Page 51 - Journal of Special Operations Medicine - Fall 2017

neurovascular compromise. He was splinted, administered device. These patients were evaluated, their wounds were
pain medication, and immediately transferred to the Role 3 treated, and they returned to duty without evacuation; light
facility, where he underwent external fixation. duty was prescribed for the two patients with minor TBI until
they were improved. The seventh patient had severe, bilateral,
Austere Combat/Train, Advise, Assist Operations lower-extremity injuries after detonation of an explosive de-
Certain SOF missions were executed well outside of an ex- vice. He underwent a left-groin exploration with conversion
isting MEDEVAC ring and were not conducive environments to laparotomy for left iliac vessel proximal control with subse-
for prestaged Role 2, FARP, and MEDEVAC assets. To en- quent ligation of the left common femoral artery and femoral
sure compliance with the golden-hour policy, only the Role vein; he had complete amputations of the both legs. He re-
2 element was established close to planned operations. Ca- ceived 10 units of PRBCs and 8 units of FFP. He was evacuated
sualty movement was by ground to the GHOST-T. Security to a Role 3 facility within 1 hour of injury, where he under-
and communications were planned for and co-located with went shunting of femoral vessels and subsequent repair. The
the GHOST-T. These missions were short. The GHOST-T eighth patient had a through-and-through GSW to the lower
only expected resupply if it provided care for a patient and leg, with no neurovascular compromise. His leg wounds were
a prepacked resupply package was staged on the MEDEVAC irrigated and debrided, and he was monitored for signs of
helicopter. Blood-product management was planned for based compartment syndrome. He was also evacuated to an Afghan
on mission duration and Collins boxes or refrigerator/freezers hospital with no evidence of compartment syndrome.
were used.
Discussion
The GHOST-T deployed twice in this configuration. On the
first mission, the team was set up with resuscitation outside Maintaining a golden-hour surgical capability for U.S. SOF
and an operating room inside a tent (Base-X; HDT Global; during Operation Freedom’s Sentinel required adaptation in
http://www.hdtglobal.com/). Security and communications FST configuration, personnel, equipment, and use. FSTs have,
were provided by a small infantry element. No patients were since the beginning of the GWOT, been used in a nondoctrinal
treated during these austere missions. Additional consider- role. Split operations have become common, and outcomes are
ations for this mission were night-vision devices to facilitate comparable between FSTs that are split and those that remain
movement of assets and surgical capability and a linguist to at full strength, including the management of mass casualty
assist with communications with co-located Afghan forces. incidents. Thorough knowledge of the battlespace allows the
7,8
surgeon to decide if a patient is stable enough to be trans-
The second mission had the team set up in a room in a con- ported to the next level of care. That is not to say lifesaving
crete building of opportunity (Figure 4). Again, security and surgery should be delayed. The decisions to delay a chest tube
communication were coordinated. This mission was extended and an external fixator in absolutely stable patients and the
to nearly 2 weeks and required two resupply missions to decision to temporarily ligate a femoral artery were made with
convert from Collins boxes to blood refrigerator and plasma a thorough understanding of the evacuation time to the Role
freezer after patient care. The team evaluated eight patients, of 3 facility; the capability and equipment available there, which
whom four required surgical intervention during the 13-day reduced risks of complication; and open lines of communica-
mission. The first patient sustained a GSW to the back with tion with their surgeons.
negative FAST examination and stable pelvis. Local wound
irrigation and debridement were performed. The second was Similar to early reports of FST combat experience in the
a host-nation patient who sustained a through-and-through GWOT, we would like to offer several recommendations to
GSW to the abdomen, requiring a laparotomy with partial col- future military medical planners when considering the cur-
ectomy, small-bowel resection, and exploration of a retroperi- rent operational environment and the ever-evolving role of the
toneal hematoma. The patient received 1 unit of PRBCs and FST in more austere, less traditional missions. The personnel
10
was then evacuated to the Afghan hospital. deployed with a GHOST-T should not be chosen arbitrarily;
these teams ideally should comprise experienced, flexible,
The next four patients had fragment wounds, and two had mi- calm individuals who will function fluidly as a member of a
nor TBIs sustained as the result of detonation of an explosive team and can adapt to any possible contingency. A selection
process that would screen potential team members to identify
Figure 4 GHOST-T set up in a concrete building. appropriate candidates may be an option. The current doctri-
nal medical supply and surgical instrument sets were found
to be extremely bulky, inefficient, and overstocked with un-
necessary equipment to provide damage control surgery. The
102nd FST spent considerable time scrutinizing all available
equipment, reviewing scenarios of prior experiences, and, ul-
timately, opening sets and preparing highly mobile, light sur-
gical instrument and equipment sets. The operational tempo
6
was high; however, the workload for the surgical teams was
low. The motto of some SOF medical providers is that a single
casualty is a bad day in the SOF environment; therefore, this
is the ideal situation for any SOF team. We made up for this
slower pace of clinical work with constant rehearsals. Sce-
narios were created by surgeons with extensive deployment
experience as well as SOF team members with similar austere
deployment experience. Unique scenarios that were beneficial

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