Staff Sgt. Alex Conrad, 26, died from wounds he received during a militant attack on a small outpost in Somalia.The aftermath of a car bomb attack at a check point near the Sanguuni military base in Somalia where Staff Sgt. Alex Conrad was killed last year.

A complex and difficult medical procedure that ultimately failed might have contributed to the death of an American Special Forces soldier killed last year in a firefight in Somalia, according to an investigation into the episode obtained by The New York Times.

The redacted Army investigation illustrates the intense violence that can accompany the Pentagon’s quiet “train, advise and assist” missions in distant corners of the globe, and the limitations of the American military despite its ambitious reach, vast resources and extensive training.

Staff Sgt. Alex Conrad, 26, died from wounds he received during an attack on June 8, 2018, at a small outpost near the town of Jamaame, about 200 miles southwest of Mogadishu, the capital. He was hit with shrapnel from a mortar round, peppering his face, neck, stomach and legs, starting an hourlong effort to save his life. Three other Americans and a Somali soldier were wounded in the attack by militants from al Shabab.

The investigation’s documents also highlight the disparity in resources between different countries overseen by the American military command in Africa. Failures from the Oct. 4, 2017, ambush in Niger that left four American soldiers and five Nigeriens dead pointed to a lack of medical evacuation support, overhead surveillance and intelligence about their enemy.

But despite the influx of resources in Somalia, where troops there had medical helicopters minutes away and drones orbiting above them, the Shabab militants still managed to organize a rapid and deadly attack that killed Sergeant Conrad before they quickly disappeared back into the underbrush without detection.

Around 2:45 that afternoon, minutes after small-arms fire was directed at the American and Somali outpost, mortar fire landed within the position. The firefight was fast and intense. The blasts from the mortars immediately wounded Sergeant Conrad and the three other Americans.

Sergeant Conrad in Somalia last year, in an image provided by his family.
Sergeant Conrad in Somalia last year, in an image provided by his family.

As the Americans scurried to tend to the wounded, Sergeant Conrad complained about the pain from the injury in his left leg, the documents say. Although he was still alert, blood from the wound in his jaw was slowly suffocating him. Ultimately, the team’s medic performed a surgical cricothyrotomy, in which he would cut into Sergeant Conrad’s neck — at his cricoid membrane — before inserting a tube that would allow unobstructed air to flow into his lungs.

The medic, whose name was redacted in the report, noted the spot with a marker before making a vertical, then horizontal, incision. Sergeant Conrad twice dislodged the tube, labeled in the report as a Shiley tube. The team’s medic tried at least once to make his initial incision longer in an effort to open the newly made airway.

Sergeant Conrad was still breathing when he was loaded in a truck to rush him to the landing zone. Two HH-60 Pave Hawk helicopters, crewed by elite Air Force pararescue medics, were racing from a larger American base outside the town of Kismayo, roughly 40 miles away. The helicopters arrived about 15 minutes after the Americans called for the medical evacuation.

Three of the wounded Americans, including Sergeant Conrad, were loaded onto one of the Pave Hawks, where those aboard began their own assessment. One of the pararescue team members started using a bag valve mask to push air into a newly inserted tube that was placed in the same incision made by the Green Beret’s medic. The Air Force medic noted that “the compression of the bag valve mask had become more difficult.”

At around 3:15, the flight arrived back at Kismayo, where a surgical team was waiting. Sergeant Conrad was pronounced dead about 15 minutes later.

The investigation found that “although fully qualified medical personnel made multiple attempts to establish an airway via surgical cricothyrotomy” on Sergeant Conrad “after he received his injuries, no incision was made through the tissue plane into his airway. This might have contributed to SSG Conrad succumbing to his injuries.”

To be sure, a cricothyrotomy in a combat zone is fraught with hazard and is often a last-ditch effort to help someone’s breathing. Even in a controlled environment, such as a hospital, the procedure is extremely challenging.

“The attempted procedure under the conditions that existed on June 8, 2018, was extraordinary in itself,” the report says. An addendum to the investigation stated that the Special Operations Command that oversees operations in Africa, and subsequent units, had already moved to review medical training related to the procedure.

Ultimately, the investigating officer concluded that no “individual, unit or organization acted in a negligent manner” during the operation and ensuing medical care.

The American military’s Africa Command had no immediate comment on the investigation.

The Green Beret team’s mission on June 8, alongside their Somali counterparts, was to push into Shabab-held territory, where the militants had been instigating attacks from, and build the small base that would later be renamed after Sergeant Conrad.

Sergeant Conrad, from Chandler, Ariz., joined the Army in 2010 and was trained to interact with local populations to glean information about militant groups. He had been to Afghanistan twice before finding himself attached to a Green Beret team from Third Special Forces Group in Somalia. When he was killed, his team had less than a month left on their deployment. He was posthumously awarded a Bronze Star with valor for running out in the early minutes of the firefight on June 8 and ushering a civilian linguist to safety.

The Shabab, an extremist group that has long tried to overthrow Somalia’s Western-backed government, has lost much of the territory it once controlled, but Pentagon officials fear the group still might be growing in Somalia and elsewhere in East Africa. Last month, Shabaab militants attacked a Somali air base used by American forces with multiple car bombs, injuring civilians there.

About 500 American troops are in Somalia, and they are mostly Special Operations units. Last year, after a broad review under Jim Mattis, the defense secretary at the time, the Pentagon announced that it was reducing the number of troops on the continent. In 2017, a member of the Navy SEALs, Senior Chief Petty Officer Kyle Milliken, was killed and two other American troops were wounded in a raid 40 miles west of Mogadishu.

The focus on providing emergency medical care to wounded troops in what is called “the golden hour” has long been a concern of Defense Department officials, especially during the height of combat in the wars that followed the attacks of Sept. 11, 2001. As defense secretary in 2009, Robert M. Gates became concerned that the rugged terrain and vast distances of the Afghanistan war zone were keeping wounded troops from reaching hospital care within 60 minutes.

Mr. Gates ordered more helicopters to Afghanistan to evacuate wounded troops, and directed that helicopters previously set aside for rescuing downed pilots be reassigned to medical evacuation. Mr. Gates also increased the number of field hospitals.

A peer-reviewed medical study published in 2015 found that those initiatives saved an estimated 359 lives from June 2009 to March 2014. Applying the same standard to operations elsewhere has proved difficult, as was evident in the ambush in Niger.


Thomas Gibbons-Neff is a reporter in the Washington bureau and a former Marine infantryman. @tmgneff