Snow!

One of our Bunkers in the Snow

For some reason, lots of folks don't realize how cold it gets in Afghanistan.  Most of the country is very mountainous.  We are in a high plain with a desert climate, surrounded by beautiful mountains.  It has rained once since my arrival - a five minute drizzle in October!  That was one of the first days that were overcast.  The mountains had a slight dusting of snow for a couple of weeks near their peaks.  Most of the time, the sky is very blue, with bright sunshine, no clouds and no wind.  The temperature at this time of the year has highs in the high 40s to low 50s, and lows in the high teens to low 20s.

Snow on Insulated Tents

The FST's Gator

Today, we awoke to a light dusting of snow!  As the sun rose, the mountains were beautifully blanketed with the white stuff.  It has remained cloudy all day, and the visibility is rather limited, but I have included a few pictures of the snow on our tents and mountains.

Snow on Mountains as seen from Airborne Hill

There is much beauty, even in the most desolate places on Earth.

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.  

Transition

The Last Soldier from the 909th Leaves the Sleep Tent

I can now announce that the 909^th FST has left the FOB.  They have been replaced by the 1982^nd FST, from upstate New York.  When the 1982^nd arrived at FOB Shank a couple of weeks ago, the folks from the 909^th moved out of the sleep tent to the transition tents.  Those of us who are the 90 day “boggers” (MDs and CRNAs) were able to remain in our hooches, since our time is not up yet.  The new guys have benefitted from the construction that the 909^th left behind that makes each bunk a home with at least a little privacy.

During transition, there is a process called “left seat – right seat.”  After a tour of the facilities and the FOB, the different sections of the FSTs meet with their replacements to discuss the operation of the facility and the doctrine that has worked in the past.  When the first couple of casualties arrived, the 1982^nd watched the 909^th in action.  Then the process was reversed, and the 909^th observed the 1982^nd, just to give advice help with the location of supplies, etc.

The 1982^nd has quickly adapted to life on the FOB, and will perform their duties well.  They are skilled providers of quality medical care, and have already begun saving lives.

The 909^th will be missed.  During their year here, they have provided life saving services to more patients than any other FST in CENTCOM.  Their officers and NCOICs have provided incredible leadership with flexibility when appropriate and discipline when necessary.  The unit has endured harsh extremes of weather, and failure of infrastructure resulting in power outages.  They have treated patients from the FOB who had received injuries from indirect fire, only to experience repeated IDF during the surgical repairs of those injuries.  Many members came to Afghanistan as young men with little sense of direction or ambition in life.  Those same folks are leaving with life experiences that few will ever understand.  They have seen the death of soldiers that they have worked with every day.  They have had the incredible feeling of implementing the interventions that they have been trained to do and watching a fellow soldier survive because of what they did to save him.  Many of these men now have plans on attending medical school or becoming a nurse anesthetist.

An Empty Bunk - the 909th has Left the Building...

Having lived and worked with the members of the 909^th, I can honestly say that this has been the best unit that I have ever been a part of in all 20 of my years in the Army.  My hat is off to MAJ Provenzano, DET SGT Biesiadecki, the officers, NCOICs and enlisted members of the unit.  I have made lifelong friends of many of you. 

To the members of the 1982^nd, let’s “get this done!”  Here’s to a great year – and I hope you will come away with the same feelings as your predecessors.  You have large shoes to fill, but I’m sure, from what I’ve seen, that you are up to the challenge!

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.  

Christmas at the FST

Trauma Entrance

Just because we are away from our families this Christmas doesn’t mean we can’t experience the fun and camaraderie of the holiday season.  We just celebrate our own way, with our deployment “family.”  Tonight we had a party in the ICU, complete with goodies from family members, smoked salmon, crackers, sausages, candy, etc.

Beer Pong

The ICU (Party Room)

Having a daughter in college, I am very familiar with the game “beer pong.”  I have never played, however.  Tonight I experienced the game first hand.  If you aren’t sure what I’m referring to, Google it (that’s what I did when I began seeing certain Facebook pictures).  Being a drinking game, and operating under “General Order Number One” (no alcoholic beverages may be consumed anywhere in country) presents a dilemma.  Fortunately, the DFAC has non-alcoholic beer.  I don’t see the attraction, but it is a popular item with the troops.

