Sean Keenan

Introduction: Each military service has independently developed austere resuscitative and surgical care (ARSC) team training courses that vary in use, content, duration, tactical exposure, and clinical emphasis. A 2020 Department of Defense Inspector General audit identified training deficits for ARSC teams. To close this gap, we developed ARSC curriculum standards for the Joint Force. Materials and Methods: A work group of Tri-Service appointed multidisciplinary subject matter experts (SMEs) reviewed available Role 2 and ARSC training courses to identify common curricular elements, best practices, and training gaps. Through an iterative process, these findings were incorporated into a standard curriculum organized into modules subdivided into terminal learning objectives (TLOs) and enabling learning objectives (ELOs), which were validated against Service doctrinal ARSC capability requirements. Results: Curricula from 12 different courses were identified and reviewed. Most prepared teams for Counter Insurgency operations characterized by short holding times and rapid aeromedical evacuation. Eighty-two clinical and nonclinical common curricular best practices were identified. Only four courses had 50% or more of SME-recommended curricular elements. Identified curricular gaps included prolonged holding (0% of courses), definitive austere surgical care (0%), austere critical care (25%), simulated tactical exposure (25%), night operations familiarization (37.5%), and simulated operational environment (62.5%). Ten modules were created comprised of 20 TLOs and 259 ELOs incorporating curricular best practices and identified gaps. Conclusion: Military medicine is preparing surgical teams for the war just fought, not the future fight and lacks a joint standard for training Role 2/ARSC surgical teams, which is a risk to force and to mission. We close this gap by creating the first Joint Role 2 forward surgical/ARSC curriculum.

Introduct ion: The demands of future large-scale combat operations may require medics and corpsmen to increasingly perform expectant casualty care (ECC). However, no detailed guidelines currently exist for providing ECC within military medicine. To guide the development of education and training guidelines and advance team training of both medics and non-medics, an in-depth understanding is first needed regarding caregivers’ experiences providing ECC in recent conflicts as well as perceived training gaps. Therefore, this study explored the experiences of medics and physicians providing ECC and investigated their perceptions of training needs in this area for future conflicts characterized by large-scale combat operations and prolonged casualty care operational settings. Materials and Methods: We conducted an engaged qualitative phenomenological study to explore ECC training needs for future conflicts. We interviewed 9 senior health care professionals (medics and physicians) who had extensive combat and deployment experiences and served primarily in the Role 1 environment. The interviews averaged 45 min each and were conducted via phone. To analyze this interview data, we reviewed the interview transcripts and then noted terms, phrases, and concepts within the interview transcripts that we found to be salient to answering the research question. Our team then met to review these codes and grouped them into categories. These categories served as the themes of this study that illustrated the participants’ perceptions and experiences. Results: Five themes emerged from our data: (1) There is a current gap in ECC training for enlisted Role 1 caregivers throughout the military; (2) ECC training is needed to shift organizational culture; (3) ECC training should be comprehensive; (4) ECC training should be deliberate; and (5) Time is the greatest challenge to implementing ECC training. Our participants noted that developing guidelines and filling training gaps is not only critical for preparing Role 1 providers for effective and ethical military medical decision-making but also for addressing death and dying on the battlefield and building moral resilience across the medical corps. Conclusion: Our results provide direction for development of ECC clinical guidance and collective team training recommendations. Following these guidelines may increase life-saving capabilities on the far-forward battlefield and equip medical directors and medics to provide ethical and compassionate care to those who cannot be saved in the setting of limited resources and evacuation opportunities.

Recognized limitations of fishery-dependent data under rapidly changing management regimes have resulted in significant effort during recent years to improve the availability of fishery-independent data in the southeastern United States. These fishery-independent surveys target numerous species and habitats with various sampling methods, including the use of trawls, longlines, gill nets, traps, and visual surveys. Although passively fished hooked gear (e.g., longlines) are often used to assess the abundance and life history of managed reef fishes, such types of gear are often limited by the habitats they can fish effectively and are species selective. To address these shortcomings, we developed and implemented an actively fished approach to provide fishery-independent data: the repetitive timed-drop hooked-gear method (RTD method). Despite the high degree of standardization applied to the RTD method, important questions remain as to whether active fishing imparts strong angler variability that may reduce the utility of survey data. Accordingly, we analyzed data from 2014 to 2018 to evaluate potential angler bias and how angler-associated variability compares to other factors often thought to be important predictors of reef fish abundance and community structure. During this study, 962 stations were sampled, representing a variety of artificial and natural reef habitats. In total, 5,770 fish were caught, representing 92 taxa. Sampling was conducted by 103 unique anglers, including 42 commercial or charter fishers and 61 scientists. Results from both population- and assemblage-level analyses found that most of the variability in the catch could be explained by hook size, habitat, water depth, and year. Angler type was rarely correlated with reef fish abundance or assemblages. Our analyses suggest that the RTD method is effective in gathering fishery-independent abundance and life history data for reef fishes in the eastern Gulf of Mexico and that the resulting data are not strongly biased by an angler effect.