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DOD Expands Trauma Registry to Include Front-line Care

Combat medics work through the “blood lab” at ...

Combat medics work through the “blood lab” at the Department of Combat Medic Training at Fort Sam Houston, Texas. The school has two “blood labs” in which the students sharpen their skills as soldier medics. One lab simulates the scene of a suicide bombing in a market place, and the other simulates a bombing in an office building. DoD photo by Fred W. Baker III See more at Army.mil (Photo credit: Wikipedia)

By Donna Miles
American Forces Press Service

WASHINGTON, Nov. 18, 2013 – Traveling around the combat theater over the past four months, Army Lt. Col. (Dr.) James Geracci was on a quest.

Like his contemporaries in military medicine, Geracci, a family physician and operational medicine specialist, is thrilled about advances over the past 12 years of conflict that have elevated casualty care to a whole new level.

Every soldier, Marine, airman and sailor on the ground is now trained as a medical first responder in basic lifesaving skills. Medical evacuation response times have dropped dramatically, and the system now moves casualties through progressive levels of care faster than ever imagined possible. Advanced lifesaving techniques are applied throughout the continuum of trauma care, reducing blood loss, controlling brain swelling, salvaging limbs and saving lives.

But the military trauma community sees its glass as half empty rather than half full. Instead of celebrating the advances that enable 98 percent of U.S. combat casualties that reach an advanced treatment facility to survive, they’re focused on improving the odds for those who don’t.

So as Geracci recently traveled around the combat theater, he went directly to the front-line commanders and combat medics he and his fellow medical professionals believe hold the key. All were familiar with new reporting and documentation procedures that require them to document the care they provide at the point of injury and as casualties are evacuated to advanced-level care.

But what Geracci quickly realized hadn’t trickled down through the chain of command was the “So what?” So he and his team took that message directly to more than 1,400 medics assigned to small combat outposts and forward operating bases across Afghanistan, as well as to their nonmedical commanders and noncommissioned officers.

“We looked them in the eye and said, ‘This is why this is important,'” Geracci said. “We tried to explain that although this is an enterprise-level initiative, it has to start at the ground level. And as we talked to them, it was amazing. A light bulb suddenly went on.”

Air Force Col. (Dr.) Mark Mavity, the U.S. Central Command surgeon, calls that recognition one of the most significant new developments in casualty care for troops in Afghanistan.

The Department of Defense Trauma Registry, established in 2005 as the Joint Theater Trauma Registry, offers detailed information about every trauma patient treated at an advanced theater facility. It tracks patients from the moment of arrival at the closest field hospital or other facility, through each movement to more advanced levels of care, and ultimately through rehabilitation.

The registry also includes autopsy results from every casualty who died.

Eight years since its introduction, the registry has become the world’s largest combat casualty care databank. By studying it, medical professionals have been able to verify which treatments were the most successful and which weren’t, and to flag areas where new or different procedures or technologies might improve survival rates and patient outcomes.

“This gave us an opportunity to step back and understand the population of patients that have moved through the continuum of care and to try to derive information about the care they received and the outcomes associated with that care,” said Air Force Col. (Dr.) Jeffrey Bailey, the Joint Trauma System director. “By being able to analyze and evaluate our practices, we have found points where we can make improvements that provide a survival advantage or some other advantage to our casualties.”

Lessons learned through the registry have resulted in “best evidence-based best practices,” he said, propelling many of the advances in caring for casualties and preventing them in the first place.

The formal documentation of injury patterns, for example, led to improvements in personal protective equipment ranging from protective ballistic undergarments to ancillary plating that protects the groin, shoulders and neck.

The registry also provided statistical evidence of the importance of immediate intervention during the so-called “golden hour.” That led then-Defense Secretary Robert M. Gates to institute a policy in 2009 reducing the timetable for medical evacuation to 60 minutes.

Data provided by the registry also validated the use of tourniquets and led to new approaches to transfusions, resuscitation procedures and hemorrhage control.

But trauma surgeons recognized a glaring weakness in the registry. Because it was based on care delivered at treatment facilities, it omitted critical information about the care provided before the patient ever got there. That “prehospital environment” was where most combat deaths occurred. “So that is where we saw the greatest opportunity to make improvements,” Bailey said.

“Some people call helicopter evacuation the ‘golden hour,’ but others have described what happens on the ground as the ‘platinum 10 minutes,'” he said. “It became clear that we needed to understand what was going on on the ground during those platinum 10 minutes before the helicopter showed up.”

That led to the stand-up of the Pre-Hospital Trauma Registry initiative earlier this year.

Army Col. (Dr.) Russ Kotwal, a family and aerospace medicine specialist assigned to the Joint Trauma System at Fort Sam Houston, Texas, was a pioneer in championing this concept. Working for more than a decade with the special operations community, much of it with the 75th Ranger Regiment, he formulated a precursor to the militarywide prehospital registry in the late 1990s.

“I saw a huge gap,” he said, lacking any documentation of patient care at the initial point of injury and on evacuation platforms.

But getting those who provided that initial care to take time out to annotate exactly what they were doing was no easy task, he acknowledged. “A lot of people find it more exciting to provide the care than to actually document the care,” Kotwal said. “Some don’t understand the big picture and how crucial it is to capture what you are doing for historical purposes, but also for performance improvement.”

So Kotwal made it his personal mission to change that. “I convinced the line command that if everybody has the potential to be a casualty on the battlefield, especially in a line unit, everybody has the potential to also be a first responder,” he said. “And if you don’t capture that information about what you are doing, that data, it is hard to effect performance improvement in that realm.”

Knowing that the success of his effort would depend on the first responders, Kotwal made the documentation process as simple and straightforward as possible. He and his senior medics changed an outdated field medical card that was standard at the time to one that focused solely on tactical combat casualty care.

Every 75th Ranger Regiment member was issued a card as part of their basic equipment, and required to keep it in a standardized location on their uniform. That way, first responders knew exactly where to look for the card if they had to report the care they provided a comrade.

“They filled it out as they provided care if they could,” Kotwal said. Sometimes they were overwhelmed with providing care or the evacuation process was so quick that they couldn’t immediately get to it, he said. “But they did it at the first opportunity,” he added.