Non-Alcoholic Beer

This message is for the families and soldiers who are separated this Christmas by war.  Holidays can be very happy times, and they can bring sadness, as well.  Don’t dwell on the hardships, but cherish the love you share with each other that distance can’t take away.  Contact each other and celebrate over the phone or with Skype.  Having done this before, I can tell you that deployment holidays can be some of the most memorable I’ve experienced.  The separation and sacrifice can make you realize the true meaning of love and relationships.  It will make the times you’ll share together in the future that much better.

From FOB Shank, Merry Christmas!

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature. 

Christmas Shopping at FOB Shank

Afghan Wal-Mart

The PX

They Always have Cigarettes...too bad the Soldiers don't get the Message...

As (I assume) most of you are tackling the traffic and hoards of shoppers at the malls, I would like to show you how we shop here at FOB Shank.  First of all, there is the PX, or Post Exchange.  This is an extension of the familiar shopping site present at each military post or base in the States.  Known for great prices and no sales tax, the PX has long been one of the favorite benefits of many service members.  Unfortunately, there is usually nothing for sale!  The supply lines through Pakistan are frequently hijacked, and nothing gets through.

Spelling isn't their Forte

It isn't quite Ranger Joe's - Trust Me!

Our other option is the “Bazaar.”  This is a small row of shops run by local national civilians who commute to the FOB every day, at great risk, to sell things to US soldiers.  If you are in the market for a fake watch, IPod, DVD player, or illegal copies of DVDs, you can find them here!  The DVDs are hysterical – when a movie comes out on a Friday in the US, you can buy it on DVD here on Saturday!  3 for $5.00!  Sometimes they even play in your DVD player!  The copies frequently were made from a camera in a theater, and you can see people get up and go out for popcorn refills!

Carpet Shop Owner making us Lunch

Lunch at the Carpet Shop

There are some high quality items for sale, as well.  There is a carpet shop that has Persian silk rugs for sale that cost in the thousands of dollars.  You have to be a savvy shopper, however, to know how to spot the valuable items.  One day in November, the carpet shop owner invited the FST surgeons and CRNAs over for lunch.  We sat on the floor (on a carpet!), and had a stew made with lamb and rice.  Everyone had a loaf of flat bread in front of him.  You tore some off, and used it to scoop some of the stew from the communal bowl.  It was really quite good, and nobody got sick!

Afghan Restaurant - Best Pizza and Burgers on the FOB!

One of the most popular spots is the Afghan Restaurant.  It is quite small, and has a rather limited menu.  The pizza and burgers with fries are a big hit!  Oh, and they also serve kebabs.

Obviously, the best way for us to shop for needed items is by using the Internet.  Unfortunately, when you order something, it can take 2-4 weeks to arrive.  It isn’t uncommon for items to get lost in the mail, as well…

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.
    

Mild Traumatic Brain Injury

SGT Dixon, CPT Johnson

Most of the casualties seen at the FST were the result of some type of explosion.  Mild traumatic brain injury (MTBI) is a frequent occurrence.  Even with no outward signs of injury, the concussive blast can cause microscopic minimal brain damage.  The patient may have headaches, be irritable, show signs of depression, be unsteady on his feet, or have slight memory loss.

In the U.S., a person who presents in the emergency department of virtually any hospital with such symptoms will receive a CT scan of his brain to rule out more severe problems such as intracranial bleeding.  MTBI, however, will not show up on a CT scan.  It is a rather subjective diagnosis.  There are only 2 CT scanners in Afghanistan – at Bagram and Kandahar, the two large airbases.  If we medevaced every casualty that had potential MTBI for a CT scan, we would quickly run out of soldiers to accomplish the mission!  This was done early on during the war, and most soldiers never returned to duty.

2 Story Deck

FOB Shank has an MTBI clinic, run by CPT Johnson, an occupational therapist.  This clinic has been in operation for almost one year.  SGT Dixon, a certified occupational therapy assistant, assists CPT J.  When a casualty arrives at the FST, one of the MTBI staff members is present and does an assessment as soon as possible.  The patient will be asked to repeat lists of numbers, recite the alphabet in reverse, state the name of the President, etc.  They will receive an assessment of all cranial nerves to check for severe brain damage.  Anyone who shows signs and/or symptoms of brain damage is sent immediately for a CT scan.

