The experience of the US Marine Corps' surgical shock trauma platoon with 417 operative combat casualties during a 12 month period of operation Iraqi freedom

Background: The Forward Resuscitative Surgical System (FRSS) is a small, mobile trauma surgical unit designed to support modern US Marine Corps combat operations. The experience of two co-located FRSS teams during 1 year of service in Operation Iraqi Freedom is reviewed to evaluate the system's efficacy. Methods: Between March 1, 2004, and February 28, 2005, two FRSS teams and a shock trauma platoon were co-located in a unit designated the Surgical Shock Trauma Platoon (SSTP). Data concerning patient care before and during treatment at the SSTP was maintained prospectively. Prospective determination of outcomes was obtained by e-mail correspondence with surgeons caring for the patients at higher echelons. The Los Angeles County medical center (LAC) trauma registry was queried to obtain a comparable data-base with which to compare outcomes. Results: During the year reviewed there were 895 trauma admissions to the SSTP. Excluding 25 patients pulseless on arrival and 291 minimally injured patients, 559 of 579 (97%) combat casualties survived; 417 casualties underwent 981 operative procedures in the two SSTP operating shelters. There were 79 operative patients with a mean injury severity score of 26 (range, 16-59) and mean revised trauma score of 6.963 (range, 4.21-7.841) who had sustained severe injuries. Ten (12.7%) of these casualties died while 43 of 337 (12.8%) deaths were seen with comparable cases treated at LAC. Conclusions: Small task-oriented surgical units are capable of providing effective trauma surgical care to combat casualties. Further experience is needed to better delineate the balance between early, forward-based surgical intervention and more prolonged initial casualty evacuation to reach more robust surgical facilities.