Conducting Pre-deployment Training in Honduras: The 240th Forward Resuscitative Surgical Team Experience.

INTRODUCTION: Since January 2002, pre-deployment training of forward resuscitative and surgical units has taken place at the U.S. Army Trauma Training Center (ATTC) in Miami, FL. In June 2019, the 240th Forward Resuscitative Surgical Team (FRST) conducted the first pre-deployment Surgical Readiness Training Exercise (SURGRETE) in San Pedro Sula, Honduras, to allow the team to rehearse in a resource-constrained environment more similar to that expected on deployment. The purpose of this study is to describe and compare the pre-deployment training experiences of the 240th FRST during their SURGRETE in Honduras and ATTC rotation in Miami, FL. MATERIALS AND METHODS: A descriptive analysis of prospectively collected data was performed for surgical cases, trauma resuscitations, and nonsurgical procedures by the 240th FRST over a 2-week SURGRETE in Honduras and 2-week ATTC rotation in Miami, FL. Items accomplished within the Individual Critical Task Lists (ICTLs) of key clinical providers on the team (general surgeon, orthopedic surgeon, emergency medicine physician, and Certified Registered Nurse Anesthetist) were identified and compared to those accomplished at the ATTC. RESULTS: During the SURGRETE in Honduras, 64 surgical cases, 1 trauma resuscitation, 2 Advanced Cardiac Life Support codes, and 213 nonsurgical procedures were performed collectively by the team. During ATTC rotation, the team performed a combined total of 10 surgical cases, 6 trauma resuscitations, and 56 nonsurgical procedures. For each key clinical provider, more of their assigned ICTLs were conducted during the Honduras SURGRETE than during ATTC rotation. The ATTC, however, offered more cases of acute life-threatening trauma. CONCLUSION: Appropriately planned SURGRETEs can provide a concentrated case volume in a resource-constrained setting and challenge the team to consider definitive management algorithms. The cases performed may not necessarily reflect the type and acuity of operations performed in a deployed environment; however, they facilitate repetition of basic skills, team cohesion, and cross-training. The SURGRETE experience could be improved by locating a facility with a trauma-dominant patient population that allows increased autonomy of U.S. physicians.

Women's Health and Contraceptive Practices of Army Physician Assistants.

INTRODUCTION: Women's roles continue to increase within the U.S. Army. Medical readiness contributes to individual readiness and supports the Army's warfighting mission. Army physician assistants are often the first-line medical providers for Soldiers and their practices, including women's health practices, should support optimal Soldier readiness. Our objective was to survey Army physician assistants' knowledge and practices related to female reproductive health care. MATERIALS AND METHODS: This was a descriptive survey-based study of Army physician assistants conducted from February to June 2017. This study was an addendum to a prior study examining women's health care knowledge and skills among physicians serving as general medical officers. Surveys were distributed via e-mail. The survey was anonymous and included 22 questions describing provider knowledge and practices in the areas of family planning and women's health screening. RESULTS: Out of 198 distributed surveys, 100 (51%) were returned. Most respondents were male (67%), 75% practiced in a troop-based medical clinic, and 73% had current or past practice experience in a military operational/deployed environment. The majority of respondents indicated that they provide family planning services to their reproductive-aged female patients. Combined hormonal contraceptives and depo-medroxyprogesterone had the highest percentage of respondents who reported comfort discussing the method. The highest percentage of respondents indicated discomfort discussing the copper intrauterine device and emergency contraception. Only 10, 17, and 33% of respondents were trained to place the copper intrauterine device, levonorgestrel intrauterine device, and etonogestrel contraceptive implant, respectively. Most respondents offered cervical cancer (74%) and chlamydia (91%) screening to their female patients. CONCLUSION: Most study respondents practiced in a troop-based primary care clinic and most reported experience as a deployed health care providers. Although most respondents indicated comfort discussing combined hormonal contraception and depo medroxyprogesterone, fewer reported comfort discussing long-acting reversible and emergency contraception. Only a minority of respondents reported prior training to place the copper or levonorgestrel intrauterine device or contraceptive implant and, of those trained, most had not placed a device for which they were trained in the preceding 12 months. Chlamydia and cervical cancer screening were offered by most respondents but was not universally offered among the respondents. These findings are consistent with our previous study evaluating women's health knowledge among general medical officers and highlight a need for improved training in the field of women's health for physician assistants serving the active duty population.

Unintended Pregnancy in the Military Health Care System: Who is Really at Risk?

Unintended pregnancy is a global issue and one that is reportedly to be higher in the military population. We sought to assess rates of unintended pregnancy among the active duty population in comparison to other military health care beneficiaries. Using a validated six-question survey, patients aged 18 to 42 were surveyed in five different clinics at three major tertiary hospitals from December 2013 to December 2014. Individual survey questions were scored 0, 1, or 2 and a total score was tabulated. A total score of 0 to 3 indicated unintended pregnancy, 4 to 9 indicated ambivalence toward pregnancy, and 10 to 12 indicated intended pregnancy. Subanalysis was performed on two survey questions specifically looking at pregnancy intentions. A total of 1,211 completed surveys were analyzed. Overall, 6.9% of all respondents had an unintended pregnancy compared to 23% of pregnancies in single active duty women. Single, active duty service members were more likely to indicate they did not intend to get pregnant or want a baby before becoming pregnant. Overall, the rate of unintended pregnancy among military health care beneficiaries is low. However, single active duty women are at significantly higher risk for unintended pregnancy and specifically targeted interventions should be implemented for this population.