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How are we currently training and maintaining clinical readiness of US and UK military surgeons responsible for managing head, face and neck wounds on deployment?
  1. John Breeze1,2,
  2. J G Combes3,
  3. J DuBose4 and
  4. D B Powers2
  1. 1Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina, USA
  3. 3Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Guildford, UK
  4. 4C-STARS (Center for the Sustainment of Trauma and Readiness Skills), R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
  1. Correspondence to John Breeze, Division of Plastic, Reconstructive, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC 27705, USA; editor.jramc{at}


Introduction The conflicts in Iraq and Afghanistan provided military surgeons from the USA and the UK with extensive experience into the management of injuries to the head, face and neck (HFN) from high energy bullets and explosive weaponry. The challenge is now to maintain the expertise in managing such injuries for future military deployments.

Methods The manner in which each country approaches four parameters required for a surgeon to competently treat HFN wounds in deployed military environments was compared. These comprised initial surgical training (residency/registrar training), surgical fellowships, hospital type and appointment as an attending (USA) or consultant (UK) and predeployment training.

Results Neither country has residents/registrars undertaking surgical training that is military specific. The Major Trauma and Reconstructive Fellowship based in Birmingham UK and the Craniomaxillofacial Trauma fellowship at Duke University USA provide additional training directly applicable to managing HFN trauma on deployment. Placement in level 1 trauma/major trauma centres is encouraged by both countries but is not mandatory. US surgeons attend one of three single-service predeployment courses, of which HFN skills are taught on both cadavers and in a 1-week clinical placement in a level 1 trauma centre. UK surgeons attend the Military Operational Surgical Training programme, a 1-week course that includes 1 day dedicated to teaching HFN injury management on cadavers.

Conclusions Multiple specialties of surgeon seen in the civilian environment are unlikely to be present, necessitating development of extended competencies. Military-tailored fellowships are capable of generating most of these skills early in a career. Regular training courses including simulation are required to maintain such skills and should not be given only immediately prior to deployment. Strong evidence exists that military consultants and attendings should only work at level 1/major trauma centres.

  • neurosurgery
  • trauma management

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  • Contributors Planning: JB and DP. Conducting: JB, DBP and JD. Reporting: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.