Looking forward – February 2015

David B. Hoyt

David B. Hoyt, MD, FACS

The military and surgery have long enjoyed a mutually beneficial relationship. Surgeons in combat areas have often uncovered new procedures and treatments, which they have brought back to the U.S. to improve civilian patient care. In the process, the troops fighting for our nation and patients throughout the world have benefited from the training that surgeons have received at U.S. medical centers prior to deployment to military hospitals. In an era of resident work-hour restrictions, an alarming increase in civilian mass casualty events, ongoing conflicts abroad, and rising demands for the efficient delivery of cost-effective, high-quality care, the need for a synergistic relationship between the American College of Surgeons (ACS) and the U.S. Department of Defense (DoD) Military Health System (MHS) has grown.

Thus, I am pleased to announce that the ACS and the MHS have entered into a strategic partnership designed to improve educational opportunities, systems-based practices, and research capabilities for both parties. This strategic alliance between the MHS and the ACS was solidified when Jonathan Woodson, MD, FACS, Assistant Secretary of Defense for Health Affairs, and I signed a charter at the 2014 Clinical Congress in San Francisco, CA. Officially known as the Military Health Service Strategic Partnership American College of Surgeons (MHSSPACS), the program launched in December 2014.

Origins of the MHSSPACS

Dr. Hoyt and Dr. Woodson

Dr. Hoyt (left) and Dr. Woodson signing the MHSSPACS charter.

The concept of the partnership originated a couple of years ago as a result of a conversation I had with U.S. Navy Captain Eric A. Elster, MD, FACS, chair and professor, Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD; and retired U.S. Marine Corps Colonel Norman M. Rich, MD, FACS, DMCC, founding chair of the department and namesake of the department of surgery at USUHS. With several members of the College’s leadership—Julie L. Freischlag, MD, FACS, Past-Chair, ACS Board of Regents; A. Brent Eastman, MD, FACS, FRCSEd(Hon), Past-President of the ACS; Michael F. Rotondo, MD, FACS, Past-Chair, ACS Committee on Trauma; and other surgeons—we agreed that the College and the military should collaborate on programs aimed at ensuring that the next generation of surgeons is prepared to provide optimal care to patients injured on and off the battlefield.

We reached out to Dr. Woodson to discuss the possibility of forming a strategic partnership. He agreed that maintaining and advancing clinical knowledge and skills are critical to the readiness of the MHS and that an affiliation with the ACS would positively affect care for patients who receive health care services through the MHS and the civilian health care system.

Under the charter, the MHS and the ACS have agreed to do the following:

  • Share information related to the curriculum used to teach military surgical skills through expansion of the ACS Advanced Surgical Skills for Exposure in Trauma course and other programs
  • Share information related to existing education offerings of importance to military and surgical communities that are interested in humanitarian and disaster response
  • Share information related to validation of the military’s Optimal Resources handbook
  • Share information related to potentially increasing the involvement of military surgeons in the ACS senior leadership program
  • Share information related to review of the DoD Combat Casualty Care Research Program
  • Share information on relevant research portfolios, including research conducted through the ACS National Trauma Data Bank® and Trauma Quality Improvement Program®
  • Plan a presentation of an ACS military surgeon symposium at the 2015 ACS Clinical Congress
  • Share information related to systems-based practice, including dissemination of surgical clinical practice guidelines and development of an optimal resources manual for surgical care
Dr. Hoyt and Dr. Woodson

Dr. Hoyt and Dr. Woodson.

The College’s activities related to this strategic partnership will be coordinated by Executive Services and the ACS Division of Member Services. M. Margaret “Peggy” Knudson, MD, FACS, professor of surgery, division of general surgery, San Francisco General Hospital and Trauma Center, University of California, San Francisco, has been recruited to coordinate this effort. Dr. Knudson noted, “The past 13 years of war, the longest in our nation’s history, have yielded unprecedented advances in combat casualty care with the resultant lowest died of wounds rate ever recorded. Through this partnership, training and education platforms, research endeavors, quality improvement programs, and combat readiness and disaster preparedness efforts will be jointly shared, benefiting surgical patients in the U.S. and throughout the world in both civilian and combat arenas.”

Building on the past, preparing for the future

As noted previously, the MHSSPACS is just the most recent addition to a long list of examples of cooperation between the ACS and the U.S. military. President Woodrow Wilson (D) appointed ACS Founder Franklin H. Martin, MD, FACS, to the Advisory Commission of the Council of National Defense to prepare for the U.S. involvement in World War I and called upon the College to assist in organizing a field hospital for the American Expeditionary Force. The College’s involvement in the Great War led to significant advances in patient care. A shortage of splinting materials led to use of the plaster orthopaedic cast for treating fractures, and lessons learned during the war led to the successful management of open chest wounds and empyema.

The Great Mace

Presentation of the Great Mace to the ACS by surgeons of Great Britain, 1920. From left: Sir William Taylor, KBE; George E. Armstrong, MD, FACS; Sir Moynihan; Albert Carless, CBE; and Francis A.C. Scrimger, VC.

In 1918, Sir Berkeley Moynihan, KCMG, CB, of the Royal College of Surgeons led a delegation to America to present the Great Mace to the ACS “in memory of mutual work and good fellowship in the Great War 1914–1918.” The Great Mace continues to be presented each year at the Convocation and is prominently displayed at the College’s headquarters to serve as a lasting reminder of this legacy.

The College’s involvement in World War II dates back to the bombing of Pearl Harbor. When traveling to examine and treat patients injured during the attack, Isidor S. Ravdin, MD, FACS, took with him a supply of albumin that he used to successfully treat seven severely burned patients. In 1942 through 1944, the College replaced its sectional meetings with War Sessions throughout the U.S. and Canada to train the many physicians and surgeons entering the Army in the care of combat injuries. Furthermore, as Theater Commander for Surgery in the Mediterranean in World War II, Colonel Edward D. Churchill, MD, FACS, developed the use of delayed primary closure and early debridement of contaminated wounds and improved the air evacuation process for wounded soldiers.

In addition, Past-Director of the ACS, Paul Hawley, MD, FACS(Hon), has been credited with drawing the blueprint for the U.S. Department of Veterans Affairs’ health care system. More recently, Landstuhl Regional Medical Center, a military hospital operated in Germany by the U.S. Army and the DoD, became the only medical center outside of the U.S. to achieve Level II Trauma Center verification status from the College. In 2011, it was verified as a Level I center.

All of the individual surgeons involved in launching this initiative anticipate that the MHSSPACS will result in even greater advances for all trauma and surgical patients. If you would like to get involved in this program, please let me know. Together, we can do much to improve the quality of care and quality of life for all Americans.

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