STS Members Serve Their Country Overseas

STS News, Fall 2013 -- As US military operations in Afghanistan wind down, several STS members have been deployed in the field, performing surgeries on soldiers and civilians in often dangerous situations. Three of them shared their experiences.

Dr. d’Amato, Surgical Director of the Cardiovascular Institute at Faith Regional Health Services in Norfolk, NE, was serving his first overseas combat zone deployment at Kandahar Airfield (KAF) in Afghanistan, a NATO Role 3 facility.

"Our mission is to serve as the Regional Command South primary trauma receiving and referral center for combat casualties, force health protection, combat stress, and humanitarian care in direct support of Operation Enduring Freedom and the International Security Assistance Force," said Dr. d’Amato.

The facilities at KAF rival many US hospitals.

Given KAF’s central role, the hospital is modern and clean, rivaling some of the best US facilities. "We have modern operating rooms, an excellent blood bank, and radiology services, including a 64-slice CT scanner. Complementing the trauma capability, our armamentarium includes peripheral and neurosurgical catheter-based interventions, some thoracoscopic and laparoscopic procedures, and surgical endoscopy," said Dr. d’Amato.

The multidisciplinary surgical staff encounters many critically injured patients who frequently have multisystem injuries from several mechanisms that include penetration, blunt force, blasts, and burns. "One of the most notable thoracic injuries required a complex repair of a tracheobronchial tear," said Dr. d’Amato. "The patient was crushed and disrupted his trachea across the posterior carina and most of the circumference of the right mainstem bronchus. He underwent a successful repair and, to the best of our knowledge, is the only reported case at the Role 3 and perhaps in theater in over a decade."

What’s driving the team’s high rate of success—if a patient arrives at KAF with a pulse, they have a 98% chance of survival—is the fact that all the physicians are willing to pitch in whenever needed, even if something is outside their specialty. "As a CT surgeon, I’ve assisted on neurosurgical, craniofacial, orthopedic, plastic-reconstructive, and ophthalmologic cases," said Dr. d’Amato. "In some instances, as many as six surgeons will work simultaneously on a single patient with multiple injuries."

He emphasized the lessons that can be learned from overseas deployments. "The knowledge gained from this 10-year military conflict will undoubtedly be emulated by the civilian sector," he said.

Dr. Donahue, Assistant Professor of Thoracic Surgery at the University of Maryland School of Medicine in Baltimore, was serving his first deployment at Forward Operating Base (FOB) Apache near Qalat, Afghanistan.

Dr. Donahue (left) and Dr. d’Amato (third from left) with other members of the surgical team.

While FOB Apache is generally well-equipped with a good blood bank and basic operating room supplies, it does not have the same level of laboratory facilities as KAF. "We do not have bronchoscopes, endoscopes, double-lumen endotracheal tubes, or thoracoscopic or laparoscopic equipment," said Dr. Donahue. "There is no CT scanner, so all decisions to operate are based on physical exam, plain film, and ultrasound findings."

Without much of the equipment he has grown accustomed to at home, Dr. Donahue finds himself frequently drawing on the knowledge and experience gained from his general surgery residency.

The main priority at FOB Apache is to resuscitate and provide emergency surgical care for soldiers, whom they receive directly from the battlefield. Most of the patients have sustained gunshot wounds or been injured by improvised explosive devices. They generally stay at FOB Apache just a few hours before being transported to a larger facility, typically to Dr. d’Amato and his colleagues at KAF.

"The majority of the cases have been either general surgical or orthopedic, although I have performed some thoracotomies and placed multiple chest tubes," said Dr. Donahue. "I have learned a great deal from the other physicians with whom I have had the privilege of being deployed."

Dr. Wright, a Director-at-Large on the STS Board of Directors, Associate Chief of the Division of Thoracic Surgery at Massachusetts General Hospital in Boston, and a Colonel in the US Army Reserves, was recently deployed at FOB Shank in southeastern Afghanistan’s Logar province.

It was Dr. Wright’s third time deploying, having previously spent time at Afghanistan’s FOB Sharana in 2010 and Iraq’s Al Asad Airbase in 2007.

Dr. Wright (right) with members of the medical team at FOB Shank.

The surgical team at the base consisted of Dr. Wright, two other surgeons, and two certified registered nurse anesthetists. They treated both US troops and members of the Afghan National Army.

"We got a good idea of what our rotation would be like on the first day, as we had two gunshot wounds followed by two rounds of indirect fire (mortar attacks)," Dr. Wright said.

The team averaged two major cases a day—fewer than Dr. Wright’s last deployment in 2010. The medics and nurses were experienced, so evaluations and resuscitations were quick and smooth.

The medical facility, made out of tents and plywood partitions, consisted of two trauma beds, two OR beds, and two ICU/PACU beds.

"I enjoyed being a trauma surgeon again and using tools and doing cases that I normally do not use or do," said Dr. Wright. "I am facile again with the FAST ultrasound exam, use the Doppler ultrasound liberally, and am even using an anoscope and sigmoidoscope liberally."

Despite the challenges of operating in a combat zone, Dr. Wright found reasons to be thankful. "We have had some good saves of US soldiers that make this experience so rewarding," he said.