274th Forward Surgical Team (Airborne)
The 274th Forward Surgical Team (Airborne)—part of the 274th Forward Resuscitative and Surgical Detachment (Airborne)[2]—is an airborne forward surgical team of the United States Army providing Level II care[3] far forward on the battlefield. It was first constituted in 1944 and served in Europe during World War II. More recently it has been involved in relief operations following natural disasters and has undertaken several recent deployments to Iraq and Afghanistan. The 274th Forward Surgical Team was part of both the initial entry forces of Operation Enduring Freedom in 2001[4] and Operation Iraqi Freedom in 2003.[5] Currently the unit falls under the command of the 28th Combat Support Hospital[6] and is based at Fort Bragg, North Carolina.
Role and structure
The 274th Forward Surgical Team (Airborne) is tasked with providing Level II combat health support[13] to coalition forces, contractors, local nationals, and enemy combatants when deployed. At the same time, it maintains the ability to split for smaller force level operations to provide front-line medical and surgical support. When the surgical team is not deployed, or has not been assigned a patient care role, it is tasked with supporting the XVIII Airborne Corps Global Response Force, and undertaking a range of tasks as part of the Fort Bragg garrison.
The forward surgical team is organized into four functional areas
Headquarters – Communications and administrative functions.
ATLS (Advanced Trauma Life Support) – Triages and prepares multiple casualties for surgery or transport and has a total of four beds.
OR (Operating room) – Sets up and begins surgery within one hour, can be at full functioning capacity within two hours of establishing an area of operations. The OR has two separate OR tables that can be used at the same time allowing treatment for a greater number of casualties in a given time. The focus is for damage control surgery
In peer-reviewed medical literature
In order to share their experiences with the medical community, the surgeons of the 274th Forward Surgical Team have written several articles for publication in peer-reviewed medical literature. Their presence in the initial entry forces of both Afghanistan in 2001 and Iraq in 2003 gave them a new look at the ability of the forward surgical team concept to function in the new “low-intensity” combat expected in each theater. Drs. George Peoples, Tad Gerlinger, Robert Craig, and Brian Burlingame were assigned as the orthopaedic and general surgeons of the FST during the early phases of Operation Enduring Freedom from October 2001 to May 2002, and during Operation Anaconda in early March 2002. They wrote of their combined experiences during this time period including all the lessons learned from their initial setup in Uzbekistan and then the split operations they conducted in Bagram, Afghanistan. At that time, their experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War.[7]
The 274th Forward Surgical Team treated 90% of the US casualties in this period, consisting of 224 combat casualties, including 153 U.S. soldiers, 19 coalition soldiers, 32 Afghan militia forces soldiers, and 20 detainees. Blast fragments were the most common mechanism of injury (49%), and the extremity was the most common location of injury (58%), whereas gunshot wounds were the most common cause of death (57%). There were few significant head, chest, or abdominal wounds (13%). The FST treated 103 surgical cases (73 with combat wounds), including neurosurgical, thoracic, general, orthopedic, and vascular cases, with a total of 180 procedures.[24] They concluded that the distribution, cause, and severity of wounds were similar to those in the Persian Gulf War, despite the obvious differences between these conflicts. The use of modern technologies, such as compact, portable, ultrasound and digital X-ray systems, expanded the capabilities of the FST. Even low-intensity conflicts can produce significant numbers of combat casualties, and the FST must be manned, trained, equipped, and supplied to treat a wide variety of combat wounds
Battle of the Bulge
The Battle of the Bulge, also known as the Ardennes Offensive, was the last major German offensive campaign on the Western Front during the Second World War which took place from 16 December 1944 to 25 January 1945.[16] It was launched through the densely forested Ardennes region between Belgium and Luxembourg. The offensive was intended to stop Allied use of the Belgian port of Antwerp and to split the Allied lines, allowing the Germans to encircle and destroy each of the four Allied armies and force the western Allies to negotiate a peace treaty in the Axis powers’ favour.
