The STEP Method: A Structured Approach to Optimize Team Performance
of Army Forward Resuscitative Surgical Detachments (FRSDs)
Bongartz T, High K, Smith JP, Palubicki J, Cleaves C, Sweigert C, Buzzelli MD 26(1). 41
Publication Type: Journal Article
Abstract:
Background: The U.S. Army Forward Resuscitative Surgical Detachment (FRSD) provides rapid damage control resuscitation and surgery near the point of injury within combat zones. To improve team performance and operational readiness within two FRSD units preparing for combat deployment, we developed a systematic, evidence-informed standard operating procedure (SOP) to address the unique challenges of far-forward trauma resuscitation.
Methods: This project was conducted under unit-level authority as an internal readiness optimization effort, consistent with every FRSD’s responsibility to develop its own SOPs. We created a theoretical framework for team performance optimization based on literature and interdisciplinary expert input. The prototype SOP was refined through simulation training and real-world trauma resuscitations during two FRSD deployments. Performance feedback and after-action reviews were used to iteratively optimize the “STEP” system.
Results: The STEP method is a framework for optimizing Army FRSD team performance, based on four crucial elements: Skill, Team organization, Equipment, and Process. “Skill” emphasizes proficiency in performing trauma resuscitation procedures and cross-training of team members for adaptability in mass casualty scenarios. “Team organization” includes clear roles and responsibilities, and a communication standard to avoid miscommunication and confusion. “Equipment” includes equipment maintenance, positioning, and familiarization. “Process” refers to the “game plan,” a structured sequence of diagnostic and therapeutic steps that supports organization and efficiency.
Conclusion: The STEP method introduces a standardized approach to traumaresus-citation by Army FRSDs, offering a replicable SOP template with broad applicability across Army medical units. It holds potential beyond trauma resuscitation, offering a versatile framework for optimizing team performance in high-stress, high-stakes environments.
Keywords: forward resuscitative surgical detachment;
Army; trauma resuscitation; damage control resuscitation; team performance; patient care team; military medicine; clinical protocols; standard operating procedures; team communication
PMID: 41865313
DOI: doi.org/10.55460/J.Spec.Oper.Med.2026.TAI8-KEKX
