Surgeon preparedness for mass casualty events: Adapting essential military surgical lessons for the home front

Authors

  • Kyle N. Remick, MD, FACS
  • Stacy Shackelford, MD, FACS
  • John S. Oh, MD, FACS
  • Jason M. Seery, MD, FACS
  • Daniel Grabo, MD, FACS
  • John Chovanes, DO, FACS
  • Kirby R. Gross, MD, FACS
  • Shawn C. Nessen, DO, FACS
  • Nigel RM Tai, QHS, MS, FRCS (Gen)
  • Rory F. Rickard, PhD, FRCS
  • Eric Elster, MD, FACS
  • C. W. Schwab, MD, FACS, FRCS (Glasg)

DOI:

https://doi.org/10.5055/ajdm.2016.0228

Keywords:

mass casualty, damage control, surgeon preparedness, military

Abstract

Military surgeons have gained familiarity and experience with mass casualty events (MCEs) as a matter of routine over the course of the last two conflicts in Afghanistan and Iraq. Over the same period of time, civilian surgeons have increasingly faced complex MCEs on the home front. Our objective is to summarize and adapt these combat surgery lessons to enhance civilian surgeon preparedness for complex MCEs on the home front. The authors describe the unique lessons learned from combat surgery over the course of the wars in Afghanistan and Iraq and adapt these lessons to enhance civilian surgical readiness for a MCE on the home front. Military Damage Control Surgery (mDCS) combines the established concept of clinical DCS (cDCS) with key combat situational awareness factors that enable surgeons to optimally care for multiple, complex patients, from multiple simultaneous events, with limited resources. These additional considerations involve the surgeon's role of care within the deployed trauma system and the battlefield effects. The proposed new concept of mass casualty DCS (mcDCS) similarly combines cDCS decisions with key factors of situational awareness for civilian surgeons faced with complex MCEs to optimize outcomes. The additional considerations for a civilian MCE include the surgeon's role of care within the regional trauma system and the incident effects. Adapting institutionalized lessons from combat surgery to civilian surgical colleagues will enhance national preparedness for complex MCEs on the home front.

Author Biographies

Kyle N. Remick, MD, FACS

COL Kyle N. Remick, MD, FACS, Military Deputy, Combat Casualty Care Research Program, Frederick, Maryland; Assistant Professor of Surgery, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.

Stacy Shackelford, MD, FACS

COL Stacy Shackelford, MD, FACS, Chief of Education and Performance Improvement, Joint Trauma System, US Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, Texas.

John S. Oh, MD, FACS

COL John S. Oh, MD, FACS, Assistant Professor of Surgery, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.

Jason M. Seery, MD, FACS

LTC (P) Jason M. Seery, MD, FACS, Deputy Commander for Surgical Services, Martin Army Community Hospital, Fort Benning, Georgia.

Daniel Grabo, MD, FACS

LTC Daniel Grabo, MD, FACS, Navy Trauma Training Center, LAC+USC Medical Center, Los Angeles, California.

John Chovanes, DO, FACS

LTC John Chovanes, DO, FACS, Director of Military Affairs, Department of Surgery, Cooper University Hospital, Camden, New Jersey.

Kirby R. Gross, MD, FACS

COL Kirby R. Gross, MD, FACS, Director, Army Trauma Training Center, Miami, Florida.

Shawn C. Nessen, DO, FACS

COL Shawn C. Nessen, DO, FACS, Commander, US Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, Texas.

Nigel RM Tai, QHS, MS, FRCS (Gen)

COL Nigel RM Tai, QHS, MS, FRCS (Gen), Clinical Director, Trauma Services, Royal London Hospital and Barts Health NHS Trust, London, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.

Rory F. Rickard, PhD, FRCS

SURG CAPT Rory F. Rickard, PhD, FRCS, Defence Professor of Surgery, Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom; Honorary Consultant, Plastic and Reconstructive Surgeon Derriford Hospital, Plymouth, United Kingdom.

Eric Elster, MD, FACS

CAPT Eric Elster, MD, FACS, Professor and Chairman, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.

 

C. W. Schwab, MD, FACS, FRCS (Glasg)

C. W. Schwab, MD, FACS, FRCS (Glasg), Founding Chief (1987-2012), Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Medicine, Philadelphia, Pennsylvania; Professor of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

 

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Published

04/01/2016

How to Cite

Remick, MD, FACS, K. N., S. Shackelford, MD, FACS, J. S. Oh, MD, FACS, J. M. Seery, MD, FACS, D. Grabo, MD, FACS, J. Chovanes, DO, FACS, K. R. Gross, MD, FACS, S. C. Nessen, DO, FACS, N. R. Tai, QHS, MS, FRCS (Gen), R. F. Rickard, PhD, FRCS, E. Elster, MD, FACS, and C. W. Schwab, MD, FACS, FRCS (Glasg). “Surgeon Preparedness for Mass Casualty Events: Adapting Essential Military Surgical Lessons for the Home Front”. American Journal of Disaster Medicine, vol. 11, no. 2, Apr. 2016, pp. 77-87, doi:10.5055/ajdm.2016.0228.

Issue

Vol. 11 No. 2 (2016): Spring

Section

Articles

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