Incoming!

From Helicopter to the Shakeout Shed

We usually have quite a bit of time to prepare for incoming casualties.  Everyone prepares his equipment, dons gloves, and waits.  It is quite calm, actually.  Most patients arrive by Blackhawk helicopters.  As soon as they arrive, the patients are whisked quickly into the "shakeout shed."  Here, their clothes are cut off, and any unexploded ordinance or weapons are removed.  A rapid triage is done.  The order of treatment is Urgent, Priority, and Routine.  A fourth category, Expectant, is for those who cannot be saved by further intervention.  They receive comfort measures, only.

SSG Hemmerle, SSG Duffy, SPC DeLeon, and CPT Abordo

In a matter of minutes, the wounded are wheeled into the ATLS section of the FST.  Teams rotate daily to care for the most urgent, second, third, etc. The ATLS staff is composed of CPT Abordo, an RN, who is the OIC (officer in charge), SSG Duffy, a paramedic, the NCOIC (non-commissioned officer in charge), SSG Hemmerle, and SPC DeLeon.  The last two are "68 Whiskeys", which means that they are graduates of the 68W school, a 6 month program including training in IV insertion, airway management, control of bleeding, chest needle decompression, etc.  The 68W is now called a "Patient Care Specialist."  This MOS has replaced the 91B designation called the "Combat Medic."  A 68W possesses the skills to be an EMT-Basic in civilian life.

ATLS Section in Action

In the ATLS, the nurse anesthetist is responsible for airway assessment, Glasgow Coma Score, respiratory care, pain control, and assessment the patient from the chest up.  The ATLS staff starts peripheral IVs and controls bleeding.  They have also become quite proficient at the FAST exam (Focused Assessment Sonography for Trauma).  This quick portable ultrasound can detect pericardial effusions as well as intra-abdominal bleeding.

The secondary assessment is done by turning the patient  from side to side to examine for further injuries.  Xrays are taken, and, if necessary, the patient is taken to the OR.

The 909th staff has performed this routine so many times, that it is poetry in motion to watch.  They are incredibly calm, effective and efficient at their duties.  There is no wasted movement.  I wish I could show you a film of them in action.  Suffice it to say, our soldiers couldn't receive any better treatment anywhere else!

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.

Before They Get to Us

Lives are being saved like never before in the War on Terror.  The IOTV (Improved Outer Tactical Vest) has armored plates that protect the thorax and abdomen.  There are side plates that protect the flanks.  I have personally seen how the ACH (Army Combat Helmet) has saved a life.  Despite these improvements in soldier protection, people still get hurt, and some die.  The two most common causes of death during this war are exsanguination (blood loss) and tension pneumothorax (collapsed lung).

IFAK

Each of us has, attached to our IOTV, an IFAK (Improved First Aid Kit).  It is to be used on the person who owns the kit and nobody else.  The kit contains a tourniquet which can be applied by the injured soldier with one hand, gloves, tape, nasal airway, compression bandage, and Z-folded gauze impregnated with a substance that stops bleeding.  Everyone carries a second tourniquet in his left trouser leg pocket.

Contents of IFAK

When a group of soldiers goes on a mission, they are usually accompanied by a 68W (Patient Care Specialist).  This is the replacement MOS of the 91B, or Combat Medic.  This person has been to a 6 month program to learn advanced life support skills and carries a medic bag full of supplies.  Many soldiers have the "Combat Lifesaver" designation, and have attended a 3 day class to learn IV insertion, airway and bleeding control skills.

Anyone who has taken a civilian first aid course has been taught the ABCs - Airway, Breathing, and Circulation.  In the military, we stop bleeding first.  The 68W has the skills to decompress a collapsed lung in the field, as well.  The improved equipment, skills, and doctrine help soldiers to survive the trip to the FST.

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 Jordanian Welcome Party

 

Some Things Just Require Video!  Enjoy!

Last night was nothing short of incredible!  The medical providers and command of the FST and Charlie Med were invited to be the guests of the Jordanian Task Force.

