Combat Casualties in Afghanistan Cared for by a Single Forward Surgical Team during the Initial Phases of Operation Enduring Freedom

Military Medicine, Jun 2005 by Peoples, George E, Gerlinger, Tad, Craig, Robert, Burlingame, Brian

Background: The 274th Forward Surgical Team (FST) was the first FST deployed to Bagram, Afghanistan, to provide surgical care for combat casualties during the initial phases of Operation Enduring Freedom. This is an analysis of the distribution, cause, and severity of wounds for combat casualties and the surgical procedures they required. Methods: A prospective database was maintained for combat casualties cared for by the 274th FST. The database included demographic data, vital status, mechanism of injury, distribution and severity of wounds, and surgical care provided. Results: The FST cared for 224 combat casualties, including 153 U.S. soldiers, 19 coalition soldiers, 32 Afghan militia forces soldiers, and 20 detainees. Fragments were the most common mechanism of injury (49%), and the extremity was the most common location of injury (58%), whereas gunshot wounds were the most common cause of death (57%). There were few significant head, chest, or abdominal wounds (13%). The FST treated 103 surgical cases (73 with combat wounds), including neurosurgical, thoracic, general, orthopedic, and vascular cases, with a total of 180 procedures. Conclusions: The distribution, cause, and severity of wounds were similar to those in the Persian Gulf War, despite the obvious differences between these conflicts. The use of modern technologies, such as compact, portable, ultrasound and digital X-ray systems, expanded the capabilities of the FST. Even low-intensity conflicts can produce significant numbers of combat casualties, and the FST must be manned, trained, equipped, and supplied to treat a wide variety of combat wounds.

Introduction

Shortly before 9 a.m. on Tuesday, September 11, 2001, the first of two jetliners crashed into the north tower of the World Trade Center in New York City; a second plane hit the south tower just minutes later. Approximately 1 hour later, a third commercial plane hit the Pentagon and, as with the two previous crashes, it wreaked havoc in a chaotic scene of death, bloodshed, and vast destruction. Operation Enduring Freedom (OEF) began on October 7, 2001, in response to these attacks, after they were determined to be the work of Osama bin Laden and his al-Qaida terrorist network headquartered in Afghanistan.

Diplomatic overtures failed to convince the ruling Taliban regime to remit bin Laden to Western authorities. Therefore, OEF was initiated with the bombing of known terrorist training camps within Afghanistan and the simultaneous insertion of U.S. Special Operations forces into the country. The latter had the mission of organizing the anti-Taliban elements within the country to overthrow the regime and to seek out and destroy the al-Qaida network. The initial phases of OEF resulted in the fall of three Taliban strongholds, Mazar-e-Sharif, Kabul, and finally Kandahar, by early December 2001. At that time, the Taliban capitulated governmental control, and an interim government was established under Prime Minister Hamid Karzai on December 21, 2001.

At that time, international peacekeepers were deployed to Kabul, and a significant number of U.S. conventional armed forces were moved into Afghanistan and centered at two places within the country, namely, Bagram Air Base, north of Kabul, and Kandahar, in the south. The purpose of the troops was to continue the search-and-destroy mission for al-Qaida terrorists and Osama bin Laden. The largest combat operation of OEF, Operation Anaconda, was staged out of Bagram on March 1, 2002, and included a multinational force in conjunction with the Afghan militia forces (AMF). The operation was aimed at destroying the largest known concentration of Taliban and alQaida terrorists in the Shah-e-kot mountains in southeastern Afghanistan.

Given the small number of U.S. soldiers and the low-intensity nature of the conflict in the early phases of OEF, only two forward surgical teams (FSTs) were initially deployed to provide surgical and advanced trauma support. The FST is highly mobile, setting up in three tents, and has the doctrinal mission of providing far-forward lifesaving surgical procedures. A FST consists of 20 individuals operating a two-bed operating room manned by four surgeons and two anesthetists, an Advanced Trauma Life Support section, and a four-bed intensive care unit. The 274th FST was initially deployed to Uzbekistan and was moved to Bagram, Afghanistan, after the fall of Kabul. The 250th FST was initially deployed to Oman and was moved to Kandahar after the fall of that city.

The following account details the experience of the 274th FST deployed in support of OEF from October 14, 2001 to May 8, 2002. During the 7 months of service in the theater of operations, the FST cared for ~90% of the U.S. combat casualties. The following analyses describe the wounding patterns, mechanisms, and severity of wounds treated and the surgical procedures performed in the FST. This information demonstrates the impact of body armor and shows the types of combat casualities most likely to be encountered by other FSTs in future lowintensity conflicts.