Forward Surgical Team Brings Advanced Care Closer

FORWARD OPERATING BASE SHARANA, Afghanistan, May 5, 2011 — A short gur­ney ride from two heli­copter land­ing pads here, an oper­at­ing room and sur­gi­cal team offer the best hope of sur­vival for many ser­vice mem­bers wound­ed in Afghanistan.
“How fast we can get some­one from that Chi­nook or Black Hawk to the triage area, and then to the oper­at­ing room … dra­mat­i­cal­ly improves our capa­bil­i­ty of tak­ing care of peo­ple who are very severe­ly injured,” the team’s leader said.

946th Forward Surgical Team
The 946th For­ward Sur­gi­cal Team per­forms two oper­a­tions simul­ta­ne­ous­ly in its oper­at­ing room at For­ward Oper­at­ing Base Sha­rana in Afghanistan’s Pak­ti­ka province, March 27, 2011.
U.S. Army pho­to by Sgt. Kyle Car­pen­ter
Click to enlarge

Army Lt. Col. (Dr.) Peter D. Ray com­mands the Army Reserve 946th For­ward Sur­gi­cal Team. Since his team hit the ground here Feb. 17, he said, it has treat­ed 73 patients and per­formed 50 sur­gi­cal pro­ce­dures on 38 of those patients. 

The team con­sists of four sur­geons includ­ing Ray, a chief nurse, a non­med­ical oper­a­tions and liai­son offi­cer, two reg­is­tered nurse anes­thetists and addi­tion­al nurs­es, enlist­ed oper­at­ing room tech­ni­cians, prac­ti­cal nurs­es and com­bat medics. 

“We real­ly sup­port the south­east region. We’re what’s known as a full for­ward sur­gi­cal team, which is 20 peo­ple,” Ray said, “[includ­ing] an Air Force advanced-trau­ma life-sup­port aug­men­ta­tion of about five people.” 

The 946th’s mis­sion includes sup­port­ing the 10-per­son for­ward sur­gi­cal team at For­ward Oper­at­ing Base Orgun‑E, south­east of here near the Pak­istan bor­der, Ray said. “If too many patients are com­ing from the bor­der [and] Orgun‑E gets maxed out on what they can do, with­in 11 min­utes they can be in Sha­rana,” he said. “And with the air­field here, we also can col­late peo­ple togeth­er and get them moved to the next high­er lev­el of care.” 

The mil­i­tary med­ical sys­tem has three lev­els of care in Afghanistan. Aid sta­tions are the first lev­el. Ray’s team, the first lev­el of sur­gi­cal assets, is Lev­el 2. Lev­el 3 is for longer-term care and stag­ing for patients mov­ing to Ger­many or back to the states. 

“I pri­mar­i­ly route my patients to the Lev­el 3 facil­i­ty at Bagram [Air­field],” he said. 

The hard­ened sur­gi­cal facil­i­ty here includes a triage area, an oper­at­ing room that can hold up to three sur­gi­cal patients at a time, and an inten­sive care area, Ray explained. The triage beds roll out to the heli­copters to bring patients into the build­ing, where the triage non­com­mis­sioned offi­cer eval­u­ates them. If there are more than three patients, the med­ical com­pa­ny next door steps in to help with triage, Ray said. 

“Usu­al­ly, a for­ward sur­gi­cal team is locat­ed with a ‘Char­lie Med’ com­pa­ny [Com­pa­ny C in a stan­dard brigade sup­port bat­tal­ion], main­ly because we don’t intrin­si­cal­ly have lab­o­ra­to­ry or X‑ray capa­bil­i­ty,” he said. “We usu­al­ly have to bor­row that.” 

The triage area includes a “rapid infuser” machine that replaces blood quick­ly through a soda-straw-sized catheter insert­ed at the groin, shoul­ders or neck, Ray said. Con­trol­ling bleed­ing is one of the most crit­i­cal aspects of lev­el-two care for patient sur­vival, he noted. 

“When peo­ple get hit and they lose an arm or a leg, it can be a few min­utes before some­one can get a tourni­quet on them,” he explained. “And that entire time, they’re los­ing blood volume.” 

The team nor­mal­ly has 30 to 40 units of blood on hand, Ray said, but it can put out a call if it needs more and start receiv­ing spe­cif­ic types of blood from sol­diers on the base with­in 30 minutes. 

“We’ve had to use the ‘walk­ing blood bank’ three times since we’ve been here,” he said. “And all those [patients] sur­vived.” The facil­i­ties at here are unusu­al­ly robust for a for­ward sur­gi­cal team, Ray said. 

