mobile field surgical team

of the Forward Reconnaissance Surgical Team. He is a graduate of the Bases and Camp Bastion's Field Hospi- Mobile Trauma Bays, which found a. Mobile surgical teams that follow troops into the field are becoming increasingly important to combat medicine, the Air Force surgeon general. cal aspects of the Korean War is the Mobile Army Surgical. Hospital (MASH). surgical teams were attached to each field hospital platoon.

Mobile field surgical team -

The Army’s first smaller, nimbler combat hospitals roll out at Camp Humphreys

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019.

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019. (U.S. Army)

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019.

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019. (U.S. Army)

An overview photo shows the 502nd Field Hospital at the Multi-Purpose Live Fire Complex, Rodriguez Range, South Korea  in March 2019.

An overview photo shows the 502nd Field Hospital at the Multi-Purpose Live Fire Complex, Rodriguez Range, South Korea in March 2019. (U.S. Army)

CAMP HUMPHREYS, South Korea — One lesson the U.S. Army learned over the past 18 years of conflict is that it needs smaller, more agile hospital units closer to combat.

At Camp Humphreys, the 549th Hospital Center, is the first unit out of 10 in the active-duty Army to reconfigure itself into smaller components that include two mobile field hospitals and their supporting units.

That way, the unit commander can send the right unit at the size that fits the mission, said Col. Andrew L. Landers, M.D., commander of the 549th and the Brian D. Allgood Army Community Hospital at Camp Humphreys.

“Now we truly do have a scalable force,” said Landers. “I can really break it down to decide what units and equipment needs to go where to support a mission set.”

The hospital center units themselves were versions of the old mobile army surgical hospitals, or MASH units, made famous by the 1970 movie of the same name and the long-running TV series set in the Korean War.

U.S. Army Forces Command in June 2018 ordered all combat support hospitals to convert to smaller hospital units by 2022. Forces Command is the largest Army command; it tailors, trains and prepares units for expeditionary and other duties according to the needs of combatant commanders, according to its website.

The order says the U.S. Army is to convert all combat support hospital units into five distinct hospital, hospital support and forward surgical teams. The teams become a new deployable force that may be further divided into two 10-person resuscitative and surgical teams that work close to areas of combat.

“After all those years following 9/11 and moving into the post-Iraq War, we noticed we needed a lot more scalable footprint, something that truly was modular,” Landers said Monday. “We needed a smaller entry surgical team.”

The older combat support hospital design could split its 248 beds into two sections of 84 or 164 beds each, depending on the mission. However, the hospital was structured to operate as one entity due to logistical and pharmaceutical constraints, for example.

With the redesign, the hospital center now consists of the 121st Field Hospital and the 502nd Field Hospital, which are smaller, more agile, with 32 beds each and entirely self-sufficient.

If more beds and services are required, four subordinate units are available to the commander — the 129th, 125th, 150th and 197th medical detachments — along with the 135th Forward Resuscitative and Surgical Team, which is designed to split into two 10-man surgical teams for greater flexibility.

Collectively, the four detachments can provide personnel and up to 176 additional beds, surgical and intensive care capabilities, nutrition and behavioral health services.

“Depending on location there are now a lot more tailorable packages that I can now move around the theatre instead of being locked into two places,” said Landers. “I can now support four to six places, which could never be done before.”

The 549th Hospital Center is currently the only active-duty unit that has completed the full design update. Landers said several units within the Army Reserve, which provides a lot of deployed medical care, have completed the conversion since the order was issued.

“No design is ever perfect, but the good thing is the Army and Army Medicine is rapidly making changes that fit the current fight,” said Landers. “Especially here in Korea, this gives us a lot of options that we never had before.”

Landers commands both the 549th Hospital Center and the new $215 million Allgood hospital, which is scheduled to officially open Nov. 15. He is the former commander of the 121st Combat Support Hospital at U.S. Army Garrison Yongsan in Seoul. The hospital deactivated on July 16 after 69 years of service, forming the new Hospital Center and its subordinate units.

Maintaining a combat-ready medical unit is a tricky situation in Korea. Landers has 87 personnel assigned to him that work outside of Korea, 77 at Tripler Army Medical Center, Honolulu, Hawaii, with the remainder at Fort Belvoir, Va., Joint Base Lewis-McChord, Wash., Fort Sam Houston, Texas, and Fort Gordon, Ga.

The specialists, such as thoracic or trauma surgeons, attached to his command need to stay in practice, so they are detached to duty stations where their services are in demand, Landers said.

“If we go to war, I need you,” he said, “but day-to-day I need that person where they are doing trauma, so they keep their skills up,”

[email protected] Twitter: @MattKeeler1231

Matthew Keeler

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Источник: https://www.stripes.com/theaters/asia_pacific/the-army-s-first-smaller-nimbler-combat-hospitals-roll-out-at-camp-humphreys-1.595275

UAB's Air Force Special Operations Surgical Team was honored following a recent overseas deployment when the team commander received a prestigious award.

mitchell heroes 1Lt. Col. Mitchell and his team deployed in support of Operation Inherent Resolve.Lt. Col. Benjamin Mitchell, M.D., the commander of an Air Force Special Operations Surgical Team operating out of the University of Alabama at Birmingham, has been awarded the 2017 Heroes of Military Medicine Award by the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.

