Skip to main content

Advertisement

Log in

“Einsatzchirurgie”—experiences of German military surgeons in Afghanistan

  • Review Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Introduction

In 2010, the world witnessed 32 wars and other armed conflicts. Epidemiological analyses of mechanisms and patterns of injury of soldiers sent into these conflicts can be utilised to identify the surgical expertise that is required in a combat setting providing important parameters to adjust medical infrastructure and training requirements for future Military Surgeons.

Experiences

Today in 2011, the German Bundeswehr runs a combat support hospital (role 3) in Mazar-e-Sharif in Northern Afghanistan providing a multidisciplinary capability profile. Furthermore, there are two role 2 medical treatment facilities (rescue centres) in Kunduz and Feyzabad for life-saving procedures and damage control operations in order to enable rapid evacuation to a higher level of care. Epidemiological analyses of injury patterns and mechanisms have shown that 2,299 soldiers of the coalition forces have been killed in Afghanistan until January 15, 2011. Of these, 21.4% died in non-hostile action (2010). The leading causes of injury were explosive devices (up to 60%) followed by gunshot wounds. Chest or abdominal injuries (40%) and traumatic brain injuries (35%) were the main causes of death for soldiers killed in action. The analysis of all surgical procedures performed in Northern Afghanistan demonstrates that most of the patients who underwent surgery until 2009 were local civilians. Most of these operations involved osteosynthesis and soft tissue debridement. Due to the recently aggravated tactical situation within the theatre, a significant increase of mass casualty situations and combat-related injuries was noticed.

Dicussion

The casualties in this military conflict present with injury patterns that are not seen in routine surgical practice at home. In an era of increasing surgical sub-specialisation, the deployed military surgeon needs to acquire and maintain a wide range of skills including a variety of surgical fields. In order to create this kind of military surgeon, the so-called DUO plus model for the training of military surgeons (specialisation general surgery plus a second sub-specialisation either in visceral surgery or orthopaedics/trauma surgery) has been developed in the Joint Medical Service of the German Bundeswehr. Other relevant skills, such as emergency neurotraumatology, battlefield surgery with integrated oral and craniomaxillofacial surgery, and emergency gynaecology are also integrated into this concept and will be addressed in special courses. On successful completion of this training programme, military surgeons will be officially appointed as “Einsatzchirurg” for a duration of 5 years. After this time, it will be obligatory to renew this “combat ready” status.

Conclusion

The buildings and materials in German military medical treatment facilities provide for excellent working conditions. The training programme for military surgeons in its end-2010 version has been designed specifically with data about injury pattern and non-battle diseases as well as the political situation and professional requirements in the civilian sphere in mind.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. http://www.sozialwiss.uni-hamburg.de/publish/Ipw/Akuf/publ/AKUF-Pressemitteilung-2010.pdf

  2. Krulak CC (1999) The strategic corporal. Leaedership in the three block war. Marines Magazine on Air University Retrieved on 2006-11-23

  3. Willy C (2010) Role of trauma surgery in military actions and terrorist threat. Unfallchirurg 113:89–90

    Google Scholar 

  4. Willy C, Gutcke A, Klein B, Rauhut F, Friemert B, Kollig EW, Weller N, Lieber A (2010) The educational program for modern military surgeons. Unfallchirurg 113:114–121

    Google Scholar 

  5. Willy C, Sterk J, Schwarz W, Gerngross H (1998) Computer-assisted training program for simulation of triage, resuscitation, and evacuation of casualties. Mil Med 163:234–238

    PubMed  CAS  Google Scholar 

  6. http://www2.aaos.org/aaos/archives/bulletin/jun03/medi.htm

  7. Peoples GE, Gerlinger T, Craig R, Burlingame B (2005) The 274th forward surgical team experience during operation enduring freedom. Mil Med 170:451–459

    PubMed  Google Scholar 

  8. http://icasualties.org/OEF/Index.aspx

  9. Willy C, Voelker HU, Steinmann R, Engelhardt M (2008) Patterns of injury in a combat environment. 2007 update. Chirurg 79:66–76

    Article  PubMed  CAS  Google Scholar 

  10. Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF (2006) Understanding combat casualty care statistics. J Trauma 60:397–401