“We have six vehi­cles, four tents, our own gen­er­a­tors, and we’re con­sid­ered to be mobile,” he said. In both Iraq and Afghanistan, he added, many for­ward sur­gi­cal teams have worked out of fixed locations. 

“[Sur­gi­cal teams’] use in Afghanistan is unique, because with the moun­tains and the weath­er, you can’t actu­al­ly get peo­ple to that Lev­el 3 facil­i­ty very eas­i­ly some­times,” Ray said. “You need these for­ward sur­gi­cal teams pep­pered around, so that they’re with­in a heli­copter flight to stop the bleed­ing, con­trol the con­t­a­m­i­na­tion and sta­bi­lize them.” The oper­at­ing room equip­ment the team uses here is “way too heavy” to trav­el with, Ray said, but is the same qual­i­ty as that used in the Unit­ed States. 

“When it comes time to do very large cas­es, we feel like we can get pret­ty close to the treat­ment you can get at the emer­gency room of a trau­ma cen­ter in a major city in the U.S.,” he said. “So far, our data bears that out.” Ray said the team has treat­ed a num­ber of sol­diers and returned them to their units with­out need­ing to send them else­where for fur­ther care. 

“The sol­diers do bet­ter if they stay with their bat­tle bud­dies,” he said. “A lot of them are very upset when we have to send them far­ther out.” The team some­times gets only a few min­utes’ notice when patients are inbound, Ray said. 

“The short­est notice we’ve got­ten is four min­utes; the longest is a day or two,” he said, “just depend­ing on what the sever­i­ty of the injury is [and] what the weath­er is. It’s a very dynam­ic process.” 

Two sol­diers from the med­ical com­pa­ny man­age the admin­is­tra­tive process­es for incom­ing patients. Army Sgt. Shay Wil­son explained that when a call comes in that sol­diers need treat­ment, he or Army Spc. Justin Mau­r­er will make the esti­mat­ed 15 or more phone calls required to coor­di­nate and track a patient’s sta­tus and location. 

“We talk to the [sur­gi­cal team] and make sure they can accept the patient,” Wil­son said. “From there, it’s a mat­ter of coor­di­na­tion, find­ing flight times and get­ting the patient here as soon as possible.” 

Army Capt. Aman­da Har­grove, the team’s chief sur­gi­cal nurse, along with two sergeants on the team, pre­pares the tools and sup­plies required for patient care and assists in surgery. 

“I’m the patient advo­cate,” she said. “I work with the sur­geon to posi­tion the patient, prep the patient for surgery, and … pro­vide the sur­geons the tools they need.” Har­grove stays with patients until they wake up after surgery and over­sees their trans­fer to inten­sive care, she said. 

Most of the sur­gi­cal pro­ce­dures the team has per­formed result from rock­et-pro­pelled grenade attacks, road­side bombs or small-arms fire, Har­grove said. Ray said the vol­ume of surg­eries here proves the val­ue of hav­ing an oper­at­ing room close to the front. 

“The folks they’re bring­ing here real­ly do need this sur­gi­cal com­po­nent,” he said. “It’s not just a med­ical receiv­ing facil­i­ty. It’s a place that does surgery to alter the outcomes.” 

Rapid evac­u­a­tion is the key to patient sur­vival, Ray said, not­ing that the envi­ron­ment and ter­rain in Afghanistan can make that difficult. 

“There’s def­i­nite­ly a moti­va­tion [in] all the peo­ple who work at Lev­el 2 to get these guys to where they need to be … as soon as we can safe­ly do that,” he said. Ray said 43 peo­ple applied for the 15 spaces avail­able on the sur­gi­cal team before it deployed. 

“Where I come from, in Mobile [Alaba­ma], this is the kind of team that peo­ple who want to make a dif­fer­ence in med­i­cine want to be in,” he said. “We have real­ly no issues with moti­va­tion or dedication.” 

With the loca­tion, the peo­ple, the blood bank, oper­at­ing rooms and air capa­bil­i­ty his team has avail­able, Ray said, “there’s no bet­ter place to sur­vive than to be brought here.” 

Source:
U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs) 

Face­book and/or on Twit­ter

Team GlobDef

Team GlobDef

Seit 2001 ist GlobalDefence.net im Internet unterwegs, um mit eigenen Analysen, interessanten Kooperationen und umfassenden Informationen für einen spannenden Überblick der Weltlage zu sorgen. GlobalDefence.net war dabei die erste deutschsprachige Internetseite, die mit dem Schwerpunkt Sicherheitspolitik außerhalb von Hochschulen oder Instituten aufgetreten ist.

Alle Beiträge ansehen von Team GlobDef →