Special Operations Surgical Teams, or SOSTs, are mobile surgical specialists with advanced medical and tactics training who can deploy to austere or hostile areas to provide surgical support. A six-member SOST is composed of an emergency physician, general surgeon, nurse anesthetist, critical care nurse, surgical technician and respiratory therapist.

UAB first became home to a SOST in 2010, allowing the team to work in the hospital’s Level 1 trauma center when not deployed overseas, which helps members hone their skills and build team cohesion.

mitchell heroes 2Team member Capt. Cade Reedy donated blood for one of his patients.Mitchell received the 2017 Heroes of Military Medicine award May 4. The award is given to active-duty military medical professionals, with one recipient each year from the Army, Navy and Air Force. The award honors outstanding contributions by individuals who have distinguished themselves through excellence and selfless dedication to advancing military medicine and enhancing the lives and health of our nation’s wounded, ill and injured service members, veterans and civilians.

Mitchell was cited for leadership when the team was posted to an austere location in support of Operation Inherent Resolve, treating multiple patients at a field casualty collection point while undergoing a mortar attack within 250 meters.

“In a SOST, you get to work with some of the best medical care providers in the military,” Mitchell said. “We operate at a high level of readiness and focus, and my team reflects the highest professionalism under extreme conditions.”

Operating out of a small concrete house with equipment from their rucksacks, the team was the first to employ a resuscitative procedure called REBOA, a technique used in cases of major bleeding from chest, abdomen or pelvis injuries. REBOA involves stopping all blood flow temporarily while treating the most traumatic injuries.

mitchell heroes 3This small house served as the field medical facility for the UAB SOST.The team employed REBOA on four patients, all of whom survived. This was the first time the technique was employed by Defense Department personnel outside of a hospital setting.

“We are honored to have Lt. Col. Mitchell and the SOST team members at UAB,” said Jeff Kerby, M.D., Ph.D., director of the UAB Division of Acute Care Surgery in the Department of Surgery in the School of Medicine.

“This collaboration between military and civilian medicine provides mutual benefit, as they gain invaluable experience in a busy trauma center such as UAB, and we learn from the advances that so often come from battlefield medicine.”

The team members serving with Mitchell in Operation Inherent Resolve were Lt. Col. Matt Uber, Maj. Justin Manley, Maj. Nelson Pacheco, Capt. Cade Reedy and Technical Sergeant Richard Holguin. UAB hosts personnel from three SOSTs, whose members rotate between active military deployments and regular shifts at UAB Hospital.

Источник: https://www.uab.edu/news/people/item/8451-commander-of-uab-s-special-tactics-medical-team-wins-prestigious-award

Defense Media Network

Special Operations Forces, typically working in isolation in far forward positions that require stealth, must be largely self-reliant when it comes to combat medicine.  Their unique requirements have led to the creation of Special Operations Command (SOCOM) joint standards for both medics and individual warfighters that far exceed those of traditional forces, such as the Army 91W Health Care Specialist (medic).

“The 91 Whiskey course provides emergency medical technician training at the basic level,” SOCOM Command Surgeon Capt. Frank Butler, a Navy SEAL, explains. “Our training provides that at the paramedic level, so our guys get cardiac life support, pediatric cardiac emergencies, civilian trauma, and, in addition, get the same TCCC (Tactical Casualty Combat Care) principles the 91s get. So there is significant overlap, but our course is a bit longer – six months – and gives them a bit more depth.

“There are many things about our combat medics regulated at the component level. For example, the 18-Deltas (Army Special Operations Medical Sergeants) have skills that go above and beyond the standard we expect everybody to have. And the SEALs go above and beyond as well, but in a somewhat different direction, working more with diving medicine than Green Beret medicine. So we build the standard and the components build on that to fit their own particular needs.”

Col. Warner “Rocky” Farr, who serves as both Army deputy chief of staff-surgeon and command surgeon-Army Special Forces Command (USASOC), says a lot has changed since he was a medic in Vietnam, not only in the training SOF medics and team members receive, but especially in the equipment they carry into battle

In addition to training, SOCOM has sought to standardize equipment and medicines – all of which must fit into the medic’s pack, with few or no opportunities for resupply in the field.

“In all wars up until the current, the killed in action rate – those who die before getting to a medic – has been about 20 percent,” Farr says. “We have fielded enough new equipment, such as dressings – not just to medics, but to individual soldiers, as well – that those numbers have dropped substantially. A lot of that is due to technology, from tourniquets to dressings.”

USASOC fields two kinds of SOF medic, the 18Ds, who are cross-trained members of the Special Forces (Green Beret) A-Teams, and the Special Operations Combat Medics (SOCMs), who are assigned to the 160th Special Operations Aviation Regiment (Airborne) and Special Operations Support Command (Airborne). About 80 percent of USASOC medics are 18Ds.

“That SOCM has had a 24-week medical course, where the 18Ds get 46 weeks. We front-load trauma medicine into the first part, so the SOCMs have the same trauma training as the 18Ds,” Farr says.  “The 18-Deltas also are trained for unconventional warfare, where they go into a country to train a local indigenous force, which might include dependents or the local population. So the second part of the course they get has veterinarian, pediatric, and so on. The SOCMs go primarily to the Ranger regiment, where trauma training is the priority.

“We also have about 50 physicians. Each unit, down to the battalion level, has a physician and physician’s assistant. There are Special Forces Group surgeons and Ranger regimental surgeons – usually a lieutenant colonel – a battalion surgeon, who is a major, and a captain. Because Special Forces train indigenous forces, they have a lot more medics than they need for themselves. That also is true at the Ranger level.”

