Aeromedical Evacuation Saves Lives in Afghanistan

BAGRAM AIRFIELD, Afghanistan, May 6, 2011 — An aeromed­ical evac­u­a­tion capac­i­ty unri­valed any­where in the world is sav­ing the lives of wound­ed war­riors in Afghanistan, said the offi­cer here who over­sees the effort at the com­bat theater’s busiest aeromed­ical evac­u­a­tion point.
Equip­ment and pro­ce­dures are being improved con­tin­u­al­ly to move wound­ed war­riors to pro­gres­sive­ly more sophis­ti­cat­ed lev­els of care in Afghanistan and ulti­mate­ly, in the Unit­ed States, said Air Force Lt. Col. Kath­leen Flar­i­ty, com­man­der of the 455th Expe­di­tionary Aeromed­ical Evac­u­a­tion Flight’s oper­a­tions here.

455th Expeditionary Aeromedical Evacuation Flight's operations at Bagram Airfield
Air Force Lt. Col. Kath­leen Flar­i­ty, com­man­der of the 455th Expe­di­tionary Aeromed­ical Evac­u­a­tion Flight’s oper­a­tions at Bagram Air­field, Afghanistan, said bet­ter equip­ment and process­es are improv­ing the way the mil­i­tary moves wound­ed war­riors to increas­ing­ly more advanced lev­els of care.
DOD pho­to by Don­na Miles
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Dur­ing the Viet­nam War, it typ­i­cal­ly took more than a month to move wound­ed troops to advanced treat­ment facil­i­ties in the Unit­ed States, she said. Today, it’s down to as lit­tle as three days.

“That’s not the goal, to get them home,” she said at her office in her unit’s com­pound, known as “Evac-istan.”

The goal is “to get them what they need, when they need it,” said Flar­i­ty, an Air Force Reserve nurse prac­ti­tion­er deployed from Peter­son Air Force Base, Colo. “That is huge, and that has changed a lot.”

Flar­i­ty attrib­uted much of that change to ini­tia­tives adopt­ed since 9/11: the use of mul­ti­ple air plat­forms to move wound­ed war­riors; state-of-the-art med­ical equip­ment able to oper­ate in demand­ing con­di­tions and high alti­tudes; and crit­i­cal care air trans­port teams spe­cial­ly qual­i­fied to trans­port even the most crit­i­cal­ly wound­ed war­riors, among them. Air Force HH-60G Pave Hawk heli­copters, oper­at­ed by elite Air Force expe­di­tionary res­cue squadrons, have joined Army “Dustoff” heli­copter crews — nick­named for their mot­to, “Ded­i­cat­ed, Unhesi­tat­ing Ser­vice to Our Fight­ing Forces” — to evac­u­ate wound­ed war­riors from remote for­ward oper­at­ing bases and com­bat out­posts.

And gone are the days when aeromed­ical evac­u­a­tion crews had to wait for a spe­cif­ic air plat­form to fly patients for care at Land­stuhl Region­al Med­ical Cen­ter in Ger­many and then on to facil­i­ties in the Unit­ed States. Now, they can use a vari­ety of air­craft: the C-17 Globe­mas­ter III, C-130 Her­cules and KC-135 Stra­totanker. “We are uni­ver­sal­ly qual­i­fied” on the dif­fer­ent plat­forms, Flar­i­ty said. “So essen­tial­ly, any time there is an air­craft avail­able, we can take our teams and our equip­ment and jump onto any air­craft. … This opens up a lot more air­craft avail­abil­i­ty.”

The C-17, with its large car­go bay and abil­i­ty to move the most patients, is a favorite among aeromed­ical evac­u­a­tion crews. Specif­i­cal­ly designed to include aeromed­ical evac­u­a­tion in its mis­sion set, “it’s big, bright and spa­cious,” Flar­i­ty said, with many built-in ameni­ties such as med­ical-grade oxy­gen and but­tons patients can push to call for assis­tance.

Although built for air-to-air refu­el­ing, KC-135s have become aeromed­ical evac­u­a­tion work­hors­es in Afghanistan. They don’t pro­vide the tem­per­a­ture con­trol of C-17s and require crews to car­ry aboard green box­es of liq­uid oxy­gen that con­verts to gaseous oxy­gen, Flar­i­ty said, but the KC-135s offer much-wel­comed and much-need­ed capac­i­ty.

