'A River Of Trauma' Leads To Five Bronze Stars
by USAF 24th Special Operations Wing Public Affairs
May 5, 2018
The brightly lit, inviting atrium of UAB Hospital is a far cry
from the two room, concrete-walled farmhouse in the Middle East
where the United States Air Force Special Operations Surgical Team,
based out of the University of Alabama at Birmingham, deployed in
2016. During their four-month tour at that casualty collection
point, the team performed the deeds that brought their families,
scores of UAB well-wishers, and senior officers from the Air Force
Special Operations Command, to the atrium for a medal ceremony on
The five members of the SOST Gold Team were awarded
Bronze Star Medals by the Air Force for their actions during that
Members of a Special Operations Surgical Team were presented five Bronze Star Medals and a Meritorious Service Medal during a ceremony at The University of Alabama at Birmingham, Alabama, Feb. 13, 2018. The team was recognized for their actions while deployed in support of Operation INHERHENT RESOLVE. SOSTs are surgical teams highly trained in providing life-saving care any time, any place. (U.S. Air Force photo by Staff Sgt. Victor J. Caputo)
A SOST is a team of active-duty Air Force medical professionals,
including a trauma surgeon, emergency physician, nurse anesthetist,
surgical scrub tech, critical-care nurse and a respiratory tech, who
are charged with providing far-forward medical care during combat
operations wherever the U.S. military is engaged.
“A SOST is
a mobile surgical team with advanced medical and tactics training
which can deploy to austere or hostile areas to provide surgical
support,” said Lt. Col. Ben Mitchell, SOST leader and emergency room
medical doctor with the 720th Operations Support Squadron. “Our
mission is to provide early, potentially life-saving surgery to
wounded American military personnel or to the local population.”
In 2010, UAB became one of the first two civilian hospitals in
the nation to host a SOST. The Air Force determined that, when not
on deployment abroad, the teams needed to be stationed at a facility
where they could best develop their medical and teamwork skills.
“Military hospitals in the states typically don’t see a lot of
trauma,” said Jeffrey Kerby, M.D., Ph.D., the director of the
Division of Acute Care Surgery at UAB. “For a medical team to keep
their skills sharp, they need a more challenging environment.”
Kerby, who was an Air Force surgeon before joining UAB, is the
conduit between AFSOC and the hospital.
“UAB is a good
training ground,” Kerby said. “We are the only adult Level 1 Trauma
Center within a 150 mile radius. We see a great many penetrating
trauma cases here from gunshot wounds, stabbings or car crashes.
Unfortunately, we are a good place to hone trauma skills.”
The team members are fully accredited staff at UAB, treating
patients in the emergency department, performing surgery and caring
for those in intensive care units.
In 2016, the UAB Gold Team
deployed in support of Operation INHERENT RESOLVE, setting up at an
austere, forward location that served as a collection point for
injured local fighters.
“When we arrived on location, we
basically were jumping into a fast-moving river of trauma,” said Lt.
Col. Matt Uber, the team’s nurse-anesthetist.
There were some
local medical personnel at the farmhouse, and some U.S .military
medics, but no surgical capacity. As word spread of their arrival,
the river of trauma began to flow.
“We had patients on site
within two hours of arrival at our location,” Mitchell said. “We
treated more than 750 patients during our deployment, working 24/7.”
Mitchell, Uber and the rest of the six-man team experienced 19
mass casualty events — when the river of patients would have
overwhelmed even a good-sized emergency department in the states.
They performed 16 lifesaving surgeries, sometimes while mortar
rounds whistled overhead. Supplies were limited. Capt. Cade Reedy
donated his own blood for one wounded fighter, while Maj. Nelson
Pacheco organized other locals to donate multiple units.
times, the patients dramatically outnumbered the providers. Tech.
Sgt. Richard Holguin, the team’s respiratory therapist, established
an airway on one casualty while single-handedly managing another
patient’s chest injury.
For the first time ever in a forward
wartime environment, Maj. Justin Manley, the team’s surgeon,
performed a REBOA procedure, in which a balloon catheter is placed
into a patient’s femoral artery. The balloon is inflated to stop
severe bleeding. It is a difficult, even risky procedure, but it
allowed the patient to survive until arrival at an operating room.
The team used the same procedure three more times during the
deployment, saving four patients who otherwise would not have
Team members say the time spent at UAB when not
overseas is important. Training and working together brings the team
“It helps to really know and understand each member
of the team — to know what they will do and how they will react to
situations that arise,” Mitchell said. “We had some rough days
during deployment, and you have to know that you can count on each
other in those times.”
UAB hosts three, six-man SOST teams,
who rotate on deployments that usually last about four months,
followed by 11-12 months at the host medical facility.
are adjuncts to the UAB staff, not replacements,” Mitchell said. “We
train with our SOST teammates, but also work alongside the
incredible medical professionals at UAB as much as possible.”
“It is gratifying to know that we can play a role in helping the
team reach and maintain peak proficiency in their medical skills
prior to a deployment where those skills might be needed to save
lives on a battlefield,” said Reid Jones, Chief Operating Officer of
The team shares their experiences with their
UAB counterparts in an exchange of learning that flows both ways.
“Most of the major, significant contributions in trauma surgery
have been made during times of military conflict,” Kerby said. “This
affiliation with the Air Force, tapping into their experience and
their expertise, certainly has a positive impact on what we are
trying to do at UAB as a trauma center. At the same time, their
opportunity to work as a team, in a busy, high-volume trauma center,
has a positive impact on what they are trying to accomplish.”
SOST members are involved in teaching residents and medical
students at UAB through presentations and side-by-side training. The
team has worked with over 200 first responders on proper techniques
for using tourniquets to stop bleeding after trauma.
tourniquet is a great example of how military medicine can change
civilian practice,” Kerby said. “Tourniquets had fallen out of favor
until recent battlefield experiences re-affirmed their utility in
stopping major bleeds following severe trauma. SOST is now helping
us re-introduce this lifesaving technique through our Stop the Bleed
Kerby says the whole approach to resuscitation has
been amended by military experiences. UAB is looking at adding REBOA
to its array of available medical procedures, and the SOST’s use of
whole blood transfusion might also have applications in civilian
“This is a win/win situation,” he said. “We help
prepare them for their mission, and they come back with new ideas
and new thinking that just might save lives in Birmingham, in
Alabama and across the nation.”
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