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brought forward. The iSTAT was sent to monitor future en­ that were necessary in this situation. Here, it was quickly
venomation patients’ toxicity but was useful for extended care learned that the walking blood bank, although useful, was not
patients as well. Antivenin is another item that many teams adequate. Keeping a supply of blood products is often not pos­
will not have access to, yet can request. US Army Medical sible because of storage and supply restraints, but obtaining
Command policy limits supplying antivenin to role 2 and this capability was a great asset. Teams moving forward in the
above Military Treatment Facilities. However, an exception to future should strongly consider the use of this capability.
policy was requested and subsequently approved, providing
antivenin to the team. Prolonged care of partner­force wounded is a heavy drain on
medical personnel and resources. The typical SFOD­A is not
6. Synchronous Telemedicine Specialty Support to equipped with the manpower or supplies to maintain large
SOF (STS3) Video Medical Consult System numbers of patients over extended periods. In this situation,
Because a damage­control surgery team was not available, the additional US Soldiers were present, allowing for the training
team used a telemedicine system. STS3 is a mobile, high­defini­ of supplemental medical personnel. Adding to this capability
tion video telemedicine system that provides synchronous au­ was the presence of BN medical personnel, an asset that is usu­
dio/video capability to converse with specialists from Dwight ally not colocated with an SFOD­A. However, even with these
D. Eisenhower Army Medical Center, Fort Gordon, Georgia, additional assets, the medical team and supplies were stretched
24 hours a day. This technology was being newly fielded and thin because of the long stays of many of the wounded. Even
came half­way through the deployment. The device is not in mature theaters with full medical resources, partner­force
currently used by many teams due to limited unavailability. fighters are returned to the local hospitals much sooner than
In addition, some reliability and portability issues need to be in this case.
addressed.
The medical team used ultrasound and eventually X­ray im­
7. Prolonged Care aging. Many teams still do not deploy with an ultrasound.
A particularly unique aspect to the situation was caring for Having this tool and skill has proven to be valuable in many
patients for several weeks before they were released back into ways. Ultrasound devices can come in very compact forms and
their country. The patients were grouped into a special area allow visualization to confirm or deny many medical condi­
of the camp. The patients stayed in that area and the medical tions. In addition, ultrasound­guided nerve blocks are a safer
team did rounds in the tents daily, providing dressing changes, alternative for obtaining anesthesia. It is recommended that
medicine, and physical therapy. Several dental procedures, ultrasound skills be added to the 18D skill set via the 18D
including tooth extraction and temporary fillings, were also pipeline. The skills used were obtained during MPT rotations
performed. before the deployment. These experiences have shown ultra­
sound­guided nerve blocks to be a force­multiplier, allowing
Only the critically injured were evacuated to the trauma cen­ the tactical medic to expand the usefulness of local anesthetics
ter several hours away. They would stay until they could be and reduce the use of opioids and other anesthetics. Getting
returned to the camp, often before they could ambulate and this device and knowledge out to the force should be given a
with external or oral fixation devices still in place. Given the high priority by those creating the curriculum for future 18D
inability to return the patients to the surgical center for rou­ classes and refresher courses.
tine follow­up appointments, it often fell on the team to re­
move these fixation devices at the appropriate times, requiring The uniqueness of practicing in an immature and austere the­
consultation with either an oral or orthopedic surgeon via the ater afforded a return to the particular abilities of the SF 18D.
STS3 telemedicine system. This experience validates the intense training of all aspects of
the 18D skills and provides lessons for further development.
Conclusion
Disclosure
This trip differed from many of those in the more mature Op­ The authors have nothing to disclose.
eration Iraqi Freedom and Operation Enduring Freedom the­
aters. With rapid MEDEVAC capabilities, teams do not have Author Contributions
to hold patients as long and do not need the robust supplies All authors approved the final version of the manuscript.

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