Military Review English Edition May-June 2014 | Page 61

M E D I C A L O P E R AT I O N S
partnership was reinforced by ongoing needs and
capabilities assessments performed by FSE staff
at TK Hospital and through frequent key leader
engagements with district and provincial health
sector officials. The knowledge gleaned from these
engagements allowed the FSE to tailor AMTPV
program training to the specific capabilities and
challenges the participants faced when they worked
at the hospital. Specific knowledge of the situation
“on the ground” at TK Hospital also permitted the
FSE to guide medical reconstruction and humanitarian assistance efforts toward providing the aid
and services that would be most sustainable and
beneficial.
A patient transfer agreement between the medical director of TK Hospital and the medical staff of
the FSE was developed to enhance the education
of AMTPV participants and to facilitate complex
trauma and initial surgical care for Afghan patients
at the FSE. TK Hospital’s director communicated
via telephone with one of TK FSE’s two embedded
interpreters, facilitating the transfer of patients with
needs exceeding TK Hospital’s capabilities to the
FSE for care by the AMTPV residents under the
supervision of FSE staff. Such transfers were typically sought because of the lack of surgical resources
at TK Hospital, compared to those at the FSE. The
patient would be transferred back to TK Hospital
for ongoing care after being stabilized, usually
after initial operative care. Local Afghan surgeons
from outside the residency program occasionally
accompanied their patients to TK FSE to participate
in operations with FSE surgeons, increasing their
skills to perform more complex procedures at their
home facility.
Patients from Uruzgan and the adjacent provinces
of Day Kundi and Zabul gained access to TK Hospital and FSE resources by first seeking care at smaller,
local Afghan facilities or SOTF Village Stability
Program sites. Then they could be referred to TK
Hospital, and then to the FSE if needed. Patients
were also evacuated by coalition medical assets from
the Village Stability Program sites for more urgent
care at the FSE followed by transfer to TK Hospital.
The FSE also hosted a clinic dedicated to caring
for local nationals, seeing primarily follow-up
patients from TK Hospital and the surrounding
area. AMTPV program participants were used in
this clinic, learning aspects of long-term care in
MILITARY REVIEW

May-June 2014

Afghan physician examining x-rays of a transferred Afghan patient
with his U.S. counterpart at the Tarin Kowt Forward Surgical Element.
(Maj. David S. Kauvar)

an austere environment. To preserve base security
and control access, the FSE used a parcha (paper)
system, requiring outpatients seeking care at the
FSE to have a referral or follow-up note signed by
one of the U.S. physicians stating their need for
FSE care on a certain day. This also ensured that in
almost all circumstances, patients would be seen at
TK Hospital before being seen at the FSE.

Partner Force Care and Training

Supporting the ability of indigenous forces to
conduct the campaign is a central principle of
COIN military operations. To this end, TK FSE and
medical elements of their local partner forces, the
8th Kandak (camp) Afghan National Army (ANA)
commandos and the 4th Kandak ANA conventional
forces, developed a partnership for the training and
supervised care of ANA soldiers. The ANA medics
had basic field medical training, including the use of
direct pressure and tourniquets to control bleeding
and the use of intravenous fluids for initial resuscitation. In consultation with senior ANA medics and
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