Mobile Surgical Units Prevent Delays In Treating Wounded Combat Patients In Iraq

Warfare used by the U.S. Marine Corps (U.S.M.C.) involves moving rapidly to reach military targets. Although effective, these tactics often result in traveling hundreds of miles away from surgical units, according to background information in the article. To avoid severe delays in critically injured Marines reaching surgical aid, the U.S.M.C. and U.S. Navy developed the Forward Resuscitative Surgery System (FRSS), small, mobile trauma surgical teams.

Lowell W. Chambers, M.D., of the First Medical Battalion/Naval Hospital Camp Pendleton, Calif., and colleagues examined the effectiveness of the FRSS during the invasion phase of the war. Ninety patients--30 U.S.M.C. and 60 Iraqis--were treated in the FRSS between March 21 and April 22, 2003. The FRSS was composed of two surgeons, an anesthesiologist, a critical care nurse, two surgical technicians, an independent duty corpsman or physician's assistant, and a basic corpsman. Only those requiring immediate care of life- or limb-threatening injuries were initially taken into the FRSS.

For Marines, the median [half-way] time from wounding to arrival at the FRSS was one hour, with a range of 15 minutes to 40 hours. Time of wounding was known in 35 of the 60 Iraqi patients, and they had a median time from wounding to arrival of two hours, with a range of 30 minutes to five days. A total of 149 procedures were performed by the six FRSS teams, with 21 patients identified as critical. Of treated injuries, 77 percent were penetrating and 64 percent occurred in patients' extremities. Seven U.S.M.C. patients developed complications due to their injuries; three confirmed deaths occurred in Iraqi patients treated in the FRSS.

"The KIA [killed in action] and DOW [died of wounds] rates of 13.5 percent and 0.8 percent, respectively, are lower than previous experiences, providing optimism that the FRSS works and is effective," the authors state. "The use of the FRSS allowed rapid access to surgical care from the point of wounding. The outcome for those treated at the FRSS was better than in previous conflicts, but the number of casualties treated was relatively small. The newly developed en route care system allowed the critically ill postoperative casualties to be transported to higher-level facilities and was vital to its success."

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(Arch Surg. 2005; 140: 26 – 32. Available post-embargo at www.archsurg.com.)