INTRODUCTION

The intent of the CPG is to provide small, conventional surgical teams both operational and clinical guidance for this unique ARSC environment. Small teams from every service have been tasked with the mission of supporting operational units (usually Special Operations Forces [SOF]) in far forward environments. The ARSC environment utilizes surgical capability outside of the conventional doctrinal guidance. The development of this CPG is not indicative of JTS support for non-doctrinal use of ultra-small teams with limited capabilities, but rather to provide guidance for teams that are deployed in support of missions that require ARSC to facilitate the best outcomes for casualties managed by ARSC teams.

It is recognized that teams are working in the ARSC environment, frequently without specific training for the unique challenges, both clinical and tactical, that these teams encounter. Small surgical teams have been increasingly utilized and have an evolving role in providing care to U.S. and partner forces on the battlefield over the last two decades of global conflict. The Task Force Commanders or their designees will be referred to as the Operational Command to represent all services throughout this document. Operational forces place high value on the support of surgical capability in their area of operations and may be constrained by policy to perform forward military operations within defined evacuation rings. During the course of current conflicts, U.S. Army Forward Surgical Teams (FST) and others were split into ever smaller elements and employed outside of published doctrinal concepts in order to meet operational demand for close surgical support,1-7 often in support of SOF. The demand for smaller and more mobile surgical teams has continued to grow and many different models have emerged over the last two decades. Examples include: the Joint Medical Augmentation Unit Surgical Resuscitative Team; Army Expeditionary Resuscitative Surgical Team and split Forward Resuscitative Surgical Team; the Air Force Ground Surgical Team and Special Operations Surgical Team; Navy Damage Control Surgical Team and Expeditionary Resuscitation Surgical System.1-11

There is no standard definition or joint doctrine specifying the exact capabilities of these small surgical teams. While this CPG has been developed based on ground combat support, the concepts can be applied to maritime environments. Recently, the Austere Surgery Teams Sub-Committee of the JTS Committee on Surgical Combat Casualty Care defined the care environment of these small teams as, “Austere Resuscitative and Surgical Care is advanced medical capability delivered by small teams with limited resources, often beyond traditional timelines of care, and bridging gaps in roles of care in order to enable forward military operations and mitigate risk to the force.”12 The goal of this guideline is to provide guidance for the leaders and personnel of ARSC teams who are tasked to deploy and provide advanced medical and surgical capability on the battlefield spanning the spectrum from point of injury (POI) up to conventional Role 2; noting that this environment of care has nuances from conventional/doctrinal surgical support. These teams are often comprised of conventional forces personnel in support of SOF missions and have a unique placement in the battlefield system of care; their ability to support these teams and remain small and agile is reliant on the proximity and capabilities of adjacent roles of care.