 2009;9(1):65–68.
The viewpoints expressed in this manuscript are those of the 17. Tien HC, Jung V, Rizoli SB, et al. An evaluation of tactical com-
bat casualty care interventions in a combat environment. J Am
authors and do not represent official positions of the US Air Coll Surg. 2008;207(2):174–178.
Force, the US Army, or the Department of Defense. 18. Morrison JJ, DuBose JJ, Rasmussen TE, et al. Military application
of tranexamic acid in trauma emergency resuscitation ( MATTERS)
Disclosure Study. Arch Surg. 2012;147(2):113–119.
The authors have nothing to disclose.
Author Contributions
All authors participated in the composition of this manuscript
through data collection (J.D., D.M.), analysis (J.D., D.M.,
C.F., I.H., S.T.), manuscript creation (J.D., D.M., C.F., I.H.,
S.T., P.B.), and editorial revision (J.D., B.M., P.B.). All authors
approved the final revision of the manuscript.
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