Combat trauma experience with the United States Army 102nd Forward Surgical Team in Afghanistan

Abstract

Background The United States Army 102nd Forward Surgical Team (FST) was deployed to Kandahar Airfield, Afghanistan, from August 2002 to March 2003, in support of Operation Enduring Freedom. The unit's primary mission was to provide trauma surgical support to units of the 101st and 82nd Airborne Divisions, to coalition special operations units, and to allied Afghan militia forces. The FST's mission was expanded to include humanitarian assistance. Methods The mission was accomplished in the austere environment of Kandahar Airfield, Afghanistan. The FST was set up in a corner of the abandoned Kandahar International Airport terminal. The team's supporting facility was a 44-bed combat support hospital at Bagram Airbase near Kabul. Patients arrived by ground ambulance, local transportation, and MediVac helicopter. Evacuation of casualties, when necessary, was by fixed-wing aircraft. Patient data were retrospectively reviewed. Results The team performed 112 surgeries on 90 patients during the course of 7 months. Three patients were female (all children). Twenty patients were <19 years old. Trauma accounted for 78% of cases; the remainders were nontrauma or elective cases. Sixty-seven percent of these surgeries were performed on Afghan militia and civilians, 30% on United States soldiers, and 3% on other coalition forces. Mechanism of injury included gunshot wounds (34%), blasts (18%), motor vehicle crashes (14%), stab wounds (5%), and other trauma (7%). By physiological system, the trauma cases were broken down into extremity (44%), head and neck (17%), multisystem (13%), trunk (8%), and vascular (3%). Conclusions “Damage control” operations necessitating multiple trips to the operating room were the norm. Hypothermia from blood loss was often exacerbated by exposure before evacuation and prolonged transport in helicopters. This was aggressively treated with passive, conductive, and active rewarming techniques. Stabilization and evacuation to higher echelons of care was common.