Aligning Air Force Ground Surgical Team (GST) Training with the Deployment Experience

Abstract

Introduction: The Air Force Ground Surgical Team (GST) Phase 1 course is a two-week pre-deployment training for the Air Force's conventional austere surgical care platform. Since the creation of the GST platform and associated training pipeline in 2017, course adjustments and improvements have relied on expert opinion and anecdote. To gain a more robust understanding of GST deployment clinical and operational activities, we conducted a survey of all surgeons who completed GST Phase 1 training from its inception in April 2017 to September 2020. Materials and Methods: 87 surgeons took the course from April 2017 to September 2020. 60 of those surgeons were still on active duty and were candidates to complete the survey sent from the Air Force Survey Office. 31 individuals responded and their identification was kept blinded. An IRB exemption was issued before study initiation. Results: Of the 31 respondents, 9 took the GST Phase 1 course but never deployed, and were excluded. The remaining 22 surgeons deployed at some point from 2017 to 2020. Four surgeons reported providing no surgical care during their deployment. 68% of the surgeons deployed to an actual standalone GST platform, while the rest were retained at larger military treatment facilities (MTFs) or Role III facilities. The median number of surgeries performed was 2 for surgeons at standalone GSTs and 7 for those at larger MTFs/Role IIIs. A holding time of greater than 12 hours was reported for 15% of operative patients and 58% of nonoperative patients at standalone GSTs. 28% (n=5) of surgeons reported taking care of patients in the Golden Hour of surgery, and 23% of teams reported a patient death. Two surgeons cared for a military working dog, and four surgeons cared for pediatric patients. 50% of surgeons had more than one patient present simultaneously for care. 50% of surgeons' resupply were in the greater than 30 days or never received category. Conclusions: The GST Phase 1 course has a unique role in preparing students to provide austere surgical care. This includes both preparing to function in the operational military environment as well as applying sound in-garrison trauma surgical care techniques to the austere, resource variable environment. The results of this survey suggest that a broadening of contentspecific deployment-related topics, the formalization of documentation education, incorporating formal evidence-based nontechnical skills training, and identifying optimal GST context-specific behaviors will strengthen the effectiveness of the course in preparing students for deployment.