MAJ Jordan, LTC Koutlas, SFC Biesiadecki, CPT Khalil

The Jordanians really know how to party!  We were warmly greeted with snacks, drinks (non-alcoholic), dancing and a hookah!  We had a hot tea which was quite sweet and spicy.

The Hookah

The hookah was filled with a very mild tobacco flavored with anise.  I was assured that there was no hashish!  It was amazing to see that so many could have so much fun without drugs or alcohol!

COL Giles, COL Aref

The Jordanian TF Commander, Colonel Aref Alzaben, invited me to sit with him.  They later honored the two of us by hoisting us up and dancing around!  How ironic it is that a war provided us with such a wonderful life experience!

 The views of 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.

Downtime

Of course, not all of our time is spent caring for casualties.  Inherently, there is downtime.  A favorite time of the day is mail delivery.  Duffy drives the gator to the mail CONEX and returns it to the FST in the morning.  Since my arrival, MAJ Jordan has, by far, received the most.  This is a picture of what he received in just one day!

MAJ Jordan's Mail

It seems as if the members of the ATLS section have to have a wrestling match at least once a day.  These guys seriously go at it!  It is a great way to blow off steam when you are 20.

Wrestling in ATLS

Everyone goes to one of the two gyms at least once a day, it seems (even me!).  They are very well equipped with treadmills, ellipticals,  stationary bikes, step climbers, weight machines, and a large selection of free weights.

East Gym

Of course, there is always the internet.  Honestly, I don't know how folks survived deployments before we each had a laptop.  The service is extremely slow and very expensive, but a necessity for most of us.

In honor of Halloween, the folks in the ICU/PACU have been inviting everyone over for nightly scary movies.  If you haven't seen "Dead/Alive", I highly recommend it!

The views of 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.

Battlefield Anesthesia Delivery

COL Bill Giles, CRNA

I have just received notification that several anesthesia students have become followers of this blog.  For their education and enjoyment, this blog is for you.  As for the rest of you, bear with me.

The Ohmeda Drawover Vaporizer

The traditional device for anesthesia delivery in the FST has been the drawover vaporizer.  It requires no power, and is extremely portable.  It can be used to deliver any inhalation agent available today with the exception of desflurane.  Patients may be spontaneously breathing or controlled.  There is no rebreathing; every breath gets fresh gas.  Therefore, there is no CO2 absorption.  As you can well imagine, you go through quite a bit of agent, and quickly!  The advantage of this device is that changes in anesthetic depth can take effect much more rapidly than in a semi-closed or closed system.

Draager Narcomed M Anesthesia Machine

Our FST is fortunate enough to have a Draager field anesthesia machine.  This platform delivers anesthetic gases much as any machine used stateside.  It is compact and relatively portable.  We have no agent analysis in the field, but we can monitor ETCO2 via a Propaq monitor.  We use this machine as our primary device, with the drawover for our second OR bed.  As always, TIVA is an available option in our anesthesia armamentarium.

Of interest to the CRNA students is that in the TO&E (table of organization and equipment) of an FST, the only anesthesia providers listed are 2 CRNAs.  An MDA can only work in an FST if he/she volunteers to fill a CRNA slot, and has approved orders.  The US military recognizes quality, cost-effective anesthesia care for its heroes!

The views of 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.

Sacrifice

Incoming!

Whenever I post to this blog or write an email, inevitably people tell me that they are praying for me and they thank me for my sacrifice.  These thoughts are truly appreciated, but in many ways, I don't think I'm making a sacrifice at all.  Being a 58 year old man, whose children are grown, on my seventh mobilization, the degree of sacrifice isn't too great.  I think of the female doctor that I know who has two small children at home, and is facing 6-12 months of separation.  I am reminded of the sergeant who is facing a divorce at home.  Other soldiers worry how they can pay the bills on their Army salary.  These folks are sacrificing much more than I am.  I am even more fortunate than most, in that my employer is supplementing my pay!

As for me, I am having the time of my life!  Sure, the job can be stressful, but I can't think of anything else that I could be doing that would bring more satisfaction to my life.  I am making a difference.  People are surviving because of what we are doing here.  There is a degree of danger, but, in a weird sort of way, that adds to the excitement.  It sure beats the daily grind of a M-F, 9-5 job!

