Abstract
Background
To improve care for battle casualties, we analyzed the surgical workload during the Dutch deployment to Uruzgan, Afghanistan. This surgical workload was compared with the resident surgical training and the pre-deployment medical specialist program.
Methods
Patient data from the trauma registry (2006–2010) at the Dutch Role 2 Medical Treatment Facility (MTF) were analyzed. The case logs of chief residents (n = 15) from the general surgery training program in the Netherlands were used for comparison.
Results
The trauma registry query yielded 2,736 casualties, among whom 60 % (1,635/2,736) were classified as disease non-battle casualties and 40 % (1,101/2,736) as battle casualties. During the study period, 1,427 casualties (336 pediatric cases) required 2,319 surgical procedures. Each graduating chief resident handled an average of 1,444 cases, including 165 laparotomies, 19 major vessel repairs, 28 amputations, and 153 fracture stabilizations, during their residency. Residents had limited exposure to injuries requiring a thoracotomy, craniotomy, nephrectomy, IVC repair, or external genital trauma.
Conclusions
The injuries treated at the Dutch Role 2 MTF were often severe, and exposure to pediatric cases was much higher than reported for other combat hospitals in Iraq and in Afghanistan. The current civilian resident training does not equip the trainees with the minimally required competences of a fully trained military surgeon. The recognition in the Netherlands of military surgery as a subspecialty within general (trauma) surgery, with a formal training curriculum, should be considered. The introduction of a North Atlantic Treaty Organization Military (and Disaster) Surgery standard may facilitate the achievement of this aim.
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Acknowledgments
The authors acknowledge the Ministry of Defense for approving this protocol. In particular, we wish to thank LCOL DN Baalbergen for his logistical assistance.
Conflict of interest
Rigo Hoencamp, Edward Tan, FlorisIdenburg, Arul Ramasamy, Teun van Egmond, Luke Leenen, and Jaap Hamming declare that they have no conflict of interest.
Ethical standard
This study was approved by the appropriate ethics committee and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Ministry of Defense and the UK and Dutch governments. The authors are employees of the UK or Dutch government.
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Hoencamp, R., Tan, E.C.T.H., Idenburg, F. et al. Challenges in the training of military surgeons: experiences from Dutch combat operations in southern Afghanistan. Eur J Trauma Emerg Surg 40, 421–428 (2014). https://doi.org/10.1007/s00068-014-0401-z
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DOI: https://doi.org/10.1007/s00068-014-0401-z