one shows that most used aircraft was a Boeing 707 (57%) and secondly the Falcon 900 (14%). 63,5% were performed to evacuate one casualty, while 36,5% were for multiple casualties155. Three hospital units of the Spanish Role 4 (Central Hospital of the Defense “Gómez Ulla”) have led the attention of these evacuees proceeding from Afghanistan. García-Cañas156 describes the activity of orthopedic surgery service and emphasizes that the procedures were performed mainly in lower members (62%), followed by the upper extremities (34%) and by the spine and pelvis (2%) being the soft tissues surgery (47%) the most common surgical procedure. Borrego 157, analyzes the evacuees admitted to Intensive care unit from 2005 to 2014. 66,7% were combat casualties for explosive devices, 11,1% for firearm and 11,1% for traffic accidents. In 2011 40% of casualties evacuated to the hospital were admitted in this unit. Finally Fernández158 analyzes the surgical casualties evacuated to Role 4 during 3 years. 65 casualties were evacuated, 76% non-combat and 24% combat casualties. The evacuations rate was 2,66 per year for every 100 deployed soldiers. The main causes were trauma, continued by abdominal diseases (colecistitis, appendicitis) and gynecological illnesses (Figure 9 and 10). Finally, the fourth medical echelon has implemented a transverse combat casualty assistance procedure that includes: military medical specialists, military nurses, military psychologists, religious help, members of his military unit, military physician of his unit and support injured in combat unit159.
Figure 9: Spanish Air Force fixed Wing aircraft employed for tactical and strategic medical evacuation of casualties.
Figure 10: Top: evacuation of two casualties using LSTAT devices on board of Spanish Air Force C-130 Hercules. Bottom: Central Hospital of Defense "Gómez Ulla" (Madrid, Spain), Spanish Armed Forces fourth medical echelon.
The Spanish Medical Corps has implemented numerous changes during the deployment in the ISAF Operation in Afghanistan. All of this has allowed a for substantial progress in the treatment of combat casualties at the scene of attack, in the advanced and strategic medical evacuations, in the damage control procedures and in the definitive treatments carried out in Spain. These advances have been similar to those made by allied countries in Iraq or Afghanistan. The authors recommend taking advantage with lessons learned in Afghanistan for future deployments in other areas of operation.
Over a decade in the NATO ISAF operation, Spanish Medical Corps has deployed numerous troops and multiple medical treatment facilities (Roles 1, Role 2 LM and Role 2E) in the area of operations in Afghanistan. During this period of time about 30,000 patients were treated and 69,000 medical acts, 1,000 surgical interventions and 1.547 intensive care stays have been conducted in Spanish Role 2 in Herat (Afghanistan). In addition, were carried out more than 500 medical evacuations missions transporting about 1,000 casualties. Despite the great medical work there developed, unfortunately 104 Spanish soldiers were killed and 87 were wounded in that area of operations.
The aim of this paper is to describe the ten most important medical changes (individual first aid kit, armored ambulances, tactical and forward medical evacuations, medical treatment facilities, health research clinical, data management, teamwork, damage control resuscitation, bleeding control and strategic evacuation to the fourth medical echelon) implemented by the Spanish Medical Corps deployed in ISAF Operation (Afghanistan) from 2005 to 2015. Spanish Medical Corps has implemented numerous changes during the deployment of troops in the ISAF operation in Afghanistan. These advances have been similar to those carried out by allied countries with forces on the ground and are needed to improve the attendance to casualties in future deployments.
International Review of the Armed Forces Medical Services
Revue Internationale des Services de Sant