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Travelling surgeons work to improve battlefield injury outcomes

  • Published
  • By Sue Campbell
  • 59th Medical Wing Public Affairs
LACKLAND AIR FORCE BASE, Texas --  As American military members and their allies fight the wars in Iraq and Afghanistan, medics from these countries work in collaboration to treat their battlefield wounds in theater hospitals.

Combat zone injuries have changed over the years, due to improved body armor protection, resulting in a higher survival rate after injury. However, damage to arms and legs remains a significant medical issue for wounded military members.

Surgeons in the United States and United Kingdom reported limb salvage rates at more than 90 percent, despite devastating wounds. However, as the focus shifts from statistical to functional limb salvage, there is a need to obtain long term or "quality" limb recovery.

"I have spoken to troops whose limbs were saved after a battlefield injury and, although all were very happy with the care they received after their injuries, one almost wished his leg had been amputated after undergoing painful surgeries and rehabilitation," said Capt. (Dr.) Gabriel Burkhardt, general surgery research fellow, assigned to the 59th Medical Wing, Lackland Air Force Base, Texas. "He was frustrated that his leg was not as functional as he'd hoped after 14 months of therapy."

Lt. Col. (Dr.) Todd Rasmussen, 59th MDW, in conjunction with U.K. surgeons Capt. Mark Midwinter, Royal navy, and Lt. Col. Nigel Tai, British army, have instituted a travelling fellowship program to investigate methods to ensure salvaged limbs are as functional as possible after recovery.

The three experts in vascular surgery developed the program that sent Captain Burkhardt to London and brought surgeon Lt. Cmdr Adam Stannard, a fellow in the Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, U.K., to Lackland Air Force Base. The two surgeons will conduct research and share information with the primary goal of improving the functionality of damaged limbs.

"We have recognized the integrated medical system in Iraq and Afghanistan. U.S. medics provide care to British casualties and vice versa." Commander Stannard said.  "Recently an American was injured in Afghanistan and British surgeons placed plastic shunts into the patient's blood vessels to restore blood flow. Then the patient was transferred to Colonel Rasmussen at another hospital for more definitive vascular care."

Commander Stannard works in the 59th Medical Wing's Clinical Research Division at Lackland, looking at the effects of vascular injuries, specifically on limbs, and how to improve the outcome from the injuries by developing different systems to intervene.

"Wilford Hall is one of the leaders in the world, conducting research that is very relevant to combat casualty care in Iraq and Afghanistan," Commander Stannard said. "We have got really good support and have been able to develop an infrastructure which allows us to do research which other groups really don't have. We can run so many protocols that are really going to make a difference."

While in Texas, Commander Stannard will also produce a thesis for a higher medical research degree in the U.K.

"By coming here I have delayed myself a year in becoming an attending equivalent, but I will have had the experience of research in a really fantastic unit," he said. "The knowledge and research I'm receiving here would take two or more years for a surgeon in the U.K. to obtain."

At the Royal London Hospital, Captain Burkhardt completed a structured observership that included exposure to physician-driven, pre-hospital healthcare delivery, and operative management of trauma in one of the U.K.'s leading trauma facilities.

"This unique experience has allowed me to see the potential benefit of physician-driven healthcare at the point of injury and to work with an international team in the operating room," Captain Burkhardt said. "The senior resident trained in Crete, the staff surgeon trained in South Africa, the junior resident trained in Pakistan, and the intern completed medical school in Germany. These diverse backgrounds required clear communication, direction and cultural sensitivity as English was well spoken but not the primary language and cultural backgrounds were diverse."

The knowledge exchange between the two countries goes deeper than vascular surgery.

"It is very helpful to learn simple things from each other, such as the names of medical instruments," Commander Stannard said. "There is a big benefit in that. Also, the connections and friendships that we're developing will be very important as we become more senior in our careers."

Captain Burkhardt was invited to participate in a Military Operational Surgery Training course, held at the Royal College of Surgeon's, designed to prepare physicians and surgeons who will be deploying in the near future.

"Having previously participated in and instructed similar courses at Wilford Hall and Brooke Army Medical Centers in San Antonio, Texas, it was illuminating to see the similarities in the content," he said. "I was very impressed with integration of the team concept. Groups of four to six were composed of a mix of general and specialty surgeons, orthopedists, emergency physicians and anesthetists from all three service branches who will be deploying to Afghanistan. As an observer and participant, it was very interesting to see the rapid improvement in cohesiveness that this exercise generated and I suspect that this will serve as excellent preparation as these medics prepare to deploy."

Additionally, both surgeons gave research presentations in 2010 during the Association of Surgeons of Great Britain and Ireland, and the Military Surgery Conference, two international military meetings.

"The research, training and opportunities our vascular surgeon mentors have made available to us are invaluable," Commander Stannard said.  "By having a better understanding of each other, we can work more closely together on collaborative work and while deployed. In the end I hope our work results in not only saving a limb from amputation, but restoring it to full functionality with minimal pain or complications."