Page 119 - JSOM Fall 2019

A SORT Plus a GHOST Equals

Experience of Two Forward Medical Teams Supporting
Special Operations in Afghanistan 2019

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Jason J. Nam, MD *; David J. Milia, MD ; Sarah R. Diamond, RN ; David M. Gourlay, MD 4
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ABSTRACT

Theater Special Operations Force (SOF) medical planners have The US military tries to address DCR and DCS by pushing sur-
been using Army forward surgical teams (FSTs) to maintain a geons capable of performing advanced procedures forward.
golden hour for US SOF during Operation Freedom’s Sentinel The US military began this early in the 2003 Iraq campaign by
in the form of Golden Hour Offset Surgical Treatment Teams employing the forward surgical team (FST) concept. It pushed
(GHOST-Ts) in Afghanistan. Recently, the Special Operations surgical teams outside of the large combat support hospitals
Resuscitation Team (SORT) was designed to decompress and (CSHs) and placed them in a more mobile units with smaller
augment a GHOST-T to help extend a golden hour ring in teams.
key strategic locations. This article describes both teams work-
ing together in Operation Freedom’s Sentinel while deployed The GHOST-T is an offshoot of this traditional FST. The
in support of SOF in central Afghanistan during the summer idea is to draw five to seven personnel from an FST to help
fighting season. support SOF missions. The GHOST-T often travels with a
MEDEVAC helicopter crew to help preserve the golden hour.
Keywords: prolonged field care; austere medicine; military These GHOST-Ts would thereby push forward with only es-
medicine; damage control resuscitation; damage control sential equipment in order to do triage and DCS in a building
surgery of opportunity, tent, or other structure. 4

The traditional FST has a 20-person team. However, in the
recent Iraq and Afghanistan campaigns, FSTs have been split
Introduction
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into two teams to cover a larger geographic area. Build-
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Hemorrhage is the leading cause of death on the battlefield. ing further on this idea, the GHOST-T moves with a smaller
Damage control resuscitation (DCR) is the strategy to reduce footprint.
tissue hypoxia, oxygen debt, and coagulopathy in the trauma
patient. A focus on hemorrhage control and blood transfu- The 848th FST used two GHOST-T configurations, light and
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sion allows preservation of tissue perfusion, prevents platelet heavy. A light team consists of five people, usually one sur-
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and coagulation factor dilution, and restores homeostasis. geon, one CRNA, one surgical technician, one medic, and one
DCR may prolong survival until damage control surgery nurse. The seven-person heavy team consists of two surgeons,
(DCS) by treating life-threatening physiologic and metabolic two CRNAs, one surgical technician, one nurse, and one
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derangements. 3 medic. The heavy team is designed to perform two simulta-
neous surgical operations. Both teams can ideally perform five
Although DCR can help prolong the interval until DCS, the surgeries before resupply. Both GHOST-T configurations can
golden hour remains the oft-touted time the trauma patient carry up to 10 units of whole blood (WB), 15 units of packed
has to reach a surgeon or definitive hemostasis. The modern red blood cells (PRBCs), and 15 units of liquid plasma (LP).
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battlefields of Iraq and Afghanistan have changed due to the Unlike FSTs, GHOST-Ts are not designed to hold any patients.
drawdown of forces. Medical evacuation (MEDEVAC) and Additionally, once committed to surgery, there are limited per-
surgical teams are no longer abundant across the theater, sonnel on the GHOST-T to resuscitate additional patients.
breaking up the once contiguous golden hour rings. Fur-
thermore, as more operations are occurring in remote areas, The Special Operations Resuscitation Team (SORT) is com-
achieving appropriate care within the golden hour has become posed of an internal medicine or emergency medicine physi-
more difficult. This especially true for SOF. cian, critical care nurse, and three Special Operations combat
*Address correspondence to Jason J. Nam, MD, US Army Special Operations Command, 528th Sustainment Brigade (SO) (A), BLDG X4047
New Dawn Drive, Fort Bragg, NC or jason.nam04@gmail.com
1 MAJ Nam is a Special Operations Resuscitation Team (SORT) physician with the US Army Special Operations Command, 528th Sustainment
Brigade, Fort Bragg, NC, and an assistant professor of medicine in the Department of Medicine, Uniformed Services University of the Health
Sciences, Bethesda, MD. LTC Milia is a trauma surgeon with the 848th Forward Surgical Team, US Army; an associate professor of surgery and
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trauma surgery at Medical College of Wisconsin, Milwaukee, WI; and the medical director of the Level I trauma program at Froedtert Memorial
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Lutheran Hospital Department of Surgery. CPT Diamond is an emergency critical care nurse and the SORT-Bravo team leader with the US Army
Special Operations Command, 528th Sustainment Brigade, Fort Bragg, NC. COL Gourlay is a trauma surgeon with the 848th Forward Surgical
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Team, US Army; professor and chief of pediatric surgery in the Department of Surgery, Medical College of Wisconsin; and medical director of
trauma surgery at Children’s Hospital of Wisconsin.
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