Military Medical Support Organization : Lessons Learned from the Dutch deployment in Afghanistan

The deployment of the Dutch Armed Forces in Afghanistan between 2001-2014, had an enormous impact on their organization and personnel. Lessons learned during and after this deployment can help the military medical support organization in improving logistics, administration of, and medical care delivered to service members that sustain injuries during ongoing and future assignments. During the International Security Assistance Force mission between 2006-2010, the Dutch Armed Forces were lead nation in the Uruzgan province, Afghanistan. On their main operating base, the Multinational Base in Tarin Kowt, a Role 2 Enhanced Medical Treatment Facility was operated under Dutch command were a variety of patients and injuries were treated. The deployed surgeon must be aware of and be prepared for being confronted with injuries far beyond the scope of a normal civilian practice. Limited resources, hostile environments, harsh climatological conditions and sometimes long evacuation times, attribute to working conditions that require an unprecedented combination of competences. Future military surgeons will therefore need a wide surgical skillset that is different from, and broader than the skillset that is needed in the highly specialized civilian environment of present day. Damage control surgery plays a prominent role in stabilizing a patient (hemorrhage and contamination control) before being evacuated from zones of combat and subsequently out of theater where more specialist and definitive care can be provided. Although timely evacuation is important, the right care for the right patient on the right time is a justifiable procedure to optimize patient outcome and quality of life. A major challenge for the future military surgeon is to seek ways to maintain essential skills and expertise when exposure to combat situations decreases. The military healthcare organization must be aware of these challenges and provide formalized training and exercise curricula that will benefit military surgeons in maintaining their competencies. This could be achieved by creating an integrated network of civil-military trauma centers that provide definitive care to polytrauma patients and where the military trauma surgeon can preserve and expand his skills in multiple anatomic regions, and in neonatal, obstetrical and aging populations. It is essential that procedures that a military surgeon needs to perform during deployments, are kept up-to-date during civilian practice. To improve trauma care and enhance international collaboration, a shared understanding of distinctive international systems of medical support is needed. Only by reaching consensus can integration of multinational (military) medical care be optimized. One of the foundations of international, joint trauma care should be coalition-wide compatible data collection, with uniform definitions. Such an international coalition-wide registry should co-exist with a detailed national military trauma registry, that preferably has possibilities to be incorporated in a national civilian trauma registry. Integration of civilian and military registries increases the learning potential of the trauma care system. Resiliency of wounded servicemembers often proves remarkable. To preserve and increase quality of life of these service members and their direct circle, it is important that all caregivers involved, join