As a double-check to ensure the reporting wasn’t overlooked, Kotwal also got the requirement integrated into the after-action review process. “This is something line guys do very well. Every time they come off a mission, they go directly into an AAR and do reports based on the mission so they can assess it and make improvements,” he said.

“The medical community didn’t do it at that level,” Kotwal said. “So we instituted a [medical] AAR that had to be done within 72 hours after a mission.”

Through this process, the 75th Ranger Regiment developed a rudimentary pre-hospital trauma registry, refined it over time and expanded across the special operations community, Kotwal reported.

Kotwal later joined the Joint Trauma System team to expand this concept to conventional forces.

Geracci, a former division surgeon in Afghanistan, said he, too, was “excited about the advancements taking place in facilities-based care,” many attributable to the Joint Trauma System and its trauma registry.

“But I was also frustrated that we hadn’t been able to apply the same degree of rigor in the prehospital environment,” he said. “I saw this as a blind spot in the JTS process. So my goal was to help [the military medical community] go after that blind spot.”

Geracci said he “jumped” at the chance to be one of the Centcom Joint Theater Trauma System’s first pre-hospital directors in the combat theater to address the gap.

“We’re building on the work already proven for about a decade on the special operations side and taking those exact same principles and importing them into the [combat] theater,” he said.

Just months after the Pre-Hospital Trauma Registry was introduced, Geracci said, he’s already seeing its rewards. We have already seen tangible benefits from putting that in place,” he said. “This is proving to be an incredibly valuable tool.”

He credited combat medics and their commanders on the ground who are putting that tool to work as they complete casualty-care cards and AARs.

“They are the reason we have seen success in such a short period of time,” Geracci said. “They understand that this information, and the data they produce, provides better care not only for their comrades, but for anyone who passes through the different levels in the continuum of care.”

(Follow Donna Miles on Twitter: @MilesAFPS)

News Briefing with Army Lieutenant General Terry from the Pentagon

COMMANDER BILL SPEAKS:  Good morning.  I’d like to welcome back to the Pentagon briefing room Lt. Gen. James Terry, United States Army, who’s been here a number of times via satellite and joins us in person today.

Lt. Gen. Terry is the commander of ISAF Joint Command, deputy commander of U.S. Forces-Afghanistan, and commanding general,


afghanistan (Photo credit: The U.S. Army)

.  This is Gen. Terry’s third tour in Afghanistan, and he assumed his current duties in July — or June 2012.  He took command of U.S. Army V Corps in November 2011.

            Prior to this assignment, he served as commanding general, 10th Mountain Division (Light), Fort Drum, New York, from September 2009 to November 2011 and was deployed as commander ISAF Regional Command South from October 2010 to October 2011.  From August 2004 to February 2007, he served as deputy commanding general operations, 10th Mountain Division (Light), and deployed as a deputy commanding general for operations for Combined Joint Task Force 76, Afghanistan, from January 2006 to February 2007, with responsibilities in what is now Regional Commands East, South and Southwest.

            Gen. Terry regularly travels throughout Afghanistan, often joined by senior Afghan national security force officers, to gather a full picture of ISAF’s coalition and partnered efforts, and today he will update us on the progress of the campaign.  He will make some opening comments and then will take your questions.

            And with that, general, I’ll turn it over to you.

            LIEUTENANT GENERAL JAMES TERRY:  Well, good morning, all, and thanks, Bill, for that — that very kind introduction.

            I can tell everybody here today it’s much, much better to see you in person than it is to be sitting there in Kabul in a little — what we call the can, staring into a video lens there, so it’s good to see you all in person.  I see some familiar faces out there, also.

            Bottom line upfront, I tell you, we are — we’re in the process of moving the Afghan National Security Forces into the lead for security.  This spring, we’ll reach milestone 2013, and the Afghan National Security Forces will plan, lead and execute all operations across Afghanistan.  IJC will train, advise, assist, and support these operations, and this is a fundamental shift.

            What I want to do today is talk to you specifically about the Afghan National Security Forces that I’ve worked with over the course of six years and three deployments, as described by Bill.  Make no mistake — the progress there I think is very real.  It’s my assessment that it is.  It’s unmistakable, and it’s very substantial.

            Let me be clear, though.  There are challenges that do remain with the Afghan National Security Forces.  But with our partners, we’re going to work through those challenges.

            In June of 2012, we began moving out of partnered operations and, in fact, now with tranche four announced, the Afghan National Security Forces will have the lead to protect over 85 percent of Afghanistan’s population once tranche four is fully implemented, beginning about the March timeframe.

            The Afghan national police and army can and do fight for Afghanistan and for the people of Afghanistan.  What we must do now is build supporting and sustaining to the Afghan National Security Forces.  Those systems and capabilities allow them to address the current threat through sustained and continuous activity.

            Now, the way we’re doing this is called security force assistance, which encompasses all activities that move the Afghan security forces to sufficient and sustainable security.  In terms of our mission, this is more specifically known as train, advise, and assist.

            Today, insurgents fear the growing capability of the Afghan National Security Forces.  We are fully engaged in supporting the government of Afghanistan to develop the security forces that are capable of containing the insurgency and managing the violence.  The challenge is to continue to build their capability and capacity, while in the current fight.  And through security force assistance, that’s exactly what we are doing.

            Afghan national security forces are taking a lead not just because of the Lisbon agreement, but more importantly because long-term stability demands that Afghans own, manage, and lead their own security efforts.  The Afghan people want this, and we all know that the nature of this fight requires indigenous forces for the long haul.

            More importantly, transition undermines the insurgent narrative of fighting foreign forces and will uncover the insurgents’ true design — to control the people of Afghanistan, who quite frankly have grown tired of 34 years of war and desire a better future for their children.  Everywhere the ANSF, the Afghan National Security Forces, are leaning into the challenges.

            Now, I’d highlight that currently they lead a large majority of all the current conventional operations.  Insurgents have been pushed out of major population areas in our pursuit.  The population centers present an urban energy, one that I did not see six years ago, marked by bustling city streets, markets, cars — and, of course, with the cars come the traffic jams.

            Cellphone coverage has expanded over 80 percent of the population, and the kids are back in school.  Human capital is one of the biggest changes I’ve seen since 2006, as more than 8 million Afghans are in elementary and secondary education, and almost a quarter of them are young girls.

