Jason B Brill, LCDR, MC, USN, James D Wallace, LCDR, MC, USN, Romeo C Ignacio, CAPT, MC, USN. Naval Medical Center San Diego
Objectives: A 1000-bed floating hospital, USNS Mercy (T-AH 19) has provided large-scale humanitarian aid (HA) throughout Southeast Asia. As the focus of these missions, designated Pacific Partnership (PP), is to provide low risk, high-yield surgical care, the experience in trauma is largely unknown. According to the World Health Organization, 15% of the global burden of disease is related to injury. Trauma-related deaths equal the annual mortality of tuberculosis, malaria, and AIDS, combined. We describe the trauma-related operations performed during PP missions in order to better prepare future missions in limited-resource countries.
Methods: Surgical case data were prospectively collected during the five USNS Mercy-led PP missions 2006-2015. Cases representing sequelae of trauma were retrospectively identified and categorized by year and specialty. Operations performed on US Navy warships or by non-governmental organizations were excluded. Standard statistical analysis was performed.
Results: Fifty-five deployed surgeons performed 3778 major and minor surgical cases. Of these cases, 266 (7.0%) were designated sequelae of trauma. Delayed burn care, the most common category encountered, included 124 (46.6% of 266) cases, followed by operative fixation of fractures at 96 (36.1%). Treatment directly involved each of the 10 surgical subspecialties on board. The highest operative volume in trauma was seen in orthopedics (127) and plastic surgery (111). The operative trauma volume did not vary significantly by year or country.
Conclusion: In areas with poor access to surgical care, sequelae of trauma continue to be sources of long-term disability. Even on short-term Navy HA missions designed around elective surgical care, traumatic injuries account for 7% of operative volume. All surgeons preparing for HA should be familiar with basic trauma care including the care of burns and fractures. As the priority of HA shifts to sustainment and capacity-building, education about trauma care in host nations should also take priority.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88789
Program Number: MSS14
Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations
Presentation Type: MSSPodium