Partnerships to Overcome the Peacetime Effect: Excelsior Surgical Society Panel Session.

The Military Health System (MHS) in the United States currently faces a crisis: maintaining medical readiness during a time of relative peace in the face of an increasingly hostile and unstable geopolitical environment. Collaboration through partnerships-with civilian academic medical centers, with academic medical societies and scientific journals, and with advocates for improved policy and supporting legislation-represents one important strategy to stave off the peacetime effect that threatens to erode our combat casualty care skills. This panel session held during the 2022 Excelsior Surgical Society Symposium at the American College of Surgeons Clinical Congress explored the way forward for the MHS amidst these historic challenges with important action items and take-home points for civilian and military surgeons alike.

War at Sea: Burn Care Challenges-Past, Present and Future.

Throughout history, seafarers have been exposed to potential thermal injuries during naval warfare; however, injury prevention, including advances in personal protective equipment, has saved lives. Thankfully, burn injuries have decreased over time, which has resulted in a significant clinical skills gap. Ships with only Role 1 (no surgical capability) assets have worse outcomes after burn injury compared to those with Role 2 (surgical capability) assets.

Military-Civilian Partnership to Improve Combat Casualty Care Readiness Among Non-physician Providers.

Background: Military-civilian partnerships (MCP) provide a bidirectional exchange of information and trauma best practices. In 2021, Penn Presbyterian Medical Center and the U.S.

Solid Metal Chemical and Thermal Injury Management.

Introduction: Solid metals may create a variety of injuries. White phosphorous (WP) is a metal that causes both caustic and thermal injuries. Because of its broad use in munitions and smoke screens during conflicts and wars, all military clinicians should be competent at WP injury identification and acute therapy, as well as long-term consequence recognition.

Complexities of autonomy in military medical ethics: A brief report.

The first Fallen Surgeons Military Educational Symposium was convened in conjunction with the the American Association for the Surgery of Trauma (AAST) 23 meeting, under the guidance of the AAST Military Liaison Committee. The daylong session included a 1.5-hour segment on military medical ethics in combat and its unique challenges.

Hemodynamic Deterioration of Trauma Patients Undergoing Interhospital Transfer.

Introduction: Organized trauma systems reduce morbidity and mortality after serious injury. Rapid transport to high-level trauma centers is ideal, but not always feasible. Thus, interhospital transfers are an important component of trauma systems.

Percutaneous thoracostomy with thoracic lavage for traumatic hemothorax: a performance improvement initiative.

Objectives: Percutaneously placed small-bore (14 Fr) catheters and pleural lavage have emerged independently as innovative approaches to hemothorax management. This report describes techniques for combining percutaneous thoracostomy with pleural lavage and presents results from a performance improvement series of patients managed with percutaneous thoracostomy with immediate lavage.

Methods: This was a prospective performance improvement series of patients treated at a level 1 trauma center with percutaneous thoracostomy and immediate lavage between April 2021 and May 2023.

The role of emergency department thoracotomy in patients with cranial gunshot wounds.

Background: Although several society guidelines exist regarding emergency department thoracotomy (EDT), there is a lack of data upon which to base guidance for multiple gunshot wound (GSW) patients whose injuries include a cranial GSW. We hypothesized that survival in these patients would be exceedingly low.

Methods: We used Pennsylvania Trauma Outcomes Study data, 2002 to 2021, and included EDTs for GSWs.

Providing Remote Aid During a Humanitarian Crisis.

Humanitarian crises create opportunities for both in-person and remote aid. Durable, complex, and team-based care may leverage a telemedicine approach for comprehensive support within a conflict zone. Barriers and enablers are detailed, as is the need for mission expansion due to initial program success.

Brief report on the development of hemorrhagic pericardial effusion after thoracic surgery for traumatic injuries.

Introduction: Hemorrhagic pericardial effusion (HPE) is a rare but life-threatening diagnosis that may occur after thoracic trauma. Previous reports have concentrated on delayed HPE in those who did not require initial surgical intervention for their traumatic injuries. In this report, we identify and characterize the phenomenon of HPE after emergent thoracic surgery for trauma.

Venous shunting and limb outcomes in military lower extremity combined arterial and venous injuries.

