Page 122 - JSOM Fall 2019

combination of SORT and GHOST-T balances the current op- Already, to better support the wars of today and tomorrow, the
erational tempo and medical rules of engagement (MEDROE), US Army is beginning to push the Forward Resuscitative Surgi-
which has led to fewer surgical procedures and overdeploy- cal Team (FRST) concept. It would house the ability to perform
ment of scarce resources. DCR and DCS in a smaller logistical footprint than a FST.
10
The FRST is designed to be more scalable, so it can be placed
Most FSTs currently exist within the reserve side, and its Sol- and moved quickly. It is important to note that although an
diers are not trained to perform tactically as the SORT has. FRST provides four surgeons, it can only be split once. Further
Additionally, the surgical equipment requirements limit mobil- splitting of the FRST is not possible due to the lack of anesthe-
ity. By staging the GHOST and SORT elements together, the sia and emergency medicine coverage. The FRST, like the FST,
SORT retains the ability to go on mission with the SOF ODA, still internally employs command and logistics personnel, with
leaving the GHOST team behind prepared to perform DCS no clinical role, which elevates their footprint in theater.
should the need arrive. The GHOST functions best if close to
the POI but sufficiently remote from the fight that it does not The smaller GHOST-T and SORT elements can be tailored to
have to defend itself while performing surgery. the mission set; each member of the team has a clinical role
and relies on SOF to assist with command and logistical sup-
port. This makes it ideal to be embedded in support of SOF
Equipment and Training Considerations
who often finds themselves forward of conventional forces or
Having both teams colocated and closely living and working even behind enemy lines. The SORT, as currently outlined, will
together also allowed for an exchange of ideas, familiarity, soon be a relic of the past as the SORT will soon transition to
equipment, and best practices. Because of the SORT’s align- the Special Operations Resuscitation Surgical Team (SORST).
ment with 1st Special Forces Command, the SORT members The addition of surgeons and CRNAs to the SORT will now
had equipment that more resembled the ODA compared with add DCS to the SORT’s previous capabilities. Strong consider-
the GHOST-T. They had weapons with advanced optics, ation should be given to the addition of a surgical technologist
lighter body armor, and more advanced night vision devices. (68D) as this position would be difficult to fill with an SOCM
It allowed the SORT to move more quickly in support of the (68WW1).
ODA in austere locations. Furthermore, the SORT had a com-
mercial off the shelf freezer for blood storage. It allowed for Conclusion
more portable and longer blood storage. The SORT had also
recently acquired handheld ultrasound (US) machines which Having two medical teams, GHOST-T and SORT, work to-
allowed for easier and nimbler point-of-care ultrasound. Last, gether in an austere MSS in support of SOF worked effectively
the SORT had extensive predeployment tactical training; they to help extend the golden hour in Afghanistan. When the the-
often conducted such training to include close quarters battle ater medical planners placed both teams together, it was ac-
with ODAs. tually a glimpse into the future of military medicine as paired
DCR and DCS teams become more common. This was a test
The GHOST-T had enhanced mobility. They had the use of of the proof-of-concept, and it works. The decisive large-scale
a lightweight tactical all-terrain vehicle. It was rapidly trans- campaigns of tomorrow will require this integration to extend
portable by CH47 rotary wing aircraft. This was a huge ad- the golden hour and our operational reach.
vantage when the SORT had to transport equipment by hand
and rickshaw. What the GHOST-T might have lacked in prem- Acknowledgments
ission rehearsals due to having reservist and PROFIS provid- The authors would like to thank LTC Albert W. Davis, 528th
ers was clearly made up by their vast clinical experience and SUST BDE Special Troops Battalion Commander, for proof-
expertise. The GHOST-T surgeons and CRNAs all worked at reading our manuscript and for his valuable inputs.
busy trauma centers and civilian practices in major metropol-
itan areas. Disclaimer
The views expressed are those of the author(s) and do not re-
flect the official policy or position of the US Army Medical De-
The Way Ahead
partment, Department of the Army, Department of Defense,
Being able to do effective DCR and DCS remains critical for or the US Government.
military medicine. After fighting 18 years of a counterinsur-
gency campaign against violent extremist organizations, the Disclosures
wars of tomorrow may be large-scale combat operations. We The authors have nothing to disclose.
will continue to increasingly engage our near peer competitors
where neither side possesses air power superiority preventing Author Contributions
our MEDEVAC assets from unimpeded travel. Furthermore, JN conceived the manuscript concept. DM, JN, and DG wrote
we may be engaged in unconventional warfare where we sup- the first draft. All authors edited subsequent drafts. All au-
port surreptitious campaigns of resistance and foreign internal thors read and approved the final manuscript. JN submitted
defense against our trade and political rivals. the manuscript and made all edits from the review committee.

As MEDEVAC may not be available or occur quickly, medi- References
cal teams will need to become experts at prolonged field care, 1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
which involves critical care medicine and nursing skills in aus- (2001–2011): implications for the future of combat casualty care.
tere, resource-limited environments over several days. This J Trauma. 2012;73(6, suppl 5):S431–S437.
type of combat scenario is where critical care patient hold ca- 2. Cap AP, Pidcoke HF, Spinella P, et al. Damage Control Resuscita-
pability will be absolutely paramount. tion. Mil Med. 2018;183(suppl 2):36–43.

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