US Army two-surgeon teams operating in remote Afghanistan--an evaluation of split-based Forward Surgical Team operations.
BACKGROUND
United States Army Forward Surgical Teams (FSTs) consist of twenty personnel and are the Army's smallest surgical units. Currently, they provide the majority of resuscitative surgical care for combat casualties in Afghanistan where the mission of the FST has been further extended to include "split-based operations." The effectiveness of these 10-person teams is unknown and outcome data has not been previously reported in the literature. This article evaluates the effectiveness of one split FST during a 14-month period in remote Afghanistan.


METHODS
The primary endpoint was died of wounds (DOW) outcomes among United States Forces, Coalition Afghani Forces, and local national citizens. Mortality was evaluated separately for patients who received a blood transfusion. Secondary endpoints of the study included number of blood products transfused, Injury Severity Score (ISS), and mechanism of injury.


RESULTS
Seven hundred sixty-one patients were treated and 327 patients underwent an immediate surgery. The average ISS was 12.05, and the DOW percentage was 2.36%. There were 61 patients with an ISS of greater than 24 (mortality = 23.0%), and 47 patients with an ISS of 16 to 24 (mortality = 2.13%). Nine of 121 patients transfused (7.4%) died. A total of 27 patients required massive blood transfusion and on average received 12.6 units of fresh frozen plasma and 18.2 units of packed red blood cell (ratio 1:1.49). Seven of 27 patients who received massive blood transfusion (25.9%) died.


CONCLUSIONS
Small two-surgeon surgical teams can achieve acceptable DOW rates when compared with other larger surgical units currently operating in the Global War on Terror.
Nessen
Shawn C
SC
US Army Institute of Surgical Research, San Antonio, Texas, USA. shawn.nessen@us.army.mil
Cronk
Daniel R
DR
Edens
Jason
J
Eastridge
Brian J
BJ
Little
Todd R
TR
Windsor
Jason
J
Blackbourne
Lorne H
LH
Holcomb
John B
JB
D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D016913:Blood Component Transfusion; D002648:Child; D003422:Critical Care; D005260:Female; D006470:Hemorrhage / Q000628:therapy; D006772:Hospitals, Military / Q000458:organization & administration*; D006775:Hospitals, Packaged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008889:Military Personnel; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D016019:Survival Analysis; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult