fAIRwell FORCE

After months together, we said goodbye to our Air Force contingent today. Their time in Afghanistan is complete. Mission accomplished.

Air Force team

One of the constants of military life is how quickly people move through it. Whether during deployments or at "permanent" duty stations, you often have intense relationships with fellow service members for a short period before moving on. Anyone who has served on active duty understands what I mean. Friends come and go rapidly.

Last goodbyes.

We appreciate all that the nurses and medics of the 466th Fighter Squadron did to serve the wounded and contribute to the mission. Whether they go on to new military assignments or to civilian life, we wish them the best and send them off with the naval service's traditional farewell:  Fair winds and following seas.

No looking back.

There is a new team on its way and we look forward to new collaborations and relationships.

Life On The FOB: Part 9 - The Zoo

The FOB is like a quaint little hamlet bounded by hescoe barriers and concertina wire.  Okay maybe it's closer to a corrugated tin-roofed, shanty-town with satellite dishes, but why quibble?  Anyhow, just like home, it has many amenities.  So whenever, we need a change-of-pace or a little pick-me-up, a visit to the zoo always makes for a great outing.  At the FOB zoo you can see:

Canines,

Cute puppy !

Cute puppy ?

felines,

Pretty, mangy kitties.

rodents (as though you really wanted to see one),

Hands on display

the reptile bin,

Mice like trash and snakes like mice.  How sweet.

the aviary,

Hawk.  Don't ask where it came from.  Don't tell why it's here.

Birds-on-a-wire, FOB style.

and the bat cave ('Uncle' Kenny, our Green Beret-turned-OR-nurse).

Don't mess with the masked vigilante.

MEDEVAC

Patient movement is integral to our mission.  In a civilian hospital, a critically ill patient would go from the emergency room or the operating room to the ICU.  We can not do this.  The FST has limited holding capacity due to staffing, facilities, and equipment.  In addition, the military doctrine on casualty care holds that a patient is moved from Level 1 (the field) in one hour, from Level 2 (the FST) in 4-8 hours, from Level 3 (the medical centers at KAF and BAF) in 24-72 hrs, and from Level 4 (theater hospital in Landstuhl) in one week.

Post operative patient in "burrito".  Patient remains on the ventilator.  Chest tubes are connected to water seal containers at the foot of the litter.

The challenge for our team and the MEDEVAC flight crews is preparation and careful movement of patients on ventilators with the potential for sudden deterioration of their condition.  The burritos are designed for heat conservation since helo flights in winter weather can be quite cold, and hypothermia can result in bleeding and deterioration.  Portable ventilators and monitors are attached to the litters.  Blood may be sent with the patient.

Louie, our flight nurse, prepares a patient for MEDEVAC.

The litters are carried to ambulance which then transports them to the flight line.

Litter bearers

Ambulance loading.

Care continues throughout the process.

Air Force PJ tends to a patient.

Blackhawk helicopters are the workhorses of the MEDEVAC system, flying at night and in poor visibility to move patients to the next level of care.

Litter on flight line.

 

Enroute to the next level.

  
The rapid movement of patients from point of injury to a hospital in the US sometimes causes substantial disorientation for patients.  There is no gathering of one's belongings or goodbyes to their units and friends.  Imagine the shock when the soldier's last memory is lying in the dirt next to a just damaged vehicle, only to come to in a clean hospital room in the US a week later with no memory of the interim.

Resolve

After counting down midnight on New Year's Eve in the operating room while performing surgery on a Afghan Army soldier's liver damaged by a gunshot wound, we have had a slow week, and given our unit's mission, slow portends to a good year.  Don't you agree?

It is time for New Year's resolutions.  I think our main resolution is to finish the home stretch of the deployment and make it home safe.  But that seems too obvious.  Sort of like resolving to breathe, it lacks panache.  Fortunately, we have the DOD to help us out.  We watch Armed Forces Network here.  Interestingly, it is a subscription service and thus there are no commercials.  Instead, during commercial breaks we see a stream of public service type announcements, or maybe I should call them military service announcements.  "Fill Out Your Power Of Attorney Paperwork Online,"  "Gambling Can Be Addictive," "Preventing Sexual Assault Is Your Responsibility," "Obey Local Customs And Laws," "Fad Diets Don't Work," "Join the US Army European Command Band," and many, many more.  Heck there are so many potential New Year's resolutions that we can't keep up.  I wish that I could show a sample but I don't have the rights.  Not to worry because there are a couple suggestions I've found on the FOB.

Therefore, for 2011, we resolve to:

Resolving to stay alive improves your odds of keeping other resolutions. Bonus!

And if that is not enough, then one might resolve to be "The 3 B's." (I know that you think you count 4 B's but just go with it.)

Just don't BE afraid of mutual exclusiveness.

Good luck with your resolutions.