A significant change in how SOF doctors move through their careers took place in 1999. Prior to then, doctors coming out of medical

Soldiers from the U.S. Army John F. Kennedy Special Warfare Center and School practice evacuating a casualty during a training exercise at Fort Bragg’s Joint Special Operations Medical Training Center. The JSOMTC conducts the intensive medical portion of Special Forces Medical Sergeant training. U.S. Army photo by Gillian M. Albro, USASOC PAO.

school would complete their internships, then join SOF units as general medical officers. After serving two years with a combat unit, they would enter a hospital residency program in their area of specialization and only rarely return to combat medicine.

The Defense Department Office of Health Affairs decided to reverse that path, requiring physicians to go directly into a residency program from their internships, then to the combat units as board-certified physicians. That transition occurred from 1999-2002, so today every SOF doctor has completed an additional three-to-five years of training and certification than was true prior to 1999. About half of those specialized in emergency medicine and the majority of the rest in family medicine, although a few other specialties also are represented.

During Operation Iraqi Freedom, regular Army and Navy doctors were placed in new forward teams, moving that level of medical care farther forward than had ever been the case for traditional combat units. SOF doctors, however, have always faced assignment much closer to the front lines – if not beyond them – even working alongside frontline SOCMs.

“It is very mission dependent how far forward the doctor goes; it has always been that way,” Farr notes. “Clearly, if a physician with more training can have the medics see patients first and select who comes back to him, that’s a good use of his expertise. But he will go as far forward as needed and wherever he thinks his skills are best used.

“We sometimes are supported by an FST (Forward Surgical Team) because our docs are doing the lifesaving care and want to turn those patients over to a surgeon at an FST or Level 3. But where we operate, it may be a very long way to that FST, so we may have to save the casualty’s life and then have a long way to get to that next level.”

In the military medical chain, Level 1 is the combat medic, Level 2 a casualty collecting point, and Level 3 a combat support hospital. The FSTs essentially are a piece of the CSH transplanted into Level 2, but the FSTs are still farther back than SOF doctors, who function exclusively as Level 1 and 2.

“We have a small Level 2 in our sustainment brigade – not an FST, but a holding hospital piece. We then get an FST to fall in on top of that to provide our surgical care. We use that to support ourselves and any other SOFs assigned to our task force,” Farr explains.

While the structure may differ from one service SOF component to another, under the relatively new SOCOM directives, there is close coordination among all Special Operations medical teams.

“There is complete cross-over in Special Ops,” Farr says.  “All our medics are trained to the same standards.  Within the command in Tampa, we have not only SOCMs and 18-Deltas, but Navy SEAL medics, PJs (Air Force Special Ops ParaJumpers), and 4N AFSOC medics, all trained to the same level. If you are fighting a SOF war and a PJ gets off the helicopter, you want to know he has the same training as an 18-Delta.”

Whatever a SOF medic can fit into his backpack may be the extent of his field supplies for days at a stretch, placing pressure on the services to find the best possible components – small, light, multifunctional, and, aside from mission-specific items, standardized and interoperable.

Capt. Jessica Maverick, simulating a car crash victim, is carried on a stretcher by Air Force pararescuemen toward a Marine CH-53 Super Stallion helicopter during a search and rescue exercise here Feb. 8. (U.S. Air Force photo by Staff Sgt. Ricky A. Bloom)

Capt. Jessica Maverick, simulating a victim, is carried on a stretcher by Air Force pararescuemen toward a Marine CH-53 Super Stallion helicopter during a search and rescue exercise. Whatever service SOF medical personnel come from, all medics are trained to the same standard. U.S. Air Force photo by Staff Sgt. Ricky A. Bloom.

“For the most part, when we send medics forward, whether Special Ops Forces medical elements or PJs, they have to have the capability to be self-sufficient, with a small footprint, and operate for prolonged periods of time in austere environments without outside support,” notes Lt. Col. Michael Curriston, Air Force Special Operations Command (AFSOC) chief of operational medicine. “We train all AFSOC operators to be first responders, to provide triage capability.”

While the PJs are inserted, usually by helicopter, to provide medical care far forward, they are considered ground operators; every effort is made to limit their involvement in casualty evacuation (CASEVAC) to no more than one hour’s transport before they can return to the combat site.

“If there is a prolonged transport time, that’s when mission planning looks at establishing a transload site within an hour’s distance, where they would go to a Special Ops medical element for handoff. That is generally a flight surgeon, PA [physician’s assistant] and IDMT [independent duty medical technician] for prolonged flight transport as well as advanced monitoring and medical capabilities,” Curriston says.

“We also have a Special Operations Surgical Team (SOST) and Special Operations Critical Care Evacuation Team (SOCCET), which are similar to the conventional mobile field surgical team or critical care air transport team. The primary difference is additional training to work far forward for prolonged periods with a smaller footprint.  SOST is a couple of surgeons, a nurse anesthetist, EMS (Emergency Medical Services) for initial resuscitation after surgery; SOCCET is an emergency medicine physician and nurse as well as a respiratory therapy technician for ventilatory support in-flight.”

Butler says a lot of time and effort has gone into reducing the SOF medical pack and protocols to the fewest instruments and medications providing the greatest versatility of  use. For example, while a hospital can store dozens of different antibiotics to fight infectious diseases, SOCOM has narrowed that to a few broad-spectrum antibiotics that do not require refrigeration.