MTBI Lounge

Those who appear to have MTBI will be sent to the MTBI clinic.  Here they will be completely removed from their unit and its activities for a couple of days to a week or more.  They will be able to relax in a comfortable environment with a comfortable bed and lounge area.  They may watch TV, play video games, and even bowl!  CPT J and SGT D are assessing and treating them during these activities.  Balance can be checked with Wii Fit.  Concentration can be assessed during games.  Long talks can reveal intimidation and depression.

One of the Bunks

Due to the intervention provided at the MTBI clinic, 99.7% of MTBI casualties have returned to duty this past year.  There have been no misdiagnoses of more severe brain damage.  This has kept the fighting force strong while conserving needed resources.  The program has been so successful that CPT Johnson has trained three additional teams that are currently deployed in RC East FOBs in Afghanistan, and an additional three teams are planned for RC South in the near future.

Bowling Alley

CPT Johnson is a unique individual, to say the least!  I like to think of him as a cross between a game show host and a used car salesman!  He has done an excellent job of selling the benefits of his program to the command structure and medical providers in the war zone.  He also has made the clinic a place where soldiers can come to relax and unwind.  An example of his resourcefulness has been his ability to network with colleges and universities to sponsor the clinic for a month at a time.  Clubs, fraternities and sororities will send “care packages” with clothing and goodies during their “month.”  They also usually send banners posters, t-shirts, etc. to demonstrate their school spirit.  Each of the bunks at the clinic has a particular school’s theme.

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.
   

"Charlie Med"

The Red Crescent is an International Symbol for a Medical Institution

The FST is fortunate to be located adjacent to Company C of the Brigade Support Battalion.  It is affectionately referred to as “Charlie Company.”  This unit is an active duty component of the 4^th Brigade Combat Team, 10^th Mountain Division, out of Fort Polk, LA.  They succeeded the 173^rd Airborne BCT out of Germany.

The Entrance into the Charlie Med Aide Station

Charlie Company takes care of the medical needs of the BCT, whereas the FST supplies emergency trauma surgical services.  The combat medics (68Ws) assist us when helicopters arrive with wounded soldiers.  They meet the chopper and help transport the wounded into the FST. 

Sick Call Registration

One of the Patient Treatment Bays in the Charlie Med Tent

C-Med has a patient holding area for sick soldiers who need to be cared for in a hospital setting until they can return to duty.  They also run a walk-in sick call clinic.  Most of the people using these services have colds, upset stomachs, need stitches, have sprains, etc.  If someone needs non-emergent surgery (i.e. – gallbladder removal), he will be sent to Bagram, where the surgery can take place in a controlled, more sterile environment.  Our surgeons could easily take care of them, but we would not be available for trauma cases, should they arrive.

Two Highly Capable C-Med Medics, Ready for Action!

The Charlie Med Pharmacy

The medics of Charlie Company are also tasked to support missions outside the wire.  Many of the 173^rd earned the Combat Medic Badge during such missions.

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.
  

The "Walking Blood Bank"

SSG Dennull and SGT York

The FST is co-located with the C company of the BSB (Brigade Support Battalion).  C Company renders medical support to the Brigade, hence the name, "Charlie Med."  One part of Charlie Med is the laboratory.  The lab is staffed by SSG Dennull, who is the NCOIC of the blood bank, SGT York (no kidding, that's his name!), the NCOIC of the laboratory functions, and SPC Gaddis.

SGT York runs a lab test

The laboratory can run most of the usual tests that a physician may order during sick call.  They can even run cholesterol checks on soldiers over 50 for their periodic physical exams.

When the FST gets a trauma victim, the lab really shows their stuff.  As soon as a casualty arrives in the ATLS section, at least 2 large bore (16g) IVs are started and a blood sample is drawn and sent to the lab for a "trauma panel."  This checks the blood for electrolytes, blood gases, clotting factors, and red blood cell concentration.  This gives us information as to how much blood has been lost, whether or not the blood has the ability to clot, and how well we are ventilating the patient.  The lab also checks for the patient's ABO/RH (blood type).  This information is on the patient's dog tags, but we don't trust it.

