As a result of the field surgeon being on the front line of medical care in an austere environment, implementation of preventive medicine practices and disease pattern recognition are his/her responsibility. Responsibilities may include stray animal euthanasia due to prevalence of rabies, enforcement of malaria prophylaxis, medical training and maintenance of snake antivenin, and assistance with other local endemic disease. The unique skill set of dermatologists in organism identification can further bolster the speed with which vector-borne diseases are recognized and prevention and treatment measures are implemented.
As coalition forces executed a mission in Afghanistan, US servicemembers began experiencing abdominal distress, chills, fevers (temperature >40°C), debilitating headaches, myalgia, arthralgia, and tachycardia. Initially, these patients were evacuated to the Role 2 BAS, hindering the mission. Upon inspection, patients had numerous bug bites; one astute soldier collected the arthropod guilty of the assault and brought it to the aid station. Upon inspection, the offender was identified as the Phlebotomus genus of sandflies, organisms that are well known to dermatologists as a cause of leishmaniasis. Clinical correlation resulted in the presumed diagnosis of Pappataci fever, and vector-borne disease prevention measures were then able to be further emphasized and implemented in at-risk areas, allowing the mission to continue.9 Subsequent infectious disease laboratory testing confirmed the Phlebovirus transmitted by the sandfly as the underlying cause of the illness.
The diverse role of the field surgeon in the deployed setting makes any one specialist underprepared to completely take on the role from the outset; however, with appropriate and rigorous trauma training prior to deployment, dermatologists will continue to perform as invaluable assets to the US military in conflicts now and in the future.