Variability of Value of Trauma Centers to General Surgery Combat Casualty Care Skill Sustainment

Objective: Military-civilian partnerships for the maintenance of trauma readiness skills will be required to maintain skills in preparation for future combat casualty care operations. There is little data describing relative worth of potential partnerships. This study aims to demonstrate that quantitative and qualitative differences are prevalent between trauma centers.

Design: A combat casualty care relevant case (CCC-RC) was determined to be one that was open, urgent, and required a blood transfusion. Total number of urgent trauma cases and number of cases requiring transfusions between January 1, 2017 and January 1, 2019 were tallied at Saint Louis University Hospital (ACS Level 1), San Antonio Military Medical Center (ACS Level 1), Madigan Army Medical Center (Washington Level 2), and William Beaumont Army Medical Center (Texas Level 3). At the participating level 1 trauma centers, cases were segregated by surgeon.

Setting: Saint Louis University Hospital (SLU), San Antonio Military Medical Center (SAMMC), Madigan Army Medical Center (MAMC), and William Beaumont Army Medical Center (WBAMC).

Participants: All general surgery/trauma cases at participating hospitals between January 1, 2017 and January 1, 2019.

Results: A total of 267 of 721 trauma cases performed by trauma/general surgeons at SAMMC were CCC-RCs, at SLU 213 of 342, MAMC, 5 of 13, and at WBAMC 1 of 33. While SAMMC had the most cases, SLU had the highest ratio of cases that were CCC-RC (p < 0.0001). The average number of CCC-RCs of the top 5 surgeons at each level 1 institutions were 15.7 cases/year (60.5%) at SLU and 10.3 cases/year (33.6%) at SAMMC (p < 0.0001).

Conclusions: The CCC-RC definition is easily used to distinguish the value and relevancy of trauma centers to general surgeon combat casualty care readiness. The volume and proportions of relevant trauma are significantly different between trauma centers. The military trauma designated hospitals are currently inadequate to support all general surgeon readiness needs. Embedding surgeons at centers with high volumes or relevant cases is the optimum solution.