The Society of Military Orthopaedic Surgeons (SOMOS) teaches the "Combat Extremity Surgical Course" (CESC) to military surgeons prior to deployment. The SOMOS Core Curriculum and Critical Skills List are derived from the CESC objectives and are presented as part of the Orthopaedic Disaster Preparedness and Trauma Care Tool Box initiative.
Core Curriculum
A. Define the spectrum of injury
B. Describe the fundamental principles of wound management
C. Demonstrate knowledge of the indications for and ability to implement emergent orthopaedic interventions (tourniquet, etc.)
A. Define levels of casualty care from point of injury to definitive care
B. Demonstrate the skills needed to evaluate the host nation’s capabilities, and apply the levels of care (what can be accomplished at each level)
C. Describe methods to document patient care
D. Understand medical logistic systems
E. Demonstrate the ability to determine extremity care logistical needs for a health care operation
F. Describe the fundamentals of safe transport of patients with extremity wounds
A. Understand the factors that affect the care options for different patient groups (locals, detainees, foreigners/soldiers and those with evacuation options)
B. Define and demonstrate debridement
C. Describe the indications for and demonstrate the ability to perform battlefield/austere environment amputations
A. Describe the initial non-surgical and surgical management of extremity fractures
B. Demonstrate appropriate application of an external fixator with limited resources and stability for transport
C. Define care guidelines for fractures of upper and lower extremities in the context of the host nation’s environment and the options available to the different patient groups
A. Describe the initial management, resuscitation, and stabilization of pelvic fractures
B. Define the initial management, resuscitation, and stabilization of spine injuries with associated neurologic injuries
A. Define compartment syndrome and describe the diagnostic limitations presented by an austere environment
B. Demonstrate proper fasciotomy techniques for the upper and lower extremities
A. Describe the initial evaluation and management of a burn patient
B. Define early management of extremity burns
C. Demonstrate the proper technique for escharotomy
A. Define the initial evaluation and demonstrate appropriate evaluation techniques of a patient with an extremity vascular injury
B. Understand the indication for vascular stents/shunts/bypass grafts and demonstrate appropriate surgical techniques
C. Describe techniques for performing extremity angiography in an austere environment
Critical Skills List
a. Gastroc - includes video
b. Soleus - includes video
c. Sural
d. Radial forearm - includes video
e. Posterior interosseous
f. Cross-finger
The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense or the U.S. Government.
Materials and editorial support for The Disaster Preparedness Toolbox is provided by Lt Col. Ky Kobayashi, MD and Col. Benjamin Kam, MD.
