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.

The ICU

It has been a while since my last entry.  For various reasons, we have intermittent internet and telephone blackouts that can last for days.  That being said, here is today's entry...

SSG Neumann, SGT Ford, CPT Ysmael, and SGT Anderson

The ICU is commanded by CPT Ysmael, who works as a neonatal ICU nurse as a civilian.  The NCOIC is SSG Neumann, a pediatric RN.  SGT Anderson is a police officer when not on active duty, and SGT Ford is an LPN who works in a dialysis unit.

The ICU is a multifaceted unit.  When patients are waiting for surgery, they are moved to the ICU from ATLS for monitoring, stabilization, etc.  After surgery, the ICU functions as a recovery room.  At times, minor surgical procedures are performed in the ICU to avoid tying up an OR bed which may be needed for more seriously wounded soldiers.

The ICU team in action, with CPT Johnson modeling his new Multi-Cam Uniform!

The ICU has the capability of holding up to four ventilated patients for up to 72 hours.  Most patients stay postoperatively for less that an hour.  The staff is responsible for preparing them for MEDEVAC transport.   Temperature is a real concern – great pains are taken to assure that the patients remain warm.   Riding in a Blackhawk helicopter can make people cold in a matter of minutes.  Patients are given blankets called “Ready Heats” that become warm when exposed to air, and space blankets.  We also have handmade quilts that are donated to the FST.   I’ll blog about them at a later date.

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 Operating Room

The Operating Room sits between the ATLS section and the ICU.  It is equipped and staffed for two simultaneous operations, but the second bed is reserved for absolute life and/or limb threatening emergencies.  We try not to have all of our OR assets tied up in case something more urgent arrives.

LTC James, SPC Nguyen, SSG Penn, and SPC Thomas

LTC James is the OIC of the OR section.  He has 22 years of military experience and works as an operating room nurse in civilian life.  SSG Penn is a firefighter/paramedic when not activated.  He has almost 20 years of military service, and functions as a second circulating nurse when necessary.  SPC Nguyen manages a nail salon at home, as well as being a personal trainer.  SPC  Thomas works as a personal trainer.

SPC Nguyen assists 2 surgeons (LTC Koutlas and MAJ Jordan) simultaneously

Penn, Nguyen and Thomas have all received the 68D MOS, which is "Operating Room Technician."  The Army course is 16 weeks in length, at which time they are taught sterile technique, basic surgical skills, and instrument nomenclature.  They must log many hours during actual surgical cases to graduate.  Thomas just graduated last December, and was immediately activated!  These men do a remarkable job.  Unlike their civilian counterparts, they frequently first assist while providing help to another surgeon at the same time.  It is not uncommon to have an orthopedic procedure taking place simultaneously with a general surgery operation on the same patient.  These soldiers have learned to suture, insert chest tubes, perform cricothyrotomies, and apply external fixations to broken bones.  Not many civilian OR Techs can boast about having those skills!

Dental Autoclave

Big Bertha

The OR staff is responsible for sterile supplies for the FST as well as several combat outposts.  Usually, FSTs are supplied with one dental autoclave for sterilizing instruments.  We are fortunate to have a "Big Bertha" full-sized autoclave that can handle larger instrument sets.  It is an amazing machine.  We power it with electricity, but it can also use almost any fuel, including kerosene, gasoline and JP8 jet fuel!  It is not as fast as a civilian autoclave.  It takes 15-20 minutes to "flash" an instrument, depending on the ambient outside temperature.  We also have 2 water distillers for use in the autoclaves.  The surgeons who rotate to the FST must be able to operate with a minimal instrument selection.  We have major, minor, thoracotomy, craniotomy, vascular, and ortho sets, but they are very basic.  Separate instruments are "peel packed" to supplement the sets.

Not all casualties need to go to the operating room.  Sometimes, minor wounds are cared for in ATLS or the ICU.  The OR is reserved for serious injuries that cannot wait for the flight to a combat support hospital.  We basically stop bleeding, apply external fixation to broken bones, shunt vascular disruptions, and stabilize the patient for transport to a level 3 facility.

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.

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.