Biomedical subjects
Alec C Beekley
Publications and source records attributed to Alec C Beekley.
Lessons learned from modern military surgery.
The era of global terrorism and asymmetric warfare heralded by the September 11, 2001 attacks on the United States have blurred the traditional lines between civilian and military trauma. The lessons learned by physicians in the theaters of war, particularly regarding the response to mass casualties, blast and fragmentation injuries, and resuscitation of casualties in austere environments, likely resonate strongly with civilian trauma surgeons in the current era. The evolution of a streamlined trauma system in the theaters of operations, the introduction of an in-theater institution review board process, and dedicated personnel to collect combat casualty data have resulted in improved data capture and realtime, on-the-scene research.
From the combat medic to the forward surgical team: the Madigan model for improving trauma readiness of brigade combat teams fighting the Global War on Terror.
BACKGROUND: Medics assigned to combat units have a notable paucity of trauma experience. Our goal was to provide intense trauma refresher training for the conventional combat medic to better prepare them for combat casualty care in the War on Terror. MATERIALS AND METHODS: Our Tactical Combat Casualty Care Course (TC3) consisted of the following five phases: (1) One and one-half-day didactic session; (2) Half-day simulation portion with interactive human surgical simulators for anatomical correlation of procedures and team building; (3) Half-day of case presentations and triage scenarios from Iraq/Afghanistan and associated skills stations; (4) Half-day live tissue lab where procedures were performed on live anesthetized animals in a controlled environment; and (5) One-day field phase where live anesthetized animals and surgical simulators were combined in a real-time, field-training event to simulate realistic combat injuries, evacuation problems, and mass casualty scenarios. Data collection consisted of surveys, pre- and posttests, and after-action comments. RESULTS: A total of 1317 personnel participated in TC3 from October 2003 through May 2005. Over the overlapping study period from December 2004 to April 2005, 327 soldiers participated in the formal five-phase course. Three hundred four (94%) students were combat medics who were preparing for combat operations in Iraq or Afghanistan. Of those completing the training, 97% indicated their confidence and ability to treat combat casualties were markedly improved. Moreover, of those 140 medics who took the course and deployed to Iraq for 1 year, 99% indicated that the principles taught in the TC3 course helped with battlefield management of injured casualties during their deployment. CONCLUSION: The hybrid training model is an effective method for training medical personnel to deal with modern battle injuries. This course increases the knowledge and confidence of combat medics deploying and fighting the Global War on Terrorism.
United States military surgical response to modern large-scale conflicts: the ongoing evolution of a trauma system.
This article provides a brief description of the evolution of military trauma surgical care since Operation Desert Storm and the ongoing evolution of the trauma system in Operation Iraqi Freedom.
Extremity vascular injuries on the battlefield: tips for surgeons deploying to war.
BACKGROUND: Recent events have refocused attention on certain principles regarding the surgical management of casualties on the battlefield. Extremity vascular injuries predominate, representing 50 to 70% of all injuries treated during Operation Iraqi Freedom, and exsanguination from extremity wounds is the leading cause of preventable death on the modern battlefield. Recent advances in military medicine have translated into a greater percentage of wounded soldiers surviving during Operations Enduring and Iraqi Freedom than in any other previous American conflict. The combat-experienced military surgeon, a fraction of those in uniform until recently, rarely has had the opportunity to convey lessons learned to the newly indoctrinated war surgeon. The purpose of this review is to do exactly that. METHODS: We collectively reviewed the experience and opinions of five U.S. Army surgeons with regard to management of extremity vascular injuries in a combat zone RESULTS: The modern battlefield has a staunch reputation of being unclean, noisy, and lacking of valuable resources. High-kinetic energy injuries such as those resulting from high explosives, munitions, and high-velocity missiles often cause soft-tissue destruction that is not routinely seen in civilian settings. Military-specific considerations in the management of these injuries are reviewed. CONCLUSIONS: The management of extremity vascular injuries on the modern battlefield presents many unique and demanding challenges to even the most seasoned of surgeons. Preparation goes a long way in overcoming some of the obstacles to seamless patient care.
Combat trauma experience with the United States Army 102nd Forward Surgical Team in Afghanistan.
BACKGROUND: The United States Army 102nd Forward Surgical Team (FST) was deployed to Kandahar Airfield, Afghanistan, from August 2002 to March 2003, in support of Operation Enduring Freedom. The unit's primary mission was to provide trauma surgical support to units of the 101st and 82nd Airborne Divisions, to coalition special operations units, and to allied Afghan militia forces. The FST's mission was expanded to include humanitarian assistance. METHODS: The mission was accomplished in the austere environment of Kandahar Airfield, Afghanistan. The FST was set up in a corner of the abandoned Kandahar International Airport terminal. The team's supporting facility was a 44-bed combat support hospital at Bagram Airbase near Kabul. Patients arrived by ground ambulance, local transportation, and MediVac helicopter. Evacuation of casualties, when necessary, was by fixed-wing aircraft. Patient data were retrospectively reviewed. RESULTS: The team performed 112 surgeries on 90 patients during the course of 7 months. Three patients were female (all children). Twenty patients were <19 years old. Trauma accounted for 78% of cases; the remainders were nontrauma or elective cases. Sixty-seven percent of these surgeries were performed on Afghan militia and civilians, 30% on United States soldiers, and 3% on other coalition forces. Mechanism of injury included gunshot wounds (34%), blasts (18%), motor vehicle crashes (14%), stab wounds (5%), and other trauma (7%). By physiological system, the trauma cases were broken down into extremity (44%), head and neck (17%), multisystem (13%), trunk (8%), and vascular (3%). CONCLUSIONS: "Damage control" operations necessitating multiple trips to the operating room were the norm. Hypothermia from blood loss was often exacerbated by exposure before evacuation and prolonged transport in helicopters. This was aggressively treated with passive, conductive, and active rewarming techniques. Stabilization and evacuation to higher echelons of care was common.