Lessons learned from the experience of visceral military surgeons in the French role 3 Medical Treatment Facility of Kabul (Afghanistan): an extended skill mix required

Objective: To evaluate the activity of visceral surgeons assigned to the Medical Treatment Facility (MTF) (role 3) in Kabul International Airport (KAIA) and identify the skills and qualifications required by these specialists.

Patients and methods: Between July 2009 and December 2010, all the patients operated by the visceral surgeons were eligible for inclusion in this study. They were International Security and Assistance Force (ISAF), Afghan National Security Forces (ANSF) soldiers, non-afghan civilians personnel and local nationals (LNs). They sustained war-related injuries, non-war related trauma emergencies, non-trauma related emergencies or had elective surgical care. The mechanisms and types of injuries, the affected organs and the surgical procedures were collected.

Results: Over the period of study, the visceral surgeons treated 261 over 971 patients (26.9%) achieving a total of 438 surgical procedures. Thirty one percent of these procedures were war-related, 26% non-war related, 24.2% non-trauma related emergencies and 18.1% elective surgery. Non-trauma related emergencies and elective surgery required the same skills as in civilian practice. War-related injuries and non-war related trauma emergencies were more challenging. Combined injuries represented 56% of the cases requiring damage control resuscitation procedures and/or treatment of severe burns. Life-threatening thoracic or vascular injuries (30%) required life-saving emergency surgical procedures.

Conclusion: A visceral surgeon in a role 3 MTF should master a wide range of skills and expertise to be able to deal with many complex situations, in particular life-threatening situations such as thoracic and vascular wounds. A comprehensive surgical training programme for surgeons in abroad deployment (Advance Course for Deployment Surgery - CACHIRMEX) has been designed and settled up in 2007 to provide these necessary skills. The feedback obtained from each previous deployment demonstrates that the advanced course for deployment surgery provides visceral surgeons the necessary skills required to deliver surgical healthcare in a role 3 MTF. However, a regular assessment of this programme is mandatory to ensure that this training stays appropriate and contributes to better outcomes and a decreased mortality rate.