Socks for Sam

The following story is about Laconia surgeon Sam Aldridge, the doctor featured in Rick Broussard’s April Editor’s Note. In mid-January, LRGHealthcare vascular surgeon Dr. Sam Aldridge left for a four-month deployment to serve with a medical unit in Afghanistan. Before he left, Dr. Aldridge agreed to email home “Letters from Afghanistan,” to keep the many people in the LRGHealthcare family who know and care about him up-to-date on his activities. As his letters began to come in, LRGHealthcare employees started asking one question, “What can we do to help Dr. Aldridge and his unit?”

Dr. Aldridge’s response was that, while care packages would be appreciated, the greatest need is for socks for the injured locals and soldiers. He said, “We have suppliers for t-shirts, sweatpants, and underwear, but no socks, so everyone leaves with cold feet! And school supplies are like gold for the local orphanages and start-up schools. Just basics like paper, tablets, pencils, and markers would be much appreciated.”

Within days, employees across LRGHealthcare were stepping up to help, and began collecting socks and school supplies. The campaign quickly grew into a community-wide effort.

How You Can Help

Cash donations to help with shipping costs would also be appreciated. Checks may be made out to “Socks for Sam” and checks or cash can be dropped off at, or mailed to, any of the participating Laconia Savings locations. Checks may also be sent to the LRGHealthcare Office of Public Relations & Marketing, 80 Highland Street, Laconia, NH 03246.

For more information on how you can help, contact:

Danielle M. Mostoller

PR & Marketing Manager

LRGHealthcare

80 Highland Street

Laconia, NH 03246

(603) 737-1026

dmostoller@lrgh.org

Letters From Dr. Aldridge

Hello again from FOB Shank!

FOB life rolls on with a very limited and predictable routine (eat, sleep, gym, sleep, read, sleep) interspersed with moments of adrenaline-soaked resusciative/operative madness. The 8th FST that I joined have been here a year and function as a well-oiled machine. They are incredibly dedicated to caring for the injured but proceed with a calm confident demeanor that only develops after several months of this duty. They have seen so much that their collective “adrenal glands have become just smoldering pits in their retroperitineums” ( a phrase attributed to my good friend and Gilford product, Dr. Fred Millham, MD, Trauma and Critical Care Surgeon).

My unit, the 909th FST, arrived yesterday and have begun a three day overlap to transition out the 8th FST. Instead of twenty people in the trauma center we now have 40—twenty of whom are mentally “out of here”, and twenty who are anxiously trying to learn a trying, intimidating task in a strange and arduous environment. Fortunately for all involved, it is going very smoothly, which is true testimony to everyone’s professional and caring nature. The war cooperates by unfortunately providing a steady stream of “training opportunities” for the new unit to test their skills. Everyone in the 909th is holding their own and the injured are receiving great care. Five of the 909th were here in an FST in FOB Salerno in 2002, and are therefore a great asset. I spent two weeks with the whole team at the Ryder Trauma Center in Miami in November so I have developed confidence in their skills and character. This helps a lot!

Yesterday was a typical slow day of injury/illness here. A mechanic with a crushed hand and metacarpal fracture; two soldiers on patrol in a MRAP (mine resistant armored personnel) vehicle rolled over by an IED (Improvised Explosive Device) with concussions, rib fractures, forearm fracture and generally rattled; one fell off cliff with ligamentous knee injury; and one profound hypothermia. The non-traumatic medical needs of the 3000 folks here at Shank are addressed by Charlie Company of the 173rd Airborne’s support battalion. Thankfully they have a super high-speed PA and a Family Doc who address all the weak and dizzy, dysentery type stuff. They will call us for surgical consultations on appy’s , hernias etc but only once a day or so.

My internet remains disjointed and weak. The 8th is selling their satellite link to the 909th but it is currently down, so I am using the bank of computers at the MWR (Morale Welfare and Recreation) facility where we only get 30 minutes.

Word to all the LRGHealthcare family.

Peace out,

Sam

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. 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.

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.

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.

From here a trip through heated and brightly lit connex container where US troops are relieved of their weapons, ammunition and ordinance 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!

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! 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.

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.

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. 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. 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.

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. The offensive in Marjah is far south of here, has fortunately seen very few US casualties, and has its own medical assets. The basin in which FOB Shank lies is locally referred to as “the Gates of the Jihad” as it is the funnel from two major routes out of Pakistan into the Southern provinces and the birthplace of the Taliban. As the weather improves more activities are expected in this region. You probably hear more about that at home than we do here cause access to news coverage is internet dependent and that is still fragmented.

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!

Peace and Love,

Sam

LTC Sam Aldridge

909th Forward Surgical Team

FOB Shank East

APO AE 09364

Hey LRGHealthcare,

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.

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!

My regards to all,

Sam