When Canada first assumed command of the R3MMU on Feb. 7, 2006, the facility consisted of an inpatient ward of 11 beds, each one a stretcher mounted on trestles. Three beds were designated high-intensity/critical care, and these were marked only by having a ventilator associated. Basic laboratory support was available, but microbiology was not. Computed tomography was not available initially, though plain film radiography was available. Ultrasonography was available using a portable machine (Sonosite). There were 2 surgical teams, each consisting of 1 general surgeon, 1 orthopedic surgeon, 1 anesthesiologist, 2 operating room (OR) nurses and 2 technicians. Additional medical specialists included a general internist, an oral surgeon and a radiologist. Initially, there was only 1 OR, which contained 2 tables.
Over time, the hospital expanded. By the time the CF handed over command of the hospital to the US Navy on Oct. 15, 2009, the hospital had about 20–30 ward beds and 5–8 high-intensity/critical care beds. The hospital boasted 2 CT scanners, 3 ORs, endoscopy capability, digital radiography and ultrasonography. The hospital also had a robust blood bank. At hand-over, the hospital medical specialist staff included 2 general surgeons, 2 orthopedic surgeons, 1 neurosurgeon, 1 oral/maxillofacial surgeon, 1 radiologist (with interventional radiology expertise), 1 intensivist-internist and a robust mental health team.
The daily routine of the hospital began with an administrative meeting followed by clinical ward rounds attended by all the clinical staff. One surgical team assumed primary responsibility for the day, but both teams operated if required by the work load. Each section used standard operating procedures developed in training, particularly for mass casualty incidents. Trauma care was provided according to the Joint Theatre Trauma System guidelines.7
From Feb. 7, 2006, to Oct. 15, 2009, the R3MMU staff performed 6735 procedures on a total of 4134 patients (). About one-quarter of these patients were NATO military forces; the majority were Afghan civilians and Afghan security forces.8
Combatant survival has increased with each major conflict over the last 100 years. Survival rates at the R3MMU include civilians injured in the conflict as well as combatants. Ninety-eight per cent of coalition soldiers and 95% of local national patients (security forces and civilians) were transferred or discharged from hospital alive. Similar combatant survival rates have been reported from other military medical facilities elsewhere in Afghanistan and in Iraq.8
Surgical procedures performed in the Canadian-led hospital at Kandahar Airfield