Abstract Journal Military Surgery

Abstract

Journal Military Surgery MS001 WHAT SURGICAL CAPABILITY IS REQUIRED IN A FORWARD OPERATING BASE IN A COMBAT ZONE? JEFFREY V. ROSENFELD Monash University, VIC The military trauma system requires flexibility depending on geography, tempo of battle, resupply and method and speed of evacuation etc. In combat zones, a Forward Operating Base (FOB) is frequently set up. A surgical capability is usually established within the FOB (Forward Surgical Team/Troop [FST]) (NATO Role 2E) so that initial wound surgery (IWS) can be as proximate to the point of injury as is feasible. This was the situation for the Battle for Mosul, Iraq in 2017. This facility was manned by a single highly trained trauma team consisting of a trauma general surgeon, anaesthetist, emergency physician, and combat medic staff. The surgical capability included Decontamination/Resuscitation/Damage Control torso and limb surgery, laparotomy, thoracotomy, vascular injury control (shunts), aortic balloon (REBOA), wound debridement, and external fixation of fractures. No CT is available, there is a limited sterilizing capability and constraints on resupply. It has a limited holding capacity and no ICU. There is minimal if any requirement for neurosurgery or ICP monitoring. There is rapid evacuation of casualties to a field hospital (NATO Role 3) which has specialty surgery and can reoperate to further stabilize the injured. The FST is a transient tented facility which can set up rapidly and move on rapidly when required. The FST is a vital element of the military trauma system. The FST saves many who would likely have died if their surgery was delayed. The difference between the FST and larger Role 2E or Role 3 facilities will be highlighted. Some case examples will be presented to illustrate the capability of the FST. MS002 THE ENDOVASCULAR APPROACH TO VASCULAR TRAUMA IN WARFARE BEATRICE KUANG AND JOSEPH DAWSON Royal Adelaide Hospital, SA During World War I and II, retrieval times of 10 hours from the combat zone resulted in the injured expiring from shock and uncontrolled haemorrhage prior to hospital arrival. Expedited transfers of the injured to military hospitals was enabled by Mobile Army Surgical Hospitals (MASH) in the Korean War and helicopter ambulances (medevacs) in the Vietnam War. In 1954, Lieutenant Colonel Carl W. Hughes first described the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) on two moribund Korean War casualties with uncontrolled intra-abdominal haemorrhage. Whilst both patients died, the blood pressure was temporarily restored in one of the patients. During the Afghanistan and Iraq wars, US endovascular trained providers were deployed for the first time. In this austere environment, a limited trauma-specific endovascular inventory was developed, and which allowed for treatment with covered stents, snare retrieval of missile emboli, and coil embolization of pelvic fracture vessels, solid organ injuries and pseudoaneurysms. The Joint Trauma System and its Combat Casualty Care Research Program by the US military during the Afghanistan and Iraq wars has provided evidence-based information for management of haemorrhage. The translation of this knowledge from the military to the civilian sector has been integral for guiding the management of haemorrhage in major metropolitan trauma centres, including the reemergence of REBOA for massive haemorrhage control. MS003 A POX DOCTOR’S CLERK (UP TO THE VIETNAM WAR) PHILIP SHARP, TERRY KELLY AND PHILIP SHARP