The Trauma Czar

The Washington Post ran a piece last week on the Trauma Czar at Bagram Air Field, or BAF as it is known in theater.  The article was brought to our attention in a recent edition of Stars And Stripes.  The gist of the article is how medical research is done in theater and what changes in clinical practice might result but it opened by lauding this young surgeon.  It is interesting to observe how the wheels of PR roll.

The air force major in the article is characterized as the trauma czar.  Often clinical guidelines are produced by the big theater hospitals like BAF without much input from 'down range.'  Then they wind up being treated more like protocols to be followed in that uniquely military top-down fashion.  Now at the risk of diminishing his accomplishments, which I don't intend, and at sounding like sour grapes, I want to point out the experience of our team.  Ted, our OIC, is on his third combat zone deployment as a trauma surgeon, while Paul, our medical director, is on his second.  They represent a wealth of experience in the field of trauma damage control surgery.  But we are a small team in a remote area of the country.  The Washington Post hasn't made it out to us.  Neither has this major.  My point is that what is printed in the press (and for that matter, blogs such as this one) usually only tell part of the story.   So allow me to toot our horn and leave it at that.

In other news, today, the 5th of January is exactly six months since the 5th of July, the day most of us left home.  We still have two and half months to go but are getting closer to homecoming.  There is light at the end of the tunnel.

Life On The FOB: Part 8 - Driven To Drink

Happy New Year!  We would love to toast the New Year with some bubbly.  This, unfortunately, is not going to happen.  If there ever was a place that would drive one to drink, then this might be it.  However, it is a US Central Command prohibited activity.  Heck, it's a prohibited New Jersey in-training activity as we unfortunately discovered back in July and August.  Therefore, in the spirit of making-the-best-of-your-situation, I present the Top Ten FOB alternatives to drinking.

10. Drink the near beer.

Is that a lager or an ale?  Does it matter?

9.  Drink a double expresso chai latte' while yearning for the good old days when you got 12 hour-old percolated black turpentine from a 5 gallon stainless steel coffee urn served in a mugged cleaned annually for the de-ratting inspection.  Just kidding.

Clean styrofoam cups just don't have that 'oomph.'

8.  Drink the bottled water.

Dare ya.

7.  Drink the tap water.

Double dog dare ya.

6.  Continue the quest for the clean latrine (helpful after all that drinking).

5.  Perform life-saving surgery (helps to be sober).

4.  Ponder how cool the Air Force PJ's and Navy SEALS are.

Living in the drink.

3. Ponder how cool Dave, the orthopedist, is.

Let me check that non-alcoholic label again.

2.  Tire-rolling.

Got to work up that thirst somehow.

1.  Did I mention the near beer?

It's the thought that counts.

The Year In Review

The bomb makers gave us a quiet Christmas but it was back to business as usual the next day.  Two casualties:  a ten year old boy in an IED blast with eviscerated bowel and a severed femoral artery and an eighteen year old in a car accident that somehow involved gunfire.  (We often get sketchy details, to say the least.)


Our Air Force contingent is quickly winding down their deployment.  Their reliefs are expected to arrive by mid January.  They are quite excited at the prospect of going home.


We continue to perform humanitarian work as we are able.  Dave, our orthopedist, and Kat, our plastic surgeon, have been busy trying to save the arm of fourteen year old boy with an infected bone, known as osteomyelitis, in his arm.  His infection is so advanced that the interior bone was essentially pus.  Osteomyelitis that advanced is virtually unknown in the West because it would have been treated much earlier.  So much so that Dave was having trouble finding any similar case reports in the medical literature to help guide treatment.  Compounding his difficulties was our lack of ability to perform certain diagnostic tests such as a CT scan or bacterial cultures.  Nevertheless, Dave was committed to providing the best care that he could provide.   We took the boy to the OR for a removal of dead bone, to washout the arm, and to place antibiotic "beads".  Whether the treatment will be save the arm remains to be seen.


Since it is the end of the year, it is seems worthwhile to look at the FST's year.  The numbers include the units that have preceded us in 2010 including the Army's 758th FST and the first Navy FST.

Trauma codes:  485
Operative cases: 133
Survival rate:  99%
Memorials for American KIAs: One (too many). 

Not bad for a 25-person team but then there are a whole host of other accomplishments in which we can take commensurate pride: 

Porches built:  One
Babies born to FST families while deployed:  One
Pittsburgh Steeler hats distributed: 25

Warming the heads of so many Colts, Cowboys, and Patriot fans.  Now that's an accomplishment.

Circum-navigations of the earth on the treadmill:  2.8 (Just an estimate.)
Air Force holiday parties:  Three (Impressive considering that they only started in July.  Outstanding prospects for an unprecedented 2011.)

Putting the 'fst' in festive.

Skype minutes to home: Not enough. Never enough.
Supply trucks unloaded:  A whole dang lot.
Circum-navigations of the earth by cans of 'near' beer consumed:  2.8  (Just an estimate.)
Dave the cool orthopedist moments:  Not enough. Never enough.

The Fashionista