            Now, unfortunately, insurgents now rely primarily on IEDs, which kill more Afghan civilians than coalition forces.  Quite frankly, the people, as I’ve said, are tired and have no desire to be controlled by the insurgents.  Perceptions of the Taliban have worsened over time.  Anti-Taliban movements are springing up as the people of Afghanistan reject the heavy-handed tactics of insurgents.  Today polls indicate that the majority of the Afghans think the country is heading the right direction, which is, again, a significant increase from my time in 2006.

Where we are now:  in June, we started moving to the next phase in the campaign, which is driven by security force assistance.  More than 400 security force assistance teams are in place, training, advising, and assisting Afghan national security forces as they take the lead for security.

            We are now bringing purposely built formations — brigade-sized, in many cases — that are focused on and trained to train, advise and assist the Afghan national security forces.  They will command the security force assistance teams, provide force protection, and, when required, provide enabler support to Afghan National Security Forces.  Our only — our early-on assessment is that these formations are serving to accelerate moving the Afghan National Security Forces forward into the lead for security.

            ISAF forces are actively training Afghan forces to provide their own enablers.  While much work remains to be done, strides have been made in the areas of casualty evacuation, logistics, intelligence fusion, counter-IED, and fire support.  It’s important to note that in most cases, these enablers will not resemble U.S. or coalition enablers.  Rather, they will be supported by and sustained by growing Afghan national security force systems.

Too often, we look at enablers as a piece of material.  What we must do is have a view toward the future that looks at how Afghans will use these capabilities within their own organizations, how they will adopt doctrinally, and more importantly, how they will educate, train, and develop their leaders for the future.

We are witnessing examples of increasing Afghan National Security Force capability.  Let me give you just one example.  In November, the Afghan National Army 205th Corps successfully conducted core-level operations across Regional Command South.  These operations included all security elements, police, army, and were Afghan-planned, Afghan-led, and logistically supported by Afghan forces.  This included planning and conducting their internal re-supply convoys and separate aerial re-supply missions conducted by the emerging Afghan air force, using Afghan helicopters and Afghan pilots.

            Now, as the Afghan organizations demonstrate their ability to operate independently, security force assistance will focus at the next organizational level.  While this supports a smaller footprint, it is not simply about doing less.  This is about putting our advising and enabling resources in the right places at the right levels within the Afghan National Security Force to ensure that Afghan partners can hold the gains of the past.

            This is about the right mix of coalition forces and capability that balances risk to security, while continuing to support the Afghan national security forces as they grow their own enablers and capability over time.  Our partners will need our help in this regard, and we will be there to help them.

Now, no doubt challenges remain.  While much has been accomplished, we still have a long road ahead.  As we look to the future, it’s not without associated risk.  Some were generational, and some were regional.  Insurgent population has proven resilient and will, without a doubt, challenge the Afghan national security forces this spring as they take the lead of security.

Now, I’m confident that with our train, advise, assist mission, and security force assistance concept, we can mitigate that risk by supporting our Afghan partners, while continuing to grow that Afghan capability.  There are no short-term solutions; rather, it will take time and a long-term partnership with the international community, as put forth in the Chicago declaration.  We will stick with our Afghan partners as they continue to grow.

I would add that while the Afghan national security forces move to the lead, coalition support and coalition forces specifically will still be conducting operations in combat conditions beside our Afghan partners.  The mission will be to train, advise and assist, but, again, it will still be in combat conditions.

            We know that an essential task in moving Afghanistan towards sufficient, sustainable security — stability is the security provided by the Afghan National Security Forces.  As those security forces grow in capability, they now have an opportunity.  That opportunity is to secure the future of Afghanistan.  This also represents an opportunity for the Afghan people, who for over 34 years of war and conflict have proven to be resilient and creative and who very much want to move forward for the next generation of Afghans.  Afghans securing the Afghan people is the path.

            As we look toward the national elections in 2014, I am confident that the security provided by the Afghan national security forces will provide space for the political process to mature and connect to the Afghan society and support an emerging private sector.  Success may not be on the front pages.  Insurgencies are defeated over time by legitimate and well-trained indigenous forces.  Those forces are taking the lead.

            Recognize that in the road ahead, there will be Afghan solutions.  My caution to all is that we should not view these solutions through Western eyes and assess them too critically.  What we are now seeing as Afghans move in the lead can and will work.  We must remain patient in support of our partners.  And, again, it will take time.

            In closing, these initial comments are the road ahead for Afghan security forces, again, is not without challenges.  They will need a partner, and they will need our help.  But they are well on the way to taking the lead of security through the transition process.

Now, I’ve been talking entirely too long, and I could go on and on, but what I’ll do is stop and ask for questions right now.


            Q:  General, thanks.  You referred very briefly to anti-Taliban movements.  Last year, there was considerable hope and even expectation that localized anti-Taliban movements in Andar districts and other adjoining districts in Ghazni might be built into something bigger, broader, more promising.  Has that petered out?  Or where does that stand?

            LT. GEN. TERRY:  There are still a series of Afghan — as I call them, local movements that are out there.  Frankly, it’s my assessment that they spring up from the fact that the Afghans have been at this for 34 years now and, again, they’re quite tired of the heavy-handed tactics of the insurgents that are out there.

We work with the Afghan national security forces, specifically the minister of interior and his forces, to try to identify those opportunities and in — move forward, where we can, to make sure that they are secured and given some space, so to speak, to continue to grow.

            Q:  So have they grown?  Or have they been crushed?  Or what —

            LT. GEN. TERRY:  There’s — they have not been crushed.  There are more of them.  They have, frankly, at this point, not grown together.  I think there’s great potential for them to at some point.


Q:  General, can you elaborate a bit on what the day-to-day responsibilities of U.S. troops in these security force assistance brigades will be?  If they’re not going on, you know, partnered operations, patrols with the Afghans, are they going to be on bases, acting as — like a QRF force?  And what levels will the partnerships occur?  It seems a bit like a headquarters force, if I’m not misunderstanding.

