The following are 2 letters from Dr. Sam Aldridge written during the early part of his deployment to his hospital back home at LRG Healthcare. These are re-published with his permission. I have added photos to his letters for the FaST Surgeon readers. The letters may provide a better understanding of Forward Surgical Team life in Afghanistan as it stands at FOB Shank, 2010.
Additionally, these letters relate to the "accidental charity" that Sam started with just
"A Whisper". This complete story appears on
Michael Yon Online Magazine. One of Sam's first letters can be found
here.
LETTERS FROM DR. ALDRIDGE TO LACONIA REGIONAL GENERAL HEALTHCARE
Hey LRGHealthcare,
The 909th FST is now firmly rooted here and has enacted some very positive changes. We have organized our facility better and enlarged the OR's, and patients flow through our facility more smoothly now that some of the obstructions and clutter have been addressed.
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| View on the backside of the 173D Airborne BSB Charlie Med facilities |
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| Our "Urban Renewal" Project - Improving the medical facilities at FOB Shank |
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| These projects provide income to the local skilled labor in and around Logar Province, Afghanistan |
Our FST is further blessed with a superb medical company (C company, aka "Charlie Company," aka "Charlie Med") from the support battalion of the 173rd Airborne. They provide daily medical care for the 173rd Airborne Troops and their Ranger unit but Charlie Med has no surgical capabilities.
Typically, an FST is a stripped down resuscitative/damage-control surgical unit with no lab or x-ray, but our association with Charlie Med greatly expands our capability and equipment, providing plain x-ray and rapid labs and a much more organized bloodbank.
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Xray services provided by 173D Airborne BSB Charlie Med Company.
SGT Wiermann (L) and SPC Hall (R) are xray technicians of the 173D
Photo By: LTC Bruce - 909th FST |
To give you an idea of how our system works, allow me to describe what occurs after a soldier is injured. Let’s say you are one of the rangers living and working from one of the dozen or so COB’s (combat operation base, much smaller and less secure than a FOB) in our task force's AO (area of operations) and while raiding a weapons cache where IED's are made. A remotely-triggered IED blast injures one of the Afghan National Army soldiers working with you, knocking him unconscious and peppering his neck and both lower extremities with fragments. He is dragged to safety, but a fire-fight ensues in which 3 Taliban are killed and you have suffered an AK-47 round through your forearm, fracturing both bones and bleeding profusely. (I know this sounds like Hollywood, but it is actually the daily reality for the combat troops here.
How would you like to eat breakfast everyday knowing this is the workday ahead of you?!? I live among these guys, see them at the gym, in the D-fac, (dining facility) and other places. Even so, I take what they do for granted, until they fly back in all exploded or shot-up, then I chastise myself for not thinking of them every minute of the day.) Sorry for the digression. Back to our injured soldiers.
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| SGT Ledoux of the 173D Airborne BSB Charlie Med Co. provides top of the line lab services. |
Number 1.If possible, remove yourself from the line of fire. Number 2. SABA, "Self-Aid, Buddy-Aid", the Army loves acronyms, but it also loves simplicity and repetition in training because it saves lives. Seventy percent of survivable battle injury is extremity injury (remember helmets and body armor) and death is from uncontrolled hemorrhage, so the Army provides a very effective nylon-velcro combat tourniquet with locking windlass to every soldier and all are trained in proper use. SABA is their mantra in the chaotic fear-drenched world of the battle-injured, when more complex first aid algorithms are impossible to recall. "Apply your tourniquet first, because if you bleed to the point of incapacity or die, you are no help to your buddy."
Number 3. "MEDIC!" Everyone knows this step from the movies, and truly, every platoon does have a highly trained (EMT level) member. The medic or other Team member calls in a "nine-line" standard casualty radio report which is a simple who, what, where (with coordinates), landing zones, security concerns etc. When the TOC (tactical operations command) receives the "nine-line", they notify the Medevac helicopters (usually only one for patients, but an armed escort bird always goes as well, and can carry patients too), "Charlie Med", as they provide security at the medevac pad, serve as the litter bearers to off-load patients and help with the initial triage. And of course, the FST is also notified, and we always turn out 100% as we have no shifts and all twenty people are needed until we see what we are up against. Many times two injured are reported, but the bird arrives with 2 or 3 extra.
The FST is immediately adjacent to the Helipad, but behind a blast wall. The litter teams and flight medics unload the patients into a triage area where the FST commander and the surgeon of the day determine which patients are seen first.
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MedEvac rolling in to HLZ with members of 173D Airborne Charlie Med and 909th FST waiting to receive patient.
