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Lowell W. Chambers, MD; Peter Rhee, MD, MPH; Bruce C. Baker, MD; John Perciballi, MD; Miguel Cubano, MD; Michael Compeggie, MD; Michael Nace, RN, CEN, ACNP-CS; Harold R. Bohman, MD

Arch Surg. 2005;140:26-32.

Hypothesis  Modern US Marine Corps (USMC) combat tactics are dynamic and nonlinear. While effective strategically, this can prolong the time it takes to transport the wounded to surgical capability, potentially worsening outcomes. To offset this, the USMC developed the Forward Resuscitative Surgical System (FRSS). By operating in close proximity to active combat units, these small, rapidly mobile trauma surgical teams can decrease the interval between wounding and arrival at surgical intervention with resultant improvement in outcomes.

Design  Case series.

Setting  Echelon 2 surgical units during the invasion phase of Operation Iraqi Freedom.

Patients  Ninety combat casualties, consisting of 30 USMC and 60 Iraqi patients, were treated in the FRSS between March 21 and April 22, 2003.

Interventions  Tactical surgical intervention consisting of selectively applied damage control or definitive trauma surgical procedures.

Main Outcome Measures  Time to surgical intervention and outcome following treatment in the FRSS.

Results  Ninety combat casualties with 170 injuries required 149 procedures by 6 FRSS teams. The USMC patients were received within a median of 1 hour of wounding with the critically injured being received within a median of 30 minutes. Fifty-three USMC personnel were killed in action and 3 died of wounds for a killed in action rate of 13.5% and a died of wounds rate of 0.8% during the invasion phase of Operation Iraqi Freedom. All Marines treated in the FRSS survived.

Conclusion  The use of the FRSS in close proximity to the point of engagement during the initial, dynamic combat phase of Operation Iraqi Freedom prevented delays in surgical intervention of USMC combat casualties with resultant beneficial effects on patient outcomes.

Author Affiliations: Departments of Surgery, First Medical Battalion/Naval Hospital Camp Pendleton, Camp Pendleton, Calif (Drs Chambers, Baker, and Bohman); Naval Trauma Training Center, Los Angeles, Calif (Dr Rhee); Naval Hospital Pensacola, Pensacola, Fla (Dr Perciballi); Naval Hospital Jacksonville, Jacksonville, Fla (Dr Cubano); Naval Hospital Camp Lejeune, Camp Lejeune, NC (Dr Compeggie); and US Marine Corps Command and Staff College, Quantico, Va (Mr Nace).

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