Page 55 - 2020 JSOM Winter

An Analysis and Comparison of Prehospital Trauma Care
Provided by Medical Officers and Medics on the Battlefield

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Andrew D. Fisher, MD, LP *; Jason F. Naylor, DSc, PA-C ; Michael D. April, MD, DPhil, MSc ;
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Dominic Thompson, SOCM, ATP ; Russ S. Kotwal, MD, MPH ; Steven G. Schauer, DO, MS 6
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ABSTRACT
Background: Role 1 care represents all aspects of prehospital including major surgical procedures. Role 2 facilities provide
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care on the battlefield. Recent conflicts and military operations advanced trauma management and resuscitation. Depending
conducted on behalf of the Global War on Terrorism have re- on the manning level and employment, they may also be aug-
sulted in medical officers (MOs) being used nondoctrinally on mented by surgical capabilities (e.g., forward surgical team).
combat missions. We are seeking to describe Role 1 trauma Role 3 and Role 4 facilities provide the staff and equipment
care provided by MOs and compare this care to that provided to care for all categories of patients, to include resuscitation,
by medics. Methods: This is a secondary analysis of previously initial wound surgery, specialty surgery, and post-operative
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described data from the Prehospital Trauma Registry and the treatment. The difference between Role 3 and Role 4 facilities
Department of Defense Trauma Registry from April 2003 is that the former is usually found in the combat zone and the
through May 2019. Encounters were categorized by type of latter is usually a fixed facility outside of the combat zone.
care provider (MO or medic). If both were documented, they
were categorized as MO; those without either were excluded. Role 1 care in maneuver units within the US Army typically
Descriptive statistics were used. Results: A total of 826 casualty have two medical officers (MOs) who provide trauma and re-
encounters met inclusion criteria. There were 418 encounters suscitative care: a physician assistant (PA) and a physician. At
categorized as MO (57 with MO, 361 with MO and medic), the battalion or squadron level, the physician is often either
and 408 encounters categorized as medic only. The composite a residency trained primary care physician (e.g., family med-
injury severity score (median, interquartile range) was higher icine, internal medicine, or pediatrics), emergency medicine
for casualties treated by the medic cohort (9, 3.5–17) than physician, or a non–residency-trained general medical officer.
for the MO cohort (5, 2–9.5; P = .006). There was no dif- These physicians are permanently assigned to units for com-
ference in survival to discharge between the MO and medic bat deployments by the modification table of organization and
groups (98.6% vs. 95.6%; P = .226). More life-saving inter- equipment (MTOE) Assigned Personnel (MAP) (legacy term
ventions were performed by MOs compared to medics. MOs for the US military’s Professional Filler System [PROFIS]).
demonstrated a higher rate of vital sign documentation than The US Marine Corps uses a similar setting, using physicians
medics. Conclusion: More than half of casualty encounters in and PAs with the support of corpsmen and independent duty
this study listed an MO in the chain of care. The difference in corpsmen. The US Air Force and US Navy have a variety of
proportion of interventions highlights differences in provider personnel in the prehospital setting, at times relying solely on
skills, training and equipment, or that interventions were dic- enlisted medical personnel.
tated by differences in mechanisms of injury.
In the deployed setting, unit MOs will often establish small
Keywords: prehospital; medic; healthcare provider; military clinics or aid stations to facilitate Role 1 care of disease,
medicine; war-related injuries non-battle injury, and battle injury. Although unit medics will
assist MOs at the aid station, most will accompany their re-
spective units on combat missions in order to provide care to
battle-injured casualties near the point of injury (POI). During
Introduction recent conflicts, more MOs have also accompanied their units
The countries of the North Atlantic Treaty Organization on missions. However, this has more frequently occurred in
(NATO) have created a common lexicon to describe roles of Special Operations Forces (SOF) units.
medical care provided by their military forces as determined
by capabilities and functions. Currently, there are four roles The training and skills of the MO can vary greatly. During the
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of care. Role 1 is the prehospital or unit level care that in- peak years of conflict in Afghanistan and Iraq, many new grad-
cludes basic sick call and medical treatment, as well as initial uates of PA school were sent to deploying units before having
trauma care, resuscitation, and life-saving interventions not the opportunity to solidify and refine their skills. Nevertheless,
*Correspondence to Medical Command, Texas Army National Guard, 35th St/Bldg 11, Austin, TX 7876; or anfisher@salud.unm.edu
1 MAJ Fisher is a general surgery resident physician at the University of New Mexico School of Medicine, Albuquerque, NM, and currently serves
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in the Texas Army National Guard. LTC Naylor is a physician assistant at Madigan Army Medical Center, Tacoma, WA. MAJ April is the
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brigade surgeon, 2nd Stryker Brigade Combat Team, 4th ID, Fort Carson, CO. SFC Thompson is a Special Operations combat medic and is
affiliated with the Division Artillery, 101st Airborne Division (Air Assault), Ft. Campbell, KY. COL (Ret) Kotwal is a family medicine physician
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affiliated with the Uniformed Services University of the Health Sciences, Bethesda, MD, and the Joint Trauma System, Defense Health Agency,
JBSA Fort Sam Houston, TX. MAJ Schauer is an emergency medicine physician with the US Army Institute of Surgical Research and Brooke
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Army Medical Center, Fort Sam Houston, TX, Uniformed Services University of the Health Sciences, Bethesda, MD.
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