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George Ivanov
George Ivanov

U.S. Combat Surgeon Killed In Iraq



Conclusion: Most battlefield casualties died of their injuries before ever reaching a surgeon. As most pre-MTF deaths are nonsurvivable, mitigation strategies to impact outcomes in this population need to be directed toward injury prevention. To significantly impact the outcome of combat casualties with PS injury, strategies must be developed to mitigate hemorrhage and optimize airway management or reduce the time interval between the battlefield point of injury and surgical intervention.Understanding battlefield mortality is a vital component of the military trauma system. Emphasis on this analysis should be placed on trauma system optimization, evidence-based improvements in Tactical Combat Casualty Care guidelines, data-driven research, and development to remediate gaps in care and relevant training and equipment enhancements that will increase the survivability of the fighting force.




U.S. Combat Surgeon Killed In Iraq


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The surgeon shook his head. Not much to be done. Stop the bleeding. Severe brain injuries are generally too complex for combat support teams. Within minutes, the patient was bundled into a body bag for warmth and reloaded onto a chopper for the larger Air Force Theater Hospital in Balad, 170 miles to the south, for neurosurgery. He would survive an "unsurvivable" wound, at least for a few more days or weeks.


The scene in the emergency room looked to be chaos. But the reality was closer to choreographed jazz: Doctors followed scripted procedures and protocols, then quick-riffed to improvisation to repair ruptured vessels and shattered limbs. Every patient was surrounded by healers in green, blue, or purple scrubs. "Blood! Two units emergency release blood, now!" sang out Colonel William Myers, an orthopedic surgeon from Augusta, Ga., on his second combat tour in Iraq.


Now we're going to hear about a trauma surgeon who was killed in Iraq on Christmas Day. Major John Pryor wrote and spoke eloquently about his work in Iraq and in Philadelphia. He was killed near Mosul where he was stationed with an army medical detachment. From Philadelphia, Joel Rose reports.


The end of the Vietnam-era draft meant that the Pentagon had to build its own combat casualty-care capabilities. The military bureaucracy could no longer simply draft busy surgeons when war broke out. But it is challenging to sustain that level of care in peacetime. Although Landstuhl uses eight of its 11 operating rooms, the hospital now caters mostly to outpatients, about 46,000 of them every year.


Another study by 17 leading combat casualty experts examined the proportion of combatants who "died of wounds" in Iraq. This measure refers only to those who died after they reached military treatment facilities; it is regarded as a more reliable measure of surgical outcomes than "killed in action," which applies to combatants who died before reaching the hospital, and the case-fatality rate, a broad measure of mortality that encompasses both groups.


"If you look at the overall death rate ... the case fatality rate is cut in half from Vietnam to now. And again I think that's due to better training, tactical combat casualty training," said Col. John Holcomb, the senior surgeon at the hospital.


LTC Mark Taylor, MD (1962-2004): Lieutenant Colonel Mark Douglas Taylor was an Army physician and surgeon who was killed in action in 2004 while serving with a Forward Surgical Team in Fallujah, Iraq. Mark graduated from the University of California at Davis with a BS in Chemistry and went on to obtain a Pharm D. at UC San Francisco and his MD/MPH at the George Washington University School of Medicine. He completed an internship in General Surgery at Madigan Army Medical Center, and then a residency in General Surgery at UC Irvine. Following residency he returned to active duty and was assigned as a staff surgeon at Womack Army Medical Center, Fort Bragg, NC. During his second combat deployment to Iraq, Mark was notified that he had been awarded a fellowship in advanced laparoscopic surgery. On March 20, 2004, Mark was killed in action while attempting to render aid during an indirect fire attack on his base in Fallujah. His awards and decorations include the Combat Medical Badge, Purple Heart, Army Commendation Medal, and the Bronze Star Medal.


Lessons learned during recent conflicts in Iraq (Operation Iraqi Freedom), Afghanistan (Operation Enduring Freedom) as well as the ongoing military actions targeting the Islamic State (ISIS) have equipped combat surgeons with a breadth of knowledge concerning the management of complex thoracic trauma. The unique environment provided by war inherently fosters the development of innovation. Management of combat injuries has become more crucial to all trauma surgeons, as high-velocity weaponry and global terrorism can produce similar injury patterns in the civilian trauma setting.


This review focuses on unique injuries seen in austere war-time environments with focus on thoracic trauma. Applications to civilian trauma are highlighted throughout the article with the hope that the experience gained by combat surgeons may aide in the advancement of trauma care.


