ACS-Military Health System Partnership focuses on surgeon readiness and sustaining trauma systems

Surgeon readiness is a priority for the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS) as the collaboration enters its second year of a three-year agreement, according to M. Margaret (Peggy) Knudson, MD, FACS, MHSSPACS Medical Director. Dr. Knudson is professor of surgery, University of California, San Francisco, and a trauma surgeon at San Francisco General Hospital and Trauma Center.

Dr. Knudson is the lead author of an article in the Journal of the American College of Surgeons that outlines the partnership’s work since its launch in October 2014 and the goals it continues to pursue.*

Development of a course

One of the MHSSPACS’ major focuses is the development of a curriculum for a pre-deployment course, which responds to concerns that the next generation of deployed military surgeons may lack the intensive trauma training required to care for troops injured in combat or victims of mass casualty events. When the Iraq and Afghanistan conflicts began, fewer than half of the surgeons deployed for the first time had received trauma-specific training. Most surgeons were within a year or two of completing their surgical residency training, and many had yet to achieve certification from the American Board of Surgery. At present, no standard surgical preparation is available to military surgeons who are being deployed, and most military surgeons are based at military health care facilities, which do not routinely provide training in trauma care.

“I see this course as being very applicable, not only to a military surgeon who’s being deployed, but it might be useful for a surgeon preparing for a humanitarian mission in an austere environment. They would need to know techniques that are a little different than those we use in training general surgeons right now,” Dr. Knudson said.

To initiate this process, a group of military surgeons with deployment experience will begin to compile a list of the skills and the knowledge base the surgeons consider essential for their colleagues facing deployment. A project manager/educator on staff, in turn, will develop a survey of all surgeons deployed in the last 15 years, Dr. Knudson said. Respondents will be asked to rank these skills in order of importance and frequency of use. Based on this blueprint, the Education Committee of the MHSSPACS will develop both curricula and methods for assessment.

“Our goal is to develop a course that will include both didactic and hands-on technical skills that will serve as the basis for predeployment preparation. If a surgeon being deployed cannot pass a certain skills station or fails a portion of the written exam, we will have the ability to provide the needed education,” Dr. Knudson said.

Between conflicts

The partnership’s second goal centers on ensuring that the military trauma system developed during the wars in Iraq and Afghanistan remains intact between conflicts. The Joint Trauma Theater System, established at the start of these wars, spans three continents and includes five levels of trauma center care, an aircraft-based intensive care unit, a trauma data registry, clinical practice guidelines, and a weekly worldwide performance improvement conference. The system produced the lowest wartime case fatality rate ever recorded, decreasing from 20 percent in 2005 to well below 10 percent in 2013, despite an increasing injury severity rate. This system has since evolved into the Joint Trauma System Defense Center of Excellence (JTS DoE). This entire system could disappear, however, unless steps are taken to preserve it. The Systems Committee of the ACS Committee on Trauma is scheduled to perform a formal review of the JTS DoE in order to assist in the identification of the elements necessary to sustain the JTS DoE between military conflicts.

Ongoing research

Research is the MHSSPACS’ third objective, according to Dr. Knudson, who noted the importance of research into matters that cannot be studied in a war zone. To boost the research arm of civilian trauma centers, Dr. Knudson joined colleagues at the National Trauma Institute and the newly formed Coalition for National Trauma Research to secure funding for 16 trauma research studies with grants from the Department of Defense (DoD). The authors noted that, despite being the second most expensive public health issue in the U.S., no research institute at the National Institutes of Health is dedicated to traumatic injury, and few non-DoD federal dollars are available for related research. Through the Combat Casualty Care Research Program, the DoD is the major funder of trauma research.

“The MHSSPACS will propose the value of a National Trauma Research Institute sustained by a more sizable, reliable, and enduring appropriations by both the DoD and non-DoD sources for trauma and injury research,” the authors wrote. Learn more about the MHSSPACS online.


*Knudson M, Elster E, Woodson J, et al. A shared ethos: The Military Health System Strategic Partnership with the American College of Surgeons. J Am Coll Surg. Available at: www.journalacs.org/article/S1072-7515(16)00226-X/fulltext. Accessed April 25, 2016.

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