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

Infectious complications were relatively few given the gross contamination in many wounds. This was attributed to the aggressive wound care outlined above. Many of the complications were a consequence of the initial injuries and prolonged ICU care. In 10 of the 11 deaths, the lethal injury was identifiable. One 5-year-old child died from multiple, severe land mine injuries. The patients with abdominal and perineal wounds died from sepsis and multiple organ failure while the burn patient died from pulmonary complications.

The CSH instituted a multifaceted program for medical education. Daily teaching rounds were conducted 6 days a week and diagnostic and treatment plans were often modified based on these discussions. A continuing medical education (CME) lecture series, adhering to the strict guidelines mandated by the U.S. Army Medical Command CME program, conferred 18 hours of category 1 credit. CME lectures focused on conditions encountered in Afghanistan and, in many cases, the details were unfamiliar to those in attendance. Participation in the weekly morbidity and mortality (M&M) conference, covering all complications and deaths, was required for all physician providers. Information from M&M was used to modify practices and improve systems within the organization. The CSH sponsored two Advanced Cardiac Life Support courses and conducted a supervised rotation program that provided a diverse group of U.S. and coalition health care providers exposure to hospital care in a combat theater.

In addition to patient care and medical education, the CSH sponsored and participated in various cooperative medical assistance initiatives. These included primary care missions to remote and/or underserved areas, U.S. military inpatient care, an educational program with the Kabul Military Hospital, coordination with the International Committee of the Red Cross and consultation on a resource sharing program directed by the U.S. Office of Military Cooperation-Afghanistan. In May 2003, the CSH sponsored the first Coalition Forces Medical Symposium in Bagram. Attended by more than 100 health care providers from 13 coalition countries (including Afghanistan), the conference provided a venue for medical education and partnership.

In summary, the 48th CSH delivered a wide range of services to a large number of soldiers and civilians during its 6-month tenure. By treating Afghan patients, the staff met important humanitarian needs while maintaining critical skills in trauma evaluation and treatment. However, these efforts created significant challenges in providing prolonged care, rehabilitation, and outpatient placement in a nation with limited medical infrastructure. Despite the complexity of injuries and challenges of the deployed setting, an ongoing process of re-evaluation and adaptation combined with an aggressive program of medical education resulted in quality care with low M&M rates.

References

1. Bellamy RF: The causes of death in conventional land warfare: implications for combat casualty care research. Milit Med 1984; 149: 55-62.