Operation Enduring Freedom: The 48th Combat Support Hospital in Afghanistan

Military Medicine, Mar 2006 by Beitler, Alan L, Wortmann, Glenn W, Hofmann, Luke J, Goff, James M Jr

Objective: To examine the experience of the 48th Combat Support Hospital (CSH) while deployed to Afghanistan, with an emphasis on trauma care. Materials and Methods: Before redeployment, a retrospective review was performed on the medical records of all patients treated at the 48th CSH from December 6, 2002 through June 7, 2003. Results: During the 6-month period, 10,679 patients were evaluated and/or treated. There were 477 hospital admissions (adults, 387; children, 90; trauma, 204) and 634 operating room procedures. The most common mechanisms of injury were land mines/unexploded ordinance (74 = 36%) and gunshot wounds (41 = 20%). Extremities were the most common site. A total of 358 cases was performed on 168 trauma patients (mean, 2 cases per patient; range, 1-12). There were 63 complications in 40 trauma patients and 11 patients died. Conclusions: The 48th CSH supported military and humanitarian operations with an ongoing process of re-evaluation, adaptation, and medical education that resulted in low morbidity and mortality rates.

Introduction

In response to the attacks on the World Trade Center and Pentagon, the United States deployed forces to Afghanistan. Health care for U.S. and coalition forces was initially provided by organic medical elements with limited surgical capabilities. This was followed by the introduction of forward surgical teams consisting of 20 individuals, including surgeons, nurses, and technicians. As the theater matured, a combat support hospital (CSH) was moved into the region to provide a wider spectrum of sustained medical and surgical care. The 86th CSH was positioned to the north in Uzbekistan and served as the first hospital in theater. The 339th CSH, a reserve unit from Pennsylvania, was deployed as the first U.S. hospital in Afghanistan. After 6 months, they were replaced by the 48th CSH on December 6, 2003.

The 48th CSH was the first multicomponent hospital deployed to a combat zone in the history of the U.S. military (Fig. 1). The unit consisted of personnel from the active and reserve components working side-by-side to provide health care to U.S., coalition, and Afghan patients. The unit had a rich history dating back to World War II. The hospital was activated as the 48th Portable Surgical Hospital on June 7, 1943. It provided direct tactical support to the Chinese Expeditionary Force during World War II and was inactivated on December 20, 1945. The hospital was reborn when the 8228th Mobile Army Surgical Hospital (MASH) was redesignated as the 48th MASH in 1951. During the Korean War, the unit received and treated all hemorrhagic fever cases, earning a reputation for excellence in the theater. Long after the war ended, the MASH was inactivated in Korea on May 1, 1964.

The 48th CSH was reactivated at Fort Meade, Maryland on October 16, 2000 as the Army's first multicomponent CSH. With a history of service during times of conflict, the hospital was mobilized on October 21, 2002 for movement to Afghanistan in support of Operation Enduring Freedom. This article recounts the experiences of the 48th CSH while deployed to Southwest Asia, with an emphasis on trauma care.

Materials and Methods

The hospital staff arrived in Afghanistan in two groups on December 3 and 5, respectively, and started caring for patients on December 6, 2002. The deployed element consisted of 124 personnel, comprising approximately 23% of the parent unit. There were 92 (74%) men, 32 women, 77 (62%) enlisted soldiers, and 47 officers. Seventy-three (59%) individuals were assigned to the unit and the remaining 51 were active duty professional fillers assigned from hospitals belonging to the Army's North Atlantic and Southeast Regional Medical Commands. The professional staff included six surgeons (general, one; general/vascular, one; general/surgical oncology, one; orthopedic, two; oral maxillofacial, one), four anesthesia providers (a combination of anesthesiologists and certified registered nurse anesthetists), one emergency medicine physician, two family physicians, one internist (initially a gastroenterologist and later an infectious disease specialist), one pediatrician, one radiologist, and one physician's assistant. The nursing staff consisted of 16 registered nurses. Radiology capabilities included computed tomography, ultrasound, and plain films while the laboratory contained a blood bank, microbiology section, and hematology and chemistry elements. An active three-man pharmacy was also an integral part of the unit.

The 48th CSH was envisioned to be a 44-bed hospital. One 16-bed intermediate care ward was not used and the CSH functioned as a 28-bed hospital with 12 intensive care unit (ICU) and 16 intermediate care ward beds. Patients initially underwent evaluation in the emergency medical treatment section where care was delivered in a sick call area for routine problems and an emergency treatment section for more urgent medical, surgical, and psychiatric needs. There were two operating rooms, equipped and staffed to perform a total of three simultaneous procedures. Initial postanesthesia care was performed in the ICU by the staff of that unit.