Skip to main content

Advertisement

SpringerLink
Log in

Can We Train Military Surgeons in a Civilian Trauma Center?

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

The objective of this study was to review the trauma workload and operative exposure in a major South African trauma center and provide a comparison with contemporary experience from major military conflict.

Materials and methods

All patients admitted to the PMTS following trauma were identified from the HEMR. Basic demographic data including mechanism of injury and body region injured were reviewed. All operative procedures were categorized. The total operative volume was compared with those available from contemporary literature documenting experience from military conflict in Afghanistan. Operative volume was converted to number of cases per year for comparison.

Results

During the 4-year study period, 11,548 patients were admitted to our trauma center. Eighty-four percent were male and the mean age was 29 years. There were 4974 cases of penetrating trauma, of which 3820 (77%) were stab wounds (SWs), 1006 (20%) gunshot wounds (GSWs) and the remaining 148 (3%) were animal injuries. There were 6574 cases of blunt trauma. The mechanism of injuries was as follows: assaults 2956, road traffic accidents 2674, falls 664, hangings 67, animal injuries 42, sports injury 29 and other injuries 142. A total of 4207 operations were performed. The volumes per year were equivalent to those reported from the military surgical literature.

Conclusion

South Africa has sufficient burden of trauma to train combat surgeons. Each index case as identified from the military surgery literature has a sufficient volume in our center. Based on our work load, a 6-month rotation should be sufficient to provide exposure to almost all the major traumatic conditions likely to be encountered on the modern battlefield.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tai N, Hill P, Kay A, Parker P (2008) Forward trauma surgery in Afghanistan: lessons learnt on the modern asymmetric battlefield. J R Army Med Corps 154(1):14–18

    Article  CAS  PubMed  Google Scholar 

  2. Beekley AC, Watts DM (2004) Combat trauma experience with the United States Army 102nd forward surgical team in Afghanistan. Am J Surg 187(5):652–654

    Article  PubMed  Google Scholar 

  3. Nessen SC, Cronk DR, Edens J, Eastridge BJ, Little TR, Windsor J et al (2009) US Army two-surgeon teams operating in remote Afghanistan—an evaluation of split-based forward surgical team operations. J Trauma 66(4 Suppl):37–47. doi:10.1097/TA.0b013e31819ce302

    Article  Google Scholar 

  4. Brooks AJ, Ramasamy A, Hinsley D, Midwinter M (2009) Military general surgical training opportunities on operations in Afghanistan. Ann R Coll Surg Engl 91(5):417–419. doi:10.1308/003588409X432167

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rew DA, Clasper J, Kerr G (2004) Surgical workload from an integrated UK field hospital during the 2003 Gulf conflict. J R Army Med Corps 150(2):99–106

    Article  CAS  PubMed  Google Scholar 

  6. Rosenfeld JV (2010) How will we produce the next generation of military surgeons? Re: skill sets and competencies for the modern military surgeon: lessons from UK military operations in southern Afghanistan. Injury 41(5):435–436. doi:10.1016/j.injury.2010.01.004

    Article  PubMed  Google Scholar 

  7. Hight RA, Salcedo ES, Martin SP, Cocanour CS, Utter G, Galante JM (2015) Level I academic trauma center integration as a model for sustaining combat surgical skills: the right surgeon in the right place for the right time. J Trauma Acute Care Surg 78(6):1176–1181. doi:10.1097/TA.0000000000000649

    Article  PubMed  Google Scholar 

  8. http://bulletin.facs.org/2016/01/highlights-of-clinical-congress-2015/

  9. Ramasamy A, Hinsley DE, Edwards DS, Stewart MP, Midwinter M, Parker PJ (2010) Skill sets and competencies for the modern military surgeon: lessons from UK military operations in southern Afghanistan. Injury 41(5):453–459. doi:10.1016/j.injury.2009.11.012

    Article  PubMed  Google Scholar 

  10. Poon H, Morrison JJ, Apodaca AN, Khan MA, Garner JP (2013) The UK military experience of thoracic injury in the wars in Iraq and Afghanistan. Injury 44(9):1165–1170. doi:10.1016/j.injury.2013.01.041

    Article  CAS  PubMed  Google Scholar 

  11. Willy C, Hauer T, Huschitt N, Palm HG (2011) “Einsatzchirurgie”—experiences of German military surgeons in Afghanistan. Langenbecks Arch Surg 396(4):507–522. doi:10.1007/s00423-011-0760-4

