Page 121 - JSOM Fall 2019

FIGURE 3 GHOST-T light’s Operating Room with two-bed and GHOST-T surgeon performed triage. The most serious
surgical capacity at recent mission support site. patient, with a posterior neck GSW, was taken immediately
to the GHOST-T room. The second (with a GSW to the angle
of the mandible with no airway compromise) and third (with
multiple superficial fragmentation injuries) soldiers were in
less serious condition and were transferred to the SORT room
for evaluation and treatment.

Three patients arriving would normally have been a mass ca-
sualty event (MASCAL) for this MSS. However, having both
teams allowed for successful triage and management of pa-
tients. This was further confirmed when a delay in the host
nation MEDEVAC prevented patient evacuation for 2 hours.
Without the augmented capabilities afforded by the SORT,
this would have incapacitated the GHOST-T and prevented
the MSS from receiving additional patients. The addition of
the SORT allowed the GHOST-T to remain green and mis-
sions to continue.
In addition to these actual events, there is great potential for
two teams like the SORT and GHOST to work together at a
remote location like an MSS in support of SOF. In addition
to DCR, the SORT can help with critical care or postoper-
ative patient hold, similar to what was true of the intensive
FIGURE 4 GHOST-T and SORT members performing
thoracotomy at recent mission support site. care unit functions in a traditional FST. In a deployed setting,
there remains the possibility of multiple surgical patients in a
single surgeon scenario like a GHOST-T light configuration.
The recent Syria campaign has a case report of two patients
requiring simultaneous REBOA with a single surgeon. Hav-
9
ing the SORT present to do DCR or advanced procedures like
REBOA placement would be of great benefit. Furthermore,
the SORT could assist a task-saturated light GHOST-T with
the management and implementation of tasks such as a walk-
ing blood bank.

Medical Augmentation
In addition to having the GHOST and SORT extending the
golden hour at an MSS, the SORT also was able to provide
additional medical coverage to ODAs. As the ODAs would
use the MSS as a jumping off point for combat missions, the
ODAs found it beneficial to have additional medical coverage.
On two occasions, the SORT physician and two SOCMs went
on a helicopter assault force (HAF) mission to occupy com-
pounds of interest. The SOCM’s presence allowed the ODA
medical sergeants to focus on their tactical responsibilities.
The physician’s presence allowed for more advanced proce-
dures to be performed near POI and offered leadership over
triage responsibilities and management of a casualty collec-
tion point (CCP) near the command element. Because of their
tactical medicine expertise, SOCMs remained in high demand
and would accompany the ODAs on other numerous combat
patrols and missions during the deployment.

Surgeon’s Perspective
The examples given here demonstrated how the combination
then transferred to the Role 3 facility with an open abdomen, of GHOST-T and SORT allows added capabilities for triage
where he received definitive surgery. and resuscitation while maintaining a small, mobile foot-
print. GHOST teams, often positioned alone, can become
On another occasion, three partner force soldiers suffered mission incapable while caring for one surgical patient and
from dismounted improved explosive device (IED) GSW inju- are underresourced to handle adequately handle MASCAL
ries, and a roll-over motor vehicle crash (MVC). They arrived by themselves. Similarly, an isolated SORT element lacks the
simultaneously to the MSS from POI. The SORT physician ability for advanced surgical and hemostasis procedures. The

Forward Medical Teams in Afghanistan Special Operations | 119