MILITARY MEDICINE, 169, 10:810, 2004 Lessons Learned: Operation Anaconda Guarantor: CPT George S. Midla, SP Contributor: CPT George S. Midla, SP With the recent long deployments of our military, a review of experienced by our battalion or myself directly. There were lessons learned becomes a vital part of mission success and many other units and supporting elements that took part in this helps to shape our forces for future conflicts. This article engagement, but I am not at liberty to discuss possible lessons examines some medical issues that were experienced by the learned on their behalf. Topics of discussion will include nutri- Raider Rakkasans of the 101st Airborne (Air Assault) Division tion, altitude sickness, medical evacuation (MEDEVAC) re- during Operation Anaconda in Afghanistan. Topics include Downloaded from https://academic.oup.com/milmed/article/169/10/810/4283548 by guest on 01 October 2021 nutrition, altitude sickness, medical evacuation requests, and quests, and the transport of patients on resupply platforms the evacuation of wounded on resupply platforms (back-haul- (back-haul). ing). When nutritional aspects of war fighting were discussed, an emphasis was placed on making a greater variety of field Nutrition rations accessible to the force with the addition of a multivi- tamin to each ration. Also, a meal high in caloric content Nutritional aspects of premission planning are often over- before infiltration and an education/inspection program to en- looked. Units are usually busy with rehearsals, equipment sure the maximum benefit of each ration was reviewed. The maintenance, and thorough inspections, as we were, when pre- use of acetazolamide to combat altitude sickness was also paring for an operation. Sleep is often given a higher priority discussed. Dosing of 250 mg BID 24 hours before a rapid than diet, but as troops are readied for bed, they are often assent, then 125 mg BID for 4 days was suggested. Line three anxious and thus have difficulty falling asleep. This could cause of the medical evacuation request was also reviewed for report- the force to be both fatigued and ill-prepared nutritionally at the ing inaccuracies. Complete physical examinations and direct onset of the mission. Once on the ground, the first 24 hours are dialogue between medical personnel and commanders was the most demanding. Operational awareness has to be gained, stressed. Last, a standard medical package to accompany any resupply during hostilities was advised, instead of releasing movement to a base or position must be accomplished, devel- ground medical personnel to attend the wounded when using opment of gun emplacements, and much more must be ad- this for an evacuation platform. dressed before a chow/rest program can be implemented. During Operation Anaconda, the first 2 days were very de- Introduction manding. Our unit was challenged with the enemy’s direct fire weapons, shoulder-fired rockets, and mortar rounds while hav- he U.S. military’s most recent involvement in Afghanistan ing to maneuver over some very rugged terrain. No one had the T began in the latter part of 2001. By 2002, U.S. and coalition opportunity for a leisurely brunch and after 2 days of little rest forces were well established in the country and many military and food, our operational sharpness began to dull. I will also add operations had been conducted, with additional missions being that we were not thinking of our meals. That is, some ate be- planned. One of these operations was code-named Anaconda. cause they knew they needed to for performance, but being shot Its mission was to destroy or capture al Qaeda and Taliban at really does curb one’s appetite. forces in mountain positions located in the Shahi-Kot Valley and As time progressed, the initial rations that we carried in were Arma Mountains southeast of the city of Zurmat. finally consumed. Resupply then became a problem. Most of our Operation Anaconda began on March 2, 2002. At the comple- unit was not able to acquire additional meals and thus went tion of this mission, U.S. and coalition forces had been involved without food, in some cases, for days. Historic records from with the longest battle in U.S. history since the Vietnam War. World War II support this finding. The Marines at Guadalcanal Anaconda was also the highest elevation engagement ever re- went through extended time periods of not being able to eat corded by the United States. because of logistical problems. The acquiring of the enemy’s Before I begin, let me state that I am the battalion physician food became a major part of some of the men’s diet during this assistant for 2/187 Infantry Regiment (Raider Rakkasans) of the campaign.1 101st Airborne (Air Assault) Division. I infiltrated the Shahi-Kot The newest