Reducing the Logistical Footprint of Forward Resuscitative Surgical Units Using aPatient-Driven Model of Clinical Events

摘要

Moving towards a concept of medical organization that achieves the objectives ofMarine Corps guidance such as Operational Maneuver from the Sea brings particular challenges when examining forward resuscitative surgical units. Surgical units must be small enough to perform abbreviated, staged surgical procedures in forward areas to accommodate today's operational requirements for greater mobility. The primary objective of this paper was to reduce the surgical footprint by developing a model of the far forward medical supply stream that linked specific clinical requirements to individual medical treatment items. One hundred fifteen clinical Subject Matter Experts (SMEs) with operational experience assisted in the development of Marine Corps specific surgical treatment profiles for 72 of the 350 DEPMEDS Patient Conditions (PCs). Medical consumables and equipment were then assigned to each of the operating room tasks, establishing the clinical requirement for each item. A patient generating model (PATGEN) was used to determine which PCs would present as candidates for forward surgery. This information was loaded into the model and used to generate the medical items required for the operating room equipment AMAL 639 and the operating room consumable AMAL 640. When compared to the current Marine Corps operating room AMALs, the proposed AMALs resulted in reductions of 15.0% in weight and 13.2% in cube for the equipment AMAL 639 and 22.4% reductions in weight and 36.3% in cube for the consumable AMAL 640. This approach, which also resulted in an increase in operating room clinical capability, produced an audit trail for each item that allows medical logisticians to substantially improve the AMAL configurations because only items that can be clinically related to a treatment task conducted in theater are considered for inclusion in the AMALs.