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Jennifer M Gurney1, Matthew D Tadlock, Bradley A Dengler
1From the Joint Trauma System (J.M.G., R.S.K., J.C.G., B.J.S., S.D.J.), DoD Center of Excellence for Trauma, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (M.D.T.), Navy Medical Center San Diego, San Diego, California; Department of Neurosurgery (B.A.D.), Walter Reed National Military Medical Center, Bethesda, Maryland; US+UAE Trauma (B.J.G.), Burn, and Rehabilitative Medicine Mission; Department of Surgery (M.S.D.) and Department of Neurosurgery (M.S.D.), Womack Army Medical Center, Fort Bragg, North Carolina; Uniformed Service University of Health Sciences (J.B.H., R.S.K., J.W.C., M.J.E., M.A.S., M.J.M.), Bethesda, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery (J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; Department of Surgery (L.C.B.), Madigan Army Medical Center, Joint Base Lewis-McChord, Washington; Department of Trauma, Surgical Critical Care and Emergency Surgery (J.W.C.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; 1st Medical Battalion (T.E.), 1st Marine Logistics Group, Oceanside, California; Division of Trauma (J.C.G., B.J.S.), Brooke Army Medical Center, Joint Base San Antonio, San Antonio, Texas; Traumatic Brain Injury Center of Excellence (TBICoE) (D.W.M.), Silver Spring, MD; General Dynamics Information Technology (D.W.M.), Falls Church, VA; Division of Acute Care Surgery Joint Medical Unit (M.J.E.), University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; Oregon Health and Science University (M.A.S.), Portland, Oregon; DoD Combat Casualty Care Research Program (T.M.P.), US Army Medical Research and Development Command, Fort Detrick, Maryland; Division of Trauma and Acute Care Surgery, Department of Surgery (M.J.M.), Los Angeles County + USC Medical Center, Los Angeles, California; Division of Surgery, Department of Neurosurgery (B.A.J.), University of Arizona School of Medicine, Tucson, Arizona; Department of Neurological Surgery (A.V.), University of Texas Southwestern Medical Center, Dallas, Texas; and American College of Surgeons Committee on Trauma (J.D.K.).
Background:
Experiences over the last three decades of war have demonstrated a high incidence of traumatic brain injury (TBI) resulting in a persistent need for a neurosurgical capability within the deployed theater of operations. Despite this, no doctrinal requirement for a deployed neurosurgical capability exists. Through an iterative process, the Joint Trauma System Committee on Surgical Combat Casualty Care (CoSCCC) developed a position statement to inform medical and nonmedical military leaders about the risks of the lack of a specialized neurosurgical capability.
Methods:
The need for deployed neurosurgical capability position statement was identified during the spring 2021 CoSCCC meeting. A triservice working group of experienced forward-deployed caregivers developed a preliminary statement. An extensive iterative review process was then conducted to ensure that the intended messaging was clear to senior medical leaders and operational commanders. To provide additional context and a civilian perspective, statement commentaries were solicited from civilian clinical experts including a recently retired military trauma surgeon boarded in neurocritical care, a trauma surgeon instrumental in developing the Brain Injury Guidelines, a practicing neurosurgeon with world-renowned expertise in TBI, and the chair of the Committee on Trauma.
Results:
After multiple revisions, the position statement was finalized, and approved by the CoSCCC membership in February 2023. Challenges identified include (1) military neurosurgeon attrition, (2) the lack of a doctrinal neurosurgical capabilities requirement during deployed combat operations, and (3) the need for neurosurgical telemedicine capability and in-theater computed tomography scans to triage TBI casualties requiring neurosurgical care.
Conclusion:
Challenges identified regarding neurosurgical capabilities within the deployed trauma system include military neurosurgeon attrition and the lack of a doctrinal requirement for neurosurgical capability during deployed combat operations. To mitigate risk to the force in a future peer-peer conflict, several evidence-based recommendations are made. The solicited civilian commentaries strengthen these recommendations by putting them into the context of civilian TBI management. This neurosurgical capabilities position statement is intended to be a forcing function and a communication tool to inform operational commanders and military medical leaders on the use of these teams on current and future battlefields.
Level Of Evidence:
Prognostic and Epidemiological; Level V.
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