{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:38:12Z","timestamp":1793317092625,"version":"4.5.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Craniomaxillofacial (CMF) trauma is significantly rising from drone delivered blasts in military and civilian settings. CMF traumatic injuries from airburst blasts present uniquely complex surgical challenges. The abrupt transmission and dissipation of energy causes barotrauma to the orbit, paranasal sinuses, tympanic membrane, inhalation injury, crush injuries, fractures and dislocations. High velocity projectiles cause deep lacerations, comminuted fractures, embedded foreign bodies, avulsion, degloving and other complex wounds. Surgical management is complicated by contamination, burns, progressive soft-tissue necrosis, and polytraumatic injuries. Opportunities for surgeons to acquire and maintain the abilities to manage these injuries are rare. We created a CMF trauma surgery course to assist with closing this training gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Tri-service military craniomaxillofacial surgeons (N\u2009=\u200952) ensured the accuracy of scope and performance requirements in the context of damage control trauma and prolonged field care in resource-limited environments. Performance objectives were written for surgeons with specialty training in otolaryngology, oral-maxillofacial surgery, and plastic surgery. Domain knowledge was measured using a 50-item case-based multiple-choice exam emphasizing reasoning, judgment, and decision-making tied to available resources, evacuation strategies, and patient holding times in various environments. A score of 80% was set as the benchmark. The standard for procedural performance objectives was independent and accurate completion of specified procedures, inclusive of pivotal judgments and surgical skills. Course resources were created to support multiple learning styles and be accessible on-demand for surgeons deployed around the world. All course resources critically reviewed for best practices and currency by 20 craniomaxillofacial trauma experts. Faculty members were selected based on key competencies including content and surgical expertise, and teaching and assessment abilities. Courses were implemented using online resources and face-to-face laboratory sessions to facilitate content presentations, case-based analyses, hands-on operative activities, and reflections about management strategies for these injuries in resource limited environments with extended prolonged care requirements. Course outcomes were determined with a purposive sample of military CMF surgeons from the United States and Canada (N\u2009=\u200942). Knowledge outcomes were determined using paired t-tests (P\u2009&amp;lt;\u2009.05). Procedural performance outcomes were determined using effect sizes (eta squared). Course evaluations were examined using non-parametric and qualitative analyses of 27 question responses from course participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were significant gains in knowledge for all participants (P\u2009&amp;lt;\u2009.01). Post scores met the performance standard (80.00 \u00b1 0.45). Effect sizes (eta squared) demonstrated procedural performance improvements: small (2 procedures), medium (5 procedures), large (1 procedure). Course evaluations were favorable for all scored elements. All participants reported the course was highly impactful for identifying and closing performance gaps in their abilities to manage traumatic CMF injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The outcomes from this study demonstrate course related improvements in domain knowledge and procedural abilities for critical damage control and prolonged care CMF traumatic injuries, such as those incurred through drone delivered blasts. These outcomes add to the evidence that high quality pre-deployment training and assessment is critical for ensuring military surgeons are well-prepared to accurately and independently manage complex traumatic injuries to best care for those in harm\u2019s way.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag237","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T11:42:58Z","timestamp":1778240578000},"source":"Crossref","is-referenced-by-count":1,"title":["Enhancing Combat Surgical Readiness: The Development and Impact of the Combat Craniomaxillofacial Trauma Surgery Course"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7403-812X","authenticated-orcid":false,"given":"Pamela","family":"Andreatta","sequence":"first","affiliation":[{"name":"Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Gaudreau","sequence":"additional","affiliation":[{"name":"Department of ENT-Otolaryngology, Naval Medical Center San Diego , San Diego, CA 92134,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara L","family":"Kemp","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Naval Medical Center Portsmouth , Portsmouth, VA 23708,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Orestes","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego , San Diego, CA 92134,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"2026052514551561000_usag237-B1","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.ajem.2024.08.001","article-title":"Analyzing unmanned aerial vehicle (drone) attacks; a disaster medicine perspective","volume":"84","author":"Shapovalov","year":"2024","journal-title":"Am J Emerg Med"},{"key":"2026052514551561000_usag237-B2","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/S0140-6736(09)60257-9","article-title":"Blast injuries","volume":"374","author":"Wolf","year":"2009","journal-title":"Lancet"},{"key":"2026052514551561000_usag237-B3","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1056\/NEJMra042083","article-title":"Blast