Visiting Scholar Proposal, Expectations, and Selection Process

Distinguished Visiting Scholar Program Summary:

Military trauma care and civilian trauma care have been inextricably linked throughout history. Advances in battlefield medicine have been brought back to the United States after each major armed conflict. During the recent conflicts in Iraq and Afghanistan the military has begun to develop an approach that utilizes many of the basic tenets of trauma system development. It is logical to develop a process that emphasizes the synergy between the civilian and military orthopaedic trauma communities. One of these proposed approaches is to develop a program of visiting civilian trauma surgeons to work at, and collaborate with, the military surgeons caring for the wounded returning from Operation Iraqi Freedom and Operation Enduring Freedom.

The purpose and process of the Distinguished Visiting Scholar Program is to help lend a bit of “gray hair” to assist the capable and competent military surgeons at Landstuhl Regional Medical Center (LRMC). The complexity and challenges of the cases cared for at LRMC are unique. The injuries are often severe and the rapidity of the current evacuation system delivers “damage control” stabilized patients to LRMC within 24-36 hours of their initial wounding. This challenge calls for a unique combination of clinical expertise as well as maturity of judgment. The purpose of the Distinguished Visiting Scholar Program is to lend that unique combination to the care of the injured soldier. It will also lend the Visiting Scholar a unique opportunity to see the processes by which the military is currently achieving an unprecedented reduction in combat mortality. It is also hoped that the insight and expertise of the Visiting scholars may add suggestions regarding how to further improve the processes and systems of care that are currently employed in theater and at LRMC.

Program structure and requirements:

  1. The military has agreed to provide room (Visiting Officer Quarters/suite) and airfare for the duration of each rotation.
  2. The military will provide a credentialing process through LRMC and the American Red Cross that will allow the visiting scholar to actively participate in clinical care. It is required to have a valid Basic Life Support (CPR) card.
  3. The ideal length of the rotation to be determined on a case by case basis. The length of the rotation needs to strike a balance between a longer (one month) rotation that will allow the individual to become thoroughly immersed and familiar with the process versus a shorter (two week) time frame that minimize the impact on the visiting scholars other scheduling and professional demands. The minimum rotation is two weeks.

Selection of Visiting Scholars:

Visiting surgeons should be individuals with at least 10 years experience in orthopaedic trauma care, a demonstrated ability to teach, an interest in participating in clinical care, and preferably a distinguished position of leadership within the AAOS or OTA. The selection committee (consisting of a tri-service panel of military orthopaedic trauma surgeons, distinguished members of the OTA and AAOS leadership, and a representative from the Orthopaedic service at LRMC) has considered the applicants very carefully to assist in the ongoing process to provide the best possible care to our wounded warriors.

Summary Points and Overview:

Support of a Distinguished Visiting Scholar in Combat Trauma Care

Travel: To Landstuhl Regional Medical Center, Germany

Length: Two weeks to one month

Purpose:

  • Clinical Expertise in care of the wounded soldier
    • Daily rounds
    • Daily Operative activity
    • Daily critical care
    • Credentials managed as Medical Volunteer through the Red Cross
  • Lend input and insight into the structure and delivery of care at the Military's Level IV facility for all casualties from Iraq and Afghanistan
  • Develop mentor relationship with military surgeons
    • Stimulate discussion regarding potential topics for development as peer reviewed journal articles
    • Provide assistance in structure and content
    • Provide mentorship and editorial assistance

Additional Background Information:

The current military evacuation policy includes care in theater provided at Level II and Level III facilities. Those soldiers requiring evacuation out of Iraq are subsequently transferred to the 332nd Air Force Theater Hospital in Balad Iraq. The 332nd serves both as a Level III combat care facility as well as the major air hub for evacuation to Germany. Casualties in Afghanistan are evacuated from the Combat Support Hospital in Bagram, Afghanistan. Injured soldiers are moved to Landstuhl Regional Medical Center (LRMC), the military’s lead facility in Europe. LRMC is the destination for all wounded and ill soldiers who are evacuated from the theater. LRMC is a joint medical center under the lead authority of the U.S. Army with medical staff provided by the Army, Air Force and the Navy. The volume and complexity of cases encountered during a single week by LRMC is variable based upon the operations tempo in theater, but a ‘usual week’ may consist of thirty to forty litter patients and as many as 200 less ill patients a week. Major surgical cases are brought to LRMC accompanied by the Air Force’s Critical Care Air Transport Teams (CCATT). In many cases the surgical patients are within four to six hours of their surgical procedures in theater and then moved by the CCATT team for the six hour evacuation flight to Germany. Complex cases including complex multiple extremity injuries, orthopaedic trauma with multi-system injuries, major vascular repairs, traumatic amputations and major burns are all seen in any given week by LRMC. A majority of the most critically ill patients are transported with ongoing mechanical ventilation, intravenous sedation and intra-cranial pressure monitoring as needed.

For more information about this program or to apply to serve as a Distinguished Visiting Scholar, please contact COL Roman A. Hayda, MD, Michael J. Bosse, MD or the Orthopaedic Trauma Association at ota@ota.org.