Role of the Field Surgeon
Within the broader structure of the army, approximately 5 battalions (each composed of 300 to 1000 soldiers) comprise a single brigade combat team. Role 1 medical facilities typically have a single battalion surgeon assigned to them. Field surgeons most commonly serve in this battalion surgeon position. Additionally, Role 2 facilities may have slots for up to 2 battalion surgeons; however, field surgeons are less commonly tasked with this assignment.1 Occasionally, in one author’s (N.R.M.) personal experience, these roles are more fluid than one might expect. A field surgeon tasked initially with a Role 1 position may be shifted to a Role 2 assignment on an as-needed basis. This ability for rapid change in roles and responsibilities underscores the need for a fluid mind-set and thorough predeployment training for the field surgeon.
PREDEPLOYMENT TRAINING
As one might expect, dermatologists who have just graduated residency or fellowship are unlikely to have honed their trauma support skills to the degree needed to support a deployed battalion actively engaging in combat. Fortunately, there are many opportunities for military dermatologists to practice these skills prior to joining their FORSCOM colleagues. The initial exposure to trauma support comes during medical internship at the mandatory Combat Casualty Care Course (C4), an 8-day program designed to enhance the operational medical readiness and predeployment trauma training skills of medical officers.4 The C4 program includes 3 days of classroom training and 5 days of intensive field training. During C4, medical officers become certified in Advanced Trauma Life Support, a 3-day course organized by the American College of Surgeons.5 This course teaches medical officers how to quickly and judiciously triage, treat, and transport patients who have sustained potentially life-threatening traumas.
The next components of predeployment training, Tactical Combat Casualty Care and Tactical Combat Medical Care, occur in the months to weeks immediately preceding deployment.1,6 Tactical Combat Casualty Care prepares participants in the initial stabilization of trauma to occur at the point of injury.6 Tactical Combat Casualty Care principles generally are employed by medics (enlisted personnel trained in point-of-care medical support) rather than physicians; however, these principles are still critical for medical officers to be aware of when encountering severe traumas.6 In addition, the physician is responsible for ensuring his/her medics are fully trained in Tactical Combat Casualty Care. Tactical Combat Medical Care is geared more toward the direct preparation of medical officers. During the 5-day course, medical officers learn the gold standard for trauma care in both the classroom and in hands-on scenarios.1 This training not only allows medical officers to be self-sufficient in providing trauma support, but it also enables them to better maintain quality control of the performance of their medics continuously throughout the deployment.1
DEPLOYMENT RESPONSIBILITIES
Dermatologists who have completed the above training typically are subsequently deployed as field surgeons to a Role 1 facility. Field surgeons are designated as the officer in charge of the BAS and assume the position of medical platoon leader. A field surgeon usually will have both a physician assistant and a field medical assistant/medical plans officer (MEDO) to assist in running the BAS. The overarching goal of the field surgeon is to maintain the health and readiness of the battalion. In addition to addressing the day-to-day health care needs of individual soldiers, a field surgeon is expected to attend all staff meetings, advise the commander on preventative health and epidemiological trends, identify the scope of practice of the medics, ensure the BAS is prepared for mass casualties, and take responsibility for all controlled substances.