Page 122 - JSOM Fall 2018

Prolonged Field Care in
Support of Operation Inherent Resolve, 2016

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Chris Blaine, 18D ; Matthew Abbott, APA-C ; Eric Jacobson, MD *
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ABSTRACT
The authors present their experience in emergency and long­ FIGURE 1 The aid station.
term medical care by Special Operations Forces (SOF) medical
providers in an austere environment. In this case, a Special
Forces Operational Detachment­Alpha (SFOD­A) was de­
ployed in support of Operation Inherent Resolve, partnered
with indigenous combat forces.

Keywords: prolonged field care; indigenous combat forces;
austere environment

Experience
The following is a review of an experience in emergency and
long­term medical care by Special Operations Forces (SOF)
medical providers in an austere environment. In this case, a
Special Forces Operational Detachment­Alpha (SFOD­A) was
deployed in support of Operation Inherent Resolve, partnered TABLE 1 Injuries From Vehicle-Borne Improvised Explosive Device
with indigenous combat forces. The team’s medical capabili­ Attack, May 2016
ties included two Special Forces (SF) Medical Sergeants (18D) Patient No. Injury
and one battalion (BN) surgeon (emergency medicine) or BN 1 Catastrophic chest and abdominal injuries
physician assistant (PA). Partner forces relied almost exclu­ 2 Mandibular fracture leading to airway compromise,
sively on the SFOD­A for all forms of medical support. traumatic brain injury
3 Hemopneumothorax, basilar skull fracture
Upon arrival, the team set up an aid station on a small out­ 4–18 Compound, comminuted long­bone fractures,
post that was approximately 100km from the nearest hospital, deep soft­tissue wounds, several mild­to­moderate
accessible only by air or off­road vehicles. There were no US traumatic brain injuries, tympanic membrane injury,
burn injuries, and many other minor wounds
Military aircraft available, and host­nation (HN) air evacu­
ation was unreliable. Ground evacuation required a 4­hour No colloids, blood products, or freeze­dried plasma were used
drive through the desert to a poorly equipped HN hospital at the outpost prior to the May 2016 MASCAL. During the
with one part­time general surgeon, no computed tomography event, pharmacologic therapy consisted of resuscitation with
scanner, and minimal blood­banking capability. The nearest crystalloid and colloid infusion, pain control with fentanyl or
trauma center was an 8­hour drive away. ketamine, and preventive measures with antibiotics (namely,
ertapenem) and tranexamic acid. These patients were trans­
The Aid Station ferred via HN medical evacuation (MEDEVAC) to the trauma
Medical supplies at the outpost were limited to those found center 1.5 hours away. Table 2 shows the minimum, best­case
within a standard SFOD­A medical load­out (Figure 1). For scenario timeline for MEDEVAC.
the first few months, this was entirely adequate, because most
medical issues were minor. Over the course of the next few TABLE 2 Host-Nation Air MEDEVAC Timeline
months, enemy activity increased and it became clear that the
aid station needed improvement. An enemy attack on partner Time from call for MEDEVAC until launch: 1 hour
forces created the first mass casualty (MASCAL) event. bring­ Flight time to our location: 1.5 hours
ing 18 wounded fighters to the outpost. This was the first of Refueling time: 20 minutes
several events that would rapidly drain the resources of the Return flight to Level 1 trauma center: 1.5 hours
small aid station. Table 1 provides brief descriptions of the Total minimum evacuation time to hospital: 4.5 hours
casualties received during this event. Total minimum time of patient care at our facility: 2.5–3 hours

*Correspondence to ejaco211@gmail.com
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1 Mr Blaine is an 18D Medical SFC with the 5th Special Forces Group (Airborne) [5th SFG(A)]. Mr Abbott is an active duty Army physician
assistant with the 5th SFG(A) and a former 18D medical sergeant. Dr Jacobson is an active duty emergency medicine physician and director of
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the Department of Emergency Medicine, Blanchfield Army Community Hospital, and was formerly assigned to the 5th SFG(A).
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