Photo By: LTC Aldridge - 909th FST |
From here a trip through heated and brightly lit connex container where US troops are relieved of their weapons, ammunition and ordinance (sic) by the Charlie Medics before they enter the ATLS (advanced trauma life support) section of the FST. Enemy combatants, civilians and even Afghan Army soldiers are stripped naked in the connex and searched for weapons or explosives before they enter the FST. Although many are "innocents" or cooperating combatants, they all live in a situation where the Taliban has access to their families and therefore even "trusted" locals can be coerced into suicide missions. Everyone leaves the connex covered by warm blankets on their rescue litters which remains their "hospital bed" throughout their visit.
The entire FST is housed in a double-walled, climate-controlled tent about the size of a double-wide mobile home. In one end and out the other, one travels through 3 sections; ER/ATLS to OR to Recovery / ICU. Kinda like a "surgical carwash" for blown-up people!
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MAJ Sucher evaluates trauma patient in ATLS section. (Operating room through doors in background.)
Background (SGT Ford (L) and LTC Aldridge (R))
Foreground (SSG Duffy (L), MAJ Sucher (M), SGT Hemmerle (R)) / Photo By: LTC Bruce - 909th FST |
Our ATLS section can handle 4 critically injured at a time. This section has two, 5-person trauma resuscitation teams consisting of right and left side medics, a certified Nurse anesthetist, Trauma nurse and Surgeon / team leader. We can have one team per patient or split the teams as the situation dictates. Once the triage surgeon out front returns he can run resuscitation with ICU nurses as well as our orthopod if necessary. Everyone is cross-trained, flexible and fast; lab and x-ray techs can start IV's and place Foleys, etc. It’s a highly condensed trauma dreamworld where clinical problems can't get CT scans so they get a lot of catheters, tubes and operations instead.
The OR is 8 feet from ATLS, separated by plywood barriers and shelves—nothing fancy. The OR "tables" are just specialized racks with armboards which hold the litters at an uncomfortably low height! The "door" is two shower curtains. Sweet!
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LTC Aldridge (L) prepares to assist with trauma operation
LTC James (R) keeps OR running efficiently
Photo By: SSG Penn - 909th FST |
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909th FST new operating room built by LTC James, SSG Penn, SPC Nguyen and SPC Thomas (in background)
This effectively tripled our space, giving us ample room to better care for our patients. |
Once your high-quality operation is performed for a reasonable price, you travel 8 feet to our recovery / ICU which can house up to 4 ventilated patients and less critical can spill-over into the Charlie Med ward to hold awaiting evacuation up the chain. Length of stay is usually 30 min to 8 hours in our ICU depending on future immediate needs.
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Members of the 909th FST and the 173D Airborne BSB Charlie Med prepare to evacuate multiple ICU patients
Photo By: MAJ Provenzano - 909th FST Commander |
Our patients fly via helo to a hard-walled facility at Bahgram Airfield Hospital where they have real OR's, CT scanners, general, ortho, hand and neurosurgery. After further stabilization, US and coalition forces are flown fixed-wing back to Landstuhl, Germany.
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PJ UH60 Black Hawk evacuating trauma patient to Bagram AirField (BAF)
Photo By: LTC Bruce - 909th FST |
On days when no injured are arriving (which we hope is every day!), we continue to organize and train. The 8th FST kept their autoclave outside which meant it was frozen and nonfunctional most of the winter necessitating chemical sterilization with cidex (nasty!). So our OR team built a nice heated shed to serve as our new central sterile supply.
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| LTC James, SSG Penn, SGT Hemmerle and SPC Nguyen building new operating room |
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LTC James (L) and SPC Nguyen (R) continue their perpetual FOB improvement project
FOB Shank, Logar Province, Afghanistan |
The surgery and anesthesia providers have been giving small lectures 3 days a week for the FST and Charlie Med staff. My lecture yesterday was "basic hemodynamics, inotropes and other vasoactive agents." I'm just glad Dr. Santos wasn't here to hear me oversimplify the function of adronergic receptors ‘cause I am sure he would have scowled, winced and developed a severe headache!!
FOB life rolls on in its surreal fashion.
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| LTC Aldridge using his own NFL style visual aids during daily lectures provided by the surgeons and CRNAs |
I have stopped wearing a watch because time means nothing here. Everything runs 24/7. The FST, the Helicopters, the gym, the D-fac, the Rangers—it’s nonstop. It seems the combatants perform route clearing operations during the day, but most combat missions are at night with NOD's (night optic devices) which provide an enormous advantage. They seem to like half a moon or less for optimal advantage and plan their missions accordingly. When we hear the chinook helos leaving at night on a skinny moon, we know business will soon pick up.
