Expeditionary surgical unit supports African Lion in Morocco 

U.S. Marine Corps and Navy reservists from 4th Medical Battalion, 4th Marine Logistics Group came here in late May to set up a Forward Resuscitative Surgical Suite trauma center as part of exercise African Lion.

This new life-saving capability, which was first employed in its current form in 2003, provides trauma and surgical care to Marines and sailors in an expeditionary environment, both in training and combat.

The battalion is headquartered in San Diego, Calif., but has small units located throughout the United States. The 23 Marines and sailors here for the exercise hail from detachments in 14 states.

Lt. Cdr. Hank Deters, a reservist with a detachment from Company A in Pittsburgh, Pa., is the officer in charge of the FRSS team here.

"Level one care is corpsman care on the battlefield," explained Deters. "Level two trauma care is what we do, the surgical part of it, usually in two tents with a surgical bed, a refrigerator for the blood, a ventilator with an anesthesiologist and other specialized equipment. Level three is a MASH-type unit, or a combat support hospital, which has more advanced equipment like intensive care units, operating rooms and operating beds. It's in a hardened structure. Level four care is a modern hospital outside a combat zone where they have post-surgical care."

Deters is the en-route care nurse on his FRSS team. During his deployment to Iraq from 2007 to 2008, he routinely traveled with patients on the flight from the mobile FRSS unit at forward outposts throughout the country's western Al Anbar Province to level three care at hospitals located at larger U.S. bases.

From the time they arrive at a forward operating base or combat outpost, a FRSS can typically set up their tents and equipment and be ready to receive patients within one hour, according to Deters.

"Some call it meatball surgery or damage control surgery because it isn't a complete surgery," said Deters. "You just do what you have to in order to save the patient's life. The guy is bleeding. We open him up, stop the bleeding, cover it with sterile plastic and transport him to a level three facility. During the Vietnam War and Desert Storm, up to 25 percent of our wounded were dying on the way to the hospital. This (the FRSS) is saving that 25 percent. We're trying to stay within that golden hour, where the patient has to go from initial point of injury to surgical care before they hemorrhage to death."

This is Deters' second time participating in African Lion. In 2006, he flew on a Moroccan helicopter with a Marine injured by a flare during training from Cap Draa to the Tan Tan airfield nearby for evacuation by Lear jet to the U.S. Army hospital in Landstuhl, Germany.

A native of Gardner, Kan., Deters is the captain of a paramedic unit in Kansas City area in his civilian life.

Prior to becoming an officer in the Navy Reserve about ten years ago, Deters was an enlisted corpsman with the 24th Marine Regiment in Kansas City for 15 years, achieving the rank of petty officer 1st class and deploying with the Marines in support of Operation Desert Storm in 1991.

Deters emphasized that his 25 years as a reservist on the Navy-Marine Corps team has helped to shape him both as an individual and as a medical professional.

Cpl. Saundra Rosenbalm from Company A's detachment in Knoxville, Tenn., is an ambulance driver on the FRSS. She moves the patient from the point of injury to the FRSS for treatment. After the surgery, she takes the patient from the FRSS to the pick-up point, usually an expeditionary airfield.

But Rosenbalm is more than just a driver. During surgery, she and the FRSS team's other Marines stand guard over the operating tents. They provide security and ensure that no one, military personnel or otherwise, brings weapons into the operating tents. Additionally, the Marines do a "sweep" of the patients coming in, ensuring that they don't have any ammunition or explosives in their pockets or gear.

"We keep everyone else out so the docs can do their jobs," she said. A personal trainer in Knoxville in her civilian career, this is Rosenbalm's third time deploying to Africa for reserve summer training. She participated in Marine Corps exercises in Senegal 2007 and in Ghana in 2008.

During her down time here, Rosenbalm keeps in top shape by running through the desert to the rocky Atlantic beach front several kilometers away.

"Weather wise, this is definitely my favorite," said Rosenbalm. "Ghana and Senegal were about 130 (degrees Fahrenheit) every day. This weather is more like home."

Rosenbalm spends most of her work days here transporting patients and guarding the FRSS during simulated casualty drills and driving out to live-fire ranges in order to be in position to evacuate troops in case of injury.

"This is definitely the best exercise I've been on in terms of training," said Rosenbalm. "All the units are busy, and everyone seems to be getting something out of the exercise."

Petty Officer 2nd Class Kenneth Justice is team leader for the first medical team on the FRSS. The first medical team receives the patients in the "pre-op" tent and prepares them for surgery. His team does triage, stabilizes airways and controls major bleeding with tourniquets and pressure bandages.

"Their job is important, because they have to decide which patents come back into the operating tent," said Cdr. Jonathan Kuehne, a reserve FRSS surgeon from San Diego, Calif. "If they send back a patient who isn't a first-priority case, you have three doctors tied up here when we could be out front doing triage or back here treating more seriously injured patients with acute hemorrhaging or airway blockages."

After surgery, the patients return to the first medical team's tent for post-operation care.

"We see patients when they come out of surgery and prep them for medevac," said Justice. "We 'package' the patients by securing all medical devices such as (intravenous) bags and oxygen tanks. We wrap them like a tamale in a flight blanket and get them ready to put on the helicopter or tactical ambulance."

A hospital corpsman and advanced laboratory technician with a total of 16 years active and reserve time in the Navy, Justice attends weekend reserve drills with Company K, 3rd Battalion, 23rd Marine Regiment in Memphis, Tenn.

"It's been an incredible experience here in Morocco," said Justice. "We get to take the skills we learn in theory and put them into practical application. Here we actually get to live and work in real combat-like conditions. We're in an encampment overseas, sleeping in tents in an environment like Iraq or Afghanistan, eating MREs, using field showers, sleeping on the ground, and working with rapid put up and rapid break down of the equipment. You can't get an experience like that back at the drill center, or from an on-line course."

In his civilian career, Justice is a field service engineer for a biomedical and diagnostics company. He typically drives more than a thousand miles a week to service equipment in the Mississippi Valley region. Sometimes his company sends parts from their headquarters in California and Florida to Justice's home in Memphis for him to service and repair.

But for one month each summer, he puts his career aside, says good-bye to his family, and goes off to serve with Marine Corps Reserve units for their annual training exercises.

"I do it for the sailors and Marines," said Justice, who earned his Fleet Marine Force Warfare Qualification in 2007. "My senior officers and my junior corpsmen are professionals who put their lives on hold and come out here and do outstanding jobs," said Justice. "These are good people, dedicated people, and they are definitely worth their weight in gold."

The FRSS had the chance to perform an actual surgery on a Marine who had an abscess on his sacrum here June 4. The surgeons made an incision and drained the abscess in their surgical tent. After several days of recovery, the reservist returned to full duty here and was able to continue training with his unit.

The reserve Marines and sailors of the FRSS team here are scheduled to head back to the States in mid-June, when exercise African Lion comes to a close. Throughout the year they will continue to train with their units one weekend a month.

Some members of the FRSS will be back here next year for African Lion 2011. Some will participate in different theater security cooperation operations in Africa, Asia or South America instead.

Regardless of where they go, the Marines and sailors of the FRSS can have pride in knowing that they are members of an elite team of medical professionals who bring a unique life-saving capability to the Armed Forces of the United States and their allies in expeditionary environments throughout the world.