FALLS CHURCH, Virginia -- Army Medicine is building partnerships to maintain the world-class trauma and surgical expertise developed during operations in Iraq and Afghanistan but is being lost because of reduced practice as U.S. combat injuries decline.
History has shown that during periods of relative peace, military medicine's ability to ramp up in the early months of a new trauma-producing conflict is slow. Individual and collective trauma skills degrade without the intense focus of wartime medicine, and the experience gained from combat medicine matures the necessary knowledge, skills, and abilities of trauma surgeons. This experience helps save the lives of the Soldiers we are committed to support, said Col. Lance Raney, the current Deputy Medical Corps Chief.
Raney is the lead for the Army Surgical Readiness Task Force established by Lt. Gen. R. Scott Dingle, the Army Surgeon General and Commanding General of the U.S. Army Medical Command, more than 1 year ago.
Regarding surgical readiness, Dingle stated, “Providing the highest quality trauma surgery to those in combat is an absolute no-fail mission. We must ensure our surgical teams are ready today, and we must sustain that readiness whether we are at peace or at war."
To ensure that critical wartime medical skills do not degrade, the Task Force set forth several initiatives to specifically address the high-risk area of trauma surgery.
Raney describes these initiatives as the result of collaborative efforts by DOD and civilian medical experts in operational medicine, trauma surgery, medical training and simulations, leader development, and talent management. The initiatives focused on defining and assessing required individual critical tasks (ICTs), developing a program to centrally manage surgeons, and increasing the scope and scale of trauma-training.
Individual Critical Task Lists
As medicine continues to evolve, the Army monitors and enhances readiness to meet both daily practice and expeditionary requirements, Raney said. Army Medicine has developed and published individual critical task lists, or ICTLs, for all officer and enlisted personnel assigned to operational units. The development of ICTLs facilitates a realistic assessment of an individual's current level of readiness and supports the ability to assess whether a training program or platform provides the necessary experience to promote and sustain medical readiness.
ICTLs provide a tool to ensure Army Medicine surgeons are receiving the experience needed for surgery on the battlefield. ICTs are refined over time as medical leaders continuously assess the skills necessary in the operational environment, and how they should be implemented across a range of military occupational specialties, Raney said.
Centralized Management of Personnel
The Army has also developed a program to centrally manage trauma surgery personnel and assets through the Centralized Management of Critical Wartime Specialties Initiative, Raney said.
The Centralized Management Program assigns the majority of Army surgeons under U.S. Army Medical Command to optimize skill sustainment, readiness, and availability for deployment. This effort involves a partnership between the Army Medical Command, U.S. Army Forces Command, and U.S. Army-Europe to proactively manage readiness and align trauma-trained and experienced surgeons against both known and unanticipated requirements, Raney said.
“This is a big change in terms of how we manage our surgeons,” he added. “Central management allows us to leverage multiple platforms to ensure our surgeons are optimally trained and ready for their mission. To maintain and improve our surgeons’ skillsets requires coordination across military, civilian, and academic centers.”
Military – Civilian Trauma Center Partnerships
Maintaining the trauma expertise of Army Medicine surgeons requires they work in busy trauma centers, performing trauma-related surgeries on a regular basis. The DOD has only one Level I Trauma Center, Brook Army Medical Center. To increase trauma workload, Army Medicine established the Army Military-Civilian Trauma Team Training Program, or AMCT3.
The military-civilian partnerships with civilian level I trauma centers greatly increases the ability to sustain trauma skillsets through real-world, hands-on experience in some of the busiest trauma institutions in the United States.
Partnerships currently exist with seven civilian centers, and additional centers will be added during the next year. Army Medicine surgeons are assigned to those civilian medical centers and work as part of their trauma staff. More than 30 Army personnel have already participated in the program, and significant growth in partnerships and in assigned personnel are expected over the next 2 years.
Current partners include Cooper University Hospital, Camden, New Jersey; Oregon Health and Science University, Portland, Oregon; the Medical College of Wisconsin, Milwaukee, Wisconsin; Vanderbilt University Medical Center, Nashville, Tennessee; Harborview Medical Center, Seattle, Washington; the University of Chicago Medical Center, Chicago, Illinois; and the University of North Carolina Medical Center, Chapel Hill, North Carolina.
COL Raney said the Task Force continues to meet regularly and is currently targeting improvements in recruiting, retention, and surgical leader development.