injuries","volume":"352","author":"DePalma","year":"2005","journal-title":"N Engl J Med"},{"key":"2026052514551561000_usag237-B4","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.ajem.2023.05.003","article-title":"High risk and low prevalence diseases: blast injuries","volume":"70","author":"Bukowski","year":"2023","journal-title":"Am J Emerg Med"},{"key":"2026052514551561000_usag237-B5","doi-asserted-by":"publisher","first-page":"e127","DOI":"10.1016\/j.bja.2021.10.007","article-title":"Injury scoring systems for blast injuries: a narrative review","volume":"128","author":"Hazell","year":"2022","journal-title":"Br J Anaesth"},{"key":"2026052514551561000_usag237-B6","volume-title":"Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects","author":"Cernak","year":"2015"},{"key":"2026052514551561000_usag237-B7","doi-asserted-by":"publisher","first-page":"2156","DOI":"10.1056\/NEJMe1102187","article-title":"Brain injuries from blasts","volume":"364","author":"Ropper","year":"2011","journal-title":"N Engl J Med"},{"key":"2026052514551561000_usag237-B8","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1136\/jramc-2018-001058","article-title":"Pathophysiology of primary blast injury","volume":"165","author":"Smith","year":"2019","journal-title":"J R Army Med Corps"},{"key":"2026052514551561000_usag237-B9","doi-asserted-by":"publisher","first-page":"e40","DOI":"10.1016\/S2542-5196(18)30265-1","article-title":"Traumatic amputations caused by drone attacks in the local population in Gaza: a retrospective cross-sectional study","volume":"3","author":"Heszlein-Lossius","year":"2019","journal-title":"Lancet Planet Health"},{"key":"2026052514551561000_usag237-B10","volume-title":"Conventional Warfare: Ballistic, Blast, and Burn Injuries","author":"Bellamy","year":"1991"},{"key":"2026052514551561000_usag237-B11","doi-asserted-by":"publisher","first-page":"1650","DOI":"10.1097\/SCS.0000000000009265","article-title":"Challenges in the head and neck department in the diagnosis and surgical treatment of patients presenting to a single tertiary hospital of Somalia with extreme war injuries","volume":"34","author":"Yasar","year":"2023","journal-title":"J Craniofac Surg"},{"key":"2026052514551561000_usag237-B12","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1097\/SCS.0000000000006345","article-title":"Shrapnel injuries on regions of head and neck in Syrian war","volume":"31","author":"Ucak","year":"2020","journal-title":"J Craniofac Surg"},{"key":"2026052514551561000_usag237-B13","doi-asserted-by":"publisher","first-page":"315","DOI":"10.7205\/MILMED-D-14-00345","article-title":"Characteristics of maxillofacial injuries and safety of in-theater facial fracture repair in severe combat trauma","volume":"180","author":"Keller","year":"2015","journal-title":"Mil Med"},{"key":"2026052514551561000_usag237-B14","first-page":"58","article-title":"Blast injuries","volume":"391","author":"Ingelfinger","year":"2024","journal-title":"N Engl J Med"},{"key":"2026052514551561000_usag237-B15","doi-asserted-by":"publisher","first-page":"1762","DOI":"10.1016\/j.jcms.2025.07.017","article-title":"The complex dynamics of maxillofacial trauma in blast and fragmentation injuries: current understanding and gaps in scientific evidence","volume":"53","author":"Grillo","year":"2025","journal-title":"J Craniomaxillofac Surg"},{"key":"2026052514551561000_usag237-B16","doi-asserted-by":"publisher","first-page":"e236","DOI":"10.1093\/milmed\/usz103","article-title":"Reconstructing the face of war","volume":"184","author":"Farber","year":"2019","journal-title":"Mil Med"},{"key":"2026052514551561000_usag237-B17","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-09506-6","volume-title":"Instructional Design: The ADDIE Approach","author":"Branch","year":"2009","edition":"1st ed"},{"key":"2026052514551561000_usag237-B18","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1001\/jamasurg.2021.4412","article-title":"A novel paradigm for surgical skills training and assessment of competency","volume":"156","author":"Bowyer","year":"2021","journal-title":"JAMA Surg"},{"key":"2026052514551561000_usag237-B19","first-page":"238","article-title":"Circumventing acute compartment syndrome: outcomes from a cadaver-based course in fasciotomy procedural skills","volume":"32","author":"Renninger","year":"2023","journal-title":"J Surg Orthop Adv"},{"key":"2026052514551561000_usag237-B20","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1093\/milmed\/usac381","article-title":"Lateral canthotomy\/cantholysis performance gap analysis and training recommendations for expeditionary physicians","volume":"189","author":"Weightman","year":"2024","journal-title":"Mil Med"},{"key":"2026052514551561000_usag237-B21","volume-title":"Measurement Theory and Applications for the Social Sciences","author":"Bandalos","year":"2018"},{"key":"2026052514551561000_usag237-B22","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988","edition":"2nd ed"},{"key":"2026052514551561000_usag237-B23","doi-asserted-by":"publisher","first-page":"S119","DOI":"10.1097\/TA.0000000000004381","article-title":"Putting the ready in readiness: a post-hoc analysis of surgeon performance during a military MASCAL in Afghanistan","volume":"97","author":"Andreatta","year":"2024","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag237\/68384640\/usag237.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag237\/68384640\/usag237.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T18:55:25Z","timestamp":1779735325000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag237\/8692845"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":23,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag237","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"article-number":"usag237"}}