But that is not why I'm writing this blog entry.  I want the reader to be aware of the sacrifice of those we left behind in the States.  Think of the parents who have had to learn to care for the kids alone.  There are housewives learning to pay bills, cut the lawn, fix computers and combat loneliness.  In my case, my employer is having to make do with one less employee, and is required to give me my job back when I return.  This means paying overtime, and occasionally hiring temporary help.

Those of us in the 'Stan volunteered to be soldiers, and knew the risks we were taking.  The ones we left behind are truly sacrificing, for they are doing it involuntarily.  The next time you see my wife, or the family member of another deployed soldier, don't start off the conversation talking about the sacrifice of the service member.  Ask the one left behind how he/she is doing, and offer to help.  Take over a meal, serve a cup of coffee, cut the lawn, or repair the leaky faucet.  Knowing that others are calling on my wife takes a great burden from me, and allows me to be a more effective soldier.

 The views of 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.

Life on the FOB - The DFAC

                                                                      Curry Night

The DFAC is the military's way of saying "Dining Hall."  Technically, it stands for Dining FACility.  There are several on the FOB, but I've never seen them.  Some say the others have better food, but I'm content with ours.

People seem to equate the military with terrible food.  Now, I've only been here a little over a week, but I think the food is pretty good!  Every morning there is a cook that will make omelets to order.  There is always oatmeal, grits, sausage, bacon, potatoes, and scrambled eggs to choose from.  We always have fresh fruit available.  There are refrigerators stocked with milk, water, Gatorade and assorted sodas.  They even have non-alcoholic beer, since no alcohol is allowed in country.

                                                                       Diet Coke

There is always an assortment of hot foods for lunch.  The salad bar is well stocked.  There are cold cuts for sandwiches, as well.  There is a different homemade soup every day, and most are quite tasty.

Dinner varies nightly.  Every Saturday, a man goes up and down the aisles with fresh homemade pizza, which is excellent!  Sunday night is Mexican/taco night.  Every Friday is "surf and turf," which includes steak and either lobster, crab, or shrimp!  I don't eat this well at home!

                                                                  The "Dining Room"

The DFAC is open 24/7 in case you can't make mealtimes.  The salad bar, cold cuts and soup are always available.  Needless to say, nobody is starving on the FOB!

The views of 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.

Life on the FOB - The Sleep Tent

                                                                    The "Wolf Den"

The members of the Wolfpack sleep in tents, with a wall separating the males from females.  Lights go out at around 2200, and on at 0700.  Even in broad daylight, it is pitch black inside, when the power goes out (not that uncommon of an experience).  The temper tent is heated and air-conditioned.  Each soldier has his own upper and lower bunk.  Most have gathered scrap wood and fashioned some sort of shelving unit and/or desk.  Some go all out!  You would think that HGTV was here!  Drapes are used for privacy.  Internet hookups are available to each soldier, but are quite pricey, so many opt for the free Internet, which is available at the MWR tent.

                                                                       My Hooch

Sleep can be evasive, at first.  Always present is the constant background drone of the many diesel generators.  Helicopters and MRAPs operate 24 hours a day.  It is amazing how quickly you seem to get used to the noise, however.  Funny – just the sound of a cricket would keep me awake at home!

You have to get used to the lack of privacy, as well.  If you want to surf the Internet after lights out, you can, but you always must be conscious of the amount of noise you make and use a dim flashlight to see around.  Just getting up to go to the latrine at night is a chore.  You must be as quiet as possible and use a red light to see your way in the dark.  It is getting cold – pretty soon we’ll have to bundle up when outside.  Needless to say, I try not to drink too much fluid before bedtime!

                                                                          Pogey Bait

As austere as the living arrangements sound, the Wolfpack has made the best of it.  It quickly becomes home, and isn’t unpleasant at all!  They share movies and “pogey bait” with each other (I’ll let you look that one up for yourselves)  We’ve learned to feel quite comfortable in our little hooch!