version of the combat ration is the meal ready to Valley on March 2 in a CH-47 (Chinook) helicopter as part of the eat (MRE). It has been designed to be a high-caloric meal to help first force on the ground. On this aircraft, I accompanied a support the soldier on the battlefield.2 A single ration contains a platoon of our C Company, a command element, a small number variety of foods. These foods are dispersed in multiple pouches of Special Forces Soldiers, and an Air Force Enlisted Terminal throughout the MRE. For the soldier to benefit the most nutri- Attack Controller team. I spent the next 12 days in multiple tionally, he/she needs to consume all or at least some part of locations throughout the battlefield. My comments concerning each individual pouch. This brings up another nutritional issue: lessons learned will be restricted to medical issues that were our troops often do not sample each portion, thus defeating the maximum benefit of the field ration. Instead, many individuals Walter Reed Army Medical Center, Cardiothoracic Surgery, Perfusion Service, 6900 get bored with the finite selection of meal choices. They then Georgia Avenue NW, Washington, DC 20307-5000. This manuscript was received for review in July 2003. The revised manuscript was attempt to function on a diet heavy in the desert items, which accepted for publication in November 2003. are more palatable and located in every meal. Examples of these Reprint & Copyright © by Association of Military Surgeons of U.S., 2004. foods include pound cake and the candy “Skittles.” These sol- Military Medicine, Vol. 169, October 2004 810 Lessons Learned: Operation Anaconda 811 diers may feel comfortable in their diet choice of eating just the huge concern, especially during air assault operations that are sweets from the meals. This reassurance is gained over a 1- or conducted at increased elevations. 2-week field exercise at their previous duty station where they Reaching altitude by vehicle or foot allows a slower assent were able to complete a given mission on such a diet. During with the ability to stop at various contour lines to acclimate, if overseas deployments, I have often had a nutritional regiment needed. At the very least, medical personnel can evaluate those strictly made up of MREs for 2 to 3 months before ever seeing developing signs and symptoms related to elevation changes the next step up in the Army cuisine, which is the tray ration and can act accordingly when using ground techniques. None of (T-rat).2–4 The T-rat is delivered in a flat rectangular pan and these luxuries are offered during insertion by helicopter (air does not require refrigeration. This ration is prepared by simply assault). submerging it in hot water, opening, and serving. Because of its During our air assault, we were and typically are shoulder to design, T-rats can offer a hot meal with a kitchen appeal to large shoulder and knee deep in equipment flying in a CH-47D. and small groups of soldiers. Even with the introduction of the Within minutes, we were at altitude and then disembarked the T-rat, on some of my deployments, the MRE was the major part aircraft and conducted combat operations with full packs in the Downloaded from https://academic.oup.com/milmed/article/169/10/810/4283548 by guest on 01 October 2021 of my daily dietary intake. This scenario is not uncommon. Our snow. Because of these expected issues, we examined the pos- troops are often not eating properly secondary to a weary pal- sibility of combating altitude sickness by pharmacological ate.5,6 means. We now must reexamine my previous comments on soldiers After our preliminary map reconnaissance of the area of op- being nutritionally depleted before a major operation and then eration (AO), an initial altitude of approximately 11,000 feet was not being able to get resupplied during conflict. Compile these determined to be our step-off point. A decision was made at that two points with the possibility of 1 to 2 months of poor eating time to premedicate for altitude sickness. Medications and dos- habits (the pound cake and Skittles diet), and we may determine ages for this illness vary. We settled on a regiment of acetazol- that part of the fighting force may not be able to give a 100% amide (Diamox), 250 mg BID, 24 hours before infiltration. That effort. dose was changed to 125 mg BID upon landing and was con- To help attack this nutritional challenge on the battlefield, a tinued for an additional 4 days, and then terminated. Diamox is multiple approach should be examined. First, a greater variety usually started 48 hours before a planned rapid assent. Our of meals must be offered to the soldier. This should be our decision to begin this medication only 24 hours before infiltra- biggest priority.