Optimizing Austere Surgical Team Efficiency: An Evaluation of Team Composition During U.S. Air Force Ground Surgical Team Training.

Abstract

Introduction: The optimal size of an austere surgical team needed to perform a damage control surgery has not been established, leading to variability in team composition among the myriad of single surgeon surgical teams within the DoD. The Air Force's conventional Ground Surgical Team (GST) includes 6 members; a surgeon, emergency physician, anesthesia provider, nurse, scrub technician, and medical administrator. The purpose of this study was to establish an evidence base for team composition among single-surgeon surgical teams by evaluating whether the addition of a second nurse would lead to an increase in effectiveness during GST phase 1 course simulations.

Materials and methods: During the 2nd week, GST phase 1 training course held at Wright Patterson Air Force Base, Ohio, GST students complete 4 high fidelity team-based simulations requiring surgical intervention. The time to first incision was chosen as the primary outcome because of its known impact on patient survival in the unsimulated environment. Secondary outcomes included first full set of vitals, first administration of blood products, and time to call for evacuation. After Institutional Review Board and command approval, baseline control time measurements were obtained during 24 simulations completed by the standard 6-person teams. Time measurements were then obtained during 24 simulations with 7-person teams which included an additional nurse.

Results: Variation was identified in the ability of both 6-person and 7-person teams to complete the measured tasks during the simulation. The addition of a second nurse had no statistical impact on the time to task completion.

Conclusions: The variability in "time to first incision" among teams during GST phase 1 course demonstrates that certain teams are more efficient in the management of their simulated patients. This study suggests that the addition of a second nurse on GST will not improve the team's efficiency; however, limitations in the study preclude any definitive conclusion. Further research is needed to identify other factors that may impact team efficiency, such as the addition of a member with a different skillset, improvement in nontechnical skills, or an increase in trauma clinical experience.