Can We Train Military Surgeons in a Civilian Trauma Center?
AIMS This paper reports the surgical experience of a UK reserve field surgical hospital during military operations in Iraq during March and April 2003. Particular reference is given to the integration of the surgical specialities, consultant led and multidisciplinary teamworking in the treatment of military and civilian casualties from all sources and of all causes. METHODS All surgical workload data was collected prospectively for the warfighting (Phase One) and specialist referral (Phase Two) phases of the operation. Standard military and Red Cross protocols were used for all injuries and microbiology studies were undertaken for penetrating ballistic injuries. Operations were classified by anatomical region; upper or lower limb; head and neck; thoracic; abdominal, including genitourinary; ophthalmic; and burns, and by whether they were primary; secondary planned or secondary unplanned. RESULTS A wide range of patterns of wounding arising from combat and non-combat related military and civilian trauma and burns were seen and treated. 323 operations were performed. There were 116 operations in phase one and 207 operations in phase two. There were 160 primary procedures (new patients), 146 secondary planned and 17 unplanned procedures (range one to eight procedures per patient). Close integration of general, orthopaedic, plastic, maxillofacial, ophthalmic and neurological surgeons and general and ITU anaesthetists allowed the delivery of a range of specialist treatment to a heterogenous patient population, including children as young as 6 months and a lady in the advanced stages of pregnancy. CONCLUSIONS Patterns of wounding in casualties surviving to reach specialist field hospital care were similar to those reported in other high intensity conflicts. A consultant led, multidisciplinary approach with field intensive care facilities allowed combined, staged and safe surgery for complex, multi-organ and multi-limb trauma in an austere environment.