The Germans achieved a total surprise attack on the morning of 16 December 1944, due to a combination of Allied overconfidence, preoccupation with Allied offensive plans elsewhere and poor aerial reconnaissance due to bad weather. American forces were using this region primarily as a rest area for the U.S. First Army, and the lines were thinly held by fatigued troops and inexperienced replacement units. The Germans also took advantage of heavily overcast weather conditions that grounded the Allies’ superior air forces for an extended period. American resistance on the northern shoulder of the offensive, around Elsenborn Ridge, and in the south, around Bastogne, blocked German access to key roads to the northwest and west which they had counted on for success. This congestion and terrain that favored the defenders, threw the German advance behind schedule and allowed the Allies to reinforce the thinly placed troops. The farthest west the offensive reached was the village of Foy-Nôtre-Dame, south east of Dinant, being stopped by the U.S. 2nd Armored Division on 24 December 1944.[17] Improved weather conditions from around 24 December permitted air attacks on German forces and supply lines. On 26 December the lead element of Patton’s U.S. Third Army reached Bastogne from the south ending the siege. Although the offensive was effectively broken by 27 December, when the trapped units of 2nd Panzer Division made two break-out attempts with only partial success, the battle continued for another month before the front line was effectively restored to its position prior to the attack.
Background
After the breakout from Normandy at the end of July 1944 and the Allied landings in southern France on 15 August 1944, the Allies advanced towards Germany more quickly than anticipated. The speed of the advance of the Allies caused several military logistics issues:
Troops were fatigued by weeks of continuous combat and rapid movement
Supply lines were stretched extremely thin
Supplies were dangerously depleted.
By December 1944, General Dwight D. Eisenhower (the Supreme Allied Commander on the Western Front) and his staff decided to hold the Ardennes region primarily as a rest area for the U.S. First Army, with limited Allied operational objectives in the area.
The Allies defended the Ardennes line very thinly, due to the favorable defensive terrain (a densely wooded highland with deep river valleys and a rather thin road network) and because they had intelligence that the Wehrmacht was using the area across the German border as a rest-and-refit area for its own troops.
Allied supply issues
The Allies faced major supply issues, due to the rate of their advance coupled with the initial lack of deep-water ports.[24] Over-the-beach supply operations using the Normandy landing areas, and direct landing ships on the beaches, were unable to meet operational needs. The only deep-water port the Allies had captured was Cherbourg on the northern shore of the Cotentin peninsula and west of the original invasion beaches,[24] but the Germans had thoroughly wrecked and mined the harbor before it could be taken. It took many months to rebuild its cargo-handling capability. The Allies captured the port of Antwerp intact in the first days of September, but it was not operational until 28 November. The estuary of the Schelde river that controlled access to the port had to be cleared of both German troops and naval mines.[25] These limitations led to differences between General Eisenhower and Field Marshal Bernard Montgomery, commander of the Anglo-Canadian 21st Army Group, over whether Montgomery or Lieutenant General Omar Bradley, commanding the U.S. 12th Army Group, in the south would get priority access to supplies.[26] German forces remained in control of several major ports on the English Channel coast into the autumn, while Dunkirk remained under siege until the end of the war in May 1945.[27]
The Allies’ efforts to destroy the French railway system prior to D-Day were successful. This destruction hampered the German response to the invasion, but it proved equally hampering to the Allies, as it took time to repair the rail network’s tracks and bridges. A trucking system nicknamed the Red Ball Express brought supplies to front-line troops, but used up five times as much fuel to reach the front line near the Belgian border. By early October, the Allies had suspended major offensives to improve their supply lines and supply availability at the front
Drafting the offensive
