274th Forward Surgical Team (Airborne)

274th Forward Surgical Team (Airborne)
Fort Bragg, NC
Engagements	World War II Panama Gulf War Iraq War Afghanistan War
Commanders
Commander	MAJ Matthew Fanning
Notable commanders	Colonel Brian D. Allgood (1997-1999)[1]
Insignia
Distinctive unit insignia of the 28th Combat Support Hospital, parent unit of the 274th Forward Resuscitative and Surgical Detachment (Airborne)

The 274th Forward Surgical Team (Airborne)—part of the 274th Forward Resuscitative and Surgical Detachment (Airborne)

In October 2001, the 274th FST (ABN) deployed to Bagram, Afghanistan in support of Operation Enduring Freedom following the September 11th attacks, where it remained until May 2002. During this period, the FST was responsible for functioning as a small combat support hospital, performing in-flight resuscitations and surgeries to soldiers wounded in combat, and leading the multinational coalition that provided medical support for Operation Anaconda.^[7]

Most recently, the 274th FST (ABN) deployed to

• Headquarters – Communications and administrative functions.
• ATLS (
  Advanced Trauma Life Support
  ) – Triages and prepares multiple casualties for surgery or transport and has a total of four beds.
• OR (
  Operating room) – Sets up and begins surgery within one hour, can be at full functioning capacity within two hours of establishing an area of operations. The OR has two separate OR tables that can be used at the same time allowing treatment for a greater number of casualties in a given time. The focus is for damage control surgery
  .
• Recovery / ICU (intensive care unit) – four beds for post-surgical care; two beds reserved for patients awaiting evacuation.

The 274th Forward Surgical Team (Airborne) consists of the following personnel:

• 1 commander
• 1 executive officer
• 1
  orthopaedic surgeon
• 3
  general surgeons
• 2 certified registered nurse anesthetists
• 1 emergency room registered nurse
• 1 critical care registered nurse
• 1 operating room registered nurse
• 3 surgical techs
• 3 licensed practical nurses
• 4 medics

After a soldier is wounded on the battlefield, the first care he or she receives is the care they give themselves or that which they receive from a fellow soldier. This usually consists of splints, bandages, and other efforts to control bleeding. Here, the

Decorations

Presidential Unit Citation for:

• Operation Iraqi Freedom 2003^[21]

Meritorious Unit Commendation for:

• Gulf War 1990 - 1991^[22]
• Operation Iraqi Freedom 2008–2009^[23]
• Operation Enduring Freedom 2012–2013(Nominated).

In peer-reviewed medical literature

In order to share their experiences with the medical community, the surgeons of the 274th Forward Surgical Team have written several articles for publication in peer-reviewed medical literature. Their presence in the initial entry forces of both Afghanistan in 2001 and Iraq in 2003 gave them a new look at the ability of the forward surgical team concept to function in the new "low-intensity" combat expected in each theater. Drs. George Peoples, Tad Gerlinger, Robert Craig, and Brian Burlingame were assigned as the orthopaedic and general surgeons of the FST during the early phases of Operation Enduring Freedom from October 2001 to May 2002, and during Operation Anaconda in early March 2002. They wrote of their combined experiences during this time period including all the lessons learned from their initial setup in Uzbekistan and then the split operations they conducted in Bagram, Afghanistan. At that time, their experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War.^[7]

The 274th Forward Surgical Team treated 90% of the US casualties in this period, consisting of 224 combat casualties, including 153 U.S. soldiers, 19 coalition soldiers, 32 Afghan militia forces soldiers, and 20 detainees. Blast fragments were the most common mechanism of injury (49%), and the extremity was the most common location of injury (58%), whereas gunshot wounds were the most common cause of death (57%). There were few significant head, chest, or abdominal wounds (13%). The FST treated 103 surgical cases (73 with combat wounds), including neurosurgical, thoracic, general, orthopedic, and vascular cases, with a total of 180 procedures.^[24] They concluded that the distribution, cause, and severity of wounds were similar to those in the Persian Gulf War, despite the obvious differences between these conflicts. The use of modern technologies, such as compact, portable, ultrasound and digital X-ray systems, expanded the capabilities of the FST. Even low-intensity conflicts can produce significant numbers of combat casualties, and the FST must be manned, trained, equipped, and supplied to treat a wide variety of combat wounds.

Drs. Craig and Peoples also wrote about their modification of a patient warming device for its use in heating intravenous fluids to help address the hypothermia routinely seen in combat casualties. By adapting the Bair Hugger patient warmer to a box they created for the purpose, they were able to raise the temperature of their irrigation and intravenous fluids to a physiologic level to help counteract the peripheral vasoconstriction and coagulopathy seen in hypothermic casualties. This technique is still discussed today in surgical training for preparations of patient care in an austere environment.^[25]

The 274th Forward Surgical Team was then, and continues to be, a source of refresher training to the United States Army Special Forces medics. The areas of greatest interest and concern were orthopedics, field transfusions, and field-expedient anesthesia. The surgeons wrote an article explaining their methods for teaching these topics to the Special Forces for the purpose of preparing future FSTs in theater for the task.^[26]

In an illustration of how multi-national surgical teams can jointly manage mass casualty situations, Dr. D. Vassalo of the British 34 Field Hospital Troop and the members of the 274th Forward Surgical Team wrote of their collaborative efforts in the treatment of 16 injured service members involved in a Chinook helicopter crash on 28 January 2002.^[27] This was the largest mass casualty incident to be dealt with in a combined fashion by the British and American medical services in Afghanistan during the initial months of Operation Enduring Freedom.^[28]

In an editorial published by the New England Journal of Medicine, Dr. Atul Gawande describes the current methodology of medical treatment in a deployed theater of operations, describing the roles of the 274th Forward Surgical Team and the 28th Combat Support Hospital. He explains the focus of the forward surgical teams being that of "damage control" in lieu of definitive fixation and repair. Orthopaedic surgeons forego X-rays and diagnose fractures by feel for treatment with external fixation. Perforated bowel injuries are stapled off, bleeding livers are packed with sponges, and dirty wounds are washed out. Surgical times are kept less than two hours to prevent the patients from becoming hypothermic and coagulopathic. Abdomens can be left open, laparotomy pads left in, bowel unanastomosed, the patient paralyzed, sedated, and ventilated. He also describes the hardships seen by the FST surgeons due to multiple deployments with only short periods of time at home.^[29]

Most recently, LTC Robert Lim and MAJ William Rice (surgeons with the 274th FST from June – October 2012) wrote of their experiences as bariatric surgeons specializing in weight loss surgery and how they adapted their skills to function in a trauma setting in Afghanistan. They describe how it is not unusual for a military bariatric surgeon to go from performing a single incision laparoscopic sleeve gastrectomy in a state-of-the-art laparoscopic suite one month to performing a neck exploration for a penetrating zone II gunshot wound in a poorly lit, nonventilated operating room in the mountains of Afghanistan the next month.^[30]

References