Concurrent Surgical Care in an Austere Military Setting: A Preparation for Mass Casualty Events

The U.S. military utilizes small, forward deployed surgical teams to provide Role 2 surgical care in austere environments. These small teams are intended to be able to perform damage control resuscitation and surgery in the event of a mass casualty incident. Our team set out to demonstrate a proof of concept evolution by utilizing 2 operating rooms concurrently with a single certified registered nurse anesthetist and single surgeon to maximize the temporal efficiency of care by performing 4 elective surgical cases staggered in 2 rooms while deployed on an amphibious warship.

The surgical component of the Fleet Surgical Team is composed of a single general surgeon, a certified registered nurse anesthetist (acting as an independent practitioner), an operating room registered nurse, a critical care registered nurse, 5 surgical technicians, and 2 general duty corpsmen (consider these individuals roughly equivalent to a licensed practical nurse). Four elective surgical cases were selected to be performed on the USS Wasp while underway on the same date, divided between 2 adjacent operating suites to replicate the logistics of overlapping surgical care required during a mass casualty event.

The average surgical care overlap time during the 3 turnover periods was 33 min. The total time saved over the course of the 4 case day, when factoring in both surgical care overlap time and natural turnover time, was 2 h and 33 min.

In the setting of multiple injured combat patients, this time saved is enough for an additional damage control trauma operation. When time is the critical factor in preventing both morbidity and mortality, the ability of a deployed surgical team to coordinate concurrent surgical care is of paramount importance. This report can act as a template for future austere surgical teams who encounter multiple simultaneous surgical casualties.