Forward surgical team (FST) workload in a special operations environment: the 250th FST in operation ENDURING FREEDOM

doi:10.1016/S0149-7944(02)00718-3

Current Surgery

Volume 60, Issue 4, July–August 2003, Pages 418-422

https://doi.org/10.1016/S0149-7944(02)00718-3 Get rights and content

Abstract

Purpose

Forward Surgical Teams (FST) deploy to support conventional combat units of at least regimental size. This report examines the injuries and treatments of an FST in an environment of unconventional tactics, limited personal protection, and extended areas of responsibility during Operation ENDURING FREEDOM.

Methods

A prospective evaluation of the personal protective measures, mechanisms of injury, types of injuries, and times to treatment in Operation ENDURING FREEDOM. Additionally, per-surgeon caseloads, operative interventions, and outcomes are examined. The first phase of this deployment involved co-locating with an Air Force Expeditionary Medical Squadron at Seeb Air Base, Oman (SABO). The second phase involved stand-alone operations at Kandahar International Airport (KIA). Participants include U.S. Special Forces, conventional U.S forces, coalition country special forces, and anti-Taliban Afghan soldiers.

RESULTS:

During the deployment, the FST performed 68 surgical procedures on 50 patients (19 SAB, 31 KIA). There were 35 orthopedic cases (2 to 28 per surgeon), 30 general surgery cases (2 to 10 per surgeon), and 3 head/neck cases. Mechanism of injury included non-battle injury (13), bomb blast (13), gunshot wounds (8), mine (8), and grenades (5). Primary injuries were to the extremities in 27, torso in 9, and head/neck in 11. Three patients had appendicitis. Five patients were wearing body armor, whereas 4 wore helmets. The mean Relative Trauma Score was 7.4. Thirty-one patients were treated at KIA with a mean time to operative treatment of 2.7 ± 2.7 hours, whereas 19 were treated in SABO with a mean time to operative treatment of 12.4 ± 15.1 hours. Nine patients received transfusions. Three nonoperative patients died of wounds.

Conclusion

Despite the lack of personal protective gear, most patients had extremity wounds as their primary injuries. In this special operations environment, time to operative treatment was significantly longer than expected.

Introduction

The Army Forward Surgical Team (FST) is the newest organizational concept originating from the employment of medical assets in Operation DESERT SHIELD and Operation DESERT STORM. Medical lessons learned on a small scale from Grenada and Panama, and then reinforced in Iraq, have driven enhanced forward surgical capability within the airborne, air assault, and special operations units.1 The Mobile Army Surgical Hospital (MASH) was felt to be too large to be tactically responsive to a more fluid battlefield.2 The need for tactically mobile surgical assets led to the development of the FST. Army doctrine states that FSTs deploy to support conventional maneuver brigades or regiments and, in certain circumstances, Special Forces’ groups.1

Although used in military operations other than war, the FST had never been used in support of American armed conflict. The rationale for the FST comes from the estimate that 10% to 15% of the “Wounded-In-Action” will require urgent surgical intervention to control hemorrhage or provide stabilization sufficient for evacuation.1 There are 57 specific injury criteria that require emergent resuscitative surgery by an FST. These include major chest or abdominal wounds, continuing hemorrhage, severe shock, wounds causing airway compromise or respiratory distress, and acutely deteriorating level of consciousness with closed head injury.1 During Operation ENDURING FREEDOM (OEF), the 250th FST (Airborne) deployed in support of the Combined Joint Special Operations Task Force-South. The purpose of this study was to prospectively evaluate the friendly force’s injuries and treatments in an environment of unconventional tactics, limited personal protection, and potentially long transport times using an airborne FST.

Section snippets

Material and methods

On October 6, 2001, the 250th FST (ABN) received a warning order for movement to Southwest Asia in support of OEF. In addition to other preparatory actions, surgeons from the FST developed a 40-point database to track patients treated in the Triage/Trauma Management section, through the operating room until evacuation. The database collection was subdivided into phases. Phase I involved integration of the FST into an Air Force Expeditionary Medical Squadron (EMEDS) hospital at Seeb Air Base

Results

At SABO, surgeons evaluated 41 patients, 19 for significant trauma. At KIA, 155 patients were evaluated, 43 for significant trauma. Nineteen were surgically treated at SABO, whereas 31 received surgery at KIA. Mechanism of injury for the 47 operative trauma patients from both locations included 13 bomb blast injuries, 13 non-battle injuries, 8 gunshot wounds, 8 mine injuries, and 5 grenade blast injuries. Blast injuries (bomb, mine, and grenade) accounted for 55% of the injuries. Air evacuation

Discussion

The mission of the United States Army FST is to provide rapidly deployable immediate surgical capability, enabling patients to withstand further evacuation to facilities staffed to provide definitive care. Usual personnel assigned to the FST are shown in Table 2. The FST is designed to complement and augment surgical capabilities for brigade-sized task forces.1 In some circumstances, that doctrine is extended to Special Forces Groups. OEF involved the use of large number of United States and

Conclusions

Despite the lack of personal protective gear, most of the injured friendly forces had extremity wounds as their primary injuries. Most wounds were blast injuries from bomb blasts, mines, and grenades. Non-battle injuries and gunshot wounds caused the remainder of the wounds. Time to operative treatment was longer than most recent conflicts even when forward deployed. However, it was significantly faster in the KIA phase than that seen during the Soviet War. Longer evacuation times into the FST

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Gary P. Wratten surgical symposiumForward surgical team (FST) workload in a special operations environment: the 250th FST in operation ENDURING FREEDOM

Abstract

Purpose

Methods

Conclusion

Introduction

Section snippets

Material and methods

Results

Discussion

Conclusions

Curr Surg

Mobile surgical hospital designlessons from 5th MASH surgical package from Operations DESERT SHIELD/DESERT STORM

Mil Med

Military medicinean operational definition

Mil Med

Gary P. Wratten surgical symposium
Forward surgical team (FST) workload in a special operations environment: the 250th FST in operation ENDURING FREEDOM

Mobile surgical hospital designlessons from 5^th MASH surgical package from Operations DESERT SHIELD/DESERT STORM