Skill sets and competencies for the modern military surgeon: Lessons from UK military operations in Southern Afghanistan Arul Ramasamy *, David E. Hinsley, Daffyd S. Edwards, Michael P.M. Stewart, Mark Midwinter, Paul J. Parker Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, West Wing, Birmingham Research Park, Vincent Drive, Birmingham B5 1SQ, United Kingdom Introduction He who desires to practice surgery, must go to war. (Ambroise Pare ´ 1510–1590). 1 He who desires to go to war, must first learn war surgery. (2009) In the past 5 years, UK military forces have been heavily committed on operations in Afghanistan and Iraq. Unlike previous peacekeeping missions in the Balkans, the recent operational tours have seen a significant increase in medium intensity combat operations. This has resulted in an attendant increase in battle injuries. 17,21 Political and humanitarian requirements to treat the local military, police and indigenous civilian population have meant that the Defence Medical Services and in particular, the main surgical specialties are now exceptionally busy on opera- tional tours. Operation HERRICK (UK military operations in Afghanistan) began in 2002, when Britain provided soldiers to the International Security Assistance Force (ISAF). Helmand Province became the area of responsibility for a much larger British force in May 2006. It remains the scene of continued heavy fighting. Our UK deployment has been, and is currently medically supported by a dual-surgeon Field Surgical Team (1 consultant orthopaedic and 1 consultant general surgeon), as part of a 50- bedded medical treatment facility. This is standard UK practice. The hospital at Camp Bastion is the surgical resuscitation node for a Injury, Int. J. Care Injured xxx (2009) xxx–xxx ARTICLE INFO Article history: Accepted 23 November 2009 Keywords: War injuries Surgical training Field hospital Paediatric injuries Afghanistan Explosions Training courses ABSTRACT Introduction: British military forces remain heavily committed on combat operations overseas. UK military operations in Afghanistan (Operation HERRICK) are currently supported by a surgical facility at Camp Bastion, in Helmand Province, in the south of the country. There have been no large published series of surgical workload on Operation HERRICK. The aim of this study is to evaluate this information in order to determine the appropriate skill set for the modern military surgical team. Method: A retrospective analysis of operating theatre records between 1st May 2006 and 1st May 2008 was performed. Data was collated on a monthly basis and included patient demographics, operation type and time of operation. Results: During the study period 1668 cases required 2210 procedures. Thirty-two per cent were coalition forces (ISAF), 27% were Afghan security forces (ANSF) and 39% were civilians. Paediatric casualties accounted for 14.7% of all cases. Ninety-three per cent of cases were secondary to battle injury and of these 51.3% were emergencies. The breakdown of procedures, by specialty, was 66% (1463) orthopaedic, 21% (465) general surgery, 6% (139) head and neck, 5% (104) burns surgery and a further 4% (50) non-battle, non-emergency procedures. There was an almost twofold increase in surgical workload in the second year (1103 cases) compared to the first year of the deployment (565 cases, p < 0.05). Discussion: Surgical workload over the study period has clearly increased markedly since the initial deployment of ISAF forces to Helmand Province. A 6-week deployment to Helmand Province currently provides an equivalent exposure to penetrating trauma as 3 years trauma experience in the UK NHS. The spectrum of injuries seen and the requisite skill set that the military surgeon must possess is outside that usually employed within the NHS. A number of different strategies; including the deployment of trainee specialist registrars to combat hospitals, more focused pre-deployment military surgery training courses, and wet-laboratory work are proposed to prepare for future generations of surgeons operating in conflict environments. ß 2009 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +44 07968 147007. E-mail address: arul49@doctors.org.uk (A. Ramasamy). G Model JINJ-4145; No of Pages 7 Please cite this article in press as: Ramasamy A, et al. Skill sets and competencies for the modern military surgeon: Lessons from UK military operations in Southern Afghanistan. Injury (2009), doi:10.1016/j.injury.2009.11.012 Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury 0020–1383/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2009.11.012