A growing partnership between the U.S. Department of Defense Military Health System and permanent civilian trauma institutions is under way creating, for the first time, a fully integrated military-civilian trauma system with the ability to train military surgeons prior to deployment, retain the critical skills of military surgeons while they’re deployed, and then bring lessons from the battlefield back home to enhance civilian trauma care.

The goals of the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS) are expanding civilian trauma centers as a critical resource for combat medical readiness and designing a collaborative process between trauma centers and the military to bolster civilian mass casualty and disaster response – to address the challenges facing military surgery and civilian trauma care.

These efforts were the focus of an MHSSPACS meeting held in December 2017, which brought together military personnel and representatives from civilian trauma centers. The deliberations of the meeting are now published as an “article in press” on the website of the Journal of the American College of Surgeons ahead of print.

MHSSPACS, launched in December 2014, is a strategic partnership between ACS and the Military Health System to facilitate collaboration and the exchange of information between ACS and MHS to advance high-quality, cost-effective care for surgical patients.  Margaret (Peggy) Knudson, MD, FACS, is Medical Director of MHSSPACS.

“The ACS has a long history of partnering with the military. Our role as the College is to assist our military colleagues with preserving the lessons learned over the past 17 years of conflict through preservation of the Joint Trauma System (JTS) and by expanding military-civilian training platforms to assure combat readiness,” said Knudson.

In December 2016, President Barack Obama signed into law the National Defense Authorization Act, which provided for the development and sustainment of the JTS – uniting the three branches of the Medical Corps to improve standards of trauma care. Knudson and coauthors note the prolonged conflicts during Operation Iraqi Freedom and Operation Enduring Freedom gave rise to an unprecedented improvement in military combat casualty care and the development of the JTS.  However, between conflicts there is a risk of losing skills and proficiencies learned during those periods.  A major focus of MHSSPACS is to preserve the JTS and establish a fully integrated military-civilian trauma system.

Learning from already established trauma training platforms, the next step is to develop a blueprint of standards for each center including performance measures that will assist the MHS in selecting and evaluating these joint ventures. According to Dr. Knudson, this manual will help serve the federal government when it is looking at possible trauma centers to partner with, providing criteria and guidelines for what should be present at a trauma center if it is to be an effective partner with the MHS.

There are a number of challenges facing military surgeons, including lack of standard pre-deployment training and the proficiency and retention of critical surgical skills needed for the expeditionary surgeon.  To address these issues, MHSSPACS has developed a Clinical Readiness Project, which includes four key components:

  • Periodic assessment of knowledge and abilities aligned with a relevant curriculum
  • Pre-deployment assessment of procedural skills
  • Appropriate training and retraining when necessary, focused on areas of need identified using a standardized assessment
  • Development of a measurable “readiness” value of pre-deployment practice
Beyond the readiness and skills retention of military surgeons, challenges exist for military surgical recruitment and retention, such as dissatisfaction amongst military surgeons with case-mix index and a gap between military and civilian pay scales, among other issues.