MSSP446: VASCULAR EMERGENCY SURGERY: SIMULATED EXERCISES FOR LIMB SALVAGE (VESSELS): CURRICULUM NEEDS ASSESSMENT FOR DEPLOYED MILITARY GENERAL SURGEONS.
C Hickey, DO1; M Cole, MD2; W B Sweeney, MD FACS2; P Liacouras, PhD2; B R Franklin, MD MHPE FACS2; 1Navy Medical Readiness & Training Command Portsmouth; 2Walter Reed National Military Medical Center
INTRODUCTION: Lower and upper limb amputations are some of the most life-altering combat injuries sustained by our military personnel. From January 2001 through October 2017, a total of 1,705 service members suffered deployment-related amputations. These men and women were 21-29 years old with 1,914 lower and 302 upper limb amputations. Salvage of a limb saves someone from impaired mobility, abnormal physiology, and social effects of amputation and is, therefore, a needed skill to the deployed surgeon. We aim to create a vascular emergency surgery simulation curriculum for the general surgeon that encompasses vascular and limb-salvage techniques. The finalized curriculum will be used as part of a more extensive simulation program to provide needed training for the deployed surgeon.
METHODS: A targeted needs assessment of general and subspecialty surgeons was performed to identify vascular emergencies and procedures faced while deployed or without access to a vascular surgeon to guide curriculum development and create a simulation model. Collected data included years of experience, subspecialty, vascular emergencies encountered while deployed, previous vascular training opportunities, and whether additional preparation would have been helpful before deployment. These results will guide the development of a vascular simulation curriculum and vascular simulation models for the general surgeon.
RESULTS: Thirteen general and subspecialty surgeons were surveyed, including six junior (less than ten years of practice) and seven senior surgeons. Deployments without immediate access to a vascular surgeon ranged from 1-10, with one surgeon who has yet to deploy. Only one surgeon manages vascular emergencies in their current practice without assistance from a vascular subspecialist. While the majority (61.5%) participated in the cadaveric Advanced Surgical Skills for Exposure in Trauma (ASSET) course, vascular procedures while deployed are uncommon. We identified a need for further vascular surgical technical training, including vessel repair, vascular control, and shunt placement.
CONCLUSION: A needs assessment of military surgeons demonstrated a need for additional limb-salvage skills training. We will use this data to create a novel low-cost arterial model for a simulation vascular emergency surgery curriculum dedicated to limb salvage. This curriculum will be incorporated into the more extensive simulation course for pre-deployment training for the general surgeon.