            LT. GEN. TERRY:  Well, I wouldn’t call it a headquarters force.  Again, it’s purposefully designed.  If I can take you back through the history a little bit.  2006 in my timeframe there, we were coalition-led operations, where we planned and executed and assessed operations that, you know, we’ve — we began the initial stages of partnering, but those were, frankly, coalition-led or there weren’t enough — simply enough Afghan national security forces to go around at that particular point in time.

            As I came back in 2010, then, we had moved to what you referred to as partnered operations.  The shohna ba shohna, the shoulder-to-shoulder, and clearly we’re now moving away from that.  And what we have to do is put the Afghan National Security Forces into the lead.

            So the activity of the soldier out there will be all about training, advising and assisting the Afghans as they lead operations.  The goal here is for the Afghans to stand on their own, but not to stand alone and not to stand without that support, which is key to them moving forward.

            I would — I would say that inside — what we’re starting to do now is shift away from the security force assistance teams that you might be familiar with that started in — oh, around January or February of 2012, and then we’re now starting to move the concept along to where we have designed the brigades, in the case of the Marine Corps, the regiments, so that it’s one organization that man, trains and equips together.  Those organizations then are not purely headquarters-focused, but they are focused then on increasing the capability of the Afghans.  It doesn’t mean that they won’t be going out on patrol with them, either.

            Now, initially, we see this as being focused at the Afghan kandak level, which is, of course, the battalion level.  As those kandaks become more capable of time, then we’ll lift up to the brigade level and then potentially, in accordance with the campaign plan, up to the core and the police zone level.  And that’s the concept.

            Q:  So is it fair to say that this is going to be a largely FOB-centric force waiting for the Afghans as they take the lead, if they need additional U.S., say, combat support, to then go out with them?

LT. GEN. TERRY:  I’m not sure what you mean by FOB-centric force.

Q:  (off mic)

LT. GEN. TERRY:  I’m not a FOB-centric kind of guy, so I’m not —

            Q:  If they’re — if they’re not going out on patrol alongside them, what are they going to (off mic)

            LT. GEN. TERRY:  I think they will be.  A certain component of this, again, is — as, you know, some of this training will obviously have to be done in contact.  As you get better at the kandak level, you can lift up to brigade, but you’ll have to — you’ll have to shadow that brigade as it moves around the battle space.  And then some of it obviously is about, you know, the force protection component that has to be with the security force assistance teams and the policy advisory teams that are out there, as they move forward.  A certainly piece of it, also, then is — is until the Afghans, you know, grow their own enabling capability out there, that when required, will come back to some of the coalition enablers that are out there.  Thanks.

            Q:  Yeah, the other side of that coin, the Afghan national security forces, where are they?  I mean, you’ve been — for years, we’ve used the crawl, walk, run.  But if this was a U.S. force and you were going out and seeing what you’re seeing, would heads be rolling?  Or would you be thinking, well, we’re making progress, given it’s a fairly new force?  Where are they?  And how far (off mic)

            LT. GEN. TERRY:  Maybe because I’m from the mountains of Georgia, I don’t tend to look at it through — look at these guys through a U.S. lens.  And that’s kind of what I try to caution note, is that we — as they grow in capability, that we view, you know, where the Afghans are headed through a Western mindset.

            From where I’m at, they’re at the run phase of this.  And, you know, I’ll be honest with you.  Three tours, back down in the hard terrain in Kandahar and — you know, which is — been considered the heartland of the Taliban movement, having seen a hard fight down there in — some of the old safe haven in Zhari, Panjway and Arghandab and places like that, I was recently down in Arghandab, and it was, frankly — I don’t want to be overly optimistic, but very pleased with where the Afghan national security forces were in holding the terrain in Arghandab.  And so I would say they’re off and running with it.  Now, again, they’re still going to need some support there.

            Q:  Can we ask you just to look forward a little bit to the — the, quote, unquote, “fighting season” for 2013?  You know, in past years around this time, someone will — we’ll get a brief where they say, well, one of the biggest concerns is assassination of leaders or — in the last year, it was insider attacks.  What are you looking towards this year as the biggest — or the biggest several threats the Afghans are going to face?

LT. GEN. TERRY:  Obviously, the insider threat is on my mind.  For my assessment, as the operational commander in Afghanistan, it is an enemy tactic, as a stated part of the last campaign plan, and we actively work with our Afghan partners.  I’m sure you’re very aware of the vetting and the counterintelligence efforts that are ongoing there, to beat back that threat.  We’re constantly aware there.

            You know, in terms of the insurgency itself, the other signature weapon there, of course, is the IED.  And, frankly, using that IED in spectacular attacks, to which they really — they really don’t hold any terrain, but what the spectacular attack does is keep them in the mind’s eye of the population that’s out there and buys them some newsworthy events.

            And so, you know, you might suggest that that’s a battle for relevance, to stay in the front of the people’s minds out there.  Sadly, this IED threat kills innocent Afghans out there.  And, you know, I think you’ve heard recently some of the religious leaders inside of Afghanistan and outside of Afghanistan condemn suicide bombings, which is — which is a huge step forward out there.

So I — I think you will see, again, a stated part of last year’s campaign plan, which, frankly, failed, was to regain a lot of the territory that they had lost from what we know as the surge period, you know?  The surge worked.  It’s the best way to describe it.  They don’t hold that sanctuary anymore.

And now it’s time, in accordance with Lisbon and — you know, what the Afghans want is to move the Afghan National Security Forces into the lead.  We’ll be there with them during this fighting season.  It’s going to be a — it’s going to be a critical time for them, but I’m confident, with the concept we have, security force assistance, with the train, advise and assist, that they’re going to get through this fighting season and be well-prepared for the future.

Q:  Can I ask you about the ALP?  I mean, it’s been a few years now.  What’s your assessment of how important they are to this and, in some sense, important post-2014?  There are some proposals to expand it even further than it has — that it is now.  How do you feel about that?

            LT. GEN. TERRY:  I’m a fan of Afghan local police.  And I’ll tell you why.  The concept starts at the local level, and it’s more about governance at the local level than it is about security.  In other words, the community comes together via the old tribal mechanism to decide that it wants to secure itself.  So it’s about communities now wanting security.  And it’s about them pushing back against the insurgent out there, which really causes insurgents a lot of problems at the village level, where they have Afghan local police.