Introduction: Combined arterial and venous lower extremity (LE) injuries present complex management challenges. Temporary arterial shunting is widely accepted, but vein shunting is not well studied. We examined the influence of vein shunting on limb outcomes in military femoropopliteal arterial and venous combined injuries.

An Intensive Multidisciplinary Approach in Management of Extensive Nonuremic Calciphylaxis of the Bilateral Lower Extremities with Angioinvasive Fungus and Mold.

Management of infected wounds related to calciphylaxis poses a significant clinical challenge with high morbidity and mortality. Given no definitive management guidelines exist specific to nonuremic calciphylaxis, multiple modalities including sodium thiosulfate, antibiotics, hyperbaric oxygen therapy, and surgical debridement with wound care must be considered. When occurring over a large surface area, standard daily dressing changes are especially labor intensive, inefficient, and ineffective.

Change in outcomes for trauma patients over time: Two decades of a state trauma system.

Background: Trauma center mortality rates are benchmarked to expected rates of death based on patient and injury characteristics. The expected mortality rate is recalculated from pooled outcomes across a trauma system each year, obscuring system-level change across years. We hypothesized that risk-adjusted mortality would decrease over time within a state-wide trauma system.

Perspectives on competencies for care in austere settings.

Austerity in surgical care may manifest by limited equipment/supplies, deficient infrastructure (power, water), rationing/triage requirements, or the unavailability of specialty surgical or medical expertise. Some settings in which surgeons may experience austerity include the following: military deployed operations (domestic and foreign), humanitarian surgical missions, care in rural or remote settings, mass-casualty events, natural disasters, and/or care in low- and some middle-income countries. Expanded competencies beyond those required in routine surgical practice can optimize the quality of surgical care in such settings.

A Technique to Minimize Aerosolization During Percutaneous Tracheostomy in COVID-19 Patients.

Background: The SARS-CoV-2 pandemic has caused respiratory failure in many patients. With no effective treatment or vaccine, prolonged mechanical ventilation is common in survivors. Timing and performance of tracheostomy, for both patient and surgical team safety, remains a question.

Lithium batteries: A technological advance with unintended injury consequences.

Lithium-ion (Li-ion) batteries have been powering portable electronic equipment since the mid-1990s. Today, they are ubiquitous in portable electronics, with more than four billion manufactured each year. However, Li-ion batteries are also associated with a spectrum of injuries related to the type of device as well as the person using the device.

Nonsurgical Admissions With Traumatic Injury: Medical Patients Are Trauma Patients Too.

Nontrauma service (NTS) admissions are an increasing problem as ground-level falls in elderly patients become more common. The admission and evaluation of trauma patients to nontrauma services in trauma centers seeking American College of Surgeons (ACS) verification, must follow the ACS mandates for performance improvement requiring some method of evaluating this population when admitted to services other than trauma, orthopedics, and neurosurgery. The purpose of this study and performance improvement project was to improve our process for the definition and evaluation of trauma patients who were being admitted to nontrauma services.

Effect of American College of Surgeons Trauma Center Designation on Outcomes: Measurable Benefit at the Extremes of Age and Injury.

Background: American College of Surgeons (ACS) verification is believed to provide benefits for trauma patients, but is associated with direct costs.

Study Design: We performed a 1-year retrospective review of the National Trauma Data Bank (NTDB) for 2012. Patients were separated into 3 age groups; Pediatric (PEDS), 0 to 14 years; adult, 15 to 65 years; and elderly (ELD), older than 65 years.

Marchiafava-Bignami disease in a trauma patient.

Marchiafava-Bignami disease (MBD) is a rare pathological condition affecting the corpus callosum (CC), characterized by progressive demyelination and necrosis. While usually found in patients with chronic alcoholism, it has rarely been characterized in non-alcoholics. We describe a trauma patient with an unknown mechanism of injury, who was found to have MBD after remaining comatose for a prolonged period of time.

Geriatric motor vehicle collision survival: the role of institutional trauma volume.

Background: Links between trauma center volumes and outcomes have been inconsistent in previous studies. This study examines the role of institutional trauma volume parameters in geriatric motor vehicle collision (MVC) survival.

Methods: The New York Statewide Planning and Research Cooperative Systems database was analyzed for all trauma admissions to state-designated Level I and II trauma centers from 1996 to 2003.