Page 48 - Journal of Special Operations Medicine - Fall 2017

The Golden Hour Offset Surgical Treatment Team Operational Concept

Experience of the 102nd Forward Surgical Team
in Operation Freedom’s Sentinel 2015–2016

Jerome M. Benavides, MD , MBA; Linda C. Benavides, MD ;
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Diane F. Hale, MD *; Jonathan B. Lundy, MD 4
3

ABSTRACT
Theater Special Operations Force (SOF) medical planners have The 102nd FST was deployed in support of Operation Free-
begun using Army Forward Surgical Teams (FSTs) to main- dom’s Sentinel from June 2015 to March 2016. The activi-
tain a golden hour for U.S. SOF during Operation Freedom’s ties of the 102nd FST were reviewed with special attention to
Sentinel required adaptation in FST training, configuration, novel ways the unit was used and the means that facilitated its
personnel, equipment, and employment to form Golden Hour success during the deployment. Mission after-action reports,
Offset Surgical Treatment Teams (GHOST-Ts). This article continuity books, patient care, and administration records
describes one such FST’s experience in Operation Freedom’s were all reviewed and key personnel were asked for input.
Sentinel while deployed for 9 months in support of SOF in
southern Afghanistan.
Mission Background
Keywords: Golden Hour Offset Surgical Treatment Team Operation Freedom’s Sentinel and the North Atlantic Treaty
(GHOST-T); austere surgery Organization (NATO)-led Resolute Support Mission were the
names for the most recent phase of the conflict in Afghanistan.
As a partnered mission, NATO soldiers were tasked with train-
ing, advising, and assisting the Government of the Islamic Re-
Introduction
public of Afghanistan and its soldiers. SOF played an integral
Evidence has been published supporting the U.S. military’s role in this mission alongside their host-nation partners. The
policy that no American Servicemember should be farther operation oversaw the planned withdrawal of U.S. and Coali-
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than 1 hour away from surgical care on the battlefield. In tion troops from forward operating bases (FOBs) throughout
Afghanistan, as the Forward Operating Base footprint con- Afghanistan. Some of these locations had MEDEVAC and
tinues to shrink during retrograde operations, U.S. forces are surgical assets co-located, maintaining a golden-hour ring for
operating out of fewer and fewer locations, resulting in medi- missions. Some FOBs were located outside the golden-hour
cal evacuation (MEDEVAC) golden-hour rings that no lon- MEDEVAC rings, requiring FST adaptation to support SOF
ger overlap. The result is a nonlinear battlefield with fewer operations and necessitating surgical capabilities to be pushed
conventional forces occupying a decreasing number of bases forward in the battlespace. 5
and a relative increased SOF presence that continues to men-
tor, train, and execute missions with host nation partners in The Army’s traditional FST was used as a manpower pool
remote locations. These missions are sometimes out of the for the GHOST-T concept, using small teams of five to seven
established MEDEVAC rings and require surgical team sup- medical personnel to jump forward, with SOF and security as-
port to maintain all Soldiers within 1 hour of a surgeon. The sets, and sometimes in conjunction with MEDEVAC helicop-
20-person FST, the U.S. Army’s workhorse for far-forward ter and crews. These GHOST-T would go forward with only
surgical treatment of battlefield trauma, may sometimes create essential equipment and set up a triage station and operating
too large a footprint and not be agile enough for this mis- theater in a fixed facility, tent, or other structure to provide
2–4
sion. Maintaining a golden hour for U.S. SOF during Opera- damage control resuscitation and surgery during the mission.
tion Freedom’s Sentinel required adaptation in FST training, The GHOST-T was typically pushed out with a security and
configuration, personnel, equipment, and employment. communications element provided by theater-level assets and
flown by rotary or fixed wing to a far-forward location to sup-
In response to these concerns, theater SOF medical planners port these missions. Once the area of operations was identified
have begun using Army FSTs for this unique mission to form and secured, the GHOST-T was responsible for establishing
GHOST-Ts. This artice describes one such FST’s experience in a triage and operating area to support the mission with re-
Operation Freedom’s Sentinel while deployed for 9 months in suscitative and surgical care. Supplies were on hand for five
support of SOF in southern Afghanistan. surgical patients, with the ability to cold-sterilize instruments
*Correspondence to diane.f.hale.mil@mail.mil
1 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; and assistant professor of surgery, Norman M. Rich Department of
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Surgery (NMRDS), Uniformed Services University of Health Sciences (USUHS). MAJ L.C. Benavides is the 67th Forward Surgical Team Chief
and a general surgeon at Landstuhl Regional Medical Center in Germany and assistant professor of surgery, NMRDS, USUHS. MAJ Hale is a
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general surgeon and general surgery clinic OIC at San Antonio Military Medical Center in San Antonio, TX, and assistant professor of surgery,
NMRDS, USUHS, Bethesda, MD. LTC Lundy is a general surgeon at Carl R. Darnall Army Medical Center, Fort Hood, TX; assistant professor
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of surgery, NMRDS, USUHS; and adjunct associate professor of surgery, Department of Surgery, UTHSC, San Antonio, TX.
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