            Once they decide — and we use some of our special operating force capability come in and train those Afghan local police, once they’ve been vetted and cleared, and then the key now is that, once you’ve come through the local governance process and the vetting is now to tie that back to the district — chief of police at the district level so that there’s oversight of the Afghan local police.

            So I think it’s one of those solutions that I talked about that’s not quite — you know, be careful how we view it through Western eyes.  I think it, frankly, works.  And, in fact, I talked to many village elders.  And when I’m out and about, they like the program.  They —

            Q:  Do you see signs that it actually reduces violence in these areas?  I mean, there’s some evidence that — at least in the initial stages, violence goes up in areas where ALP (off mic)

            LT. GEN. TERRY:  I think over time it does decrease it.  You’ve got to remember that this is a threat to the insurgents, so it will be attacked out there, also.  So I’d just caution you with that one.

            Q:  You’ve sketched very clearly sort of the campaign plan for the hands-on aspect of train, advise and assist.  And thanks for that.  But can you talk a little bit about some of the not hands-on pieces which are probably a lot more challenging, casualty evacuation, close air support?  What is your assessment?  What are the challenges?  What are the big pieces that are going to be the heavier lifts?

            LT. GEN. TERRY:  Sure.  Logistics is the number-one thing on my mind right now, followed by counter-IED.  I would follow that with surface fires.  One of the things the Afghans are concerned about the most is their rotary wing fleet, as it grows in capability to replace what’s there from the coalition.

            We have been working hard with our Afghan partners especially on the logistics side, doing something I learned as a young lieutenant years ago in Germany.  It’s called the maintenance and sustainment terrain walk.  And it’s where you take combat leaders, you know, kind of like — kind of like I was once upon a time, and you walked them through the entire system.

And what we were able to do is now kick this off at the national level with Dan Bolger and the NTM-A, good friend of mine, and then take it from the national level, the depot level, if you will, and the repair parts and that level of maintenance, and then actually walk it down all the way to the kandak level.  And then through that process, then you start to uncover the challenges that the Afghans are under.

            Now, I bring with me Gen. Karimi — or Gen. Rahman from the police, who’s been over working with the police or the army, and then so they’re now exposed to this.  And what they’ve started doing is bringing their entire staff with them.

            And so when we go down to the core, as we recently did with the 207 Corps up in Herat what you find out is that it is not so much the process of walking through the maintenance sustainment terrain walk.  It’s everything that the Afghans did — Afghan national security forces did prior to that, simply trying to get ready for that.

            And a lot of that, you know, in the U.S. Army — I apologize.  I go back to look at it a little bit through Western eyes, then — gets into the old readiness briefings.  And then, you know, how does that now relate to that capability out there?

In terms of the casualty evacuation, we’re starting to move toward ground casualty evacuation.  And what has happened here in terms of an Afghan solution is quite interesting.  You know, they’ve — they’re starting to partner with the minister of public health and find the hospitals and the clinics, and then actually through mutual agreements then, as they evacuate their casualties back by ground, use those clinics and hospitals that are out there.  205th Corps is next, one example.  209th Corps up in the north recently did this, also, is it extended itself out toward the west.  And they fall back in on those systems.  And then when they can — what we’re starting to see, when the aircraft do become available, the Afghan aircraft, the Mi-17s, they’re coordinating non-standard casualty evacuations — what we call it on the U.S. side — not MEDEVAC.  I mean, it’s not a UH-60 with a doc on there or anything like that.

But they’re starting to coordinate that through the coordination centers at the regional level and then move forward and pick up casualties, and then eventually move them back to the military hospitals and the police hospitals.  And so it’s those kind of solutions over time, as you — as we look at things like close air support, what we must do then is bring the surface fire capability to fruition.  And that’s the indirect fire — observed indirect fire.

The D-30 howitzer, we recently filled an initiative for 60-millimeter mortars.  You might think that’s a lot, but, boy, when I was a company commander, I relied on that 60-millimeter mortar that’s out there.  And so now instead of, you know, calling back up into the air, they have those organic capabilities inside their formations.

Now, the other capability that’s starting to emerge out there is the mobile strike force, which is an armored, wheel-based platform.  Don’t get it confused with Strykers.  It’s not quite that size, but it is a very, very capable platform that’s out there.

            And there will be seven kandaks of these that will be under two emerging brigades that work at the national level, but be allocated down to the corps that are out there.  So now you’ve got some ground mobility, and in those platforms, I think potentially we’ll look at if we need to put a gun system on one of those platforms.  And then, again, that would help take care of some of them.

            Did that answer your question?  Okay.  Sure.

Q:  General, thank you, sir.  Still some Afghans have fear among them that what is their future, because one generation is already gone, 34 years or more that they have gone through the wars and still going.  What they’re asking is that after you leave, what is their future?

And also, as far as reconciliation is concerned, or talking to Taliban or bringing them to the mainstream, you think it’s working?  Or what will the future after you leave?  Because some Taliban are saying, after U.S. leaves, they are waiting for another war within Afghanistan.

LT. GEN. TERRY:  So your question’s about the concern on the part of the Afghans?

Q:  Yes.

LT. GEN. TERRY:  I think there’s concern about the uncertainty.  I think this past week here with events in Washington have helped solidify some of those questions that are out there.  And I think they’ll look toward future announcements by the president about, you know, what the future looks like out there.

You know, the Afghans are somewhat cautious as they look toward the future because of the past 34 years of war.  And when you look at everything they’ve been through, I don’t think we’d be any different than that.

            And I — again, I think there are multiple opportunities out there for them that they have to capitalize on.  One of the opportunities that they have, quite honestly, is a younger generation that has advantaged itself over the last 11 years in terms of education.  I mean, there’s a younger generation underneath the surface of the Afghans out there that are very smart, very intelligent, and I — I try to talk to them as much as possible, although I look like an old guy.  I know for certain they don’t want to go back to the way of the Taliban.

            And, again, I’m sure there’s going to be some solution that’s out there.  And I can’t look toward the future and tell you exactly what it is, but I think the Afghans will sort it out.

Q:  Quick follow-up.  As far as — many nations in the region, including India and including Pakistan are amongst, their fears that after you leave, what will happen, those Talibans and Al-Qaeda still inside Pakistan and in Afghanistan, where they will go?  Because India is also fearing and Pakistan is also among other nations that fear, what is the — what surety or guarantee can you give to those who are working in Afghanistan from other nations?