Dr. Bill Krissoff, United States Navy Medical Corps (Carlsbad, California) Dr. Bill Krissoff was commissioned Lieutenant Commander in the Navy Medical Corps on November 17, 2007, at the age of 61. His decision to apply to the Navy Medical Corps to care for Marines came in response to the death of his oldest son. In December 2006, his son First Lieutenant Nathan Krissoff, USMC, who was serving as a Counterintelligence Officer with the 3rd Recon Battalion in Iraq, was killed in combat. Inspired by his son’s commitment and dedication to serving his country, Dr. Krissoff decided to apply himself. Initially told by his recruiter that it was very unlikely that he would qualify because of the age limit, Dr. Krissoff did not give up. During a private meeting with President Bush in Reno, Nevada, Dr. Krissoff asked for assistance on an age waiver for the Navy Medical Corps. The wavier was soon granted so that he could begin the application process. Now commissioned, he is preparing for deployment as an Orthopedist in a Forward Resuscitative Surgical System (FRSS), a Level II combat surgical team treating injured Marines in the field. Dr. Krissoff has closed his private practice, and he and his wife, Christine, have relocated to the San Diego, California area, where he is assigned to the 4th Medical Battalion, 4th Marine Logistics Group. In addition, the Krissoff’s youngest son, Second Lieutenant Austin Krissoff, USMC, is stationed at Camp Pendleton, California.


A member of the Georgia National Guard is entitled to one free National Guard specialty plate. The surviving spouse of a member of the National Guard who was killed while serving in a combat arena is also eligible as long as he/she does not remarry. There is no registration fee, manufacturing fee, or annual registration fee for this specialty plate. An applicant is also entitled to one additional specialty plate upon payment of a $25 manufacturing fee. An applicant will also be required to pay a $25 annual registration fee for the additional specialty plate.


An assigned or attached member of troop program units of any branch of the active reserve components of the United States inside or outside the State of Georgia is entitled to one free reserve component specialty plate, which will identify his/her specific reserve military branch of service. A retiree from any branch of the active reserve components is also entitled. The surviving spouse of a member of the active reserve components of the United States who was killed while serving in a combat arena is also eligible as long as long as he/she does not remarry. There is no registration fee, manufacturing fee, or annual registration fee for this specialty plate. An applicant is also entitled to one additional specialty plate upon payment of a $25 manufacturing fee. An applicant will also be required to pay a $25 annual registration fee for the additional specialty plate.


Surgical treatment performed at specific level 2 and 3 medical treatment facilities. All these level 3 facilities had a permanent neurosurgeon, while the level 2 facilities did not. Treatment of head injury excludes scalp repair but includes intracranial pressure monitoring. This graph excludes those killed in action (KIA) and killed non-enemy action (KNEA).


Patients that died of wounds with types of head injury managed at specific level 2 and 3 MTF. All the level 3 facilities had a permanent neurosurgeon, while the level 2 facilities did not. This graph excludes those killed in action (KIA) and killed non-enemy action (KNEA). TBI, traumatic brain injury.


Patients who died of wounds with types of head injury managed at level 2 and 3 MTF demonstrating the effect of aeromedical evacuation to a neurosurgeon on treatment. This graph excludes those killed in action (KIA) and killed non- enemy action (KNEA). TBI, traumatic brain injury.


This study is the first to directly compare the US and UK combat trauma system databases. Our analysis should be considered in the light of the differing inclusion criteria and data recording within these databases; however, we have found that overall likelihood of survival after combat HI is markedly increased when a neurosurgeon is present in the deployed trauma care system, independent of other risk factors. Combat HI is associated with death and long-term severe disability. In the recent conflicts in Iraq and Afghanistan, the US and UK adopted differing approaches; the US deployed neurosurgeons to many of their Role 3 facilities, whereas the UK did not, relying on forward neurosurgery by non-neurosurgeons or stabilisation by non-neurosurgeons and TACEVAC of selected casualties for neurosurgical care. The use of both active duty and reserve neurosurgeons provided flexibility towards care, with numbers at any particular time varying between locations, reflecting the requirements of that moment. Since the start of the Iraq conflict in 2003, there has been fluctuating numbers of neurosurgeons in both the US DoD and UK MoD that have served on active duty and has varied by service. Future neurosurgery manning for US military medicine in particular is currently under consideration within the broader National Defense Authorisation Act, which is authorised by the US Congress.


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