Type O Packed Red Blood Cells from the Red Cross

Fresh Frozen Plasma

If blood is needed, we start with type O packed red blood cells for everyone.  Type O is considered the "universal donor."  We usually give fresh frozen plasma with the PRBCs, to add the necessary volume and clotting factors.  The bank stocks a par level of 40 units of O Pos PRBCs, 40 units FFP, and 20 units of cryoprecipitate (another clotting factor.)

If it looks as if we are going to need many units of blood, we activate the "Walking Blood Bank."  The lab maintains a list of soldiers on the FOB who have consented to being blood donors when needed.  These persons can be called at a moment's notice when their blood type is required for a casualty.  They have been prescreened for HIV, hepatitis, ABO/RH, antibodies, and RPR.  The lab folks just take a unit and run it back to us.  This blood is type-specific, meaning that it is the same blood type as the patient.  It is still warm when we administer it!  Whole blood is the best at carrying oxygen and clotting.  Many lives have been saved this way.

When to activate the Walking Blood Bank is a tough decision.  We need to make the call early, as it will take at least 45 minutes to get the first unit.  How many units to ask for is a hard call, as well.  We want to only take what is needed, since the donor will not be able to give again for 56 days.  Some blood types are rare.  We only have 10 donors who are type AB Positive, for instance.

The database of screened blood donors currently has approximately 350 soldiers.  Another 450 have been prescreened, and will be added to the database as soon as they are approved by the lab at Bagram.

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.
 

Support from Home for Our Wounded

A Homemade Quilt

As soon as a wounded soldier is taken off of the helicopter on arrival to the FST, he is taken to the shakeout shed.  Here, triage is done, and all clothing is cut off.  After treatment,  most are evacuated to Bagram Air Field, followed by Landstuhl, Germany, and then Walter Reed in the States.  All of his clothing and personal effects will still be in Afghanistan.

Another Gift of Love and Support

We have a terrific supply of shirts, sweatpants, socks, slippers, underwear, etc. that have been donated by patriotic citizens of the US who want to support our wounded heroes.  Right before they get on the helicopter to leave us, they are dressed comfortably.  They are given a toiletry kit made of donated items.  They will also receive a blanket or quilt, usually homemade.  Many of these quilts come with a personal letter from the maker thanking the serviceman for his service and wishing him a speedy recovery.  What a terrific way to express one's gratitude!  These quilts exude love!

Sewn on a Handmade Quilt

Letter Sent with a Quilt

The majority of the clothing and toiletry items are sent to us by the Landstuhl Hospital Care Project, a non-profit group from Virginia.  These folks are in constant contact with the hospital in Landstuhl, and the deployed medical units in Afghanistan and Iraq.  When supplies of a particular item are low, they post it on their website, and citizens may donate them, or send money for the purchase of the needed supplies.

People are always wanting to send "care packages" to me and others in my unit.  While we certainly appreciate the support, we really do not need anything that is not provided for us already.  Frankly, sometimes items that people back home have purchased for us and lovingly sent here go unused.  If you would REALLY like to help, I strongly suggest that you go to the LHCP website, at:

www.landstuhlhospitalcareproject.org

From the homepage, click on "how to help."  This will take you to a page that lists specific items that are urgently needed.  You can also make a monetary donation.  Believe me, you will be making a difference in the life of a wounded soldier!

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.

Thanksgiving in a Theater of War

Ready to run!

How do we celebrate Thanksgiving at a Forward Operating Base in Afghanistan?  Well, for starters, there was the Fallen Heroes 5K run at 0630!  This run was to honor the memory of soldiers from the 27th Engineer Battalion who have "paid the ultimate price" during this deployment.  As usual, the 909^th showed everyone how athletic they are by blowing away the competition.   

At 1000 the strongman competition started.  This unit has some SERIOUS weight lifters, and they came away with several medals.

At lunch and dinner, the senior officers and NCOs of the 10^th Mountain 4^th Brigade Combat Team served a delicious dinner with all the fixin’s.  The DFAC tent was decorated well, too!  General order #1 prohibits the consumption of any alcohol in a war zone, but we were served sparkling grape soda poured from champagne bottles!

