Page 121 - Journal of Special Operations Medicine - Spring 2016

exercised planning for missions requiring flexibility of area support (AS) and direct support (DS) operations in
personnel and equipment tailored to operations con- SOCFWD-NWA.
ducted by US SOF.
The distance to a surgical team prior to the MFST de-
All MFST and ECCT members completed an Evasion ployment put SOF at an unacceptably high risk and se-
and Conduct After Capture course at Lackland Air verely limited conduct of operations. Although French
Force Base in San Antonio, Texas. Based on the threat Role II hospitals were in place in N’Djamena, Chad, and
of AQIM and Boko Haram in the AOR and the permis- in Madama, Niger, the evacuation time for a US Soldier
sive environment in sub-Saharan Africa, this training ranged from 12 to 24 hours throughout the SOCFWD-
was mandated for the MFST and ECCT. In addition, NWA AOR. This lack of timely CASEVAC limited any
the emergency physician from the MFST and the critical risk management offered by the French Role II hospitals
care physician from the ECCT attended the Operational and prevented conduct of high-risk operations by SOF. 4
Clinical Infectious Disease Course at the Walter Reed
Army Institute of Research, enabling the teams to diag- With the MFST and ECCT providing DS, the time to
nose and treat the myriad infectious diseases endemic to CASEVAC and damage-control surgery (DCS) was sig-
the SOCFWD-NWA AOR. nificantly reduced to within 4 to 12 hours. This directly
lowered risks to SOF from medical threats, nonbattle
5
After completing predeployment training, the eight- injury, and enemy contact, and permitted operations
person MFST and ECCT arrived in Niamey, Niger in to advise and assist partner nations in the interdiction
November 2014 to conduct a 6-month tour as the first of AQIM and Boko Haram forces. By providing DS to
conventional surgical and critical care teams deployed forward forces, the MFST and ECCT improved casualty
to Africa in support of US SOF (Figure 2). care, provided transfusion of packed red blood cells and
plasma in the prehospital setting, and significantly re-
Figure 2 A Nigerien security element near a landing strip duced time to DCS on the highest-risk missions. Opera-
remote from the AOB. tions conducted simultaneously outside the CASEVAC
ring surrounding the MFST and ECCT meant CASE-
VAC times were degraded beyond 12 hours for opera-
tors conducting missions far from the MFST and ECCT.
However, time to resuscitation and DCS was reduced
to within 1 hour when the surgical team was embedded
with the SOF team conducting operations. Neither the
MFST nor ECCT were trained and equipped to provide
care in this manner. The teams required familiarization
training by U.S. SOF providers while deployed, acquired
additional equipment, and integrated with SOCMs to
be effective. Furthermore, providing DS this far forward
removed US surgical capability as an option for the re-
maining deployed SOF personnel. The AOR was too
vast for a single MFST and ECCT to cover simultaneous
operations and this highlights the need for more surgi-
cal and critical care evacuation teams to deploy to the
Operations AOR to permit robust DS during split operations while
Upon arrival, equipment and supply shortfalls were iden- mitigating risk for remaining personnel.
tified and medical and transportation capabilities were
assessed. Working with medical planners at SOCFWD- The concept of operations for the MFST and ECCT
NWA and SOCAF in Stuttgart, Germany, the MFST and evolved significantly over the course of the first deploy-
ECCT built and equipped a medical facility in an Alaska ment. The legacy mission of mobilizing the teams for
Shelter capable of surgical and critical care with a lim- DS from a central hub needed to be flexible to meet
ited holding capacity for up to four critically ill patients. challenges inherent in an AOR with limited CASEVAC
A concept of operations was developed based on the aircraft, vast distances, and finite and few medical re-
mission drawing on the years of experience from simi- sources. The mobilization of both teams for DS missions
larly equipped SOF surgical teams and the requirements to remote locations meant a degradation of the ability to
designated by the Advanced Operations Base (AOB) provide effective AS while away from the higher medi-
Commander with guidance from the SOCAFRICA sur- cal capability and centralized transportation hub at the
geon. Once fully equipped and operational, the MFST AOB. The limiting factor for effective support of US
and ECCT, under the tactical control of the AOB began and partner forces was CASEVAC. Without dedicated

USAF Medical Providers Supporting SOCAFRICA 105