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Maintaining vascular trauma proficiency for military non-vascular surgeons
  1. Andrew Hall1,
  2. Iram Qureshi2,
  3. Kegan Brumagen3,
  4. Jacob Glaser4,5
  1. 1Surgery, 96th Medical Group, US Air Force Regional Hospital, Eglin AFB, Florida, USA
  2. 2Biomaterials and Epidemiology, Naval Medical Research Unit San Antonio, San Antonio, Texas, USA
  3. 3Surgery, Keesler Air Force Base, Biloxi, Mississippi, USA
  4. 4Austin Shock Trauma, St. David's South Austin Medical Center, Austin, Texas, USA
  5. 5Naval Medical Research San Antonio, San Antonio, Texas, USA
  1. Correspondence to Dr Andrew Hall; andrew.b.hall14.mil{at}mail.mil

Abstract

Background Vascular injuries in combat casualty patients are common and remain an ongoing concern. In civilian trauma centers, vascular surgeons are frequently available to treat vascular injuries. Within the military, vascular surgeons are not available at all locations where specialty expertise may be optimal. This study aims to determine if a visiting surgeon model, where a general surgeon can visit a civilian trauma center, would be practical in maintaining proficiency in vascular surgery.

Methods All vascular trauma relevant cases done by any surgical service were identified during a 2-year period at Saint Louis University Hospital between October 1, 2016 and September 30, 2018. These included cases performed by trauma/general, thoracic, vascular, and orthopedic surgery. Predictions on the number of call days to experience an operative case were then calculated.

Results A total of 316 vascular cases were performed during the time period. A surgeon on call for five 24-hour shifts would experience 2.1 urgent vascular cases with 95% certainty. To achieve five cases with 95% certainty, a surgeon would have to be on call for 34 24-hour shifts.

Discussion A visiting surgeon model would be very difficult to maintain to acquire or maintain proficiency in vascular surgery. High-volume trauma centers, or centers with significant open vascular cases in addition to trauma, may have more reasonable time requirements, but would have to be evaluated using these methods.

Level of evidence Economic and value-based evaluations, level II.

  • general surgery
  • education
  • vascular system injuries
  • war-related injuries
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors AH contributed to design, data gathering, interpretation, and writing. IQ contributed to data analysis and writing. KB contributed to data gathering. JG contributed to data interpretation and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Air Force, the Department of Defense, or the US Government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The research was done using data obtained after non-human research determination at Saint Louis University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Data can be obtained through the Saint Louis University Hospital Trauma Registry.

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