• Andrew B Hall, Elizabeth Davis, Matthew Vasquez, Jaime Umberger, Matthew D Tadlock, Iram Qureshi, Avery Walker, Jacob Glaser, Hampton McClendon, and Jennifer M Gurney.
• From the Department of Surgery, 96 Medical Group, Eglin AFB, Florida (A.B.H., H.M.); Department of Surgery, William Beaumont Army Medical Center (E.D., A.W.), El Paso, Texas; Department of Surgery, Naval Hospital Camp Pendleton (M.V.), Camp Pendleton, California; Department of Surgery, Keesler Medical Center (J.U.), Biloxi, Mississippi; Department of Surgery, Naval Medical Center San Diego (M.D.T.), San Diego, California; Department of Surgery, Naval Medical Research Unit San Antonio (I.Q., J. Glaser), San Antonio, Texas; and Department of Surgery, Joint Trauma System and the US Army Institute of Surgical Research (J. Gurney), Defense Center of Excellence, San Antonio, Texas.
• J Trauma Acute Care Surg. 2020 Dec 1; 89 (6): 1054-1060.

BackgroundThe management of battlefield trauma requires a specific skill set, which is optimized by regular trauma experience. As military casualties from the prolonged conflicts in the Middle East decrease, challenges exist to maintain battlefield trauma readiness. Military surgeons must therefore depend on the Military Health System. The purpose of the study was to evaluate the frequency of surgical cases relevant to deployed combat casualty care performed at military treatment facilities (MTFs).MethodsCombat casualty care relevant cases (CCC-RCs) were defined as emergent, open surgical cases in which the patient required a blood transfusion. Case logs from four military treatment centers with surgical residency training programs were used. Twenty-four months of case records between January 1, 2017, and January 1, 2019, were included to determine total numbers of CCC-RCs at each institution. The results were compared with San Antonio Military Medical Center's, the Department of Defense's only American College of Surgeons-verified level 1 trauma center.ResultsFifty-one trauma/general surgeons and six vascular surgeons case logs were examined. Thirty (0.3%) of 10,529 cases performed by trauma/general and vascular surgeons over the 2-year study period were considered CCC-RCs. These results were in contrast to San Antonio Military Medical Center, which had a significantly higher proportion of CCC-RCs (113 of 320 cases, 35.3%, p < 0.0001).ConclusionA cross-section of MTF surgical case complexity demonstrates a lack of cases considered to be CCC-RCs. At the MTFs evaluated, surgical case surrogates for combat trauma and combat casualty care is close to zero. These data are potentially representative of other military treatment centers, which focus on beneficiary care. For readiness purposes, MTFs that care primarily for Tricare beneficiaries without a significant trauma population should not be considered meaningful sources of CCC-RCs for trauma/general and vascular surgeons.Level Of EvidenceTherapeutic/care management study, level V.

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