Advanced Modular Manikin and Surgical Team Experience During a Trauma Simulation: Results of a Single-Blinded Randomized Trial.

Background: Our aim was assess whether an integrated Advanced Modular Manikin (AMM) provides improved participant experience compared with use of peripheral simulators alone during a standardized trauma team scenario. Simulation-based team training has been shown to improve team performance. To address limitations of existing manikin simulators, the AMM platform was created that enables interconnectedness, interoperability, and integration of multiple simulators ("peripherals") into an adaptable, comprehensive training system.

Development of a Field-Expedient Vascular Trauma Simulator.

The past few years have noted significant declines in combat casualty exposure over the course of a deployment. As a result, overall confidence and comfort in performing potentially life-saving therapies may wane during a deployment. Development of training simulators provides a method for bridging this gap.

Achieving Mastery of General Surgery Operative Skill in the Army Healthcare System.

Introduction: Operative case volumes for military surgeons are reported to be significantly lower than civilian counterparts. Among the concern that this raises is an inability of military surgeons to achieve mastery of their craft.

Material And Methods: Annual surgical case reports were obtained from seven Army military treatment facilities (MTF) for 2012-2016.

Objective Evaluation of the Effects of Deployment on Laparoscopic Skills: The Simulation and Deployment Laparoscopic Skills Study.

Objective: To assess the effects of deployment on basic laparoscopic skills of general surgeons and obstetrics/gynecology (OB/GYN) physicians.

Methods: This was a prospective 10-site study. Active duty Army OB/GYN and general surgery physicians scheduled to deploy were invited to participate.

What Patients Really Want: Optimizing the Military Preoperative Evaluation Clinic.

The idea of the preoperative anesthesia clinic as a means of examining and treating the patient so that he will arrive in the operating theater as strong and healthy as possible is well established in practice and literature.However, problems in clinic design and execution often result in high patient waiting times, decreased patient and staff satisfaction, decreased patient capacity, and high clinic costs. Although the details of clinic design, outcomes, and satisfaction have been extensively evaluated at civilian hospitals, we have not found corresponding literature addressing these issues specifically within military preoperative evaluation clinics.

What is the future of training in surgery? Needs assessment of national stakeholders.

Background: The Curriculum Committee of the American College of Surgeons-Accredited Educational Institutes conducted a need assessment to (1) identify gaps between ideal and actual practices in areas of surgical care, (2) explore educational solutions for addressing these gaps, and (3) shape a vision to advance the future of training in surgery.

Methods: National stakeholders were recruited from the committee members' professional network and interviewed via telephone. Interview questions targeted areas for improving surgical patient care, optimal educational solutions for training in surgery including simulation roles, and entities that should primarily bear training costs.

Hemostasis in a noncompressible hemorrhage model: an end-user evaluation of hemostatic agents in a proximal arterial injury.

Objective: 1. Evaluate hemostatic bandages by the end user using subjective and objective criteria. 2.

Management of complex extremity injuries: tourniquets, compartment syndrome detection, fasciotomy, and amputation care.

Historically, complex extremity injuries, otherwise known as mangled extremities, have been difficult management problems. This is especially true in multiply-injured patients where many priorities exist and where amputation is considered a failure of limb salvage. Over the past decade, advances in the total management of complex extremity injuries, from the placement of life-saving and limb-saving tourniquets in the prehospital setting to the advancement of prosthetics and rehabilitation months to years later, have resulted in superb functional results regardless of whether limb salvage or amputation is undertaken.

Factors influencing humanitarian care and the treatment of local patients within the deployed military medical system: casualty referral limitations.

Background: Humanitarian medical care is an essential task of the deployed military health care system. The purpose of this study was to analyze referral acceptance in treating injured local national patients during Operation Enduring Freedom.

Methods: A prospective observation study of local nationals who were referred for humanitarian trauma care in Afghanistan from March through August 2009.

Intensive skills week for military medical students increases technical proficiency, confidence, and skills to minimize negative stress.

The effects of stress induced cortisol on learning and memory is well documented in the literature.1-3 Memory and learning are enhanced at low levels while high levels are detrimental. Repetitive training in stressful situations enables management of the stress response4 as demonstrated by the high intensity training military members undergo to prepare for tactical situations.

Perceived effects of deployments on surgeon and physician skills in the US Army Medical Department.

Background: The military health care system is unique in that almost every physician deploys for ≥6 months to a combat or far-forward setting. The aim of this study was to determine the perceived changes in clinical skills in this deployed population.

Methods: A survey was sent out to all specialty consultants to the Army Surgeon General to query active duty staff physicians in their specialty areas who have deployment experience in August 2007.

Transforming US Army trauma care: an evidence-based review of the trauma literature.

The US Army has been charged to transform to meet the demands of current and anticipated near-future combat needs, covering a full spectrum of military operations. The US Army combat trauma care system was created to deliver combat casualty care in a variety of situations and has been adapted to meet the needs of such care in both Operations Enduring Freedom and Iraqi Freedom. Questions related to our current system include the use and positioning of medical evacuation assets, the type of training for our trauma care providers, the positioning of these providers in proximity to the battlefield, and the type of units most suited to the wide variety of medical operations required of today's military medical team.

