The Importance of Medical Readiness Training Exercises: Maintaining Medical Readiness in a Low-Volume Combat Casualty Flow Era.

Abstract

Ringed external fixation has demonstrated promising results in the management of severe combat-related extremity injuries. The purpose of this study was to identify and compare rates of wartime-related surgical cases at times of high and low casualty time periods, and then compare these case numbers with those performed during a 2-week Medical Readiness Training Exercise (MEDRETE) in Honduras. A retrospective review was performed of patients treated at a single Military Treatment Facility with definitive ringed external fixators during a 2-year period of high-volume combat casualty flow (January 2009-December 2010) and a subsequent 2-year period of low-volume combat casualty flow (January 2013-December 2014). These data were then compared with cases performed over a 2-week period during a MEDRETE in 2011 to Honduras. Sixty-one cases were identified as having definitive treatment using ringed external fixation at the Military Treatment Facility during the high- and low-volume eras. During the high-volume era, 47 ringed external fixators were used as a definitive treatment. During the low-volume era, only 14 of the definitive ringed external fixation were identified. Of the 32 total cases performed during the 2-week MEDRETE to Honduras, 11 cases of definitive ringed external fixator placement were performed. This accounted for 34.4% of all cases performed during this 2-week period. Appropriately planned MEDRETEs can provide a concentrated case volume to allow maintenance of complex surgical skills related to the management of severe combat-related extremity injuries. These training exercises will be vital to maintain surgical skills during a low-volume combat casualty flow era.