The SOF combat operations environment also affects those choices as well as training, including how best to deal with both trauma and non-trauma medical emergencies in a tactical setting.

“We expect our combat medics, if confronted in an austere environment with pneumonia or an allergic reaction, to have both the training and equipment to treat those. That is a capability that, at this point in time, is unique to SOF medics,” Butler says.

A Special Forces medic tends to the wounds of a local Afghan near Kandahar, Afghanistan. Because SF soldiers provide humanitarian aid to the people in their areas of operation, Special Forces medics are trained to care for children and families as well as in emergency medicine. DoD photo.

“Other things unique to SOF medicine include distribution of assets and a number of physiological aspects. If you are deploying to Afghanistan and operating at 9,000 feet, are you safe going straight from your flight to the field to your operating locale? Another is CASEVAC (casualty evacuation) – how do we do that, who flies the aircraft, what are the onboard care teams like – 18-Delta, SOAR medic, PJ, or 4-November – and what can all those different flavors of medic do on the aircraft?”

CASEVAC also is unique to SOF, which is about the only combat element for which immediate medical evacuation (MEDEVAC) – often within 30 minutes of being wounded – is unlikely due to their more remote (and often clandestine) operations. As a result, all SOCMs are trained to hold a patient for up to 72 hours before transport to a higher level of care. Those completing the 12-month training course also are taught to use platforms of convenience for CASEVAC, as well as how to develop a plan to turn civilian casualties over to the care of host nationals if they have to leave before evacuation is available.

The primary training center for all SOF medics is the Joint Special Operations Medical Training Center (JSOMTC), part of the Army JFK Special Warfare Center & School at Fort Bragg, N.C. Col. Kevin N. Keenan serves as both JSOTC dean and commander of the Special Warfare Medical Group (Airborne).

“We teach MEDEVAC in the first six months, CASEVAC in the second – and how to deal with both human and animal patients if no evacuation is possible,” he says. “We also teach how to carry patients on horses and mules – but not on camels or llamas – not only treating and diagnosing those animals but also loading patients on [horseback] (as opposed to camelback). We teach diagnosis and treatment of camels, but only PowerPoints on using them for CASEVAC as platforms of convenience, not choice.”

Keenan says the overall standards of proficiency and practice for SOF medical personnel has always been exceptionally high, but while 20th century medics were highly skilled and well-trained, today’s six-month graduates leave the school with a much improved knowledge base and skills proficiency.

“What we have changed in terms of training and the product – the SOCM – is tremendous improvements in the basic medic, SEAL corpsman, and aviation regiment medic. That six-month course is a tremendous improvement, reflecting improvements in civilian medicine for paramedics and in conventional force medicine, who have much greater trauma skills than those of prior wars,” he adds.

“The 12-month grad is not tremendously better because they were always great. What has changed is some of the equipment, which is lighter, more reliable, and provides more useful information. So the equipment is much more efficient, but the warrior is equally as superb in terms of Green Beret, independent duty SEAL, and independent duty Force Recon Corpsman.”

In some respects, it is not lessons learned from the ongoing war on terrorism and field operations in Southwest Asia that form the core of SOF medic training, but lessons learned from World War II operations by the Office of Strategic Services (forerunner to the CIA) that have evolved with changing technologies and improving medical knowledge.

While the civilian standard for conventional force medics is EMT-Basic, the equivalent for SOF tri-service medics is the more advanced EMT-Paramedic, plus additional trauma and primary care screening skills.

“That is driven by isolation, protracted evacuation time, and dispersal on the battlefield [distance from higher level care]. So we have additional training, especially in trauma,” Keenan says. “That tri-service standard is exceeded by Army Special Forces and some of the Navy SEAL IDCs and in the Marine Corps Force Recon community. Those three come back here for an additional six months of training beyond the six months SOCMs get.

“In that second period, we talk about families, children – more medical practice in an austere environment, because we think these warriors will work with populations – local villagers – who will never be evacuated. World War II also taught us that guerrilla or irregular fighters fought better, harder, and longer if they knew good medical support was available.”

As of March 2005, all SOF combatants – not just medics – are trained in TCCC, something conventional warriors do not get.

Staff Sgt.Thomas Brennan, Multi-National Corps-Iraq Surgeon Cell, applies the Special Operations Forces Tactical Tourniquet to the arm of Sgt. Sherrie Knight, MNC-I Surgeon Cell, during a class at Camp Victory. While training and the standard of care have seen major improvements in SOF medicine, new technologies have also been saving lives. DoD photo by Spc. Jeremy D. Crisp/MNC-I PAO.

“The standard we aspire to is to have each combatant provide life-saving care for his teammate, so if three operators are on a mission and the medic goes down, the other two can care for him,” Butler explains. “That was mandated in response to a growing awareness, based on individual reports coming back from theater, that training medics in TCCC was a good and correct step, but an incomplete solution. There were multiple reports of individuals who had to have life-saving care rendered by a teammate when no medic was available.”

Neither JSOMTC nor the service SOCs provide special training for physicians, nurses, or PAs assigned to SOF units, but they are encouraged to become familiar with field medic operations.

“From a SOCOM standpoint, we have not tried to impose a standardized training package for physicians beyond the Joint Special Operations Medical Officer orientation course, which is taught at the Joint Special Ops University twice a year,” Butler says. “The new training instruction strongly encourages commanders to send their nurses, physicians, and PAs to this course, because most have no background in Special Ops and won’t get that in hospitals or medical school. So it is important to get a look at Special Ops force structure and some of the peculiar characteristics of SOF medicine.”