LT. GEN. TERRY:  I can’t look for the future and answer that question for you.  I think what we have to look at then is, as we — we have to rest comfortable with — that — through Bonn, Lisbon, Chicago, or to Tokyo, the international community has made a huge commitment to Afghanistan.  And, frankly, I think they’ll have an impact on the region.

And so when you look at, you know, $16 billion that have been pledged in international commitment, again, I don’t want to be overly optimistic, but I don’t Afghans are going to be — Afghanistan is going to be left there, you know, standing alone.  We want them to stand up, but, again, I think we need to be there beside them.

Q:  (off mic) and then one on Pakistan.  Can you review the bidding on — what is the profile of the enemy — of the insurgency today?  Roughly how many Taliban are there?  How many Al-Qaeda?  What are your best estimates and, you know, the breakdown between the hardcore and those that are seasonal?

LT. GEN. TERRY:  That is a very difficult question.  You know, part of it — part of it deals with, you know, the nature of how things move in and out of Afghanistan for certain.  I’ve seen numbers, quite honestly, as low as 20,000 insurgents and — up there, as I listen to my Afghan partners, around 30,000.

The exact percentage of what’s hardcore and what is not is — is very hard to break apart.  I would tell you, I think there’s three sources of violence in Afghanistan.  One is the ideology the drives the insurgency.  I think there’s probably some tribal dynamics and ethnic dynamics that are out there, and I think there’s a criminal component to it, also.  So to kind of take those three apart is quite hard.

            Q:  Well, and a follow-up, too.  What progress has the U.S. and Pakistan made in shrinking the safe havens?  What’s the extent of the cross-border coordination center coordination, basically?

            LT. GEN. TERRY:  We — from a military perspective, we are starting to move away from — because we have to — a trilateral type of — you know, with Afghans, U.S. and Pakistan, in other words, Afghans in the middle.  And I think it will take time, to where we’ve got to now have Afghans and Pakistan talking together.

And then, you know, if you’re familiar with the border nation coordination centers on the military side, that is a mechanism that’s — it’s a tool, if you will, for when there is tension at the border that can come together, discuss it, and move off.  And then we have what we call the border flag meeting process, which involves the general officers.

Now, I would just offer to you that, you know, on the political side, we’re starting to see Afghans and Pakistan start to engage more.  And I think there’s great potential there in that regard.  And I apologize.  One more.  We’ve got to go meet some people here.


            Q:  Sir, can you speak to the pace of U.S. withdrawal of the 66,000 troops in 2013 and 2014?  And also, sir, if I could, you said the Afghans are   tired of war.  The insurgents have proved resilient.  Do you have indications that possibly the enemy is growing tired, too?

            LT. GEN. TERRY:  Well, it’s certainly — I think the enemy’s getting tired.  You know, so the short answer there is yes.

            I would just — in terms of your first question, though, I would tell you that the president’s stated in the coming months here he’s going to make some announcements about the next phase of the drawdown that’s out there.  And it would be — it would be inappropriate for me to even speculate on Gen. Allen’s assessment and recommendation to the secretary of defense and the chairman, so I’m not going to.

            Okay, thanks, guys.  I appreciate it.  And I apologize for having to talk and run.  I would just leave you with this.  I have — I think you’ve all heard my introduction that I’ve been there for — for three different times.  The IJC motto is, “Make it matter.”  And unfortunately, you know, I’m getting older.  This is probably going to be my last tour in Afghanistan.  And I’ve been truly fortunate and blessed to lead coalition forces there, not just the U.S. side of this.  I’ve spent, let’s see, three Thanksgivings, three Christmases that are there.  And, you know, I can — I can tell you that the sacrifices of our soldiers, sailors, airmen and Marines have contributed significantly to the progress of the Afghan National Security Forces.

            I’ve spent three 9/11s there, also.  And I think the fact that we haven’t had a 9/11 event since that timeframe from that region is owed to those sacrifices of our service members out there, also.  So never forget that.  And look forward to seeing some of you in Afghanistan.  I’ve got about three months left, so get on over.  Thanks.

            Q:  Thanks.


EOD tech earns Silver Star

Honor and courage

Tech. Sgt. Deslauriers, an explosive ordnance disposal technician from the 1st Special Operations Civil Engineer Squadron. (U.S. Air Force Photo/Airman 1st Class Hayden K. Hyatt)


by Airman 1st Class Hayden K. Hyatt
1st Special Operations Wing Public Affairs

11/16/2012 – WASHINGTON (AFNS) — An Air Commando from the 1st Special Operations Civil Engineer Squadron received a Silver Star during a ceremony at the Pentagon Nov. 14.

by Airman 1st Class Hayden K. Hyatt
1st Special Operations Wing Public Affairs

11/16/2012 – WASHINGTON (AFNS) — An Air Commando from the 1st Special Operations Civil Engineer Squadron received a Silver Star during a ceremony at the Pentagon Nov. 14.

Tech. Sgt. Joseph Deslauriers, an explosive ordnance disposal technician, earned the medal for gallantry in action while serving in Afghanistan on Sep. 23, 2011.

“It seems to me that valor is of the moment — character is built over a lifetime,” said Col. Jim Slife, commander of 1st Special Operations Wing. “The events of the 23rd of September last year can be described less as a case of spontaneous valor and more as a predictable outcome of circumstance and character intercepting on the battlefield.”

According to the award’s citation, Deslauriers rendered safe one improvised explosive device and conducted a post-blast analysis of three subsequent detonations all within a four-hour
time frame. After doing so, he then provided medical aid to an injured service member and used his detector to clear a safe path for the medical evacuation helicopter to land.

While clearing the area, Deslauriers stepped on an initiation system for an IED device. Despite sustaining grave injuries, and as his teammates treated him with aid, he continued to pass information about the device that helped his team continue the mission. His actions led to the extraction of two injured Marines, two vehicles and completion of the mission.

“We talked about honor, sacrifice, and courage,” Deslauriers said. “We don’t think about that stuff; we just do what we do, and we love it. I’d do it all over again.”

