Forward Surgical Teams Provide Comparable Outcomes to Combat Support Hospitals During Support and Stabilization Operations on the Battlefield

Background: Forward Surgical Team (FST) provide forward deployed surgical care within the battle space. The next level of care in theater, the Combat Support Hospitals (CSH), are distinguished from the FST by advanced resource capabilities including more complex diagnostic imaging, laboratory support with blood banking, and intensive care units. This study was intended to assess the effect of FST capability on the outcome of seriously injured casualties in comparison to the CSH. Methods. We reviewed all casualty records in the Joint Theater Trauma Registry database from April 2004 to April 2006. The study cohort included all US military battle casualties who were admitted to either a FST or a CSH and were not returned to duty within 72 hours. Data were tabulated and assessed for basic demographics, mechanism of injury, injury severity score, ventilator and critical care days, and mortality. Statistical inferences were made using Chi square and Student's t tests. Results: As of April 2006, the above information was available in the Joint Theater Trauma Registry on 2,617 US military battle casualties who survived to reach care at a FST and/or CSH. Of this population, 77 subsequently died of wounds and 2,540 survived. We found no significant difference in died of wounds rates between the sample populations or rates of ventilator or critical care days between the two groups, nor did controlling for injury severity score alter this picture. The most significant predictor of mortality in both these groups was head injury. Conclusions: The disparity between the availability of the highest level of injury care and the ability to care for injury as soon as possible is an issue of central importance to both the civilian and military trauma care communities. Our analysis demonstrates that despite the operational and logistic challenges that burden the FST, this level of surgical care confers equivalent battlefield injury outcome results compared with the CSH.