I’ve been getting emails from friends who seem to feel sorry for us at this time of year.  Don’t!  Being deployed isn’t a bad thing.  Sure, there are certain hardships, and the separation from family and friends can be a drag, but we have much to be thankful for!  When you live and work in an austere environment such as this, it makes you realize how fortunate we are to live in such a beautiful and bountiful country, the USA!  It makes you prioritize what is important in life, and not “sweat the small stuff.”  We cared for two severely injured Afghan soldiers today, who are fighting to protect a way of life that is vastly different from anything we are used to.  These men truly are risking their lives – their friends may be Taliban tomorrow.  Aren’t you glad that we don’t have to live like that in our country?

On this Thanksgiving Day, I hope that you can truly appreciate the freedoms that we have, and the bounty that we all share as US citizens.  The war on terror is here, not at home.  Let’s keep it that way!

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.

The 909th Command Structure

SFC Biesiadecki, CPT Murphy, MAJ Provenzano

The Commander (OIC - Officer in Charge) of the 909th FST is MAJ Provenzano.  As a civilian, "MAJ Pro" is a nurse anesthetist.  He oversees all functions of the FST.  He is quite an athlete, as well.  His emphasis on fitness is quite contagious - this is the most athletic unit that I've ever served with.

The Detachment Sergeant (NCOIC - Non-Commissioned Officer in Charge, or First Sergeant) is SFC Biesiadecki.  SFC "Bies" works as an elevator mechanic when not in the Army.  He oversees the enlisted members of the unit.  His responsibilities include water, power, discipline, evaluations, supplies, training, movement, and anything else that the unit does!  His is a 68W and M6 which stands for Licensed Practical Nurse.

CPT Murphy is the unit's XO.  As an officer in this position, he is responsible for PAD (Patient Administration).  He tracks patient movement and assists the commander in arranging medevac flights.  He also manages the unit's equipment inventory.  In the civilian world, CPT Murphy teaches 8th grade science in a public school.

MAJ Provenzano, Commander, in the TOC

The office in which the command structure personnel work is referred to the TOC - Tactical Operations Center.  Here they are able to communicate with other medical assets in the theater of operations.

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.

The Providers

COL Giles, MAJ Ochsenknecht, CPT Khalil, LTC Koutlas, MAJ Jordan

The Army uses the term "providers" to mean any licensed independent practitioner in the Medical Department.  In an FST, this includes doctors and nurse anesthetists.  Medical units may have physicians’ assistants and/or nurse practitioners, dentists, optometrists, etc.

Usually, the providers of an FST rotate in for 90 days at a time, unless they are extended.  (Of course, the Army can do whatever it wants!)  This policy came about after the first Gulf War, after which many medical practitioners who had been activated lost their civilian practices and subsequently resigned their commissions.  Other members of the unit deploy for approximately 12 months.

"Joker" repairing a vascular injury

LTC Koutlas, MD, has been a reservist for about 6.5 years.  His radio call sign is “Joker.”  This is his 3^rd mobilization; he has previously served for two tours in Iraq.  A resident of North Carolina, he is a pediatric and adult cardiac surgeon.

"Sawbones" repairs a muscle injury with help from Nguyen

MAJ Jordan, MD, “Sawbones,” is our orthopedic surgeon.  As a former infantry officer (HOO-AHH!), he was deployed with the 1^st ID in Kosovo.  He is the only active duty soldier in the unit.  Due to his expertise, he not only performs surgery, but he also sees many clinic patients who require orthopedic consults.

"Ox"giving a spinal anesthetic

MAJ Ochsenknecht, CRNA, “Ox,” has 19 years of military service under his belt.  He is a prior enlisted soldier who was a member of the signal corps.  This is his 5^th mobilization, 4^th time overseas, and the 3^rd deployment to a combat zone.

The author, "Underdog," passing gas

COL Giles, CRNA, “Underdog,” (me), just completed his 20th year of service.  This is his 7^th mobilization, 3^rd overseas, and 2^nd in a combat zone.  

"Rambo" in action

CPT Khalil, MD, "Rambo," is our other general surgeon.  He brings to the FST his expertise as a general surgeon, trauma specialist, and critical care provider.  He would like nothing better than to go "outside the wire" on a mission.  Fortunately for us and the wounded soldiers, providers will always be "Fobbits," a term for those who never leave the FOB. 

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.