Military Trauma and Surgical Procedures in Conflict Area: A Review for the Utilization of Forward Surgical Team

Introduction: Forward surgical teams (FSTs) have been used as highly mobile surgical facilities that provide "damage control" medical support in modern wars. FST regiments differ greatly in different armed services and nations. We systemically reviewed the utilization of FSTs around the world with an emphasis on the medical conditions and workloads encountered by FSTs in modern wars. Materials and Methods: We searched for terms related to FSTs, such as "Forward Surgical Team" and "Field Surgical Team," in the PubMed, EMBASE, Web of Science, and MEDLINE databases and collected any articles that provided numerical data on the organization of medical personnel combat casualty characteristics, including the casualty composition, injury types and locations, and mechanisms of injury, and surgical procedures performed. Technical articles, case reports of specific types of injury or disease, and literature reviews of previous experiences and logistical theories were discarded. Results: We identified 24 articles involving 29 FSTs that were included in the analysis. The FSTs were typically composed of 8-20 medical personnel and had limited medical capacity. Battle-related injuries constituted approximately two-thirds of all injury types treated by the FSTs. The extremities, torso, and head and neck were the three most frequently injured sites and accounted for approximately 51.1%, 16.6%, and 13.2% of all wounds, respectively. The three most frequent injury mechanisms were fragments or explosive injuries (44.8%), gunshot wounds (28.1%), and motor vehicle accidents/road traffic accidents (9.1%). Soft tissue surgeries (41.0%) and orthopedic operations (31.6%) were the two procedures that were most frequently performed by the FSTs. The average numbers of surgical procedures performed by small FSTs (1.27/unit.day) and full FSTs (1.28/unit.day) seemed to be comparable. Conclusion: Modern conflict may require more flexible small FSTs, especially during the initial phases of war. More orthopedic surgeons should be included in FSTs, and orthopedic skill training should be intensified before deployment. The utilization of FSTs and level III facilities must be evaluated within the context of the battlefield conditions, medical care requirements, and evacuation efficiency.