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Battlefield Casualties Treated at Camp Rhino, Afghanistan: Lessons Learned

Bilski, Tracy R. MD; Baker, Bruce C. MD; Grove, Jay R. MD; Hinks, Robert P. MD, FACS; Harrison, Michael J. MD; Sabra, John P. MD; Temerlin, Steven M. MD; Rhee, Peter MD, MPH, FACS

The Journal of Trauma: Injury, Infection, and Critical Care: May 2003 - Volume 54 - Issue 5 - p 814-822
doi: 10.1097/01.TA.0000046627.87250.1D

Background  Operation Enduring Freedom is an effort to combat terrorism after an attack on the United States. The first large-scale troop movement (> 1,300) was made by the U.S. Marines into the country of Afghanistan by establishing Camp Rhino.

Methods  Data were entered into a personal computer at Camp Rhino, using combat casualty collecting software.

Results  Surgical support at Camp Rhino consisted of two surgical teams (12 personnel each), who set up two operating tables in one tent. During the 6-week period, a total of 46 casualties were treated, and all were a result of blast or blunt injury. One casualty required immediate surgery, two required thoracostomy tube, and the remainder received fracture stabilization or wound care before being transported out of Afghanistan. The casualties received 6 major surgical procedures and 11 minor procedures, which included fracture fixations. There was one killed in action and one expectant patient. The major problem faced was long delay in access to initial surgical care, which was more than 5 hours and 2 hours for two of the casualties.

Conclusion  Smaller, more mobile surgical teams will be needed more frequently in future military operations because of inability to set up current larger surgical facilities, and major problems will include long transport times. Future improvements to the system should emphasize casualty evacuation, en-route care, and joint operations planning between services.

From the Department of Surgery, 1st Medical Battalion/Naval Hospital Camp Pendleton (T.R.B., B.C.B.), Camp Pendelton, Department of Surgery, Naval Medical Center San Diego (J.R.G.), San Diego, Department of Surgery, 3rd Marine Air Wing (S.M.T.), Miramar, and Department of Surgery, Naval Trauma Training Center (P.R.), Los Angeles, California, Department of Surgery, 2nd Medical Battalion/Naval Hospital Camp Lejune (R.P.H., M.J.H.), Camp Lejune, North Carolina, and Department of Surgery, Naval Medical Center Portsmouth (J.P.S.), Portsmouth, Virginia.

Submitted for publication September 30, 2002.

Accepted for publication October 23, 2002.

The opinions and conclusions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the United States Marine Corps, United States Navy, or the Department of Defense.

Presented at the 61st Annual Meeting of the American Association for the Surgery of Trauma, September 26–28, 2002, Orlando, Florida.

Address for reprints: Peter Rhee, MD, MPH, FACS, NTTC + LAC, 1200 North State Street, Room 6336, Los Angeles, CA 90033; email:

© 2003 Lippincott Williams & Wilkins, Inc.