Enhancing Combat Surgical Readiness: The Development and Impact of the Combat Craniomaxillofacial Trauma Surgery...

Craniomaxillofacial (CMF) trauma is significantly rising from drone delivered blasts in military and civilian settings. CMF traumatic injuries from airburst blasts present uniquely complex surgical challenges. The abrupt transmission and dissipation of energy causes barotrauma to the orbit, paranasal sinuses, tympanic membrane, inhalation injury, crush injuries, fractures and dislocations. High velocity projectiles cause deep lacerations, comminuted fractures, embedded foreign bodies, avulsion, degloving and other complex wounds. Surgical management is complicated by contamination, burns, progressive soft-tissue necrosis, and polytraumatic injuries. Opportunities for surgeons to acquire and maintain the abilities to manage these injuries are rare. We created a CMF trauma surgery course to assist with closing this training gap.

Tri-service military craniomaxillofacial surgeons (N = 52) ensured the accuracy of scope and performance requirements in the context of damage control trauma and prolonged field care in resource-limited environments. Performance objectives were written for surgeons with specialty training in otolaryngology, oral-maxillofacial surgery, and plastic surgery. Domain knowledge was measured using a 50-item case-based multiple-choice exam emphasizing reasoning, judgment, and decision-making tied to available resources, evacuation strategies, and patient holding times in various environments. A score of 80% was set as the benchmark. The standard for procedural performance objectives was independent and accurate completion of specified procedures, inclusive of pivotal judgments and surgical skills. Course resources were created to support multiple learning styles and be accessible on-demand for surgeons deployed around the world. All course resources critically reviewed for best practices and currency by 20 craniomaxillofacial trauma experts. Faculty members were selected based on key competencies including content and surgical expertise, and teaching and assessment abilities. Courses were implemented using online resources and face-to-face laboratory sessions to facilitate content presentations, case-based analyses, hands-on operative activities, and reflections about management strategies for these injuries in resource limited environments with extended prolonged care requirements. Course outcomes were determined with a purposive sample of military CMF surgeons from the United States and Canada (N = 42). Knowledge outcomes were determined using paired t-tests (P < .05). Procedural performance outcomes were determined using effect sizes (eta squared). Course evaluations were examined using non-parametric and qualitative analyses of 27 question responses from course participants.

There were significant gains in knowledge for all participants (P < .01). Post scores met the performance standard (80.00 ± 0.45). Effect sizes (eta squared) demonstrated procedural performance improvements: small (2 procedures), medium (5 procedures), large (1 procedure). Course evaluations were favorable for all scored elements. All participants reported the course was highly impactful for identifying and closing performance gaps in their abilities to manage traumatic CMF injuries.

The outcomes from this study demonstrate course related improvements in domain knowledge and procedural abilities for critical damage control and prolonged care CMF traumatic injuries, such as those incurred through drone delivered blasts. These outcomes add to the evidence that high quality pre-deployment training and assessment is critical for ensuring military surgeons are well-prepared to accurately and independently manage complex traumatic injuries to best care for those in harm's way.