Page 42 - Journal of Special Operations Medicine - Fall 2017

Surgical Instrument Sets for
Special Operations Expeditionary Surgical Teams

Diane F. Hale, MD *; Justin C. Sexton ; Linda C. Benavides, MD ;
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Jerry M. Benavides, MD, MBA ; Jonathan B. Lundy, MD 5

ABSTRACT
Background: The deployment of surgical assets has been driven and 2003, respectively. By doctrine (modified table of orga-
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by mission demands throughout years of military operations in nization, MTOE FY2006), the traditional FST is a 20-mem-
Iraq and Afghanistan. The transition to the highly expeditious ber team consisting of four general surgeons (or three general
Golden Hour Offset Surgical Transport Team ( GHOST-T) surgeons and one orthopedic surgeon), two certified registered
now offers highly mobile surgical assets in nontraditional nurse anesthetists (CRNAs), three registered nurses (RNs; one
operating rooms; the content of the surgical instrument sets emergency/trauma RN, one critical care RN, and one operat-
has also transformed to accommodate this change. Methods: ing room RN), three licensed practical nurses (LPNs), three
The 102nd Forward Surgical Team (FST) was attached to Spe- surgical technicians, four medics, and one administration
cial Operations assigned to southern Afghanistan from June officer. The traditional FST model has the capability of two
2015 to March 2016. The focus was to decrease overall size operating rooms, 10 operations per day, a total of 30 opera-
and weight of FST instrument sets without decreasing surgi- tions in 72 hours, and postoperative care for eight patients
cal capability of the GHOST-T. Each instrument set was evalu- for no more than 6 hours. The blood resuscitative capability
ated and modified to include essential instruments to perform includes 20 units of packed red blood cells, 20 units of fresh
damage control surgery. Results: The overall number of main frozen plasma, and, possibly, cryoprecipitate. Traditionally,
instrument sets was decreased from eight to four; simplified the ability to use fresh whole blood depended on availability
augmentation sets have been added, which expand the capa- of additional personnel. There is no dedicated technician for
bilities of any main set. The overall size was decreased by 40% radiology, laboratory, blood-product management, communi-
and overall weight decreased by 58%. The cardiothoracic, tho- cation, or generator and electronic mechanic; thus, members
racotomy, and emergency thoracotomy trays were condensed of the team are cross-trained to provide these assets beyond
to thoracic set. The orthopedic and amputation sets were re- their basic scope of practice. 2,3
placed with an augmentation set of a prepackaged orthope-
dic external fixator set). An augmentation set to the major or Throughout the current operations, the deployment of FSTs
minor basic sets, specifically for vascular injuries, was created. has evolved into split-based operations, usually in fixed loca-
Conclusion: Through the reorganization of conventional FST tions. Then these transitioned into “flex missions” in the form
surgical instrument sets to maintain damage control capabili- of highly mobile split-based teams. Surgical split-based teams
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ties and mobility, the 102nd GHOST-T reduced surgical equip- of ever-decreasing size have provided the same level of care with
ment volume and weight, providing a lesson learned for future limited resources and personnel. The next iteration was add-
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surgical teams operating in austere environments. ing mobility as surgical resuscitative teams (SRTs) in light and
heavy configurations. The SRT light team consisted of an eight-
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Keywords: austere surgery; forward surgical team; Golden member unit: one general surgeon, one CRNA, one trauma RN,
Hour Offset Surgical Treatment Team (GHOST-T) one surgical technician, two LPNs, and two medics. This unit
can be modified per mission demands by an additional surgeon,
or it can be smaller by decreasing a medic or LPN. 4
Introduction
The SRT light mission was the beginning of the current Golden
Many surgical lessons have been learned through the current Hour Offset Surgical Transport Team (GHOST-T). The
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operations in Iraq and Afghanistan. The deployment of surgi- GHOST-T can perform damage control surgery in extremely
cal assets far forward to preserve life, limb, or eyesight has austere environments with minimal supplies or support. The
proven to provide exceptional care to our deployed Soldiers. limits of the team are unique to each mission. The heavy team
The Forward Surgical Team (FST) model has been the main- can surgically treat more than one casualty simultaneously.
stay of damage control care in Afghanistan and Iraq since 2001 This team is not ideal for mobility because it requires more
*Correspondence to diane.f.hale.mil@mail.mil
1 MAJ Hale is a general surgeon and general surgery clinic OIC at San Antonio Military Medical Center in San Antonio, TX, and assistant pro-
fessor of surgery, Norman M. Rich Department of Surgery (NMRDS), Uniformed Services University of Health Sciences (USUHS), Bethesda,
MD. SGT Sexton is a surgical technologist (68D) and operating room noncommissioned officer in charge of the 102nd FST in Joint Base Lewis-
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McChord, Washington. MAJ L.C. Benavides is the 67th Forward Surgical Team Chief and a general surgeon at Landstuhl Regional Medical
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Center in Germany and assistant professor of surgery, NMRDS, USUHS. MAJ J.M. Benavides is the chief of orthopedic surgery, 212th Combat
Support Hospital, Rhine Ordnance Barracks, Germany; chief of foot and ankle orthopedics at Landstuhl Regional Medical Center in Germany;
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and assistant professor of surgery, NMRDS, USUHS. LTC Lundy is a general surgeon at Carl R. Darnall Army Medical Center, Fort Hood, TX;
assistant professor of surgery, NMRDS, USUHS; and adjunct associate professor of surgery, Department of Surgery, UTHSC, San Antonio, TX.
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