The experience of the US Marine Corps' Surgical Shock Trauma Platoon with 417 operative combat casualties during a 12 month period of operation Iraqi Freedom.
BACKGROUND
The Forward Resuscitative Surgical System (FRSS) is a small, mobile trauma surgical unit designed to support modern US Marine Corps combat operations. The experience of two co-located FRSS teams during 1 year of service in Operation Iraqi Freedom is reviewed to evaluate the system's efficacy.


METHODS
Between March 1, 2004, and February 28, 2005, two FRSS teams and a shock trauma platoon were co-located in a unit designated the Surgical Shock Trauma Platoon (SSTP). Data concerning patient care before and during treatment at the SSTP was maintained prospectively. Prospective determination of outcomes was obtained by e-mail correspondence with surgeons caring for the patients at higher echelons. The Los Angeles County medical center (LAC) trauma registry was queried to obtain a comparable data-base with which to compare outcomes.


RESULTS
During the year reviewed there were 895 trauma admissions to the SSTP. Excluding 25 patients pulseless on arrival and 291 minimally injured patients, 559 of 579 (97%) combat casualties survived; 417 casualties underwent 981 operative procedures in the two SSTP operating shelters. There were 79 operative patients with a mean injury severity score of 26 (range, 16-59) and mean revised trauma score of 6.963 (range, 4.21-7.841) who had sustained severe injuries. Ten (12.7%) of these casualties died while 43 of 337 (12.8%) deaths were seen with comparable cases treated at LAC.


CONCLUSIONS
Small task-oriented surgical units are capable of providing effective trauma surgical care to combat casualties. Further experience is needed to better delineate the balance between early, forward-based surgical intervention and more prolonged initial casualty evacuation to reach more robust surgical facilities.
Chambers
Lowell W
LW
Department of Surgery, 1st Medical Battalion/Naval Hospital Camp Pendleton, California 92055-5191, USA.
Green
D J
DJ
Gillingham
Bruce L
BL
Sample
Kenneth
K
Rhee
Peter
P
Brown
Carlos
C
Brethauer
Stacy
S
Nelson
Thomas
T
Narine
Nalan
N
Baker
Bruce
B
Bohman
H R
HR
D000328:Adult; D016022:Case-Control Studies; D017598:Efficiency, Organizational; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006775:Hospitals, Packaged / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007493:Iraq; D008297:Male; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015996:Survival Rate; D015599:Trauma Severity Indices; D014218:Triage / Q000458:organization & administration; D014481:United States / Q000453:epidemiology; D014857:Warfare; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*