, Salem, MA


November 11, 2013

Column: Saving lives in the 'Golden Hour'

I am currently serving in the mountains of eastern Afghanistan only a few miles from the Pakistani border. I am the commanding officer of a 17-person forward combat surgical team consisting of personnel from the Navy, Army, and the Air Force. Our mission is to provide Role II emergent medical and surgical stabilization and expeditious transfer of critically wounded casualties operating in our area of responsibility.

Let me talk about the different roles or echelons of care with military medicine in a combat area. Role I care is provided by the medics and corpsmen who serve directly on the front lines, embedded with the soldiers and Marines (trigger-pullers) providing security to the area. These medics and corpsmen are like the EMTs for their units and carry all their medical equipment on their backs. They are typically the first responders to a casualty and are the true heroes of military medicine. They bandage wounds, splint fractures, place tourniquets to stop extremity bleeding, start IVs, intubate and, most importantly, communicate with the medical evacuation team to get the casualty expediently to the next role/echelon of care. They do this typically in a hostile environment with little regard to their own safety.

My surgical unit is one of several providing this Role II care in Afghanistan. Our goal is to receive and treat the casualties within that first “Golden Hour” to increase the chances of survival and minimize disability (save life, limb, eyesight). I am the orthopedic surgeon on the team, which also contains two general surgeons, two anesthesiologists, an emergency medicine physician, a critical-care physician, two critical-care nurses, an operating room nurse, an administrative officer and six enlisted medics/corpsmen. We provide advanced trauma life support in our emergency area and have a two-bed operating room that can be run simultaneously in response to multiple casualties. Emergent surgeries are performed to control bleeding, vascular injury repair, secure airways, stabilize fractures, wash out wounds and treat burns. We also have a two-bed intensive care unit with a four-hour holding capability as the casualties await transport to the next higher echelon of care. We have blood transfusion capability, X-ray, basic labs and medications. The medical evacuation system is outstanding, and we typically receive our casualties, many critically wounded, directly from the front lines and within a very short time from their time of injury.

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