Page 120 - JSOM Fall 2019

medics (SOCM)/advanced paramedics. It also carries an X-ray assigned. The MSS was created out of buildings of opportu-
technician, laboratory technician, and patient administrative nity (Figure 2). In addition to establishing a 1-hour evacuation
specialist. It is the only Role 2 asset of its kind in US Army ring and DCR/DCS capabilities, the MSS also housed 1 ODA,
8
Special Operations Command (USASOC). Due to the mili- a security and communications element, partner forces, a valu-
tary’s relative shortage of surgeons, battlefield commanders, able forward arming and refueling (FARP), and co- located
specifically in SOF, can push this type of asset forward to help MEDEVAC.
extend the golden hour. 8
FIGURE 2 A mission support site in support of Special
Unlike the GHOST-T or FST, the SORT receives extensive Operations Forces in Afghanistan. Note GHOST-T light
tactical training to be able to integrate with the SOF teams, mobility all-terrain vehicle at foreground.
allowing them to perform under a variety of tactical situations
without being a liability for the battlefield commander. The
SORT is able treat patients on a variety of casualty evacuation
(CASEVAC) and aerial platforms, work out of a rucksack, and
set up a four-bed intensive care unit in the house model (Figure
1). The SORT can also carry up to 10 units of WB, 15 units of
8
PRBCs, and 15 units of LP.
FIGURE 1 SORT DCR room with two-bed intensive care and
monitoring capabilities at recent mission support site.

This temporary evacuation ring not only allowed combat
operations to be staged out of the MSS but also allowed for
other multiple combat operations to be conducted in the area
nightly. The GHOST-T light plus SORT helped expand the
medical evacuation golden hour ring by 40 nautical miles and
ensured key district centers did not fall to enemy hands during
the summer fighting season.
In recent Afghanistan and Syrian campaigns, the SORT was Patient Scenarios
embedded with the smallest echelon of US Special Forces,
the 12-man Operational Detachment-Alpha (ODA), and per- During this mission, over a 4-week period, the team treated
formed DCR very close to the fighting and point of injury five patients on three occasions, which highlighted this
(POI). 9 strength of this GHOST-T–plus–SORT configuration (Figure
3). The first included one partner force soldier evacuated from
combat Operations with a gunshot wound (GSW) to the torso,
The Mission
and he required needle decompression of the chest and tube
In the summer fighting season of 2019, SOF operations pushed thoracostomy. The partner force soldier first went to a host
even farther forward to ensure key district centers and prov- nation hospital, where he received a chest tube and had large
inces did not fall to the Taliban. These operations were often hemothorax. He arrived hypotensive and obtunded. Interven-
outside the golden hour MEDEVAC ring. The weather and tions performed by the GHOST-T and SORT included trauma
geographic location also made immediate evacuation unreli- assessment, chest tube replacement, central line placement, an
able. To accomplish this, a work-around solution was designed extended FAST examination, and WB resuscitation. When the
to provide DCS capabilities within 1 hour and also allow the patient continued to decompensate, the patient underwent a
potential for extended care before and after DCS if necessary. thoracotomy (Figure 4).
Theater medical planners assigned a light GHOST-T from the
848th FST to a SOF advanced operations base (AOB). Because The second patient was a partner force soldier with a GSW to
it was anticipated that immediate medical evacuation would the torso. He also was initially brought initially from POI to a
not always be achievable and there was potential for high ca- partner force hospital, where he received an exploratory lap-
sualty rates in the area, the theater medical planners assigned arotomy. He arrived confused and hypotensive. Interventions
a SORT to help augment triage, DCR, and postoperative and performed by the GHOST-T and SORT included trauma as-
critical care capabilities. sessment, subclavian central line placement, an extended FAST
examination, placement of a thoracostomy tube, exploratory
In a key strategic area, the AOB helped establish a mission laparotomy, packing of a damaged liver, small bowel and co-
support site (MSS) to which the GHOST-T and SORT were lon resection, dressings, and WB transfusion. The patient was

118 | JSOM Volume 19, Edition 3 / Fall 2019