title: Initial experience of US Marine Corps forward resuscitative surgical system during Operation Iraqi Freedom.
abstract: OBJECTIVE
  Modern US Marine Corps (USMC) combat tactics are dynamic and nonlinear. While effective strategically, this can prolong the time it takes to transport the wounded to surgical capability, potentially worsening outcomes. To offset this, the USMC developed the Forward Resuscitative Surgical System (FRSS). By operating in close proximity to active combat units, these small, rapidly mobile trauma surgical teams can decrease the interval between wounding and arrival at surgical intervention with resultant improvement in outcomes.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Echelon 2 surgical units during the invasion phase of Operation Iraqi Freedom.
  
  
  METHODS
  Ninety combat casualties, consisting of 30 USMC and 60 Iraqi patients, were treated in the FRSS between March 21 and April 22, 2003.
  
  
  METHODS
  Tactical surgical intervention consisting of selectively applied damage control or definitive trauma surgical procedures.
  
  
  METHODS
  Time to surgical intervention and outcome following treatment in the FRSS.
  
  
  RESULTS
  Ninety combat casualties with 170 injuries required 149 procedures by 6 FRSS teams. The USMC patients were received within a median of 1 hour of wounding with the critically injured being received within a median of 30 minutes. Fifty-three USMC personnel were killed in action and 3 died of wounds for a killed in action rate of 13.5% and a died of wounds rate of 0.8% during the invasion phase of Operation Iraqi Freedom. All Marines treated in the FRSS survived.
  
  
  CONCLUSIONS
  The use of the FRSS in close proximity to the point of engagement during the initial, dynamic combat phase of Operation Iraqi Freedom prevented delays in surgical intervention of USMC combat casualties with resultant beneficial effects on patient outcomes.
authors.affiliation: Department of Surgery, First Medical Battalion/Naval Hospital Camp Pendleton, Camp Pendleton, Calif. 92055-5191, USA.
authors.forename: Lowell W
authors.initials: LW
authors.lastname: Chambers
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Baker
authors.forename: John
authors.initials: J
authors.lastname: Perciballi
authors.forename: Miguel
authors.initials: M
authors.lastname: Cubano
authors.forename: Michael
authors.initials: M
authors.lastname: Compeggie
authors.forename: Michael
authors.initials: M
authors.lastname: Nace
authors.forename: Harold R
authors.initials: HR
authors.lastname: Bohman
mesh_terms: D001753:Blast Injuries / Q000601:surgery; D006775:Hospitals, Packaged / Q000458:organization & administration*; D006801:Humans; D007493:Iraq; D008887:Military Medicine / Q000379:methods* / Q000458:organization & administration; D008889:Military Personnel; D009873:Operating Rooms / Q000458:organization & administration; D011481:Protective Clothing; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D014481:United States; D014857:Warfare; D014948:Wounds, Gunshot / Q000601:surgery