Hitler felt that his mobile reserves allowed him to mount one major offensive. Although he realized nothing significant could be accomplished in the Eastern Front, he still believed an offensive against the Western Allies, whom he considered militarily inferior to the Red Army, would have some chances of success.[33] Hitler believed he could split the Allied forces and compel the Americans and British to settle for a separate peace, independent of the Soviet Union.[34] Success in the west would give the Germans time to design and produce more advanced weapons (such as jet aircraft, new U-boat designs and super-heavy tanks) and permit the concentration of forces in the east. After the war ended, this assessment was generally viewed as unrealistic, given Allied air superiority throughout Europe and their ability to continually disrupt German offensive operations.[35]
Hitler’s plan called for a Blitzkrieg attack through the weakly defended Ardennes, mirroring the successful German offensive there during the Battle of France in 1940, and aimed at splitting the armies along the U.S.-British lines and capturing Antwerp.[36] The plan banked on unfavorable weather, including heavy fog and low-lying clouds, which would minimize the Allied air advantage.[37] Hitler originally set the offensive for late November, before the anticipated start of the Russian winter offensive. The disputes between Montgomery and Bradley were well known, and Hitler hoped he could exploit this disunity. If the attack were to succeed in capturing Antwerp, four complete armies would be trapped without supplies behind German lines
Operation names
The Wehrmacht’s code name for the offensive was Unternehmen Wacht am Rhein (‘Operation Watch on the Rhine’), after the German patriotic hymn Die Wacht am Rhein, a name that deceptively implied the Germans would be adopting a defensive posture along the Western Front. The Germans also referred to it as Ardennenoffensive (‘Ardennes Offensive’) and Rundstedt-Offensive, both names being generally used nowadays in modern Germany.[citation needed] The French (and Belgian) name for the operation is Bataille des Ardennes, ‘Battle of the Ardennes’. The battle was militarily defined by the Allies as the Ardennes Counteroffensive, which included the German drive and the American effort to contain and later defeat it. The phrase ‘Battle of the Bulge’ was coined by contemporary press to describe the way the Allied front line bulged inward on wartime news maps.[43][44]
While the Ardennes Counteroffensive is the correct term in Allied military language, the official Ardennes-Alsace campaign reached beyond the Ardennes battle region, and the most popular description in English speaking countries remains simply ‘Battle of the Bulge
United States invasion of Panama
The United States invaded Panama in mid-December 1989 during the presidency of George H. W. Bush. The stated purpose of the invasion was to depose the de facto ruler of Panama, General Manuel Noriega, who was wanted by U.S. authorities for racketeering and drug trafficking. The operation, codenamed Operation Just Cause, concluded in late January 1990 with the surrender of Noriega.[9] The Panama Defense Forces (PDF) were dissolved, and President-elect Guillermo Endara was sworn into office.
Noriega, who had longstanding ties to United States intelligence agencies, consolidated power to become Panama’s de facto dictator in the early 1980s. In the mid-1980s, relations between Noriega and the U.S. began to deteriorate due to fallout of the murder of Hugo Spadafora and the removal from office of President Nicolas Ardito Barletta. His criminal activities and association with other spy agencies came to light, and in 1988 he was indicted by federal grand juries on several drug-related charges. Negotiations seeking his resignation, which began under the presidency of Ronald Reagan, were ultimately unsuccessful. In 1989, Noriega annulled the results of the Panamanian general elections, which appeared to have been won by opposition candidate Guillermo Endara; President Bush responded by reinforcing the U.S. garrison in the Canal Zone. After a U.S. Marine officer was shot dead at a PDF roadblock, Bush authorized the execution of the Panama invasion plan.
On December 20, the U.S. invasion of Panama began. Panamanian forces were rapidly overwhelmed, although operations continued for several weeks. Endara was sworn in as president shortly after the start of the invasion. Noriega eluded capture for several days before seeking refuge in the Holy See diplomatic mission in Panama City. He surrendered on January 3, 1990, and was then flown to the U.S., where he was tried, convicted and sentenced to 40 years in prison.
The Pentagon estimated that 516 Panamanians were killed during the invasion, including 314 soldiers and 202 civilians. A total of 23 U.S. soldiers and 3 U.S. civilians were killed. The United Nations General Assembly, the Organization of American States and the European Parliament condemned the invasion as a violation of international law.[10][11] The United States invasion of Panama can be seen as a rare example of democratization by foreign-imposed regime change that was effective long-term