Among those unique aspects is who provides what level of care in the field. SOF non-commissioned officers are trained to use equipment and techniques only employed by medical professionals in conventional forces.

“They use ultrasound to look for blood in the belly; shoot, develop, and interpret their own X-rays,” Keenan says. “That equipment – similar to what you would find in a field hospital and used by physicians, nurses, or physicians assistants – is packaged in parachute-droppable containers to be deployed in theater for use by SOF NCOs. They also carry broad-spectrum antibiotics, narcotics, and interosseous fluid administration kits, which not all conventional medics carry.

“These are high-school graduates doing physician-level work. That’s the uniqueness, not special equipment. The equipment is standard, the soldier is the special part of the system.”

In addition to caring for local human and animal populations, SOF medics also are trained to repair a wide range of medical equipment – including older systems rarely found in U.S. hospitals or clinics. The end goal is not to use such host nation resources, which often are scarce, but to return them to use by local doctors and nurses. When their own supplies begin to be depleted, SOF medics will call back to their support chain and request parachute drops of “push-packs” – supply pallets they created prior to deployment.

As to the future, Butler says it will be a continuing evolution, combining lessons learned from every combat theater of the past with new techniques and technologies, creating an ever-more capable medical care system for Special Operators in remote, austere environments.

“If you look at what has happened since Vietnam and the original TCCC paper, there has been a recognition of the need to combine good tactics and good medicine. That led to the concept of three phases of care – under fire, tactical field, and CASEVAC,” he says. “Each phase has a gradual reduction of the threat from the enemy and an increase in the capability to do more advanced things for the casualty. You can do more while flying back on a helicopter than on a battlefield under fire, but in the past those differences were not defined in terms of what specifically could be done in each phase.

“The original combat casualty care paper also made a point of saying combat medics might need to return fire instead of render care, at least initially,” Butler continued. “There were those who said medics should be observant of the Geneva Convention and not carry automatic weapons. We researched that with Convention lawyers and found SOF combat medics are not afforded any special protections because they do carry weapons and do not wear a Red Cross. So they are considered combatants who know how to treat injuries.”

The distinction is not a mere technicality. Even as all SOF combatants are now being trained in combat casualty care to a level equivalent to Vietnam medics, so have all SOF medics become full-time warriors.

This article first appeared in The Year in Special Operations: 2006 Edition.

By J.R. Wilson

J.R. Wilson has been a full-time freelance writer, focusing primarily on aerospace, defense and high...

Источник: https://www.defensemedianetwork.com/stories/special-operations-forces-combat-medicine/

MSF project coordinator

We talked a lot about the various scenarios the unit might face in the field, and altered the design and structure accordingly.

How will we manage all the wounded? How will the patient flow work? How much electricity will we need?

The unit is made up of five trailers containing an operating theatre; a recovery room and intensive care unit; a sterilisation room; a pharmacy for medical supplies; and a storeroom for logistical equipment.

It enables an MSF team located close to the frontline of a battle or in the middle of an emergency to conduct 100 surgeries without the need to bring in more supplies.

Inside the 'MUST'

1 Arrival - Wounded people arriving at the unit are received in the general triage tent, one of four tents set up in front of the trailers.

2 Triage - Medical staff assess the patients. Less urgent cases are transferred to another tent for treatment, while serious cases are moved to the surgical triage tent.

3 Transfer - Patients in the surgical triage tent are prioritised according to the severity of their injuries. From there they are carried by stretcher to the trailers for surgery.

4 The site - The site for the mobile unit surgical trailer needs to be at least 40 square metres to accommodate all the trailers and tents, and to be as flat as possible. A reliable source of water close by is a priority.

5 Logistics storeroom - Contains 40 square feet of storage for equipment, including water bladders and hygiene and IT equipment.

6 41 kVA generator - Along with two other generators, it allows the unit to function without an external power supply for days

7 Scrubbing and preparation - Operating theatre staff change their clothes in this area and the surgical team scrub up at the sink. Patients are transferred to a second stretcher to prevent the outside stretcher from contaminating the operating theatre.

8 Operating room - One surgical procedure can be conducted at a time. Within the operating theatre, and the unit as a whole, strict surgical care procedures and are apples good for you during pregnancy prevention and control protocols are maintained.

9 Recovery and intensive care unit - After surgery, patients are moved first to the recovery room, and then either to the three-bed intensive care unit or to the referral tent, to be taken to the nearest hospital.

10 Pharmacy - Contains 40 square feet of storage for medicines, vaccination fridges, surgical clothing and bedsheets.

Closest surgical facility to the frontline

"Once the design was finalised, the trailers were customised and equipped with all the necessary kit at a warehouse in Apeldoorn, in the Netherlands.

Everything inside the trailers – equipment, medicines, instruments – has to be boxed or shelved and then strapped into place for transport.

That meant finding a fridge, for example, that could stay switched on to keep vaccines cool even when the unit is on the move.

It’s important to remember that this is not a hospital.

But then again, at MSF we’re used to working in emergency chase bank cd rates today where surgery happens outside – under trees or in tents. Just in terms of hygiene, this is a vast improvement on that.

The other big issue is that we couldn’t change the size of the containers. The lack of space created problems when we were designing the operating theatre.

