Page 120 - JSOM Winter 2021

Ultramobile Surgical Set for Austere Damage Control Surgery

Jonathan Lundy, MD *; Brian K. Sparkman, MD ;
1
2
Justin J. Sleeter, MD ; Zvi Steinberger, MD ; Kyle N. Remick, MD 5
4
3

ABSTRACT
The authors describe an equipment list for an ultramobile, have allowed for surgeons to provide successful DCS in the ex-
surgeon-carried equipment set that is specifically designed for tremes of circumstances, there is a limit as to what is too small
missions that require the extremes of constraints on personnel a package to provide consistently efficacious lifesaving DCS. 5
and resources conducted outside the ring of golden hour ac-
cess to damage control surgery (DCS) capabilities.
The Mission
Keywords: damage control surgery; damage control resusci- A US Army Golden Hour Offset Surgical Trauma Team
tation; surgical equipment; austere; packing; pack; backpack; (GHOST-T) deployed to southern Afghanistan to support
trauma; surgeon; surgery a US Army Special Forces Operational Detachment Alpha
(ODA). The GHOST-T was intimately involved in mission
briefings, as its capabilities were essential to facilitating ODA
and partner force operations. Multiple missions were briefed,
Introduction
planned, rehearsed, and executed that required adapting the
The current nonlinear battlefield continues to push modern surgical assets to atypical scenarios on a nonlinear battlefield.
surgical capabilities into more austere environments. Since the One mission in particular presented a unique challenge to
start of conflicts in Afghanistan in 2001 and Iraq in 2003, the team that required limiting equipment and personnel to
there have been multiple examples of surgical teams of ev- the smallest possible capability still able to provide DCS and
er-decreasing size providing DCS and resuscitation (DCR) DCR. A key leader engagement (KLE) was planned as part of
in an expeditionary setting. Currently, a combination of the ODA mission to support its partner forces. The mission re-
1–3
low-intensity conflicts, expeditionary warfare with small Spe- quired a small, ultramobile surgical team of four personnel be
cial Forces/Operations elements making up the bulk of person- collocated with the KLE, as it was to occur outside the golden
nel with boots on the ground, as well as mandating access to hour evacuation ring required to ensure timely access of all US
surgical care within one hour, has led to this change. Evolving personnel to DCS and DCR capabilities. DCS is abbreviated
concepts of DCS and DCR have also facilitated this push of surgery aimed to rapidly stop bleeding and control contami-
surgical elements farther towards the front lines. nation without definitively managing injuries that would re-
quire a lengthier and physiologically taxing procedure. DCR
Small surgical elements, such as the US Army Forward Surgical is the use of components that match as near as possible whole
Team (FST), Golden Hour Offset Surgical Trauma Team, US blood or simply using whole blood as the basis for resuscita-
Air Force Special Operations Surgical Team, and others, have tion of hemorrhagic shock, along with adjuncts to combat the
inventories and packing lists for surgical equipment. However, sequelae of exsanguinating hemorrhage.
no guidance exists for what the individual surgeon might carry
into an austere environment. These types of environments typ-
ically require ultralight, ultramobile capabilities. The authors The Preparation
4
have experiences on multiple combat deployments that neces- Surgical equipment and items were specific to DCS and scruti-
sitated compiling an ultramobile surgical equipment set. The nized for mission requisite and then further scrutinized for ease
authors’ experience culminated in the creation of a packing of transport. When possible, equipment was sought that could
list for a self-carried, mission-specific bag capable of providing serve dual purposes to further limit the footprint of overall
lifesaving DCS for at least one casualty during similar mis- packaging. A list of equipment considered essential for such
sions. The purpose of this report is to provide a standardized a mission was compiled. This equipment was paired down to
packing list for an ultramobile surgical equipment set to ben- essentials and each surgeon augmented the kit based on their
efit future surgeons in similar circumstances. One caveat the personal preferences while maintaining the mission capabil-
authors wish to communicate is that this report does not con- ities. Joint Trauma System Clinical Practice Guidelines (JTS
done such small surgical teams. While flexibility and audacity CPG) and literature pertaining to combat injuries in southern

*Correspondence to jlundy1313@gmail.com
1 Dr Jonathan Lundy is a hand, trauma, and burn surgeon at the US Army Burn Center, US Army Institute of Surgical Research, Fort Sam Hous-
ton, TX. Dr Brian K. Sparkman is a general surgeon at Carl R. Darnall Army Medical Center at Fort Hood, TX. Dr Justin J. Sleeter is a general
3
2
4
surgery resident at Brooke Army Medical Center at Fort Sam Houston, TX. Dr Zvi Steinberger is a hand surgeon specialized in microsurgery at
5
Sheba Medical Center, Israel. Dr Kyle N. Remick is a trauma surgeon at the Uniformed Services University of the Health Sciences, Bethesda, MD.
118
118