    Article  PubMed  Google Scholar 

  12. Bonnet S, Gonzalez F, Poichotte A, Duverger V, Pons F (2012) Lessons learned from the experience of visceral military surgeons in the French role 3 Medical Treatment Facility of Kabul (Afghanistan): an extended skill mix required. Injury 43(8):1301–1306. doi:10.1016/j.injury.2012.03.002

    Article  CAS  PubMed  Google Scholar 

  13. Hoencamp R, Vermetten E, Tan EC, Putter H, Leenen LP, Hamming JF (2014) Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan. Injury 45(7):1028–1034. doi:10.1016/j.injury.2014.02.012

    Article  PubMed  Google Scholar 

  14. Hoencamp R, Tan EC, Idenburg F, Ramasamy A, van Egmond T, Leenen LP, Hamming JF (2014) Challenges in the training of military surgeons: experiences from Dutch combat operations in southern Afghanistan. Eur J Trauma Emerg Surg 40(4):421–428. doi:10.1007/s00068-014-0401-z

    Article  CAS  PubMed  Google Scholar 

  15. Hoencamp R, Idenburg FJ, Hamming JF, Tan EC (2014) Incidence and epidemiology of casualties treated at the Dutch role 2 enhanced medical treatment facility at multinational base Tarin Kowt, Afghanistan in the period 2006–2010. World J Surg 38(7):1713–1718. doi:10.1007/s00268-014-2462-x

    Article  PubMed  Google Scholar 

  16. Hoencamp R, Idenburg F, Vermetten E, Leenen L, Hamming J (2014) Lessons learned from Dutch deployed surgeons and anesthesiologists to Afghanistan: 2006–2010. Mil Med 179(7):711–716. doi:10.7205/MILMED-D-13-00548

    Article  PubMed  Google Scholar 

  17. Kong VY, Clarke DL (2016) Analysis of 5 years of morbidity and mortality conferences in a metropolitan South African trauma service. S Afr Med J 106(7):695–698. doi:10.7196/SAMJ.2016.v106i7.10549

    Article  PubMed  Google Scholar 

  18. Clarke DL, Furlong H, Laing GL, Aldous C, Thomson SR (2013) Using a structured morbidity and mortality meeting to understand the contribution of human error to adverse surgical events in a South African regional hospital. S Afr J Surg 51(4):122–126. doi:10.7196/sajs.1537.0.57

    Article  PubMed  Google Scholar 

  19. Laing G, Bruce J, Skinner D, Allorto N, Aldous C, Thomson S, Clarke D (2015) Using a hybrid electronic medical record system for the surveillance of adverse surgical events and human error in a developing world surgical service. World J Surg 39(1):70–79

    Article  PubMed  Google Scholar 

  20. Laing GL, Bruce JL, Skinner DL, Allorto NL, Clarke DL, Aldous C (2014) Development, implementation and evaluation of a hybrid electronic medical record system specifically designed for a developing world surgical service. World J Surg 38(6):1388–1397. doi:10.1007/s00268-013-2438-2.2.35

    Article  CAS  PubMed  Google Scholar 

  21. Laing GL, Skinner DL, Bruce JL, Aldous C, Oosthuizen GV, Clarke DL (2014) Understanding the burden and outcome of trauma care drives a new trauma systems model. World J Surg 38(7):1699–1706. doi:10.1007/s00268-014-2448-8.2.35

    Article  CAS  PubMed  Google Scholar 

  22. Kong VY, Oosthuizen GV, Sartorius B, Keene CM, Clarke DL (2015) Correlation between ATLS training and junior doctors’ anatomical knowledge of intercostal chest drain insertion. Surg Educ 72(4):600–605. doi:10.1016/j.jsurg.2015.01.022

    Article  Google Scholar 

  23. Kong VY, Odendaal J, Sartorius B, Clarke D (2015) International medical graduates in South Africa and the implications of addressing the current surgical workforce shortage. S Afr J Surg 53(3–4):11–14

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, 719 Umbilo Rd, Durban, South Africa

    H. Uchino, V. Y. Kong, G. V. Oosthuizen, J. L. Bruce, W. Bekker, G. L. Laing & D. L. Clarke

  2. Department of Surgery, University of the Witwatersrand, 7 York Rd, Johannesburg, South Africa

    D. L. Clarke

Authors
  1. H. Uchino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Y. Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. V. Oosthuizen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. L. Bruce
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Bekker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. L. Laing
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. L. Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. L. Clarke.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uchino, H., Kong, V.Y., Oosthuizen, G.V. et al. Can We Train Military Surgeons in a Civilian Trauma Center?. World J Surg 42, 26–31 (2018). https://doi.org/10.1007/s00268-017-4149-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4149-6

Search

Navigation