Page 50 - Journal of Special Operations Medicine - Fall 2017

initiation of damage control resuscitation by experienced pro- neurological function. The team was involved in the care of
viders during MEDEVAC. several patients needing wound and burn care, superficial and
complex laceration repair, and traumatic brain injury (TBI)
Expeditionary, Fixed-Facility Operations evaluation. Many of these Soldiers were treated and returned
This mission was an enduring mission throughout the deploy- to duty, alleviating the need for evacuation.
ment, providing a fixed facility at a hub of operations. The
GHOST-T maintained a presence at this location throughout Large, Temporary Forward Operating Base
the deployment. The team’s structure was an Alaskan Tent This mission was undertaken in support of large-scale combat
(Alaska Structures; https://alaskastructures.com/) and had two missions lasting several days with a larger number of personnel
surgical beds and two resuscitation beds (Figure 2). The SOF at risk. The GHOST-T and MEDEVAC would move forward
element would conduct partnered train, advise, and assist mis- to establish a temporary 1-hour evacuation ring and surgical
sions from this location and project forward by ground (ve- capability. Most often, facilities of opportunity on a prior U.S./
hicle) or air (rotary wing). With a large presence, the base had NATO base that had been turned over to Afghan forces were
power, giving the GHOST-T the ability to run a blood refriger- used and served as a staging base for the operation. This for-
ator and plasma freezer. The addition of a plasma thawer and ward location provided medical/surgical care, forward arming
Belmont infusion system (Belmont Instrument Corp.; http:// and refueling (FARP), and co-located MEDEVAC assets to en-
www.belmontinstrument.com/) allowed for resuscitation with sure care for any potentially wounded Soldier within 1 hour.
warm blood products. Resupply was coordinated for blood Coordination with security elements, Afghan forces for use of
and medical supplies and usually received within 1 to 2 days their base, and MEDEVAC assets was critical during planning
of request. Communications were over cellular phone, secure and execution. Secure communication was necessary for pa-
phone, official and secure e-mail, and satellite radio. The SOF tient movement and evacuation, and resupply.
operations cell, along with their medical planners, would co-
ordinate with the team leader when missions were scheduled The logistics for the scope and magnitude of the operation
and all medical assets (i.e., SOF, MEDEVAC, and GHOST-T) were sizeable and numerous assets were collocated on the tem-
were synchronized. porary FOB. Missions longer than 72 hours required use of
formal blood refrigerator and plasma freezer. Styrofoam tem-
Figure 2 Alaskan tent containing two surgical beds and two porary blood storage (Collins) boxes could be used for mis-
resuscitation beds.
sions lasting 24 to 28 hours, but longer missions required the
larger coolers (Figure 3).
Figure 3 Styrofoam temporary blood storage (Collins) boxes could
be used for missions lasting 24 to 28 hours, but longer missions
required the larger cooler.

The GHOST-T was involved in surgical patient care on sev-
eral occasions in this setting. During an on-base mass casualty
event, the GHOST-T treated five patients with high-velocity
gunshot wounds (GSWs). Injuries included one patient with a
GSW to the face, two patients with GSW to extremities, and
two patients with gunshot wounds to the torso. Interventions During this type of mission, the team treated patients on two
performed by the GHOST-T included trauma assessments of occasions. The first included two patients evacuated from
five patients, including one emergent airway, one irrigation combat operations, one with a GSW to an extremity and one
and debridement of the face, application of tourniquet and with a GSW to the torso and extremity requiring prehospital
conversion to a compression dressing, wound care, and se- needle decompression of the chest. Interventions performed by
rial abdominal and focused assessment with sonography for the GHOST-T included trauma assessments of two patients,
trauma (FAST) examinations on two patients. All patients two extremity debridements and dressings, and an extended
survived with no missed injuries noted at the Role 3 facil- FAST examination, which was negative. The patients were
ity. On a separate occasion, a single patient presented with transferred to the Role 3 facility, where a pigtail catheter was
an open skull fracture and evidence of intracranial hyperten- placed for a small pneumothorax in the patient with the needle
sion. This patient was treated with airway management and decompression. On another occasion, a Soldier was evacu-
medical treatment of head injury. He was rapidly transferred ated to the GHOST-T after a fast rope insertion via helicopter
to a Role 3 facility and subsequently to higher levels of care injury with severe thigh pain and inability to ambulate. He
for further treatment. He continues to recover with improving was evaluated and found to have a femur fracture with no

48 | JSOM Volume 17, Edition 3/Fall 2017