Incidence of low vitamin A levels and ocular symptoms after Roux-en-Y gastric bypass.

Background: Previous reports have demonstrated a significant incidence of fat-soluble vitamin deficiency after bariatric surgery. The purpose of the present study was to determine the incidence of vitamin A deficiency after Roux-en-Y gastric bypass and to correlate the laboratory findings with ocular symptoms potentially related to vitamin A deficiency.

Methods: All patients who had undergone Roux-en-Y gastric bypass were invited to participate in a nutritional screening.

Potential roles of military-specific response to natural disasters -- analysis of the rapid deployment of a mobile surgical team to the 2007 Peruvian earthquake.

The August 2007 earthquake in Peru resulted in the loss of critical health infrastructure and resource capacity. A regionally located United States Military Mobile Surgical Team was deployed and operational within 48 hours. However, a post-mission analysis confirmed a low yield from the military surgical resource.

Efficacy of three topical hemostatic agents applied by medics in a lethal groin injury model.

Background: Advanced topical hemostatic agents are increasingly utilized to control traumatic hemorrhage. We sought to determine the efficacy of three chitosan based hemostatic agents in a lethal groin injury model when applied by combat medic first responders.

Methods: After creation of a standardized femoral artery injury in a goat model, medics attempted hemorrhage control with standard gauze dressing followed by randomization to one of three hemostatic agents in this two tiered study.

Laparoscopic gastric gastrointestinal stromal tumor resection: the mayo clinic experience.

Hypothesis: Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) is safe and effective.

Design: Retrospective medical record review.

Setting: Tertiary referral center.

Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis.

Purpose: Laparoscopic colectomy has only recently become an accepted technique for the treatment of colon cancer. We sought to analyze factors that affect the type of resection performed and associated outcomes from a large nationwide database.

Methods: All admissions with a primary diagnosis of colon cancer undergoing elective resection were selected from the 2003 and 2004 Nationwide Inpatient Samples.

Training physicians for combat casualty care on the modern battlefield.

Introduction: Trauma training among nonsurgical physicians in the military is highly variable in amount and quality. However, all deployed military physicians, regardless of specialty, are expected to provide combat casualty care. The goal was to assess the effectiveness of an intense modular trauma refresher course for nonsurgical physicians deploying to a combat zone.

Application of the Mangled Extremity Severity Score in a combat setting.

Objective: The aim of this study was to examine the Mangled Extremity Severity Score (MESS) in a combat setting.

Methods: Data on extremity injuries were collected from a forward surgical team. MESS and Revised Trauma Score values were retrospectively calculated for each patient.

From the combat medic to the forward surgical team: the Madigan model for improving trauma readiness of brigade combat teams fighting the Global War on Terror.

Background: Medics assigned to combat units have a notable paucity of trauma experience. Our goal was to provide intense trauma refresher training for the conventional combat medic to better prepare them for combat casualty care in the War on Terror.

Materials And Methods: Our Tactical Combat Casualty Care Course (TC3) consisted of the following five phases: (1) One and one-half-day didactic session; (2) Half-day simulation portion with interactive human surgical simulators for anatomical correlation of procedures and team building; (3) Half-day of case presentations and triage scenarios from Iraq/Afghanistan and associated skills stations; (4) Half-day live tissue lab where procedures were performed on live anesthetized animals in a controlled environment; and (5) One-day field phase where live anesthetized animals and surgical simulators were combined in a real-time, field-training event to simulate realistic combat injuries, evacuation problems, and mass casualty scenarios.

Surgical support for low-intensity conflict, limited warfare, and special operations.

Low-intensity conflicts and special operations present a wide range of injury scenarios for military and civilian surgeons alike. Harsh environments, difficult and high-risk missions, long lines of communication, and isolated locations are but some of the factors that create challenge in providing care for patients in this category. Often surgeons and other medical personnel are faced with many additional medical and nonmedical tasks outside their usual expertise because of the small number of support personnel and medical footprints brought forward in these missions.

The use of damage-control principles for penetrating pelvic battlefield trauma.

Background: High-velocity, penetrating pelvic injuries present one of the most difficult challenges to military trauma surgeons. The patients often present in physiologic extremis, and their injury-site patterns frequently include soft tissue, pelvic fractures, genitourinary tract, rectum, vascular structures, and intra-abdominal viscera.

Methods: A retrospective review of the 31st Combat Support Hospital damage-control laparotomy database, under an Institutional Review Board-approved protocol, revealed 28 patients with severe multisystem penetrating pelvic injuries.

Extremity vascular injuries on the battlefield: tips for surgeons deploying to war.

Background: Recent events have refocused attention on certain principles regarding the surgical management of casualties on the battlefield. Extremity vascular injuries predominate, representing 50 to 70% of all injuries treated during Operation Iraqi Freedom, and exsanguination from extremity wounds is the leading cause of preventable death on the modern battlefield. Recent advances in military medicine have translated into a greater percentage of wounded soldiers surviving during Operations Enduring and Iraqi Freedom than in any other previous American conflict.