Ministero della Difesa

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‘FAST Exam’ Training at the Forward Surgical Team (USA) of Farah (Afghanistan)

Notizie dai Teatri Operativi - Gennaro Palermo

Farah (Afghanistan),  26 marzo 2013

A number of medical rescuers of T.F. South - based in Farah - attended an updating training in ‘FAST-Exam’ at the FST (Forward Surgical Team – USA, i.e. the medical team responsible for surgical management and stabilization of trauma patients).
The activity was coordinated by Medical Lt. Col. Gennaro Palermo - Chief of the Italian ROLE 1 Medical Services –, and Major A. Silvester - FST Senior Medical Officer -.
The initiative falls within training activities for military rescuers in compliance with the Army General Staff medical directive on Afghan theater.
Greater attention was focused on the practical exercise of rescuers in order to assure better performances in first aid maneuvers at the point of wounding.
FAST Exam (Focused Assessment with Sonography for Trauma) is an examination performed through portable ultrasound imaging device for fast diagnosis of life-threatening injuries (ex. tension pneumothorax, internal bleeding, etc.)
In operations, chest and abdominal traumas are the most critical conditions: an accurate and early diagnosis through FAST Exam can help to avoid deadly complications and positively affect wound healing.
During the course, rescuers attended both theoretical and practical classes, individually simulating a practical approach to patient thanks to comrades’ cooperation.
In the holistic perspective of a common (beyond national identities) commitment to emergency care, this activity was very welcomed by both Italian and American attendees; in particular the new approach to training was appreciated. Other similar courses for military rescuers have been already scheduled.
In the military scenario, FAST Exam has a critical role in diagnosis and treatment of potentially reversible lesions in hostile environment, and in patient stabilization before medical evacuation.
The main characteristic of patient management in combat zone is the variability in time of pre-hospital care intervention.
Because of various contingencies (persistent enemy threat; climate, surface and ground conditions which can impede helicopter landing) casualty evacuation can be delayed of even one hour or more before to move the patient to deployable medical treatment facilities (ROLE 2/3): in this pre-hospital phase, FAST Exam - beside its fundamental function of early diagnosis of internal lesions - can also be used to perform an ultrasound monitoring of patient’s conditions.
FAST Exam, indeed, allows to perform a continuous and effective re-evaluation of patient, whose conditions can abruptly change from hemodynamic stability to critical conditions so varying also the assignment of care priority and evacuation triage.
Thanks to my personal experience in Afghan theater, I can emphasize the importance on the battle field of Focused Assessment with Sonography for Trauma (FAST) in primary survey of the unstable patient or secondary survey of the stable patient, as it helps to quickly recognize life-threatening lesions.

This approach has allowed not only to reduce evacuation time, but also to move the patient to the most suitable medical facility in the operational theater.