Posts Tagged ‘IED’

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Read this fascinating and rather frightening dialogue published by ABC News (Australia) on The Golden Hour

MAJOR MATT HUEMAN: The golden hour is when the person has an injury . . .within the first two to five minutes there’s a certain number of people who will die that are not saveable. The next hour is where a lot of people, if they don’t get to a place that has surgical capability and the full gamut of taking care of them, will die as well. So the golden hour really reflects those people that are saveable if you’re able to get them to a place like a forward surgical team.

MAJOR BRYAN HELSEL: We provide 21st century intensive care, critical care for patients that would otherwise die. I mean there’s no way around, some of these people would have died.

CORCORAN: Too many soldiers wounded on Afghanistan’s remote battlefields were bleeding to death before reaching surgery at the big military hospitals. So last year, army surgical teams were moved much closer to the fight, to beat the golden hour.  For those who make it here alive, often with horrific injuries, there’s now a 98% chance of survival. A young female solider pulled from the wreckage of the MRAP has multiple fractures. For her comrade, Sgt. Adam Sandifer, hit by the massive concussive blast, the injuries are less clear.

MAJOR MATT HUEMAN: We try and get the chest and pelvis within the first ten minutes with all the other things that we do like checking the airway, making sure that they’re breathing, making sure they have a pulse, getting an IV in, doing an ultrasound making sure that they don’t have blood in their abdomen.

CORCORAN: Matt Hueman and Bryan Helsel both served in Iraq. They’re well practised in treating IED victims – but this is a different war, with different injuries.

(TO HUEMAN) So even if they are travelling in the new armoured MRAP’s they still can suffer severe injuries?

MAJOR MATT HUEMAN: They can, and it’s deceptive because it tends to be internal injuries so you know in my last deployment, we would see amputations, significant like above the knee amputations with the Hummvees. In this deployment the leg still appears to be functionally intact, but it’s still a significant injury inside so it’s actually sometimes a little bit harder to figure out.

In a compelling story published today by the Washington Post, “Military medics combine ultramodern and time-honored methods to save lives on the battlefield” of Afghanistan.

Key Highlights:

  • At 6:09 p.m., Dustoff 57 has just left this base deep in Taliban-infiltrated Kandahar province, headed for a POI, or point of injury. Somewhere ahead of the aircraft is a soldier who minutes earlier stepped on an improvised explosive device, the signature weapon of the wars in Iraq and Afghanistan. All the helicopter crew knows is that he’s “category A” – critical.  The trip out takes nine minutes.  Fifteen minutes have now passed since the soldier was wounded. Speed, simplicity and priority have always been the hallmarks of emergency medicine. The new battlefield care that flight medics and others on the ground practice takes those attributes to the extreme.
  • Four people run to the helicopter with the stretcher holding the wounded soldier. He lies on his back partially wrapped in a foil blanket. His chest is bare. In the middle of it is an “intraosseous device,” a large-bore needle that has been punched into his breastbone by the medic on the ground. It’s used to infuse fluids and drugs directly into the circulatory system when a vein can’t be found. It’s a no-nonsense technology, used occasionally in World War II, that fell out of favor when cheap and durable plastic tubing made IV catheters ubiquitous in the postwar years. Until they were revived for the Iraq and Afghanistan wars, intraosseus devices were used almost exclusively in infants whose veins were too small to find. On each leg the soldier has a tourniquet, ratcheted down and locked to stop all bleeding below it. These ancient devices went out of military use more than half a century ago because of concern that they caused tissue damage. Now every soldier carries a tourniquet and is instructed to put one on any severely bleeding limb and not think of taking it off.
  • Tourniquets have saved at least 1,000 lives, and possibly as many as 2,000, in the past eight years. This soldier is almost certainly one of them. They’re a big part of why only about 10 percent of casualties in these wars have died, compared with 16 percent in Vietnam.  On the soldier’s left leg, the tourniquet is above the knee. The tourniquet on his right leg is lower, below the knee; how badly his foot is injured is hard to tell from the dressings. His left hand is splinted and bandaged, too. Whether he will need an amputation is uncertain. The hospital where he’s headed treated 16 patients in September who needed at least one limb amputated. Half were U.S. soldiers, and the monthly number has been climbing since March.
  • After three minutes on the ground, the helicopter takes off.  Eleven minutes after lifting off from the POI, the helicopter lands at the so-called Role 3, or fully equipped, hospital at Kandahar Airfield, about 30 miles to the east of the also well-fortified Forward Operating Base Wilson. There, surgeons will take care of the injuries before transferring the patient, probably within two days, to the huge military hospital in Landstuhl, Germany, and there, after a week or so, to the United States. It’s been 28 minutes since the helicopter left Forward Operating Base Wilson.

SFTT Analysis:

  • Before every Grunt leaves the wire, they want to know if air or artillery support is readily available and more importantly, if required, will an aerial medevac be responsive – in Joe speak “Time on Target for Air and Arty and a quick Nine-line medevac request . . . how quick will the angels of mercy get here?”.   Quick means quick, the sooner the better obviously, since every minute counts.  Secretary Gates figured this out when he began his battlefield circulation tours in Afghanistan when he became Secretary of Defense and quickly realized that the “Golden Hour”, that period in time that is the standard from time of request for a medevac to arrival at the point of injury and back to medical care on a base, was not being met in Afghanistan due to lack of medevac resources and the distant out-posts that troopers were operating from.  Secretary Gates made it a personal mission to close the gap and ensure that troopers were supported by the “Golden Hour” standard and personally kept the pressure on logistics planners to increase medevac resources and establish medical unit facilities in support of all forward deployed personnel.   The only question SFTT raises regarding this issue is why did it take the Secretary of Defense to correct this situation?  
  • The Washinton Post online article provides a remarkable photo gallery,  – of note is:
    • the destructive nature of an IED that targeted a Mine Resistant Ambush Protected (MRAP).  The simplicity of a pressure plate device loaded with hundreds of pounds of fertilizer (and other components) can defeat US “resistant” vehicles.  More telling is that a device of this size takes time and local support to emplace;
    • grunts not wearing all of their protective gear – no throat, deltoid, or groin protectors – obviously a commanders call, but is the decision not to wear the complete armor suite because of weight and comfort?;
    • the chinstrap for the Advanced Combat Helmet is a flimsy strap of material – no chin pads are provided and the harness is simply used to hold the “brain bucket” in place.  At least the trooper is being medevaced for treatment of a possible TBI.

