Page 61 - JSOM Winter 2019

Leveraging Combat Casualty Reporting in the
Afghan National Army Special Operations Command for
Evidence-Based Changes in the ANASOC School of Excellence

Jonathon Florance *; Matthew Hicks, PA-C 2
1

ABSTRACT
The Afghan National Army Special Operations Command FIGURE 1 CJSOTF-A Surgeon observes ANASOC MASCAL
(ANASOC) uses several documents for casualty reporting. training.
By analyzing these documents from a period of March to De-
cember 2018, the authors demonstrate the predominance of
gunshot fatalities within ANASOC at approximately 63% of
combat deaths and a high rate of prehospital death at approxi-
mately 97% of combat deaths. The data also demonstrate rela-
tively few cases of long-term disability from ANASOC soldiers
wounded in action. The authors used these conclusions to cre-
ate a Combined Joint Special Operations Task Force-Afghani-
stan (CJSOTF-A) working group that recommended changes to
the medical curriculum at the ANASOC School of Excellence.
These recommendations centered on an increased emphasis on
bleeding control to prevent death from hemorrhagic shock.

Keywords: Afghanistan; military medicine; warfare; wounds
and injuries; war wounds; violence; military personnel;
wounds, gunshot; wounds, penetrating; blast injuries

Introduction
US and NATO Special Operations elements have spent more
than a decade advising counterparts at the ANASOC School
of Excellence. Combat medical training is an essential com- Public Affairs Office. The material in this article is categorized
petency within the curriculum, both in the Commando Qual- as official Department of Defense information because it was
ification Course focused on hemorrhage control and in the acquired by uniformed personnel as part of official duties and
advanced Commando Medic Course with learning objectives was not conducted for the purpose of a research project that
based on US medic competencies ranging from intravenous might otherwise request institutional review board approval.
access to cardiopulmonary resuscitation (Figure 1). While the Although this study is most easily characterized as a cross-sec-
advanced Commando Medic Course provides broad skills for tional study with descriptive analysis using deidentified casu-
the robust practice of military medicine, a cursory review of alty data, the methodology of the investigation was designed
the program with the CJSOTF-A Surgeon questioned whether to advise ANASOC counterparts and recommend improve-
a greater focus on combat medical skills would be appropriate ments to the ANASOC School of Excellence curriculum as
after recognizing an equal share of classroom instruction on part of the Resolute Support Mission.
hemorrhage control as the treatment of animal bites. Given the
recent increased fidelity of casualty data within the ANASOC Data Sources
enterprise beginning in 2018, the authors sought to build ev- In 2018, the ANASOC Medical Detachment began system-
idence-based recommendations for the curriculum that could atically tracking and maintaining casualty reporting data.
lead to fewer deaths within the force. Through the advising relationship between the CJSOTF-A
Surgeon and the ANASOC Corps Surgeon, the authors ob-
tained deidentified data on all of ANASOC casualties from the
Methods
first nine months of the Afghan year 1397, roughly spanning
Design and Study Setting March to December 2018. The ANASOC Surgeon was unable
Publication of this material was approved by the Special Oper- to produce consistent casualty documentation from before
ations Joint Task Force-Afghanistan Staff Judge Advocate and this period. The included data encompassed more than 1000
*Correspondence to jonathon_florance@hms.harvard.edu
2
1 Maj Florance is with the Special Forces, US Army National Guard and a member of the Harvard Medical School Class of 2020. Capt Hicks is
in the Medical Specialist Corps and with the Combined Joint Special Operations Task Force-Afghanistan (CJSOTF-A) Surgeon.
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