Once you have a patient and the whole surgical team, it’s very cramped. We had to move the table to the side to create more space.

Once it had been transported to Iraq, the unit was positioned in a village just south of Mosul, making it the closest surgical facility to the frontline. On 16 February 2017, it received its first patients.

The unit can be set up and ready for use in under three hours, while everything inside it can be strapped down and stored for quick transportation.

After the unit was deployed in Iraq, we received really useful feedback from the teams who used it, which we’re now incorporating into the design, so next time it’s deployed it will be even better.

It was really nice to know that the unit helped save lives in Iraq. Hearing that made all the long hours we worked in the cold worthwhile.”

MSF in Iraq

Iraq is recovering from years of conflict and instability.

Although the civil war ended in late 2017, the security situation remains complex and unpredictable due to ongoing political disputes, tribal conflicts and attacks by armed groups.

Although displaced people continued to return to their homes in 2019, more than a million still face significant barriers that prevent them from doing so. Some have been living in camps for years, with little access to basic services.  At the end of the year, the violent crackdown on protests in various cities across the country put additional pressure on the health system.

Learn more >

Источник: https://msf.org.uk/article/inside-must-mobile-unit-surgical-trailer

In our series, Profiles in Service, we highlight people who dedicate their lives to helping others, often at great risk to themselves. An estimated 26,000 American troops are deployed in Iraq, Afghanistan and Syria. If they're wounded in action, their survival rate is now about 90 percent – the highest it's ever been in combat. At Hurlburt Field, outside Pensacola, Florida, CBS News' Tony Dokoupil met an elite Air Force surgical team, partly responsible for that remarkable record.

Some of the footage in the above video has been blurred to protect identities and location.


Special operations surgical teams are doctors and nurses deployed as close to the fighting as possible. Conceived in the weeks after 9/11, the teams have logged thousands of days in conflict and several members have earned the Bronze Star. Just miles from the front lines in the fight against ISIS, six members of an elite unit are fighting a battle of their own -- a battle to save lives.

Last summer, emergency medicine physician Maj. Regan Lyon, anesthesiologist Maj. Dan Farber, and surgeon Maj. Marc Northern deployed for four months as part of the Air Force's special operations surgical team.

"We can provide that life-saving intervention to our special operators, to the – the folks that are down range, protecting us, that are bringing the fight to ISIS," Northern said.  

For security reasons, they can't tell us exactly where they serve, but this is "outside-the-wire medicine." Handling dozens of mass casualty situations, treating thousands of patients, military and civilian, most with combat trauma. 

pis.jpg


 "No matter the training that you do, you can't quite prepare to see the civilians that were hurt," Lyon said. "They hit an explosive device. And now they're on our doorstep."
 
Lyon recalled one patient, a boy about 10 years old, who fractured his femur after an explosive device was detonated in a school. 

"He rolled in on the stretcher. And we were trying to help him over…And he waved us off and then moved his own broken leg over to the bed with him," she said. 
 
At Florida's Hurlburt Field Air Force Special Operations Command, the team undergoes tactical training and spends six months honing their skills into a cohesive unit. 

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"When the teams are as small as ours, when the stakes are as high as they are down range – that's what's so important about picking the right people," Northern said. "We wouldn't be able to do it without each other," Lyon added.

They move as the front lines move – an ER and operating room shrunk down to six people – working in whatever space they can find with spotty electricity, no x-rays and no running water.
 
"We train to work in pretty much any environment that is kind of put in front of mobile field surgical team Farber said.
 
Including in the back of a CV-22 Osprey aircraft. Despite the often tight, unpredictable and dangerous conditions, 98 percent of their patients survive long enough to move on to a more advanced facility. When patients come in, Lyon says they tell them "We're Americans and we're gonna get you home."

As civilian doctors, they'd likely have better pay, weekends off and far less risk to themselves.

"There's something to be said about being somewhere horrible and smoking a cigar with a good friend and then possibly being that familiar face that they look up to you in the scariest moment of their life. And that – that's why I do it," Waukesha state bank online banking sign in said.

"Being able to take care of some of the most deserving men and women of our military, our partner forces and civilians who are caught in the way. I wouldn't trade the opportunity to do this job for anything," Farber said.

Back home, the team is training together in both military hospitals and civilian trauma centers, where they treat the type of injuries that will keep them sharp for their next deployment. Combined, they have more than 30 years of active duty and counting.

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Источник: https://www.cbsnews.com/news/profiles-in-service-air-force-elite-surgical-team/

These are the Air Force medics trained for special ops

Everyone knows about the famous 4077th MASH, or Mobile Army Surgical Hospital. But if you ever wanted to see the kind of docs that Michael Bay or Jerry Buckheimer would do a movie about, look at the First citizens bank closing hours Force’s Special Operations Surgical Teams, or SOSTs.


A MASH unit usually had about 113 people. In 2017, Combat Support Hospitals began transitioning to Field Hospitals. According to the Army, the conversion reconfigures the 248-bed CSH into a smaller, more modular 32-bed FH with three additional augmentation detachments including a 24-bed surgical detachment, a 32-bed medical detachment, and a 60-bed Intermediate Care Ward detachment. The FH and the augmentation detachments will all operate under the authority of a headquarters hospital center.

According to the Air Force web site, the SOST is much smaller. It has six people: an ER doctor, a general surgeon, a nurse anesthetist, a critical care nurse, a respiratory therapist, and a surgical technician.

