Golden Hour’ Initiative Pays Off in Afghanistan

BAGRAM AIRFIELD, Afghanistan, May 4, 2011 — Two years ago, Defense Sec­re­tary Robert M. Gates trav­eled through­out Afghanistan, promis­ing deployed troops he would make sure they had every­thing they need­ed to accom­plish their mis­sion — includ­ing more for­ward-deployed med­ical capa­bil­i­ties in the event they were wound­ed.

 Camp Leatherneck in Afghanistan
Dur­ing a May 7, 2009, vis­it to Camp Leath­er­neck in Afghanistan, Defense Sec­re­tary Robert M. Gates promis­es Marines he will ensure they have the med­ical capa­bil­i­ties they will need if they’re wound­ed. U.S. med­ical per­son­nel in Afghanistan and Ger­many say they’re see­ing the fruits of that increased capa­bil­i­ty in lives saved.
U.S. Air Force pho­to by Mas­ter Sgt. Jer­ry Mor­ri­son
Click to enlarge

The goal, he told a group of Marines dur­ing a stop at Camp Leath­er­neck, was “to pro­vide the ‘gold­en hour’ here in Afghanistan that we have in Iraq,” refer­ring to a stan­dard that gets troops to advanced-lev­el treat­ment facil­i­ties with­in the first crit­i­cal 60 min­utes of being wound­ed.

“We hope we don’t need it for any of you,” Gates said of the increased med­ical capa­bil­i­ty. “But I want it to be there if it is need­ed.”

Med­ical and aeromed­ical evac­u­a­tion per­son­nel in Afghanistan at Land­stuhl Region­al Med­ical Cen­ter in Ger­many say they’re see­ing the results of that ini­tia­tive in lives saved, report­ing that casu­al­ties are get­ting med­ical treat­ment faster and clos­er to the point of injury than ever before.

The mil­i­tary med­ical sys­tem has moved assets clos­er to the front lines to be more respon­sive to patient needs, and sur­gi­cal teams are posi­tioned clos­er to the troops they sup­port. In addi­tion, an exten­sive aeromed­ical evac­u­a­tion capa­bil­i­ty quick­ly moves wound­ed war­riors to pro­gres­sive­ly more advanced lev­els of care.

Air Force Lt. Col. (Dr.) Ray­mond Fang, direc­tor of trau­ma at the Land­stuhl med­ical cen­ter, mea­sures the suc­cess of the “gold­en hour” ini­tia­tive in wound­ed war­riors whose ear­ly live-sav­ing inter­ven­tions helped them sur­vive to receive “Lev­el 4” care in Ger­many.

“The empha­sis in Afghanistan is on try­ing to place med­ical assets in such a way that … every patient has access to med­ical care [and] sur­gi­cal care with­in one hour of injury,” he said. “I think that has been achieved. … I think as a strat­e­gy it is effec­tive.”

Although weath­er con­di­tions some­times ham­per get­ting wound­ed war­riors to advanced med­ical and sur­gi­cal care with­in the first hour of injury, Fang said, the abun­dance of med­ical assets in Afghanistan makes this the rare excep­tion.

With addi­tion­al capa­bil­i­ties and the ben­e­fit of lessons learned over near­ly a decade of con­flict, Air Force Lt. Col. (Dr.) Guiller­mo Tellez, com­man­der of the Staff Sgt. Heathe N. Craig Joint The­ater Hos­pi­tal here, said the goal is no longer to sim­ply match the stan­dard set dur­ing the troop surge in Iraq.

“This is dif­fer­ent than in Iraq, and in fact it is actu­al­ly bet­ter, because the exper­tise at all these lev­els has got­ten bet­ter,” he said. It’s bet­ter, med­ical per­son­nel agree, because it extends to where it can make the biggest dif­fer­ence — on the front lines with ini­tial bat­tle­field care. “It all begins at the point of injury, with those young medics and sol­diers and Marines out there,” Tellez said. “That is where care begins.”

Air Force Lt. Col. Kath­leen Flar­i­ty, com­man­der of aeromed­ical evac­u­a­tion at Bagram, agreed. “It real­ly takes that first respon­der,” she said. “Every sol­dier, sailor, air­man, Marine knows how to do self-aid [and] bud­dy care. So if some­one is injured, they take care of them­selves and they take care of each oth­er.”

At that point, wound­ed war­riors advance to increas­ing­ly bet­ter-equipped facil­i­ties. The bat­tal­ion aid sta­tion, part of the unit it sup­ports, pro­vides first-lev­el med­ical inter­ven­tion. From there, wound­ed war­riors are moved quick­ly to for­ward sur­gi­cal teams, which sta­bi­lize patients and when required, pro­vide ini­tial life- and limb-sav­ing surg­eries. With­in hours, patients arrive at the­ater hos­pi­tals in Bagram or Kan­da­har, where they receive high­ly spe­cial­ized care rang­ing from neu­ro­surgery to advanced ortho­pe­dics to advanced trau­ma care.

Tellez cred­its the ini­tial bat­tle­field care pro­vid­ed at the point of injury with enabling 2,300 trau­ma patients to reach the Craig hos­pi­tal to receive care dur­ing the first three months of 2011 alone. Of those patients, 800 suf­fered the most severe “Lev­el 1” injuries. Yet, sta­tis­tics show that patients who live to receive treat­ment at Bagram have a 98 per­cent chance of sur­vival, Tellez report­ed.

Mov­ing patients through this con­tin­u­um of care wouldn’t be pos­si­ble with­out a robust aeromed­ical evac­u­a­tion capac­i­ty, Flar­i­ty said. That, too, begins at the point of injury, often with Army “Dustoff” heli­copter crews — nick­named for their mot­to, “Ded­i­cat­ed, Unhesi­tat­ing Ser­vice to Our Fight­ing Forces” — swoop­ing in to for­ward oper­at­ing bases, patrol bases and com­bat out­posts to evac­u­ate wound­ed troops. Air Force HH-60G Pave Hawk heli­copters, oper­at­ed by Air Force expe­di­tionary res­cue squadrons, also sup­port the effort.

Wound­ed troops ulti­mate­ly arrive at Bagram, the largest aeromed­ical evac­u­a­tion hub in Afghanistan. There, after treat­ment at the the­ater hos­pi­tal, they are flown to Ram­stein Air Base, Ger­many, aboard C-17 Globe­mas­ter III, KC-135 Stra­totanker and C-130 Her­cules air­craft.

Dur­ing the Viet­nam War, Flar­i­ty said, it typ­i­cal­ly took about a month for wound­ed troops to be trans­port­ed state­side. Now, after receiv­ing advanced care at Land­stuhl, it’s down to as lit­tle as three days before they arrive at Wal­ter Reed Army Med­ical Cen­ter in Wash­ing­ton, D.C., the Nation­al Naval Med­ical Cen­ter in Bethes­da, Md., or Brooke Army Med­ical Cen­ter in San Anto­nio.

Flar­i­ty attrib­uted the speed with which wound­ed war­riors in Afghanistan receive med­ical care — and the qual­i­ty of that care — to a well-oiled machine built on expe­ri­ence and a uni­fied focus on the mis­sion.

“We are part of a greater sys­tem,” she said, with “every­body in our sis­ter ser­vices work­ing col­lab­o­ra­tive­ly togeth­er to care for that wound­ed war­rior.”

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

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