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General Surgery

From Sea to Air: Surgical Simulation in Extreme Environments

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Introduction/Purpose:

Background: In this three-phase experiment, the U.S. Navy assessed the feasibility of placing modular resuscitation and operation rooms aboard small, mobile ships to reduce the time between battlefield injury and life-saving surgical care.

Methods or Case Description:

Methods: Three surgical teams were formed from 15 active duty military members. Simulated surgeries were performed aboard the USNS Brunswick using “Cut Suit” technology developed by Strategic Operations Inc to simulate four common battlefield injuries. Participants were fitted with individual monitors to assess dynamic and kinematic motion tracking and Motion Sickness Assessment Questionnaires (MSAQ) were given to participants. Each surgery was graded by subject matter experts on a Likert-type scale from zero to five with four or five deemed successful.

Outcomes:

Results: 112 operations were performed in phase III and 89% were deemed successful with 46% completed at the roughest conditions tested. MSAQ scores revealed low motion sickness scores throughout most of the study and MSAQ positively correlated with sea state conditions (p < 0.001). The only significant predictor for patient outcome scores was surgeon/team performing operations.

Conclusion:

Conclusions: Surgical performance scores provide evidence that ship motion does not adversely affect surgical outcomes. Our next investigation tests the previous procedures in non-traditional aircraft such as the V-22, a vertical take-off and landing tiltrotor aircraft currently used by the U.S military for casualty evacuation.  Future research should also investigate the potential implications in the civilian sector for surgical stabilization in certain motion-induced trauma evacuation settings where immediate intervention is necessary.