Page 43 - Journal of Special Operations Medicine - Fall 2017

equipment and personnel. The light team is highly expeditious Table 1 Comparison of Instrument Sets Between the GHOST-T
with fewer personnel and less equipment but with decreased Model and the Traditional FST
surgical ability (one surgical patient at a time). The SRT light Instrument Sets*
team, with its mobility and lightweight model, is the basis for GHOST-T Traditional FST
the GHOST-T model. Major basic (3) Major basic (3)
Minor basic (3) Minor basic (3)
There is no doctrine on the GHOST-T model; it is based-on Thoracic (2) Cardiothoracic (2)
the traditional FST model and modified by the individual
units conducting the missions. The 102nd FST deployed with Craniotomy (1) Thoracotomy tray (1)
traditional, doctrine-based surgical instrument sets (MTOE Vascular (2, augment) † Emergency thoracotomy (1)
FY2006), which were found to be bulky, inefficient, and im- Hoffman 3 external fixator Craniotomy/burr hole (1)
mobile. Remick et al. have laid groundwork for instrument-set (2, augment) † Orthopedic (1)
Amputation (1)
description of the SRT light team; this included two lapa- *The number in parentheses indicates the number of individual packs
rotomy sets, one thoracotomy set, one vascular set, and one of the specific instrument included in the overall pack.
soft-tissue set. The SRT heavy team had additional cricothy- † “Augment” indicates it is not a set intended for use alone, but rather
roidotomy and resuscitative thoracotomy sets. To capitalize in combination with the minor basic or major basic, depending on the
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on the ability of the GHOST-T to maintain mobility without injury pattern.
decreasing damage control surgical capability, the surgical in- extremity or neck injuries. The concept behind the augmenta-
strument sets originally described were used as a foundation tion sets was to supplement the minor basic set in the event of
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to maximize the ability of the GHOST-T to mold to current vascular or orthopedic injury. The specific augmentation sets
damage control surgical needs. The aim of this paper is to de- are vascular and a prepackaged orthopedic external fixator set
fine the current surgical instrument sets of the GHOST-T, with (i.e., Hoffman 3). Specific key instruments were transitioned
a focus on the rationale of each specific instrument set. from within standard sets to individually packed instruments
for expeditious use, specific instruments in limited supply, or
Methods instruments that could be used with multiple sets. The indi-
vidually pack instruments are listed in Table 2.
The 102nd FST was attached to the Special Operations Forces
assigned to southern Afghanistan from June 2015 through Table 2 GHOST-T Individually Packed Instruments
March 2016. Planning for these missions instigated the modi- Individually Packed Instruments*
fications. The missions allowed two all-terrain vehicles (ATVs) Balfour retractor (1)
to pack all the equipment and travel in a CH47 Chinook he-
licopter (Boeing; http://www.boeing.com). During mission Richardson large retractor (1)
planning, the GHOST-T personnel determined the current sets Hudson brace (hand-held craniotomy drill; 1)
(MTOE FY2006) were too heavy and cumbersome for pack- DeBakey aortic clamp (2)
ing and transportation purposes. They were also organized Gigli bone saw wire (6)
inefficiently for damage control surgical use. A working group Gigli bone saw handles (3 pairs)
of surgeons and surgical technologists identified the problem, Rongeurs (2)
devised the plan, and reorganized the instruments. Surgical Sterile 7-qt basin (1)
instrument sets were molded within the mission needs, thus *The number in parentheses indicates the number of individual packs
allowing the 102nd GHOST-T to be more lightweight and of the specific instrument included in the overall pack.
compact than previous surgical teams while maintaining the
same surgical capabilities. The revision of surgical instrument Each instrument set was thoroughly evaluated to include the
sets was to maximize efficiency of conducting damage control most commonly used instruments to perform damage con-
procedures, and decrease weight and volume, thus maximizing trol surgical care anticipated for the GHOST-T missions. The
the mobility of the GHOST-T. specific instruments in the major basic set are listed in Table
3. Overall, it was taken down to the essentials to perform
Results damage control surgery by decreasing the number of forceps
clamps, tissue forceps, needle drivers, retractors, scissors, and
To maximize mobility by minimizing size and weight of by removal of the storage/sterilization container. To address
the instrument sets, without losing any surgical ability, the the possible abdominal vascular injury without having to open
GHOST-T surgical sets were reorganized into main surgical a separate set of instruments, a large, curved vascular clamp
sets with key instruments individually packed and augmenta- was added. This set can be supplemented with any of the indi-
tion sets for specific injury patterns (i.e., orthopedic and vas- vidually packed instruments (Table 2) to increase its versatility.
cular injuries). Table 1 lists the GHOST-T and traditional FST Due to bulk and limited utility in the damage control setting,
instrumentation sets for a simple comparison. The traditional only one self-retaining retractor (Balfour) was included in the
FST sets per doctrine included eight individual main sets (i.e., GHOST-T inventory for missions.
major basic, minor basic, cardiothoracic, thoracotomy tray,
emergency thoracotomy tray, craniotomy, orthopedic, and Similar changes were made in the minor basic set (Table 4).
amputation). The GHOST-T sets include four main sets (i.e., The concept of the minor basic set was for damage control ex-
major basic, minor basic, thoracic, and craniotomy). The four tremity injury or smaller wound washouts. If a vascular injury
main sets cover the major body cavities for damage control was suspected, the augmentation of the specific vascular set
surgeries. The major basic set was designed for abdominal (Table 5) facilitates the ability for damage control treatment
cases, the thoracic set for the thorax injuries, the craniotomy with temporary shunting, ligation, or repair of the vessel. Most
set for head injuries, and the minor basic set to be used for of the reorganized vascular set was created from within the

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