These are the Air Force medics trained for special ops

The MASH and CSH have trucks and vehicles to deliver their stuff. SOSTs only have what they can carry in on their backs. Oh, did I mention they are also tactically trained? Yep, a member of a SOST can put lead into a bad guy, then provide medical care for the good guys who got hit.

In one Air Force Special Operations Command release, what one such team did while engaged in the fight against We vibe sync amazon is nothing short of amazing. They treated victims who were suffering from the effects of ISIS chemical weapon attacks, handled 19 mass casualty attacks and carried out 16 life-saving surgical operations. A total of 750 patients were treated by these docs over an eight-week deployment.

Again, this was with just what mobile field surgical team carried on their backs.

These are the Air Force medics trained for special ops

At one point, the team was treating casualties when mortar rounds impacted about 250 meters away. The six members of the team donned their body armor, got their weapons ready and went back to work. Maj. Nelson Pacheco, Capt. Cade Reedy, Lt. Col. Ben Mitchell, Lt. Col. Matthew Uber, Tech. Sgt. Richard Holguin, and Mobile field surgical team. Justin Manley received Bronze Stars in February 2018 for their actions. 

It takes a lot to get into a SOST. Fall selection is quickly approaching:

Fall 2021 Selection 

Applications Due: 3 Sep 2021

Phase 1 (record review): 9 Sep 2021

Phase 2 (in-person selection): 17–21 Oct 2021

** Report date 12 October for COVID testing. **

**These dates are subject to change based on mission requirements.**

Learn more and apply here: https://www.airforcespecialtactics.af.mil/Special-Tactics/Battlefield-Surgery/

One thing for sure, these are the most badass folks with medical degrees!

Источник: https://www.wearethemighty.com/mighty-trending/these-are-the-air-force-medics-trained-for-special-ops/

Trauma

Trauma is accidental or intentional injuries that lead to life threatening situations. The more experienced the healthcare facility, the better a trauma patient's chances of survival. In fact, the American College of Surgeons Committee on Trauma suggests that this level of experience can be obtained by treating 600-1,000 trauma patients each year. We see more than 1,400 trauma patients per year at USA Health's Trauma Center.

The Fanny Meisler Trauma Center at University Hospital is the first, and the only, in south Alabama to earn level I status. Here, we utilize resources from all medical specialties to meet first convenience bank new mexico routing number special needs of a seriously injured patient at a moment's notice. Only level I trauma centers can offer comprehensive emergency care, including necessary life-saving interventions, prevention, advanced surgical care and rehabilitation.

Construction/Parking Update

As construction continues on the expansion of our Fanny Meisler Trauma Center, there are some changes on how you access the USA Health University Hospital emergency department. The drop off for the patient entrance will remain under the portico/ambulance drop off and all patient emergency parking has moved to the main lot. We also now have valet parking at the main hospital lobby Monday through Friday from 8 a.m. to 5 p.m. Construction will be completed in summer 2020.

Источник: https://www.usahealthsystem.com/specialties/trauma

After the earthquake, a surgical team works nonstop

What was the situation that you found in the South? 

The first place we arrived was the town of Les Cayes. It was very impressive. It brought me back to the earthquake in 2010, because it was practically the same kind of destruction – houses completely collapsed, mobile field surgical team in the streets. There were places where we could not pass at all, where we had to find another way. We spent our first night in Les Cayes, before moving on; a colleague of ours was already supporting the operating theatre at the hospital there. 

The next morning we left for Jérémie. Before we reached the River Glace, we mobile field surgical team that the road was blocked by a landslide. We already knew that the death at a funeral watch for free was blocked, but no one could tell us whether a car could squeeze through the rocks there. We exited the vehicle and took photos of how rocks blocked the road for at least a kilometre. Then we had a little scare because we were close to the cliff, and then there was an aftershock, and a few stones came down. We turned back to Les Cayes, and finally we took a helicopter to reach Jérémie. 

Источник: https://www.msf.org/surgical-team-works-nonstop-after-haiti-earthquake

The Army’s first smaller, nimbler combat hospitals roll out at Camp Humphreys

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019.

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019. (U.S. Army)

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019.

Col. Andrew Landers, M.D., left, briefs Lt. Gen. Michael Bills, Eighth Army commander, on the field hospital conversion concept at Rodriquez Range, South Korea, in March 2019. (U.S. Army)

An overview photo shows the 502nd Field Hospital at the Multi-Purpose Live Fire Complex, Rodriguez Range, South Korea in March 2019.

An overview photo shows the 502nd Field Hospital at the Multi-Purpose Live Fire Complex, Rodriguez Range, South Korea in March 2019. (U.S. Army)

CAMP HUMPHREYS, South Korea — One lesson the U.S. Army learned over the past 18 years of conflict is that it needs smaller, more agile hospital units closer to combat.

At Camp Humphreys, the 549th Hospital Center, is the first unit out of 10 in the active-duty Army to reconfigure itself into smaller components that include two mobile field hospitals and their supporting units.

That way, the unit commander can send the right unit at the size that fits the mission, said Col. Andrew L. Landers, M.D., commander of the 549th and the Brian D. Allgood Army Community Hospital at Camp Humphreys.

“Now we truly do have a scalable force,” said Landers. “I can really break it down to decide what units and equipment needs to go where to support a mission set.”

