Transforming an academic military treatment facility into a trauma center: lessons learned from Operation Iraqi Freedom.
BACKGROUND
To manage the influx of patients with predominately extremity injuries from Operation Iraqi Freedom (OIF), our center was required to transform from a nontrauma academic hospital to a trauma hospital by using a multidisciplinary approach.


METHODS
A retrospective chart review was performed of casualties from OIF who were received over 14 months.


RESULTS
A total of 313 casualties were received. The average number of admissions was 16 per month, except during November 2004, when there were 88 admissions over 7 days. The mean ISS for all patients was 14.1 +/- 10.3. A total of 113 patients (36%) required admission to the intensive care unit for an average of 7.5 +/- 5.2 days. The mean interval between injury and arrival in the continental United States was 6.5 +/- 4.6 days. Most casualties suffered multisystem trauma, with extremity injuries predominating. The multidisciplinary approach to casualty care consisted of several meetings a week and included everyone involved in caring for these combat casualties.


CONCLUSIONS
A multidisciplinary approach transformed an existing medical center into a trauma receiving hospital capable of managing and maintaining a surge in patient admissions resulting in minimal morbidity and mortality. This model further supports a multidisciplinary approach to trauma care and could serve as a guideline for transforming existing medical centers into trauma receiving hospitals to deal with patient overflow in the event of future civilian mass casualties.
Elster
Eric A
EA
Department of Surgery, National Naval Medical Center, Bethesda, MD, USA. eric.elster@med.navy.mil
Pearl
Jonathan P
JP
DeNobile
John W
JW
Perdue
Philip W
PW
Stojadinovic
Alexander
A
Liston
William A
WA
Dunne
James R
JR
Mil Med. 2006 Jul;171(7):595-7
16895122
J Head Trauma Rehabil. 2007 Nov-Dec;22(6):377-89
18025970
Ann Surg. 2004 Mar;239(3):295-303
15075644
Ann Surg. 2004 Mar;239(3):304-10
15075645
Ann Emerg Med. 1999 Aug;34(2):160-7
10424916
N Engl J Med. 2004 Dec 9;351(24):2471-5
15590948
N Engl J Med. 2005 Jan 20;352(3):219-22
15659720
Arch Surg. 2005 Jan;140(1):26-32
15655202
J Trauma. 2004 Aug;57(2):201-7
15345962
Crit Care Med. 2005 Jan;33(1 Suppl):S48-52
15640679
Mil Med. 2005 Apr;170(4):268-72
15916291
Ann Surg. 2004 Mar;239(3):311-8
15075646
J Trauma. 2003 May;54(5):814-21
12777893
J Am Coll Surg. 2005 Jul;201(1):7-12; discussion 12-3
15978435
J Orthop Trauma. 2007 Apr;21(4):254-7
17414553
Ann Emerg Med. 2004 Feb;43(2):263-73
14747818