The SHADER model: forward surgical teams managing high-intensity, low-frequency military surgery incidents

INTRODUCTION: The UK Defence Medical Services (UK DMS) surgical teams have been deployed in small, low resource, remote mobile Role 2 (R2) facilities globally to provide Damage Control Resuscitation and Surgery for combat casualties. It is vital that commanders understand the expected workload for specific operations for planning and training and sustainment of high-quality surgical capability. The current study examined the surgical workload from a complete forward UK DMS R2 facility deployment to better inform future operations of this nature.

METHODS: A retrospective observational study was undertaken using a prospectively collected Operative Department Logbook to determine the number and type of procedures undertaken during a complete deployment between September 2019 and March 2024 (including 18 deployments of 3 months each). Patient and operative details were collected, including the indication (trauma or non-trauma), and compared between Trauma & Orthopaedic (T&O) and General & Vascular (G&V) surgeons.

RESULTS: There were 35 patients who had surgery. The median age was 25 (IQR 22-31), and 33/35 (94%) were male. There were 20/35 (57%) procedures following trauma, and the remainder were for non-trauma emergencies. 11/35 (31%) patients were injured by gunshot or blast mechanism. No mass casualty situations within the Area of Operations, nor outbreaks of infectious diseases within the deployed forces occurred during the time period. More procedures were undertaken by G&V specialists than T&O for (20 vs 16, respectively, with one combined procedure). However, the operations were less likely to be for a trauma indication as a proportion of their workload (6/20 (29%) vs 15/16 (93%), respectively; p<0.001).

CONCLUSIONS: This remote, forward R2 deployment was characterised by low volume of surgical workload, but a requirement for high readiness and competency in major trauma surgery. This represents a challenge for training and currency that must be addressed for optimal surgical care in ongoing and future operations.