title: Surgeon preparedness for mass casualty events: Adapting essential military surgical lessons for the home front.
abstract: Military surgeons have gained familiarity and experience with mass casualty events (MCEs) as a matter of routine over the course of the last two conflicts in Afghanistan and Iraq. Over the same period of time, civilian surgeons have increasingly faced complex MCEs on the home front. Our objective is to summarize and adapt these combat surgery lessons to enhance civilian surgeon preparedness for complex MCEs on the home front. The authors describe the unique lessons learned from combat surgery over the course of the wars in Afghanistan and Iraq and adapt these lessons to enhance civilian surgical readiness for a MCE on the home front. Military Damage Control Surgery (mDCS) combines the established concept of clinical DCS (cDCS) with key combat situational awareness factors that enable surgeons to optimally care for multiple, complex patients, from multiple simultaneous events, with limited resources. These additional considerations involve the surgeon's role of care within the deployed trauma system and the battlefield effects. The proposed new concept of mass casualty DCS (mcDCS) similarly combines cDCS decisions with key factors of situational awareness for civilian surgeons faced with complex MCEs to optimize outcomes. The additional considerations for a civilian MCE include the surgeon's role of care within the regional trauma system and the incident effects. Adapting institutionalized lessons from combat surgery to civilian surgical colleagues will enhance national preparedness for complex MCEs on the home front.
authors.affiliation: Military Deputy, Combat Casualty Care Research Program, Frederick, Maryland; Assistant Professor of Surgery, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Kyle N
authors.initials: KN
authors.lastname: Remick
authors.affiliation: Chief of Education and Performance Improvement, Joint Trauma System, US Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, Texas.
authors.forename: Stacy
authors.initials: S
authors.lastname: Shackelford
authors.affiliation: Assistant Professor of Surgery, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: John S
authors.initials: JS
authors.lastname: Oh
authors.affiliation: Deputy Commander for Surgical Services, Martin Army Community Hospital, Fort Benning, Georgia.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Seery
authors.affiliation: Navy Trauma Training Center, LAC+USC Medical Center, Los Angeles, California.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grabo
authors.affiliation: Director of Military Affairs, Department of Surgery, Cooper University Hospital, Camden, New Jersey.
authors.forename: John
authors.initials: J
authors.lastname: Chovanes
authors.affiliation: Director, Army Trauma Training Center, Miami, Florida.
authors.forename: Kirby R
authors.initials: KR
authors.lastname: Gross
authors.affiliation: Commander, US Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, Texas.
authors.forename: Shawn C
authors.initials: SC
authors.lastname: Nessen
authors.affiliation: Clinical Director, Trauma Services, Royal London Hospital and Barts Health NHS Trust, London, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
authors.forename: Nigel Rm
authors.initials: NR
authors.lastname: Tai
authors.affiliation: Defence Professor of Surgery, Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom; Honorary Consultant, Plastic and Reconstructive Surgeon Derriford Hospital, Plymouth, United Kingdom.
authors.forename: Rory F
authors.initials: RF
authors.lastname: Rickard
authors.affiliation: Professor and Chairman, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Eric
authors.initials: E
authors.lastname: Elster
authors.affiliation: Founding Chief (1987-2012), Division of Traumatology, Surgical Critical Care and Emergency Surgery, Penn Medicine, Philadelphia, Pennsylvania; Professor of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: C W
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D055826:Afghan Campaign 2001-; D000488:Allied Health Personnel; D002959:Civil Defense; D004189:Disaster Planning; D006801:Humans; D054542:Iraq War, 2003-2011; D054527:Mass Casualty Incidents; D008887:Military Medicine / Q000379:methods* / Q000458:organization & administration; D024802:Nurse's Role; D010819:Physician's Role; D024382:Professional Role; D066231:Surgeons; D014194:Traumatology / Q000379:methods* / Q000458:organization & administration; D014947:Wounds and Injuries / Q000601:surgery*