Explosive ordnance disposal Airmen use their training to dispose of anything from roadside bombs to decommissioned missiles — all to save lives.

“You see this room filled with all these people and my family here,” Deslauriers said. “To hear ‘the most decorated EOD tech in the career field’ —  it’s an honor for me to be here.”

Deslauriers said he felt honored to be standing in the Pentagon’s Hall of Heroes, a place that honors the memory of hundreds of service members including Medal of Honor recipients.

“You belong here,” said retired Gen. Norton Schwartz, former Chief of Staff of the Air Force.

“Thank you, sir,” Deslauriers said. “To hear that from you, and from everybody here, is a great honor.”

The Silver Star is the third highest military decoration for valor and is given for gallantry in action against enemies of the United States., an explosive ordnance disposal technician, earned the medal for gallantry in action while serving in Afghanistan on Sep. 23, 2011.

“It seems to me that valor is of the moment — character is built over a lifetime,” said Col. Jim Slife, commander of 1st Special Operations Wing. “The events of the 23rd of September last year can be described less as a case of spontaneous valor and more as a predictable outcome of circumstance and character intercepting on the battlefield.”

According to the award’s citation, Deslauriers rendered safe one improvised explosive device and conducted a post-blast analysis of three subsequent detonations all within a four-hour
time frame. After doing so, he then provided medical aid to an injured service member and used his detector to clear a safe path for the medical evacuation helicopter to land.

While clearing the area, Deslauriers stepped on an initiation system for an IED device. Despite sustaining grave injuries, and as his teammates treated him with aid, he continued to pass information about the device that helped his team continue the mission. His actions led to the extraction of two injured Marines, two vehicles and completion of the mission.

“We talked about honor, sacrifice, and courage,” Deslauriers said. “We don’t think about that stuff; we just do what we do, and we love it. I’d do it all over again.”

Explosive ordnance disposal Airmen use their training to dispose of anything from roadside bombs to decommissioned missiles — all to save lives.

“You see this room filled with all these people and my family here,” Deslauriers said. “To hear ‘the most decorated EOD tech in the career field’ —  it’s an honor for me to be here.”

Deslauriers said he felt honored to be standing in the Pentagon’s Hall of Heroes, a place that honors the memory of hundreds of service members including Medal of Honor recipients.

“You belong here,” said retired Gen. Norton Schwartz, former Chief of Staff of the Air Force.

“Thank you, sir,” Deslauriers said. “To hear that from you, and from everybody here, is a great honor.”

The Silver Star is the third highest military decoration for valor and is given for gallantry in action against enemies of the United States.

Doc begins ‘service before self’ at 61


Doc begins 'service before self' at 61


by Tech. Sgt. Amanda Savannah
380th Air Expeditionary Wing Public Affairs

7/3/2012 – SOUTHWEST ASIA (AFNS) — Walking into the office of Lt. Col. (Dr.) Joseph Keenan, one could possibly imagine him in private practice in his home town — the warm, caring doctor the community has known for many years.

But his Air Force “community” has only known him for two years.

Keenan, who has been an ear, nose and throat doctor for more than 30 years, will celebrate his third anniversary of becoming an Air National Guard member in October. It will also be his 64th birthday.

As he got older, the more he realized how fortunate he was to be born in America, said Keenan, who is a flight doctor assigned to the 131st Fighter Squadron in his home town of Westfield, Mass.

“All four of my grandparents were immigrants from different countries,” he said. “They came here because there was more opportunity. I just realized that as I got older, how lucky I was here and how good life was to me.”

He initially was unsure of his ability to achieve that desire, knowing there were age restrictions to joining the military. He said he came to realize that he could receive an age waiver and decided to try to join.

His first application was unsuccessful.

“It was only when one of the (approval authority) colonels who was deployed to Afghanistan came back,” Keenan said. “He looked at my credentials and said, ‘We’re going to try everything possible to get this guy in.'”

The process took about a year and included many steps, the final being with the secretary of the Air Force, Keenan said. He was finally sworn in on his 61st birthday.

“It was really quite a time for celebration, one of the best birthday presents I could have received,” he said.

Not only has the doctor gained new patients at his Guard unit, he was sent far from home to treat others.

Keenan is currently assigned to the 380th Expeditionary Medical Group on his first deployment. Though he said the majority of his patients here are young and healthy and are seen for urgent care matters, he has had a few opportunities to assist with patients during temporary duty in Afghanistan.

“I was at Bagram and Kandahar and saw first-hand the sacrifices that are being made by the troops over there,” Keenan said. “(I saw) how the coalition partners work with the nationalities that we deal with, and how seamless the medical care is that is being delivered to the troops in the field.”

Keenan said he has been very happy with his life as a guardsman.

“It’s one of the best decisions I’ve ever made to join the United States Air Force,” he said. “I’m having a great time and I feel so fortunate to be able to serve my country. I know from the feedback I get that people are very happy that I’m here and doing what I’m doing. It’s just been a win-win situation for everything.”

Lt. Col. Christopher Borchardt, the 380th EMDG deputy commander, said he most appreciates Keenan’s attitude.

“I can train someone to be a doctor, but I can’t train enthusiasm,” Borchardt said. “It’s difficult to recruit doctors, so when one steps forward, willing to accept the challenges and hardships imposed on their families and lifestyle, it is truly a force multiplier for this mission and the Air Force. Our patients have already benefitted from his unique skills and experience, and I know he’s been having the time of his life contributing to our mission.”

702nd Expeditionary Airlift Squadron deactivates at Kandahar Airfield

by Capt. Frank Hartnett

451st Air Expeditionary Wing Public Affairs

6/20/2012 – KANDAHAR AIRFIELD, Afghanistan (AFNS) — A small group of Air Guardsmen were joined by senior leaders June 18 to celebrate the completion of their deployment in support of Operation Enduring Freedom and to honor the deactivation of the 702nd Expeditionary Airlift Squadron here.

The 702nd EAS was activated here July 31, 2011, and charged to operate the C-27J Spartan in direct support of U.S. Army missions in the Regional Command – South area of operations.

During this rotation, the majority of the Airmen from 702nd EAS were from the Maryland Air National Guard. This deployment marked their third rotation to Afghanistan in five years.