New med­ical equip­ment has improved the process. A pump intro­duced dur­ing the ini­tial stages of the Iraq war enables patients to admin­is­ter their own pain med­ica­tion, with­in pre­scribed lim­its, and local­ly admin­is­tered anes­the­sia is pro­vid­ed through strate­gi­cal­ly placed catheters.

A new liq­uid oxy­gen sys­tem is among new tech­nolo­gies being explored to give aeromed­ical evac­u­a­tion crews addi­tion­al capa­bil­i­ty.

In these and oth­er improve­ments, Flar­i­ty said, the empha­sis has been on com­mon sys­tems across the ser­vices that don’t need to be changed as patients move through dif­fer­ent lev­els of care. “That way, I can take your pump and give you back mine, instead of chang­ing out all the tub­ing and pieces and parts,” she explained.

The pres­i­den­tial­ly man­dat­ed elec­tron­ic health record sys­tem is anoth­er devel­op­ment mak­ing steady progress across the aeromed­ical evac­u­a­tion sys­tem. The tran­si­tion has been rel­a­tive­ly smooth for long mis­sions to Ram­stein Air Base in Ger­many and Joint Base Andrews in Mary­land, Flar­i­ty said. But dur­ing 20-minute flights between for­ward oper­at­ing bases in Afghanistan flown under low-light con­di­tions, she acknowl­edged, it pos­es more chal­lenges.

Chal­lenges are noth­ing new to aeromed­ical evac­u­a­tion crews, Flar­i­ty not­ed. Oper­at­ing in con­di­tions that include noise, vibra­tion, air-pres­sure fluc­tu­a­tions, tur­bu­lence, and some­times ene­my fire, today’s crews are the most expe­ri­enced and bat­tle-test­ed the Air Force has ever seen, she said.

Flar­i­ty called these “rain­bow crews” — a mix of active-duty, Air Force Reserve and Air Nation­al Guard mem­bers — the back­bone of the sys­tem com­mit­ted to doing what it takes to get wound­ed war­riors home safe­ly.

“Ulti­mate­ly, what we do is about those sol­diers, sailors, air­men, Marines [and] Coast Guards­men … is for the war­rior at the bat­tle­front,” she said. “And because we are here, it allows them to focus on their mis­sion, … know­ing we have their backs.”

Air Force Tech. Sgt. Latre­sia Pugh, the mis­sion man­age­ment tech­ni­cian on a recent aeromed­ical evac­u­a­tion flight to Andrews, said she feels hon­ored to be able to pro­vide that sup­port. “These are our broth­ers and sis­ters, and we want to take care of them,” she said.

“These guys are risk­ing their lives for us, and we have to get them back to their fam­i­lies safe­ly,” agreed Air Force Staff Sgt. Napolean Gif­ford, a crit­i­cal care air trans­port res­pi­ra­to­ry ther­a­pist from Dou­glas, Ga. “That is the very least we can do for them.”

Air Force Maj. Ger­ry Mar­tinez, a flight nurse deployed to Ram­stein from Lack­land Air Force Base, Texas, said he’s often touched to hear his patients express appre­ci­a­tion to the aeromed­ical evac­u­a­tion crews.

“They are so grate­ful that we are here tak­ing care of them,” he said. “But what I say to them is, ‘Thank YOU.’ These guys are the ones mak­ing the ulti­mate sac­ri­fices.”

Air Force 1st Lt. Don­na Olson, a Mis­sis­sip­pi Air Nation­al Guards­man who served as med­ical crew direc­tor dur­ing a recent mis­sion trans­port­ing 24 patients from Ram­stein Air Base, acknowl­edged that trans­port­ing wound­ed war­riors, many younger than her own chil­dren, can some­times be emo­tion­al­ly tough.

“But I love this job, and wouldn’t trade it for any­thing in the world,” she said. “I have the grat­i­fi­ca­tion of help­ing them through all this and return­ing them home so they have the oppor­tu­ni­ty to live full lives.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)

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