At Bagram, when the initial surge ended, trauma surgeons cleaned floors and administrative staff rounded to identify patients ready for discharge. Physicians applied their skills in non-traditional roles, such as the urologist who served as an operative assistant to the trauma surgeon and performed wound care duties. In OPF, non-medical personnel assisted with patient movement and stocking supplies. As such, administrative nurses assumed clinical duties and medics moved from the prehospital to the inpatient setting to assist with patient care. In Mogadishu, more than 200 casualties arrived at the hospital during a time when staffing was already short due to a reduction of hospital personnel. When resources are stretched thin, delegation may require assigning personnel to tasks that are outside the scope of their typical duties. The content of this article is drawn from the lessons learned after MCEs in military and civilian healthcare settings.Äelegation of tasks is key to maintaining quality care during a surge and returning to normal functions promptly. Whereas much has been written about delivering care during an MCE, the focus of this article is to highlight shared strategies to deal with the aftermath of MCEs. The speakers described their experience dealing with multiple casualties and strategies to handle the aftermath after the initial surge as they transitioned their hospitals to normal operation. To expand on this theme, the American Association for the Surgery of Trauma (AAST) assembled a cadre of military and civilian physicians with experience in mass casualty trauma care to facilitate domestic preparedness for the next MCE. Partnerships have formed, with a combined military–civilian response to Hurricane Harvey, a train derailment in Tacoma, Washington, and the Las Vegas massacre. 1 As such, lessons borrowed from the military have been applied to domestic healthcare. The last 15 years of war have advanced care after mass casualty events (MCEs), dramatically improving patient survival. This article focuses on the lessons learned from military and civilian surgeons in the days after MCEs. The events described were the First Battle of Mogadishu (1993), the Second Battle of Fallujah (2004), the Bagram Detention Center Rocket Attack (2014), the Boston Marathon Bombing (2013), the Asiana Flight 214 Plane Crash (2013), the Baltimore Riots (2015), and the Orlando Pulse Night Club Shooting (2016). A panel discussion entitled The Day(s) After: Lessons Learned from Trauma Team Management in the Aftermath of an Unexpected Mass Casualty Event at the 76th Annual American Association for the Surgery of Trauma meeting on Septembrought together a cadre of military and civilian surgeons with experience in MCEs. Much has been written about strategies to deliver care during an MCE, but there is little about how to transition back to normal operations after an event. Military and civilian collaboration has led to partnerships which augment the response to MCE. Care during mass casualty events (MCE) has improved during the last 15 years.
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