Competency-based vascular surgery training for austere conditions

Prompt evaluation and management of penetrating vascular injuries are crucial responsibilities for surgical teams supporting military operations. Recommendations in this work are drawn from studies and experiences of veteran surgeons from the Global War on Terrorism and nongovernmental organizations like the Global Surgical and Medical Support Group, which operates in austere conditions during conflicts in Iraq and Ukraine. Modern warfare, since the Vietnam War, has fostered advancements in combat casualty care, including prehospital tourniquets, damage control resuscitation, arterial balloon occlusion, and improved diagnostic imaging, resulting in greater than 92% survival and reduced amputation rates. However, conflicts with near-peer adversaries, like China and Russia, may challenge the delivery of skilled surgical care on modern battlefields. This article outlines the essentials for delivering competent vascular surgery in austere environments.