Policy – Corruption Perceptions Index 2010 

Key Highlights

  • The 2010 Corruption Perceptions Index measures the perceived levels of public sector corruption in 178 countries around the world.

    Afghanistan is 176 of 178 and scored a 1.4 on the index.

  • Iraq is 175 of 178 and scored a 1.5 on the index.

 

Analysis:  After almost 10 years of war in Afghanistan and almost 7 years after the US toppled the Saddam regime we have these lovely achievements to pass on to future generations – puts things into perspective. 

Policy — Four More Years of War

Key Highlights:

  • The secret date for the withdrawal of U.S. forces from Afghanistan has been hiding in plain sight for months. It’s certainly not the much ballyhooed July 2011 date, which will only begin withdrawals. It’s not even July 2012 to smooth President Obama’s reelection campaign. It’s the end of 2014. The plan, NATO diplomats say, is for NATO leaders to formally announce this date at their Lisbon summit on November 19-20. Their thinking is to do this soon to reassure worried, friendly Afghans, to signal resolution to the Taliban, and to use their allied unity for political cushioning at home. NATO emissaries are still bargaining over exactly how many troops will remain after departure day and for what purposes.
  • Details aside, the devastating truth is that U.S. forces will be fighting in Afghanistan for at least four more years.

Analysis:   The fact of the matter is that we are looking at being stuck in the Afghan tar-baby for an additional four years without effectively deterring the threat of global terrorism or knowing what the outcome in Afghanistan will have on Pakistan.   This reality will impact the viability of beginning to reduce the current US footprint (and troop strength) in July 2011 as called for by the President – while the NATO summit decisions are critical, they will be superimposed by the December 2010 policy review ordered by the President – maybe at this juncture in July 2011, the costs of COIN in perpetuity will become evident and a realistic strategy will take hold.  In the mean time the Army’s patchchart continues to upload Brigade Combat Teams for Deployment-Dwell-Deployment.

Policy – The Afghan War: Why the Kandahar Campaign Matters

Key Highlights:

  • Late last month, the push began to move insurgents back from the critical roadway, and U.S. Army scouts, who are relied upon as a flexible, quick response unit, assaulted the area by helicopter. Within minutes of securing a compound, they came under heavy fire from fighters on all sides and hiding in the tree line. The gun battle raged for more than 12 hours the first day, 10 hours the second, with soldiers nearly going “black,” or out of ammunition, before a resupply chopper bailed them out. Air support, in the form of helicopter gunships, fighter jets and bombers that loom overhead with devastating weapons at the ready, is a crucial U.S. advantage. Indeed, when the engagement ended, officers estimate that close to 20,000 lb. (9,000 kg) of ordnance was dropped.
  • Since then, it has been a steady grind. In the latest phase of the operation, the scouts were tasked with supporting another company engaged in house-to-house clearing aimed at extending the security belt further away from the highway, while armored vehicles plowed up roads for bombs. Massive booms erupted in the distance over the first few days, some going off beneath the hulking vehicles, but mostly from air strikes against various IED-placement teams spotted by the balloon cameras and unmanned drones that also prowl the skies. The crescendo peaked at around noon on Day Two, when a 500-lb. (230 kg) bomb crashed to earth less than a half-mile from where the scout platoon was holed up, instantly killing a pair of Taliban bombmakers.
  • But, as one Scout bluntly put it, “We have air support. The Taliban has IEDs.” Of the dozens of casualties suffered by 101st Airborne Division so far, more than 80% have been caused by IEDs. They come in every conceivable form, spanning the ordinary (pressure plates, trip wires, remote control) to the elaborate (directional fragmentation devices, which might be triggered on the ground and explode sideways, and crush boxes that can be stepped on multiple times before finally detonating). The dizzying array of booby traps demands that soldiers keep an eye on the ground even as they survey the badlands around them for signs of trouble. A fatal pop could happen anywhere. “If you get lazy, you can be sure an IED will be there. It’s a minefield,” says Captain Bill Faucher, 25, who cited hypervigilance and good fortune as reasons why no one in his platoon has gotten hurt.

Analysis:

  • The IED threat has mushroomed and it appears that there is very little that US/NATO forces can do about it except to report the data.
  • Anytime you have to rely on a scout/reconnaissance unit for real-time objective intelligence, you are in fact conducting a kinetic operation with very little local support – so to that end, throw out the COIN manual and dust off your Operations manual.  Oh, and by the way, being cut off for 12 hours in a raging firefight never bodes well for any unit or operational plan – something FUBAR was up the minute the insertion of the scouts was complete.
  • SFTT added a Time Magazine Photo array titled “R&R at Kandarhar Airfield” for your viewing pleasure.  Imagine the organizational energy and contractor upkeep required to maintain this level of “R&R”.  Now compare it to the comfort items deposited to the Scout Platoon that was almost “black on ammunition”…bet the Scouts had a door bundle of re-supply water and MRE’s, batteries, 5.56/7.62, but no “Salsa” music.
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