LAUSR

We thank Major (Dr) Hansen for his recent publication about the need for increased volume and increased complexity of cases for the military surgeon. We also appreciate the humanitarian effort that can be brought forth by providing surgical care to the underserved global platform. We would like to comment on 2 areas: the current surgical volume in theater and the medical rules of engagement. The data as reported by Edwards and colleagues demonstrating the current average of 1 operative case per month might not be reflective of all locations, or of all surgeons, in other theaters of war. We are in agreement, however, that the case volume is substantially lower more recently. His proposal for a global austere operative exposure would only further tax the US Army military surgeons who are deploying at 12to 24-month intervals. Although these missions would increase operative depth and broaden the scope of practice, it would overwhelm the surgeons with additional requirements and time away from home. One contributing reason for the decreased operative exposure experienced by the currently deployed US surgical assets revolves around the medical rules of engagement. These rules often restrict who can obtain medical evaluation and treatment while overseas. The more current rules restrict or prevent most humanitarian work in the theater of wardcreating a medical disengagement of our medical assets from the civilian populations of the countries we aim to assist. Our proposal would be to broaden the medical rules of engagement by allowing elective surgical care to the local population and even urgent (or emergent care) to local foreign troops of the host country. These elective and urgent cases would match the same quality and breadth of surgery as outlined by Dr Hansen. There are 2 added benefits to this approach. First, the deployed surgical team can gain experience as a team in theater, and when a war casualty is presented, the team is ready. The team will also be more familiar with their equipment, capabilities, and limitations. The second benefit is that this humanitarian work provides a way to broaden the depth and complexity of the operating team without additional travel and training between deployments. We do acknowledge that the resources to meet these needs can be restricted, and certain elective operations could not be done safely in the most austere environments, but this would hold true on most global surgical missions. Our proposal is a win for the host country civilians, a win for the host country military forces, a win for US surgical assets, and a win for the casualties of war. REFERENCES