Initial Experience of US Marine Corps Forward Resuscitative Surgical System During Operation Iraqi Freedom

HYPOTHESIS: Modern US Marine Corps (USMC) combat tactics are dynamic and nonlinear. While effective strategically, this can prolong the time it takes to transport the wounded to surgical capability, potentially worsening outcomes. To offset this, the USMC developed the Forward Resuscitative Surgical System (FRSS). By operating in close proximity to active combat units, these small, rapidly mobile trauma surgical teams can decrease the interval between wounding and arrival at surgical intervention with resultant improvement in outcomes. DESIGN: Case series. SETTING: Echelon 2 surgical units during the invasion phase of Operation Iraqi Freedom. PATIENTS: Ninety combat casualties, consisting of 30 USMC and 60 Iraqi patients, were treated in the FRSS between March 21 and April 22, 2003. INTERVENTIONS: Tactical surgical intervention consisting of selectively applied damage control or definitive trauma surgical procedures. MAIN OUTCOME MEASURES: Time to surgical intervention and outcome following treatment in the FRSS. RESULTS: Ninety combat casualties with 170 injuries required 149 procedures by 6 FRSS teams. The USMC patients were received within a median of 1 hour of wounding with the critically injured being received within a median of 30 minutes. Fifty-three USMC personnel were killed in action and 3 died of wounds for a killed in action rate of 13.5% and a died of wounds rate of 0.8% during the invasion phase of Operation Iraqi Freedom. All Marines treated in the FRSS survived. CONCLUSION: The use of the FRSS in close proximity to the point of engagement during the initial, dynamic combat phase of Operation Iraqi Freedom prevented delays in surgical intervention of USMC combat casualties with resultant beneficial effects on patient outcomes.