From the September 2010 RNFA eNewsletter Issue

By H. Evan Williams, Major/BSN, MAOM (Master of Arts in Organizational Management), CNOR

A U.S. Army Forward Surgical Team (FST) is a 20-person team that provides far-forward surgical intervention (that is, surgical intervention at the leading edge of the battlefield) to render nontransportable patients sufficiently stable to allow for medical evacuation to a Level III CSH hospital (combat support hospital).

In Afghanistan split operations are used to allow more points of care in a given area to reduce evacuation time from point of injury to surgical intervention. This creates a series of 9- to 11-person teams to provide the main effort on trauma resuscitation. The Army’s research has found that there is little to no effect on patient outcomes from the use of split operations, however, such operations create their own challenges that are very specific to the deployed military surgical unit.

Within the military medical profession there is a sense of responsibility, not only to the soldiers and coalition forces but also to the host nation community. In Afghanistan this included sustainable teaching for the local hospital personnel and local coalition forces, which included Afghan Police and Afghan National Army. So as the Officer in Charge of the 67th Forward Surgical Element (FSE) Forward Operating Base Sharana and the Operating Room nurse, I had to now balance providing health care between my trauma mission and my civic mission.

In two separate trips the senior surgeon, the senior female Intensive Care Unit Nurse and senior Emergency Room Nurse and I were able to tour the local hospital town of Sharan, in Paktika Province. This was accomplished in two separate visits due to mission and cultural issues. This hospital was amazing for what it did with the available resources that it had. Due to the hospital’s financial restraints, most of the employees were from the local area and had on-the-job medical training, most with little to no formal medial training.

After visiting the hospital we were able to identify ways in which to assist in creating better and more sustainable patient outcomes. The most interesting intervention was on lower-extremity traumatic injuries. With almost any fracture, Afghans would usually cast the extremity. Since there was no available orthopedic surgeon or internal fixation sets, we started teaching the local surgeons to place external fixators. During a meeting with the Paktika Provincial Minister of Health, it was determined that it was very hard for the local hospital to procure the external fixation sets. So we changed our course of action by educating the medical and surgical staff on splinting and washout procedures to provide long- term care for traumatic fractures, including education on compartment syndrome.
With this and many other measures, including: chest tube insertion and training Afghan National Army and Afghan Police on combat medic tasks and aseptic dressing changes, the local hospital reported that we were able to decrease their morbidity rate by 45%.

The true credit goes to my staff: every nurse, surgeon, medic, operating room technician and CRNA on my team. Their support and expertise provided the tools to achieve success. With their input, skills and dedication, we were able to fully perform our duty as a far-forward surgical team, and we left the community with a hospital that was able to provide better care.


Harold Evan Williams/Major/BSN, MAOM (Master of Arts in Organizational Management), CNOR
Education: BSN, Nursing management, 1998. East Central University, Ada, Oklahoma MAOM, Master of Arts in Organizational Management, 2004, University of Phoenix, Arizona
Present Position: Instructor Perioperative Services/ S4, Army Trauma Training Center
Past Positions:
• Weekend and Night Supervisor at Walter Reed Army Medical Center 2002-04
• Preceptor for the Surgical Technologist Course at Walter Reed Army Medical Center 2004-05
• Operating Room Staff Nurse, Morale Officer, Interim Head Nurse Operating Room, Infection Control Nurse, for the 47th CSH in Iraq 2005-06
• Chief Nurse/OR Nurse/Interim Commander for the 67th Forward Surgical Team, responsible for all clinical activities 2006-09
• Deployed site Officer in Charge (OIC) 67th Forward Surgical Element Sharana, Afghanistan 2009-10
• Co-Author for Small-Pox in the Operating Room in AORN (Association of Peri-Operative Nursing) 2002
• In the process of writing an article for AORN on Humor in the Peri-Operative Arena