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Combat readiness for the modern military surgeon: Data from a decade of combat operations

Tyler, Joshua A. MD; Ritchie, John D. MD; Leas, Michelle L. RN; Edwards, Kurt D. MD; Eastridge, Brian E. MD; White, Christopher E. MD; Knudson, M. Margaret MD; Rasmussen, Todd E. MD; Martin, R. Russell MD; Blackbourne, Lorne H. MD

Journal of Trauma and Acute Care Surgery: August 2012 - Volume 73 - Issue 2 - p S64–S70
doi: 10.1097/TA.0b013e3182625ebb

OBJECTIVE Hundreds of general surgeons from the army, navy, and air force have been deployed during the past 10 years to support combat forces, but little data exist on their preparedness to handle the challenging injuries that they are currently encountering. Our objective was to assess operative and operational experience in theater with the goal of improving combat readiness among surgeons.

METHODS A detailed survey was sent to 246 active duty surgeons from the army, navy, and air force who have been deployed at least once in the past 10 years, requesting information on cases performed, perceptions of efficacy of predeployment training, knowledge deficits, and postdeployment emotional challenges. Survey data were kept confidential and analyzed using standard statistical methods.

RESULTS Of 246 individuals, 137 (56%) responded and 93 (68%) have been deployed two or more times. More than 18,500 operative procedures were reported, with abdominal and soft tissue cases predominating. Many surgeons identified knowledge or practice gaps in predeployment vascular (46%), neurosurgical (29.9%), and orthopedic (28.5%) training. The personal burden of deployment manifested itself with both family (approximately 10% deployment-related divorce rate) and personal (37 surgeons [27%] with two or more symptoms of posttraumatic stress syndrome) stressors.

CONCLUSION These data support modifications of predeployment combat surgical training to include increased exposure to open vascular procedures and curriculum traditionally outside general surgery (neurosurgery and orthopedics). The acute care surgical model may be ideal for the military surgeon preparing for deployment. Further research should be directed toward identifying factors contributing to psychological stress among military medics.

LEVEL OF EVIDENCE Epidemiologic study, level IV.

From the Department of General Surgery (J.A.T., J.D.R, R.R.M.), San Antonio Military Medical Center, Texas; US Army Institute of Surgical Research (M.L.L, B.E.E, C.E.W., T.E.R., L.H.B.), Fort Sam Houston, Texas; Department of General Surgery (K.D.E.), Tripler Army Medical Center, Honolulu, Hawaii; and Department of Surgery (M.M.K.), University of California San Francisco.

This work was presented as a podium presentation at the Advanced Technology Applications in Combat Casualty Care Meeting, Fort Lauderdale, Florida, in August 2011, as well as at the American Association for the Surgery of Trauma meeting as a poster in Chicago, Illinois, in September 2011.

Address for reprints: Joshua A. Tyler, MD, Department of General Surgery, San Antonio Military Medical Center, MCHE-SDG, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234; email:

© 2012 Lippincott Williams & Wilkins, Inc.