Management of trauma cases at a forward surgical center in a counter-insurgency Ops

Abstract

Introduction: Forward surgical centers (FSCs) provide combat medical support to troops in the field. They comprise a surgical team with radiology and laboratory services. Methodology: Two years data from a single FSC located in a counter-insurgency operational zone were recorded and analyzed on several parameters. The admission and discharge registers, operation theater records of surgery and anesthesia, and the fatal case records were used as data sources. Results: About 60% of the trauma cases were penetrating trauma. The most common region of the body that was injured was the extremities mainly upper limbs. The torso injuries were less than expected presumably due to the use of body armor. Majority of the cases were priority 2 cases requiring urgent surgery. Fifty percent of cases required general anesthetic and the remaining were done under neuraxial blockade or regional or local anesthesia. Eight percent of cases required blood transfusion at the FSC. As banked blood was not readily available, the FSC relied on fresh whole blood. Forty-nine percent of the operated cases were discharged from the FSC without needing transfer to the rear. In 85% of the cases, the surgical team was able to perform definitive surgery. Forty-seven percent of cases were transferred to the next level of surgical care. The overall survival of the trauma cases received at the FSC was 97.12% with a mortality of 2.88%. The leading cause of death was head and chest injuries. The results of this study are comparable to the results of the American experience in Iraq and Afghanistan. Conclusion: This study analyzes the data from a FSC to provide an analysis of the surgical case load in a counterinsurgency area. In spite of multiple limitations, the FSC provided definitive surgery to more than 85% of the trauma cases. The remaining 15% received emergency surgery and were later transferred to the next higher medical facility for superspecialty treatment. About half the number of patients were discharged from the FSC, implying that the true picture of combat trauma should be assessed at the level of FSC and not a referral/zonal hospital.