What the Heck is an FST?

                                                                         The 909th FST ("Wolfpack")

An FST (Forward Surgical Team) is a highly mobile, small medical unit that is designed to render life saving surgical intervention far forward in the theater of operations.  By doctrine, it is made up of 20 persons:  1 administrative officer, 4 medical doctors, 2 nurse anesthetists, 3 registered nurses, with the remaining enlisted soldiers functioning as medics, nursing assistants, or surgical technicians.  It is usually transported by wheeled vehicles, and can be ready to receive patients in as little as 30 minutes after moving to a new location.

The mission of the FST is to care for soldiers who are too unstable to be transported to the CSH (Combat Support Hospital).  The patients are stabilized with life saving surgical procedures (stopping bleeding, application of external fixation devices to broken bones, placement of chest tubes, creation of surgical airways, etc).  Most patients are evacuated to the next level of care CSH immediately after surgery.  Many of them will be operated on again there, before further evacuation to Landstuhl, Germany.

The FST is a level 2 unit.  The combat lifesaver and Battalion Aid Station administers level 1 care.  The CSH is level 3, and Landstuhl, Walter Reed, etc. are level 4 facilities.  The goal is to stabilize and evacuate to the next level as soon as possible.

The 909^th FST is housed in temper tents, which are heated and air-conditioned.  We have an ATLS section which functions as an emergency department.  There is one operating room with 2 beds, so that 2 operations can occur simultaneously.  Just beyond the OR is the ICU/Recovery room, which can house about 4 patients.

                                                                                OR bed 1 - 909th FST

I have been on active duty with many units during my army career, but the 909th is the best I've ever seen!  Their leadership is strong, and their skills are remarkable.  When we get patients, the unit functions like a well-oiled machine.  I have worked in trauma units stateside, and the care here is as good or better!  The soldiers know they are well cared for.  This is important for their morale - they know that if they become a casualty, the FST is always ready to do what is necessary.  The 909th has seen its share of trauma since they arrived in theater.  They have had many successes, but have also faced the death of soldiers that they knew personally.  The 909th will leave behind a legacy that will be hard for the follow-on unit to match!

The views of 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.

And So it Begins!

I finally arrived at the FOB (Forward Operating Base).  After a very quick orientation to the layout, I was allowed to sleep for the remainder of the day.  I'm sure it will take some time to adjust to the time zone.  We are 8.5 hours ahead of Eastern time.  (I didn't even know that time zones could vary by 30 minutes)

It has been a while since I blogged.  The main reason has been the increased security being place on us.  While at the CRC (CONUS Replacement Center) at Fort Benning, I was forbidden from taking pictures of most of the interesting sights and activities.  As you can imagine, the same is true here.  It is going to be much harder to give the reader a feel of what we are experiencing during this deployment.  The last time, when I was in Iraq, the rules weren't as strict. 

CRC wasn't that bad this time.  It was much better organized, and the facilities have been vastly improved.  We spent about a week qualifying on our weapons, going to briefings, learning about IEDs, and getting equipment issued.  We flew to the 'Stan on 3 different aircraft.  One was a C-17, which is very uncomfortable for the soldiers, due to the wearing of our body armor and cramped seats.  Fortunately, as the ranking officer, I was able to sit in the cockpit!  I had a reclining seat that swiveled, and had adjustable lumbar support!  Whereas the soldiers didn't have any windows, I could see everything.  We flew over Dubai, and I saw the palm tree shaped man-made island at night.  I also viewed the sunrise over the mountains of Afghanistan.  It was quite beautiful!  It isn't so beautiful from the ground.

We are located on a flat plain at more than 6,000 ft. elevation.  The terrain is desert.  We are surrounded by mountains that have a small amount of snow on them.  The temperatures are very similar to the foothills of the North Carolina mountains.  The weather has been quite pleasant so far, with bright sunny days and cool evenings.  Due to blackout rules, at night, the stars are magnificent!  The Milky Way is very prominent and beautiful.  I must start doing some amateur stargazing while I'm here. 

Time to end for now.  I'll post some pics soon, I promise!