    Article  PubMed  Google Scholar 

  11. Helgeson MD, Potter BK, Tucker CJ, Frisch HM, Shawen SB (2009) Antibiotic-impregnated calcium sulfate use in combat-related open fractures. Orthopedics 32:323

    Article  PubMed  Google Scholar 

  12. Manring MM, Hawk A, Calhoun JH, Andersen RC (2009) Treatment of war wounds: a historical review. Clin Orthop Relat Res 467:2168–2191

    Article  PubMed  CAS  Google Scholar 

  13. Sakorafas GH, Peros G (2008) Principles of war surgery: current concepts and future perspectives. Am J Emerg Med 26:480–489

    Article  PubMed  Google Scholar 

  14. Hospenthal DR, Murray CK, Andersen RC, Blice JP, Calhoun JH, Cancio LC, Chung KK, Conger NG, Crouch HK, D'Avignon LC, Dunne JR, Ficke JR, Hale RG, Hayes DK, Hirsch EF, Hsu JR, Jenkins DH, Keeling JJ, Martin RR, Moores LE, Petersen K, Saffle JR, Solomkin JS, Tasker SA, Valadka AB, Wiesen AR, Wortmann GW, Holcomb JB (2008) Guidelines for the prevention of infection after combat-related injuries. J Trauma 64:S211–220

    Article  PubMed  Google Scholar 

  15. Calhoun JH, Murray CK, Manring MM (2008) Multidrug-resistant organisms in military wounds from Iraq and Afghanistan. Clin Orthop Relat Res 466:1356–1362

    Article  PubMed  Google Scholar 

  16. Lechner R, Achatz G, Hauer T, Palm HG, Lieber A, Willy C (2010) Patterns and causes of injuries in a contemporary combat environment. Unfallchirurg 113:106–113

    Google Scholar 

  17. Montgomery SP, Swiecki CW, Shriver CD (2005) The evaluation of casualties from operation Iraqi freedom on return to the continental United States from March to June 2003. J Am Coll Surg 201:7–12, discussion 12–13

    Article  PubMed  Google Scholar 

  18. Kluger Y, Peleg K, Daniel-Aharonson L, Mayo A (2004) The special injury pattern in terrorist bombings. J Am Coll Surg 199:875–879

    Article  PubMed  Google Scholar 

  19. Guesgen C, Achatz G, Palm HG, Kollig E, Engelhardt M, Willy C, Lieber A (2010) Spectrum of surgical procedures performed in German rescue centers and the field hospital in Afghanistan in 2008. Unfallchirurg 113:99–105

    Google Scholar 

  20. Chambers LW, Green DJ, Gillingham BL, Sample K, Rhee P, Brown C, Brethauer S, Nelson T, Narine N, Baker B, Bohman HR (2006) The experience of the US Marine Corps' Surgical Shock Trauma Platoon with 417 operative combat casualties during a 12 month period of operation Iraqi Freedom. J Trauma 60:1155–1161, discussion 1161–1154

    Article  PubMed  Google Scholar 

  21. Hauer T, von Lubken F, Johann M, Schreyer C, Hartmann V, Kollig E, Willy C (2010) German military surgeons in deployment abroad: life and working conditions. Unfallchirurg 113:91–98

    Google Scholar 

  22. Kuhne CA, Mand C, Sturm J, Lackner CK, Kunzel A, Siebert H, Ruchholtz S (2009) The Trauma Network of the German Society for Trauma 2009. Unfallchirurg 112:878–884

    Article  PubMed  CAS  Google Scholar 

  23. Wutzler S, Lefering R, Laurer HL, Walcher F, Wyen H, Marzi I (2008) Changes in geriatric traumatology. An analysis of 14, 869 patients from the German Trauma Registry. Unfallchirurg 111:592–598

    Article  PubMed  CAS  Google Scholar 

  24. Trunkey DD (2002) In search of solutions. J Trauma 53:1189–1191

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christian Willy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Willy, C., Hauer, T., Huschitt, N. et al. “Einsatzchirurgie”—experiences of German military surgeons in Afghanistan. Langenbecks Arch Surg 396, 507–522 (2011). https://doi.org/10.1007/s00423-011-0760-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-011-0760-4

Keywords

Navigation