factors in the medical treatment facilities. Coordination between the military engineers and the medical team has been necessary and essential to allow the construction of the hospitals in order to properly support the military force43. Spain has deployed 3 medical treatment facilities (Role 2) in Afghanistan. The first in Bagram (February to September, 2002), the second one in Kabul (December, 2004 to March, 2005) and the third one in Herat (May, 2005 to October, 2015)2. The Spanish Role 2 was installed in the Forward Support Base of Herat in early May, 2005 employing materials from UMAAD (Unidad Médica de Apoyo al Despliegue) Zaragoza and UMAAD Madrid. After 7 days of assembly, it was operational. This Role 2 consisted of tents and a 20-foot container used for radiology, with 415 m 2 of total surface area. A total of 150 electromedical devices were available in the area of triage, stabilization area, intensive care unit, laboratory, radiology, two operating rooms, psychology clinic, hospitalization area, pharmacy, veterinarian department, odontology clinic and aeroevacuation unit. Subsequently, dentistry service was located in a container, such as the medical headquarters and the administration are a. The storage of medical equipment was also improved thanks to a refrigerating container. Five months after the initial deployment, a technical review of medical devices was performed, finding breakdowns in 35 devices (20%) (mostly due to climatic and environmental conditions). Immediately after this situation, and taking into account that Spanish presence could be prolonged in this base for years, it was proposed to reinstall the Role 2 in a more solid structure which will maintain a better protection of devices and greater capacity for patients and to for the medical personnel 44, 45. The new Spanish Role 2 Medical Treatment Facility occupied more than 1000 m2, with 900 m2 built. It was chosen to use expandable and prefabricated 20" containers along with 20" flat pack containers. The construction was done in two phases, in the first 41 were built and the in second 21 containers. The transfer from the tents to this new medical facility ended in February, 2007. From this moment, the material capacity of the Role 2 increased progressively ending with 110 containers, a constructed area of 1617 m 2, occupying an area of 2000 m2, 300 electromedical devices, one scanner, an ortopantomogragh and a telemedicine system. The supply was supported in a very satisfactory level capable of giving to the Role 2E almost all of the requested material with only ten days from its request. In October, 2015 the end of the Spanish troops in Afghanistan is carried out and a part of Role 2E material. From this point on, Italy leads medical capacity in the base of Herat and is expected to finally be ceded to the Afghan government (Figure 4)45, 46. In those days, the Spanish Army deployed medical treatment facilities (Roles 1) in Bagdhis province (North of the West region in Afghanistan). The most important base of this province was Qal i Now. From there they established forward positions in Sangatesh, Moqur,
Figure 4: Top: Spanish Role 2LM in Herat (2005). Bottom: Spanish Role 2E in Herat (2015).
Ludina and Darre-i-Bum. Tents were used initially for the first medical echelons, except in Qal i Now (General Urrutia Base) with 5 20x20" containers and from January 2011 (Ruy González de Clavijo Base) 44 containers were built with triage room, hospitalization, pharmacy, veterinary, psychology, telemedicine and 16 containers more for the living area. In conclusion during these years this capability has improved a lot 7, 47-58.
RESEARCH: TELEMEDICINE, TELESURGERY AND SIMULATION…
Throughout the history, the wars have promoted a multitude of technological and medical advances. Military medical research has increased notably in the last years and their findings are beginning to be used in both the civilian and military scientific communities 59-61. The Spanish Medical Corps has been aware of this fact since the beginning of the conflict. For this