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Trauma team delivers critical care, saves lives in Afghanistan

  • Published
  • By Maj. Tony Wickman
  • 455th AEW/PA
On the combat frontier, the ability to deliver advanced medical care usually means the difference between life and death for injured service members.

In Afghanistan, that lifesaving capability is delivered by a highly specialized team of medical professionals at the Craig Joint Theater Hospital.

According to U.S. Air Force Maj. Stephen Varga, 455th Expeditionary Medical Group trauma czar, the hospital provides surgical capabilities in trauma, general surgery, orthopedics, neurosurgery, urology, vascular surgery and otolaryngology, all of which are critical to helping 98 percent of patients who come to the hospital survive their injuries.

“CJTH provides surgical care for all troops, coalition forces, contractors, civilians and local nationals here in Afghanistan,” said Varga, who is on his first deployment and whose home station is the San Antonio Military Medical Center at Ft. Sam Houston, Texas. “As trauma czar, my role is organizing care for complex surgical patients, many of whom have wounds requiring not only immediate lifesaving surgery, but additional surgeries by specialty teams such as orthopedics and neurosurgery.”

Varga said he takes care of a patient from the moment he or she is wheeled into the trauma bay, throughout surgery, while they recover in the intensive care unit and until the patient is transferred out of theater as safely and efficiently as possible.

“Penetrating trauma like gunshot wounds, shrapnel injuries and the like are a surgical disease. The only way to fix hemorrhagic shock from penetrating trauma is to get patients into an operating room as quickly as possible,” said Varga. “Most combat related injuries are from gunshot wounds or IED (improvised explosive devices).”

According to U.S. Air Force Col. Jacqueline Mudd, 455TH EMDG chief nurse and surgical services flight commander, it’s important to have surgical and operation room capabilities here because it dramatically increases patients’ survival rate while minimizing morbidity and mortality.

“If we weren’t here, patients would be subject to risky travel out of the AOR (area of responsibility) before receiving medical care, which can increase morbidity and mortality,” said Mudd, who is on her sixth deployment and whose home station is the David Grant Medical Center at Travis Air Force Base, California. “We deliver world-class quality surgical care and capability here at Bagram.”

The CJTH surgical services flight is made up of three elements: operating room, including the sterile processing department; anesthesia element; and, surgeon element. Since April, the more than 20 surgeons, nurses and technicians have supported 264 cases, executing 474 procedures over 1,500 hours of surgery, including three mass casualty events and 70 trauma cases.

According to Varga, maintaining a Role 3 hospital in Afghanistan and the surgical capability it brings is vital to ensuring that the men and women who continue the fight against terrorism have the best chance of making it back home.
“The fatality rates of military members involved in this conflict are the lowest in history, and we aim to reduce those numbers even further,” said Varga. “Complex, traumatically injured patients require a multi-disciplinary approach to provide the best outcome and it’s essential someone is here to organize that approach.

“In a combat environment where moments can mean the difference between life and death for a military member, coalition force or local child, trauma surgeons are trained to evaluate multiple injuries very quickly and prioritize those surgeries necessary to save lives, and then to continue care and schedule follow-up surgeries in a way to best preserve quality of life and recovery,” said Varga.

As the team wraps up their deployment, Mudd shared her highlights of the team saving lives in the operating room.

“Memorable cases including saving the life of a (Service member) who had shrapnel pierce his heart, and another who had a gunshot wound to the brain that is now walking and talking with minimal residual deficit,” said Mudd. “There was also the young 8-year old girl who was caught in crossfire, and the patient who required multiple days of surgery to restore his face to normal.”

Varga said the skill and capabilities of the team resulted in some truly incredible saves in the past six months.

“One solider suffered a GSW to his chest and abdomen and his excessive blood loss caused his heart to stop while he was transported to CJTH. The moment he arrived, we rushed him immediately to the OR, restarted his heart and proceeded to repair multiple complex injuries to his liver and kidney along with major vascular repairs,” said Varga. “He survived and will soon be going home to his family.”

Varga also remembered the Service member who had shrapnel pierce his heart.

“The survival rate with this type of injury, even in a Level 1 Trauma Center in the U.S. with full surgical and cardiac capabilities, is less than three percent. I was able to get him into the OR and operated directly on his heart without the use of cardiopulmonary bypass-- in other words, I repaired his heart while it continued beating in his chest,” said Varga. “We stabilized the patient and very quickly coordinated a complex transfer to a cardiac surgeon in Germany who had the infrastructure to repair the multiple injuries to the valves in his heart.

“This required a truly awe-inspiring coordination of care from recognition of a rare and complex injury to medical transport across borders for an imminently necessary surgery,” said Varga. “That patient is now fully recovered and home with his family.”

Varga said the entire CJTH team wants nothing more than to provide the best care possible and save the lives of fellow service members who are on the front lines serving his or her nation.

“We’re delivering health care equal to the care found in the best trauma centers in the U.S., a feat that can only be managed because of the extensive medical, security, administrative, supply and airlift support of the joint U.S. military services,” said Varga.

“Our mission is to continue improving the historically high survival rates currently seen in combat medicine despite severe and complex injuries suffered by our military and NATO members and our Afghan partners,” said Varga. “Our goal is make sure every service member we see in this hospital recovers and makes it home to the family he or she loves and the country he or she protects.”

For Col. Gianna Zeh, 455th EMDG commander, she enjoys working with the joint medical team at CJTH and watching their efforts to save life, limb and eyesight of all the patients who come through the hospital.

“I’m humbled to lead this incredibly talented group of medics,” said Zeh. “They’ve answered their nation’s call and served with compassion.”