The hospital center units themselves were versions of the old mobile army surgical hospitals, or MASH units, made famous by the 1970 movie of the same name and the long-running TV series set in the Korean War.

U.S. Army Forces Command in June 2018 ordered all combat support hospitals to convert to smaller hospital units by 2022. Forces Command is the largest Army command; it tailors, trains and prepares units for expeditionary and other duties according to the needs of combatant commanders, according to its website.

The order says the U.S. Army is to convert all combat mobile field surgical team hospital units into five distinct hospital, hospital support and forward surgical teams. The teams become a new deployable force that may be further divided into two 10-person resuscitative and surgical teams that work close to areas of combat.

“After all those years following 9/11 and moving into the post-Iraq War, we noticed we needed a lot more scalable footprint, something that truly was modular,” Landers said Monday. “We needed a smaller entry surgical team.”

The older combat support hospital design could split its 248 beds into two sections of 84 or 164 beds each, depending on the mission. However, the hospital was structured to operate as one entity due to logistical and pharmaceutical constraints, for example.

With the redesign, mobile field surgical team hospital center now consists of the 121st Field Hospital and the 502nd Field Hospital, which are smaller, more agile, with 32 beds each and entirely self-sufficient.

If more beds and services are required, four subordinate units are available to the commander — the 129th, 125th, 150th and 197th medical detachments — along with the 135th Forward Resuscitative and Surgical Team, which is designed to split into two 10-man surgical teams for greater flexibility.

Collectively, the four detachments can provide personnel and up to 176 additional beds, surgical and intensive care capabilities, nutrition and behavioral health services.

“Depending on location there are now a lot more tailorable packages that I can now move around the theatre instead of being locked into two places,” said Landers. “I can now support four to six places, which could never be done before.”

Mobile field surgical team 549th Hospital Center is currently the only active-duty unit that has completed the full design update. Landers said several units within the Army Reserve, which provides a lot of deployed medical care, have completed the conversion since the order was issued.

“No design is ever perfect, but the good thing is the Army and Army Medicine is rapidly making changes that fit the current fight,” said Landers. “Especially here in Korea, this gives us a lot of options that we never had before.”

Landers commands both the 549th Hospital Center and the new $215 million Allgood hospital, which is scheduled to officially open Nov. 15. He is the former commander of mobile field surgical team 121st Combat Support Hospital at U.S. Army Garrison Yongsan in Seoul. The hospital deactivated on July 16 after 69 years of service, forming the new Hospital Center and its subordinate units.

Maintaining a combat-ready medical unit is a tricky situation in Korea. Landers has 87 personnel assigned to him that work outside of Korea, 77 at Tripler Army Medical Center, Honolulu, Hawaii, with the remainder at Fort Belvoir, Va., Joint Base Lewis-McChord, Wash., Fort Sam Houston, Texas, and Fort Gordon, Ga.

The specialists, such as thoracic or trauma surgeons, attached to his command need to stay in practice, so they are detached to duty stations where their services are in demand, Landers said.

“If we go to war, I need you,” he said, “but day-to-day I need that person where they are doing trauma, so they keep their skills up,”

[email protected] Twitter: @MattKeeler1231

Matthew Keeler

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Источник: https://www.stripes.com/theaters/asia_pacific/the-army-s-first-smaller-nimbler-combat-hospitals-roll-out-at-camp-humphreys-1.595275

What equipment do Army combat surgeons have?

First responders to combat casualties are typically other soldiers trained as medics (or sometimes other soldiers in a unit, with EMT training or not). Surgical teams are equipped with both general surgery and anesthesia packs, and in situations that require a quick medical response, some types of these packs also include rapid-response surgical kits with essential first aid items plus basic surgical tools.

The next level of care, known as level II care, was once a MASH unit, the Army's now outdated mobile surgical hospital. But since Operation Iraqi Freedom, the Army's forward surgical teams (FST) and forward resuscitative surgical system (FRSS) care for injured soldiers. Forward surgical teams mobile field surgical team patients in the critical moments before they're transported to a hospital. The FRSS is a lightweight mobile operating room. These mobile units are designed to be easy to move and easy to deploy. The surgical teams consist of a staff of 20, usually broken into four specialties: triage and trauma management, surgery, post-op recovery and administration and operations.

The units are equipped with portable oxygen-generating systems and within, surgical teams are equipped to administer general anesthesia, perform surgery (each FRSS is equipped with two operating tables), treat major injuries, including the following:

  • Shock
  • Hemorrhaging
  • Chest and abdominal trauma
  • Respiratory distress
  • Fractures
  • Crush injuries
  • Closed head wounds

These surgical teams are also able to provide postoperative care for up to eight patients for a maximum of six hours. Overall, the mobile operating room is self-sustaining for 72 hours or 30 patients.

Wounded soldiers may then be transported by helicopter, such as a CH47 with a critical care team (known as a critical care air transport or CCAT) on board, to a combat support hospital (CSH).

A combat support hospital is an expandable mobile military hospital, with care and equipment that rivals a fixed-location hospital. The 10th Combat Support Hospital, for example, houses the following:

  • 84 beds (with another 164 available)
  • A fully equipped operating room
  • Intensive and intermediate care units
  • A lab
  • A blood bank
  • A radiology section (complete with portable, digital x-ray equipment)
  • A pharmacy

To learn more about Army surgeons' equipment, check out the links on the next page.

Источник: https://health.howstuffworks.com/medicine/army-medicine/army-combat-surgeon-equipment.htm

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