War Surgery and Patient Movement: Partner Nations collaborate to save lives Published Dec. 31, 2013 By Dr. (Maj.) Brian Neese 12th Air Force (Air Forces Southern) Global Health Engagement Action Officer and Chief, Internationa DAVIS-MONTHAN AFB, Ariz. -- Like other countries in Central and South America, Perú is fighting a guerilla insurgency. The enemy is ideological and fierce, hiding in the Valley of the Apurímac, Ene and Mantaro Rivers (VRAEM). The Peruvian military has taken the fight directly to these insurgents, and in the process, casualties have mounted. Surgeons working day and night out of mobile hospital tents, stabilize injured soldiers, providing life-saving surgical care to their soldiers. These injured soldiers are then transported by fixed wing aircraft over the Andes Mountains to Lima, Peru, where they receive definitive medical care. The United States Air Force International Health Specialists (IHS) from 12th Air Force (Air Forces Southern) Headquarters in Tucson, Ariz., has a long-standing relationship with the Peruvian military medical community. Over the last two years especially, with the New Horizons 2012 humanitarian exercise and other health related engagements, members of both communities have been in dialogue about ways to collaborate. The needs of the Mobile Surgical Unit (Unidad Quirúrgica Móvil) in the VRAEM and the movement of those injured became priority for bilateral partnership. The AFSOUTH IHS team canvassed subject matter experts from across the Air Force in the field of trauma medicine and patient movement. The precise expertise needed was soon identified: trauma surgeons with field experience in Afghanistan, and Flight Surgeons from Peru's State Partner, the West Virginia Air National Guard. These Guardsmen specialize in Disaster Preparedness and Response, in particular how to move sick patients from a contingency area to definitive care. Working with members from the Peruvian Air Force's (Fuerza Aérea del Perú) Aerospace Medicine community, led by Lt. Col. Andres Cedron, we formulated a two-pronged mission that focused on both trauma medicine and patient movement. Over the course of one week, the dual missions would converge into a capstone experience, correlating with the natural history of an injured soldier's experience coming out of the VRAEM. The Air Force's Emergency War Surgery (EWS) course is a crash-course in the fundamentals of field trauma surgery. The Director of the EWS course in San Antonio, Texas, Col. Gregory York, was able to bring a tailored version of the course to Lima, Peru. Along with two other Air Force Surgeons, the team built a EWS Conference to share the most up-to-date information in field trauma surgery. For the Patient Movement aspect of the collaboration, the AFSOUTH IHS team reached out to Col. Sidney Jackson, State Air Surgeon for the West Virginia Air National Guard. Jackson led two medical groups that focused on various aspects of disaster response and patient movement. He identified two other Flight Surgeons to bring along with him to execute a three day Aerospace Medicine Subject Matter Expert Exchange. With the teams set, Cedron prepared the battlespace for both missions to execute in Lima. The Emergency War Surgery Conference took place at the Hospital Central Fuerza Aérea del Perú (HCFAP), with over 40 participants coming from all military services and various professions within the Trauma Medicine field. Topics included lesions to the head, chest, abdomen, management of extremity fractures and amputations, and burn management among others. While the EWS Conference took place at the Hospital, the Aerospace Medicine experts toured the medical facilities throughout Lima, Peru. The Headquarters of Fuerza Aérea del Perú (FAP) health care, the Dirección de Sanidad, as well as the Hospital Las Palmas (HOLAP), both located at Las Palmas Air Force Base are the center for Aerospace Medicine in Perú. The FAP's Aerospace Physiology Training Center (Centro de Entrenamiento Fisiologico de Medicina Aeroespacial, CEFMA), is part of this facility and prepares pilots and aircrews for the physiological effects of flight, to include altitude chamber qualification. Cedron provided an extensive overview of the training the FAP delivers in key topics such as Spatial Disorientation and the use of Night Vision Goggles. The team then visited the Base Aérea de Callao in Lima which contained the primary airframes used for Aeromedical Evacuation throughout Perú. As such, the medical unit at Callao provides Aeromedical support to evacuation efforts carried out on these aircraft. The Air force Flight Surgeons meet their FAP counterparts and discussed the Aeromedical Evacuation mission in detail. On the final day, of the EWS Conference, all Air Force personnel joined in as York led participants in a table top disaster response exercise. The focus of the exercise was triaging patients to maximize limited resources in an emergency response situation. Breakout groups by service worked with representatives to respond to various disaster scenarios. Through the table top exercise, lessons learned from both trauma surgery and patient movement exchanges came together in full view. The amount of discussion and interaction between these two Partner Nations expanded from the exercise scenario to the real world fight being waged in the VRAEM. Trauma Surgeons and Flight Surgeons in the Peruvian military, alongside their Air Force colleagues, developed ideas for improving capabilities in the forward deployed surgical units and for moving those patients back home to definitive care. As the Peruvian military continues to fight narcoterrorists in the VRAEM region, soldiers know their medical teams are waiting in the wings. Trauma specialists and Aeromedical Evacuation team's standby, ready to treat them by any means necessary, to save their lives and get them back home. The Air Force and the AFSOUTH International Health Specialist are right there by their side collaborating to ensure their mission succeeds.