The squadron deactivated after flying 3,200 missions, moving 1,400 tons of cargo, transporting 25,000 passengers and executing 71 airdrops, officials said. The achievements are even more impressive since the squadron operated only two aircraft.

“Persistent powerful presence-that’s the mission of the 451st Air Expeditionary Wing, and the 702nd (EAS) has lived up to that statement in every respect,” said Col. Robert Kiebler, the 451st Expeditionary Operations Group commander.

As the 702nd EAS becomes a part of history, the support provided to time-critical tactical airlift will not go with it.

“We will continue to provide world-class tactical airlift in support of operations in Regional Command – South,” said Kiebler.

The U.S. Army 25th Combat Aviation Brigade served as the link for the 702nd EAS to the Army while it conducted operations in Afghanistan. The squadron flew missions that were directed and scheduled by the brigade.

The 25th CAB commander praised the departing Air Guardsmen for adopting his unit’s motto, “We fly for the troops,” during the deactivation ceremony.

“It emphasizes to every Soldier, and now every Airman, that has been in our formation that it’s not about us,” said Army Col. Frank W. Tate, the 25th CAB commander. “It’s not about what is convenient for us. It is about what we can do to take care of that Soldier, Marine, Airman or Sailor on the ground. They are the ones who carry that heavy burden; they are the ones with the most significant challenges.”

Supporting the warfighter was a constant focus of the squadron in its 10 months of operation. The squadron prided itself in providing rapid response in support of the mission.

“We had folks bring in boxes of blood (to the squadron), with crews already at the plane,” said Lt. Col Michael Lunt, the 702nd EAS commander. “We walked it out to the aircraft, and it went out the door to Tarin Kowt.

“You can’t find a better mission than tactical airlift,” Lunt said.

A clear sense of accomplishment prevailed among the unit and leadership.

“This rotation has been for me, and the men and women of the Maryland, Ohio, Georgia, Mississippi, North Dakota and Arkansas Air National Guard, a very challenging, but, in many ways for us, the most rewarding rotation we’ve been on,” Lunt said.

“We feel like we’ve made a difference for the young troops on the tip of the spear.”

U.S.-India Bilateral Security and Regional Cooperation

India Gate

India Gate (Photo credit: aroris)


Fact Sheet

Office of the Spokesperson
Washington, DC
June 13, 2012


Since the inauguration of the U.S.-India Strategic Dialogue in 2010, the United States and India have advanced their security cooperation in a range of critical areas, including defense cooperation, humanitarian assistance and disaster relief, and research and development, Afghan security, counterpiracy and maritime security, counterterrorism, homeland, and border security, cyber security and cybercrime, illicit finance, and megacity policing. This remarkable growth has been realized through a range of enhanced consultations and formal dialogues, including the Defense Policy Group, the Homeland Security Dialogue Ministerial, the Counterterrorism Joint Working Group, ongoing Cyber Consultations, Political-Military talks, and our Strategic Dialogue. A number of recent developments highlight the ongoing strong momentum in security and defense cooperation:

Defense Cooperation

  • Defense Sales and Co-Production: The United States and India continue to develop their defense partnership through military sales and joint research, co-production and co-development. With more than $9 billion dollars in sales over the last decade and another $10 billion in the pipeline, U.S. defense sales to India will create hundreds of U.S. jobs.
  • Humanitarian Assistance and Peacekeeping: Through defense sales, the United States and India will have the largest C-17 transport fleets in the world, strengthening their ability to deliver humanitarian assistance across the region and facilitating their continued roles in United Nations peacekeeping operations around the world.
  • Joint Military Exercises: In 2011 the United States participated in 56 cooperative events across all services with India—more than India has with any other country. These include the Malabar, Shatrujeet, and Yudh Abhayas exercises.
  • Recovery of U.S. Service Member Remains: In support of the United States’ commitment to accounting for all Americans missing from past conflicts, India has agreed to resume U.S. missions to recover service member remains in India. There are an estimated 400 unaccounted for U.S. service members in Northeast India, primarily as a result of WWII aircraft crashes.

Regional Stability

  • Afghanistan and Regional Stability: In support of advancing stability in Afghanistan, India has committed over $2 billion to development since 2001. In addition, both India and the United States have signed Strategic Partnership Agreements with Afghanistan and continue to partner in support of security.

Homeland and Cyber Security

  • Homeland Security: Deputy Secretary of Homeland Security Jane Holl Lute has visited India and received a range of high-level Indian officials in Washington in support of the Department of Homeland Security-Ministry of Home Affairs led Homeland Security Dialogue inaugurated by President Obama in 2010. DHS and MHA are conducting a range of reciprocal visits, including: air and sea port exchange visits to Washington, DC, New York City and Los Angeles; port security visits to Kandla, Mundra, Mumbai and Chennai; and law enforcement exchange visits in Washington, DC and New York City. These visits and exchanges will facilitate sharing of best practices, training, tactics, techniques and procedures to address terrorist threats.
  • Counterterrorism: The State Department, through its Antiterrorism Assistance programs, conducted eight courses in India in 2011 and will provide 14 courses in 2012 on topics ranging from bomb blast investigation, critical incident management, and tactical commanders training to cyber investigations and forensics.
  • Disaster Management and Preparedness: In support of disaster management, the U.S. Trade and Development Agency is sponsoring a reverse trade mission in autumn 2012 to bring officials from India’s Ministry of Home Affairs, National Disaster Management Authority and leading states to meet with U.S. response and preparedness equipment, technology, and service providers. This initiative builds on an ongoing feasibility project with MHA to establish an integrated emergency communications system and supporting infrastructure in Hyderabad, Andhra Pradesh, funded by USTDA and cost-shared by a U.S. firm; this project is helping to define standards for national implementation of emergency communications used by first responders.
  • Cyber Security: India and the U.S. recently held another successful round of cyber security consultations chaired by their national security councils. The delegations agreed to form a working group chaired by the State Department and the Ministry of External Affairs to further discuss international norms in cyberspace and internet governance. The group will also work to coordinate national positions in advance of important international cyber events. Robust operational cooperation continues between the U.S. Computer Emergency Readiness Team (U.S.-CERT) and India’s Computer Emergency Response Team (CERT-IN).

PRN: 2012/967