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| Moon over FOB Shank, Logar Province, Afghanistan |
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Time-lapse photo of the Quick Reaction Force (QRF) at FOB Shank
(The red streak is SFC Beisiadecki walking along the vehicle with his tactical red light on his forehead) |
The other surgeons and I pace around our shrunken world like worried parents who can't sleep until their teenagers are home. My Hooch is 100 feet from the FST which is 100 feet from the gym which is 100 feet from the D-fac which is 100 feet from my Hooch.
This weekend has unfortunately been steady which casualties in our AO. One route clearing convoy discharged a pressure plate IED and the occupants of the lead MRAP were tossed about unmercifully in their vehicle. One 1st Lumbar vertebral fracture and ruptured kidney, one with bilateral calcaneal fractures and three with concussions. The next day we received two local nationals exploded and shot by the Taliban (I never heard why). One peppered with shrapnel with a femoral artery laceration who had a life-saving tourniquet applied by the flight medic, and one shot in the neck suffering an arterial and esophageal injury. The 909th worked well as a team, the cases went smoothly and they all made it......this time. (whew!) A good week in Logar province: FST 7, War 0.
That’s about it for now. Say hello to all my hard-working vascular surgery bros and the rest of the LRGHealthcare Family!
Sam
LTC Sam Aldridge
909th Forward Surgical Team
FOB Shank
Sorry I haven't written sooner but we have been rather busy. The Taliban tends to be a "fair weather" terrorist organization and we have had some sunny days in the high 50's, which means more blasts and other injuries. Most of the recent victims have been Afghan National Army/Police or civilians, all of whom are recovering satisfactorily. Fortunately, there were no serious US injuries or fatalities in our AO (Area of Operations) this week.
Your emails and others from hometown friends have described an ENORMOUS community response from the LRGHealthcare Family and the Lakes Region at large for the
"Sock Drive!” The generous efforts of all those involved have sparked good cheer among my colleagues in the 909th FST and I am now deferentially referred to as the "Sock Pimp" of FOB Shank! I told them I preferred "Sock Broker" as a more socially acceptable title.
Mail delivery from Bahgram has been interrupted the last seven days as the local truck drivers were negotiating a new contract because they decided being hijacked, shot at and blown up merited a better pay scale (valid point). The helicopters are too busy with people, food and other supplies to carry mail consistently, so nearly 100,000 pounds (not a typo!) backed up in Bahgram awaiting transport to the various FOB's and COB's (Combat Operating Bases).
It all started rolling again yesterday, and with it came the first "sock deliveries," a huge box from Mary and Ellen at Granite State Surgical, with tons of socks and school supplies. We also got a fabulous goodie box with candy, socks, coffee and other cool stuff from Diane Smith (Smith Office Services). Based on what I heard from my wife and friends, I expect lots more socks and school supplies in the near future. Thank you Lakes Region Folks!!!!!! I took some pictures of the supplies being sorted and allocated by our ICU staff and will post them later this week when I get a consistent internet signal.
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| L to R: SSG Neumann, SGT Ford, MAJ Aitchison with nearly arrived boxes from Mary and Ellen at Granite State Surgical as well as boxes from Diane Smith (Smith Office Services) - Photo By: LTC Aldridge - 909th FST |
While FOB Shank may become "sock-saturated,” that's not really a bad problem to have. We can distribute to other areas via medevac and supply helos from here. The ICU staff is quite talented at arranging such "unofficial" deliveries so rest assured that we can redistribute whatever arrives.
Thanks again for all the interest—it brings everyone here great courage and enthusiasm to know that people back home care so much!
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LTC Sam Aldridge in his "hooch" writing letters back to Laconia, NH - FOB Shank, Logar Province, Afghanistan |
Sam
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| Sunset on FOB Shank, Logar Province, Afghanistan |
Footnote
- LTC Aldridge's charity began accidentally, but turned into a great gift to the villages around FOB Shank. We will continue to funnel school supplies through the Chaplain. Sam tells me that have reached sock supersaturation (in other words, please... no more socks).
The
best way to help is by finding an organized charity that does this job well. Our primary mission here is picking up and although it gives us great satisfaction to participate in charity work, we simply don't do it as well as can be done by others. One such charity is
Soldier's Angels in Germany.
Michael Yon has recommended this charity to me.
Thank you all, from Sam and the rest of the 909th FST!
