Page 146 - 2022 Spring JSOM

Committee on Surgical Combat Casualty Care Position

Statement on Single-Surgeon Teams

his position paper addresses the risks associated with 2. Surgical teams are a limited resource. They are most effec-
Tthe evolving use of single-surgeon teams in the deployed tive in saving critically injured casualties when positioned
environment. to receive them as soon as possible after injury.
• A single-surgeon team (SST) is a surgical team that con- 3. Tactical Combat Casualty Care (TCCC), damage control
sists of one qualified general surgeon. resuscitation, damage control surgery, and perioperative
• A qualified general surgeon is one with current and rel- critical care are necessary on the battlefield to save lives.
evant trauma experience. 4. Single-surgeon management of severely injured trauma pa-
• There has been no standardization of this capability tients is not standard practice at major trauma centers in
among the Services. the United States.
• Employment of an SST may carry more risk than fully 5. SSTs are neither manned nor equipped to manage more
understood. than one severely injured casualty, nor do SSTs have the
capacity to hold patients. Task saturation risks can degrade
Background overall capability.
Hemorrhage is the most common mechanism of death result- 6. Despite the wide deployment of SSTs, training, staffing, and
ing from potentially survivable battlefield injuries. Minimizing equipment are not standardized, leading to limited inter-
the time to hemorrhage control has driven the requirement for changeability and interoper ability in a joint environment.
rapid access to surgical care on the battlefield. Over the last 7. SSTs may mitigate risk imposed by time and distance be-
10 years the size of the surgical teams providing resuscitative tween point of injury and traditional multi-surgeon teams.
care and damage control surgery has decreased; smaller, more SSTs are most likely to mitigate this risk when properly
mobile teams are being deployed closer to the tactical environ- trained, equipped with blood transfusion capability, and
ment where forces are actively engaged in combat activities. supported by medical evacuation assets to transport casu-
The demand for progressively smaller SSTs were not driven by alties rapidly to higher roles of care with expeditious resup-
evolutions in surgical practice, or improved survival rates, but ply of the SST.
rather out of a necessity to meet operational demands which 8. The decision on whether or not to perform damage control
exceed the available supply of surgeons. surgery in austere conditions with limited resources requires
significant experience in managing complex trauma patients.
Data exist that demonstrate a survival benefit associated with
traditional multi-surgeon Role 2 surgical teams, but only lim-
ited outcome data exist for SSTs. Neither the training nor the Recommendations
composition of SSTs are standardized, and the smaller size of Given the likely continued operational requirement for small
SSTs (4–8 personnel) limits capability and capacity more than mobile surgical teams, the CoSCCC, DCoT, and JTS endorse
traditional Role 2 surgical teams. While an optimal surgical the following:
team size has not been established, logic dictates a reduction 1. SSTs should not be used as a mitigation strategy in high-
in team size will cause a progressive degradation in capability risk operational contingencies when a standard Role 2
and capacity. SSTs are typically tasked to provide Austere Re- team could be placed in the same area of operations.
suscitative Surgical Care (ARSC) at the request of operational 2. Mobile SSTs located close to point of injury can provide
commanders who deem standard Role 2 capability and foot- rapid surgical re sponse for a small number of casualties
print would not be justified by the operational contingencies with minor-to-moderate injuries.
or surgeon availability. ARSC is defined as “advanced medical 3. An SST, when compared to an equidistant multisurgeon
capability delivered by small teams with limited resources, of- team, will be less likely to save a critically injured casualty.
ten beyond traditional timelines of care, and bridges gaps in 4. SST capability and capacity are very limited and lack re-
roles of care in order to enable forward military operations dundancy in team capability compared to larger surgical
and mitigate risk to the force.” teams; this impacts anesthesia, transfusion, critical care,
and the ability for sustained clinical operations. It is un-
The Committee on Surgical Combat Casualty Care (CoSCCC), likely that an SST can successfully manage more than one
part of the Defense Committee on Trauma (DCoT), recognizes critical surgical patient at a time.
the need for a subject matter expert position statement to list 5. Casualties with complex injuries that SSTs are positioned
the risks and benefits of SSTs compared to traditional Role 2 to manage – i.e., intrathoracic or intra-abdominal hemor-
surgical teams. rhage – are less likely to be saved by an SST than a doctrin-
ally-resourced Role 2 team.
Facts and Principles 6. The use of SSTs must take into account the system of care
1. Surgical care provided by multisurgeon teams paired with which supports the risks these teams are deployed to mit-
robust blood supply saves lives on the battlefield. igate. For example, casualties who are rescued by an SST

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