Early in the twilight dawn on Birmingham’s Ruffner Mountain, a line of seven men in fatigues snakes along a heavily wooded, steep trail. On their backs are tan rucksacks, 30 to 45 pounds each. There’s no talking, they have another mile to go. At their destination, deep in the woods, they open the packs and set up their gear – not tents and sleeping bags, but a mobile operating room.
They are members of a United States Air Force Special Ops Surgical Team-Special Ops Critical Care Evacuation Team (SOST-SOCCET in military shorthand) with the 1st Special Operations Support Squadron at Hurlburt Field in Florida, led by Lt. Col. Jon Winkler, M.D., a trauma surgeon and the team commander.
But rather than being stationed at a stateside Air Force base where most military hospitals are primary care facilities, this team is helping create a new definition of readiness – they’re also full-fledged members of the University of Alabama at Birmingham’s Level I trauma center, where more than 3,000 patients are seen each year with injuries – from car wrecks, accidents or crime – that mimic what the team would see in battle.
Winkler’s team is on Ruffner Mountain for a training exercise. One day a week, they shoulder their gear and hike on steep, rocky trails — the kind of terrain they might find in Afghanistan, Iraq or anywhere else the U.S. military might be deployed. They can set up an operating room nearly anywhere — farm house, shack, mountain top or valley floor.
“UAB sees a lot of trauma,” he notes. “I performed more trauma surgeries in just a few months here than I did during the previous year at Hurlburt Field. When we deploy next, our trauma skills and our team skills will be top notch.”
SOST-SOCCET comprises trauma and orthopedic surgeons, emergency physicians, a nurse anesthetist, surgical scrub tech, critical-care nurse and respiratory tech. They work together at UAB, in surgery, in the trauma center and in the intensive-care units.
They carry a combination litter/operating table. One rucksack has surgical gear; another has anesthesia equipment. They have trauma packs, critical-care nursing supplies and electronic monitors. Their job is to provide forward — far forward — care to injured members of U.S. Special Forces teams during missions in any of the world’s dangerous hot spots.
“We can be positioned with special operations forces, to provide damage-controlling, life-saving surgery,” said Winkler. “We can stabilize and then transport them to a higher level facility where they can receive care.”
Most military hospitals typically don’t see the volume or severity of cases that are seen at a major trauma center like UAB, the only one in the state and in a 150-mile radius. Conventional pre-deployment refresher courses have been less than satisfactory, Winkler says.
“Refresher courses, though held at top civilian hospitals, were for only a few weeks duration and mainly for observation,” said Winkler. “We had no real responsibility, no decision-making authority. It was more like being in medical school or the early stages of residency. We needed a better way to maintain our team’s skills at peak levels.”
The Air Force solution was to position a full team at a Level I trauma center for an extended tour of duty, up to three years, at UAB and also in St. Louis.
“Being in a Level I trauma center enables each specialty within the team to maintain a very high proficiency in their skill level,” said Winkler. “And we work together, so when we are deployed everyone knows the other team members well and we work smoothly together.”
The team has been at UAB since summer 2010, with one classified deployment in early 2011.
“UAB is a good training ground,” said Jeff Kerby, M.D., Ph.D., a UAB trauma surgeon. “We have a great many penetrating trauma cases here, so much of what we see in the civilian setting mimics what they will be seeing when they deploy.”
Kerby, a former Air Force trauma surgeon, is the link between UAB and SOST-SOCCET. He calls the arrangement a win-win for both UAB and the military.
“Most of the major, significant contributions in trauma surgery have been made during times of military conflict,” he said. “So I think this affiliation with the military and tapping into their experience, their expertise, certainly has a positive impact on what we’re trying to do here as a trauma center. At the same time, for them to work as a team, in a busy, high-volume trauma center, has a positive impact on what they are trying to accomplish.”
For Winkler and his team, it’s about being ready to do the job to the best of their ability when they are called upon.
“The goal, the underlying goal, is to make ourselves as proficient as we can be,” he said, “so that if our soldiers, sailors or airmen are injured, we stand ready to provide the best possible care.”