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From the classroom to the fight: Preparing for surgical care on the battlefield

Bringing expeditionary resuscitation and surgical teams directly to the battlefield reduces time and distance, increasing chances for survival. Made up of experienced surgeons, physicians, and nurses with specialties ranging from general surgery to emergency room care, the teams are equipped to provide crucial surgery procedures out in the field. (U.S. Air Force Photo by Staff Sgt. Kyle Brasier) Bringing expeditionary resuscitation and surgical teams directly to the battlefield reduces time and distance, increasing chances for survival. Made up of experienced surgeons, physicians, and nurses with specialties ranging from general surgery to emergency room care, the teams are equipped to provide crucial surgery procedures out in the field. (U.S. Air Force Photo by Staff Sgt. Kyle Brasier)

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For surgical care on the battlefield, the difference between life and death comes down to time, resources, and training. Preparing for the unique circumstances of an austere setting can pose a challenge for the most experienced health care professionals used to working in hospital settings. But thanks to research advancements in surgical care training, realistic preparation for surgery in a war zone has improved.

Downrange surgical care has improved the survival of combatants as the specialty has grown over the last 15 years of war, said Army Reserve Maj. Matthew D’Angelo, assistant professor and interim associate dean for faculty affairs at the Uniformed Services University of Health Sciences’ Graduate School of Nursing

“We know surgical care saves lives, but unfortunately there’s a barrier of getting those injured folks into the clinical setting,” said D’Angelo, speaking at the Military Health System Research Symposium Aug. 27.

Bringing expeditionary resuscitation and surgical teams directly to the battlefield reduces time and distance, increasing chances for survival. Made up of experienced surgeons, physicians, and nurses with specialties ranging from general surgery to emergency room care, the teams are equipped to provide crucial surgery procedures out in the field.

Since competency of skills can be context-related, being successful in a modern hospital setting may not translate into the same success in an austere environment, said D’Angelo. The curriculum is designed to educate and help health care providers adapt to a tactical setting. The team is trained to perform resuscitation, damage control surgery, triage and emergency room care, critical care transport, and prolonged field care.

“They work in a brick-and-mortar facility, so there are some challenges to these types of teams,” said D’Angelo. “How do we take someone who is from a military treatment facility and orient them to the austere locations?”

To help teams learn to work together quickly and adjust to the special operations forces mission, MEDCOM reached out to the U.S. Army Medical Department Center and School. Its division of predeployment medicine came up with a 21-day training platform. The program is broken down into eight days of pre-requisite ERST training and 13 days of ERST training. The first seven days of ERST training focuses on equipment and team development. The last six days are primarily field exercises, which allow teams to work hands-on with equipment in a tactical setting.

Calling the curriculum “developmental,” D’Angelo described the scenario- and problem-based training experienced by students at Joint Base San Antonio, Texas. As the course’s difficulty gradually builds each day, teams face more challenges and must work together.

From the clinical side of surgical care, experts provided updates on current research to address various aspects of surgical procedures. Navy Lt. Luke Johnson, a general surgery resident at Walter Reed National Military Medical Center, said the goal of his project was to look at the use of tranexamic acid, or TXA, for traumatic combat injuries.

By the end of the study, all massive transfusion patients were given the solution. The data show TXA was successful, but overusing it can increase risk for complications. Researchers continue their search for solutions to curb excessive bleeding in traumatic combat injuries and to reduce the risk of complications.

The Military Health System Research Symposium brings together medical providers, researchers, and senior leaders to share research and health care advancements. The symposium highlights research for combat casualty care, operational medicine, clinical and rehabilitative medicine, and infectious diseases.

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The total number of cold weather injuries among active component service members in 2016 – 2017 cold season was the lowest since 1999. 2016 – 2017 versus the previous four cold seasons  •	A total of 387 members of the active (n=328) and reserve (n=59) components had at least one medical encounter with a primary diagnosis of cold weather injury. •	Rates tended to be higher among service members who were in the youngest age groups, female, non-Hispanic black, or in the Army. •	Cold weather injuries associated with overseas deployments have fallen precipitously in the past three cold seasons due to changes in military operations in Iraq and Afghanistan. There were just 10 cases in the 2016 – 2017 season.  •	Frostbite was the most common type of cold weather injury. Bar chart displays numbers of service members who had a cold injury (one per person per year), by service and cold season, active and reserve components, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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