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

Two FSTs were positioned in outlying areas of Afghanistan based on operational considerations. These teams treated 91 patients who were subsequently sent to the CSH. Of those, 7 were brought to the FSTs following evaluation and/or treatment at a local Afghan hospital. Eight individuals came to the CSH directly from other hospitals, either local Afghan or coalition military facilities. The remaining 105 patients came directly to the CSH. Of the 99 individuals evaluated at FSTs or other hospitals, 68 underwent procedures beyond basic resuscitation.

A total of 358 procedures was performed on 168 trauma patients (mean, 2 cases per patient; range, 1-12). Eighty-two individuals underwent a single procedure. Irrigation and debridement of wounds were the most common procedures, comprising all or part of 219 cases. Other common procedures are detailed in Table II. Sixty-two amputations were performed on 48 individuals (Table III). Transfusions of packed red blood cells were administered to 53 patients, with a mean of 4 units per patient (range, 1-32 units). Fresh frozen plasma was given to 6 patients (mean, 4 units; range, 1-8 units). There were 63 complications in 40 trauma patients (Table FV) and 11 patients died (Table V).

U.S. service members and American contractors with significant medical and/or surgical problems were evacuated to Landstuhl Regional Medical Center in Germany within 3 to 5 days of admission. Critically injured U.S. soldiers were transferred to Germany with the assistance of Air Force critical care air transport teams. One of these teams was colocated with the 48th CSH in Bagram. Of the trauma patients, 25 were evacuated to Germany. Two additional coalition soldiers were returned to their home countries after sustaining injuries. In most cases, Afghan patients remained in the hospital until they were ready for discharge. A total of 14 individuals were transferred to Kabul Military Hospital. These patients were sent when medical conditions required prolonged treatment and/or when the CSH was full and beds were needed for more acute care.

Discussion

The deployment of the 48th CSH marked the first time a multicomponent hospital treated patients in a combat theater. The unit blended reserve and active component elements into one hospital. During a period when the United States is increasingly relying on National Guard and Reserve forces, this experiment deserves a brief critical review. The mixing of soldiers from the reserve and active components, elements with different cultures, necessitated an adjustment early in the deployment. This primarily occurred in areas of discipline and military readiness. With time, however, these differences melted away. Staffing of the organization did not account for the complexities of the mission. For example, a shortage of ward nurses was exacerbated by the requirement for protracted care for Afghan patients. A number of positions went unfilled and some rotating soldiers were not replaced, further reducing end-strength. This lean organization was further challenged by the need to regularly provide soldiers for a myriad of military details. Faced with ongoing requirements overseas, a precarious balance must be maintained to adequately staff units without necessitating repetitive, prolonged deployments that adversely impact morale and retention for medical personnel.