Air Guard Assists Critical-care Evacuations

RAMSTEIN AIR BASE, Ger­many — Min­utes after take­off here, Air Force Col. (Dr.) Charles Chap­puis jumped to his feet aboard a C‑17 Globe­mas­ter III air­craft to check on Army Spc. Adam Castagna, one of three crit­i­cal patients under his care being trans­port­ed to the Unit­ed States for advanced med­ical care.
Chap­puis is the sur­geon for a three-per­son Air Nation­al Guard air trans­port team deployed to Ram­stein to treat crit­i­cal­ly wound­ed and ill patients flown from the com­bat the­ater.

National Guard critical-care air transport team
A three-per­son Nation­al Guard crit­i­cal-care air trans­port team treats Army Spc. Adam Castagna, one of three crit­i­cal patients under their care dur­ing an aeromed­ical evac­u­a­tion flight from Ram­stein Air Base, Ger­many, to Joint Base Andrews, Md., April 29, 2011. Team mem­bers are, from left, Air Force Tech. Sgt. Chris Howard, the team’s res­pi­ra­to­ry ther­a­pist; Air Force Col. (Dr.) Charles Chap­puis, the sur­geon; and Air Force Lt. Col. David Wor­ley, the crit­i­cal-care nurse.
DOD pho­to by Don­na Miles
Click to enlarge

Castagna was among 24 patients aboard the April 29 aeromed­ical evac­u­a­tion flight to Joint Base Andrews, Md. Sev­en patients were in crit­i­cal con­di­tion, requir­ing two crit­i­cal-care teams –- in this case, an Air Nation­al Guard team and an active duty team –- to mon­i­tor them con­tin­u­al­ly dur­ing the eight-hour flight. 

Eleven days ear­li­er, 14 days shy of his 2nd Stryk­er Cav­al­ry Regiment’s rede­ploy­ment to Vilseck, Ger­many, Castagna had been on a patrol in the Pan­jwai dis­trict of Afghanistan’s Kan­da­har province. An ene­my attack on his pla­toon, and the explo­sion that ensued result­ed in the wound­ing of his right eye and liv­er which ulti­mate­ly cost 37-year-old Castagna his spleen, his younger broth­er, Mike, explained. 

In past con­flicts, patients with wounds as severe as Castagna’s nev­er could have been trans­port­ed so ear­ly in their recov­ery. But the crit­i­cal care air trans­port teams have changed all that, said Air Force Lt. Col. (Dr.) Ray­mond Fang, trau­ma direc­tor at Land­stuhl Region­al Med­ical Cen­ter in Germany. 

The teams not only speed up the process of mov­ing patients to increas­ing­ly more advanced care clos­er to their loved ones, but also free up hos­pi­tal space need­ed for new­er bat­tle­field casualties. 

“We can’t hold every­body at Bagram [Air­field in Afghanistan], and we can’t hold every­body until they are well at Land­stuhl,” Chap­puis said. “We have to keep them mov­ing, because there are more com­ing. And if we don’t move them, then we reach our choke­point. So our goal is to pro­gres­sive­ly move them until they are back in the Unit­ed States.” With every patient move, he said, the goal is to pro­vide “not only first-class care, but a step up in the advance­ment of care.” 

The crit­i­cal-care teams work close­ly with pri­ma­ry-care and trau­ma teams to ensure patients’ move­ment through that con­tin­u­um of care is as safe and smooth as pos­si­ble. “We get them to as good as we can get them before they get on the air­craft” to min­i­mize, and ide­al­ly, elim­i­nate com­pli­ca­tions, Chap­puis said. 

With about 750 pounds of high-tech med­ical equip­ment that essen­tial­ly turns an air­craft into an air­borne inten­sive-care unit, the teams ensure there’s no lapse in patient care dur­ing transport. 

“Our envi­ron­ment has been described as a fly­ing ICU, and I think we pro­vide the equiv­a­lent high-tech med­i­cine that you would get if you were in an ICU in Wash­ing­ton, D.C.,” Chap­puis said. “We have all the drugs and all the equip­ment to mon­i­tor the patients. And I think the proof of that is our suc­cess rates are so good.” 

In Jan­u­ary, the Air Guard read­opt­ed the crit­i­cal-care trans­port team mis­sion, which it had phased out about six years ago, bring­ing wel­comed sup­port to active-duty and Air Force Reserve teams that had been con­duct­ing the mis­sion, along with a wealth of civil­ian trau­ma-care experience. 

Chap­puis, for exam­ple, has 30 years of sur­gi­cal expe­ri­ence under his belt. When not in uni­form with the Louisiana Air Nation­al Guard, he works as a pro­fes­sor of clin­i­cal surgery at Louisiana State Uni­ver­si­ty School of Med­i­cine and as chief of surgery at the Uni­ver­si­ty Med­ical Cen­ter in Lafayette, La. 

In addi­tion to being a Ken­tucky Air Guards­man, Air Force Lt. David Wor­ley, the team’s crit­i­cal care nurse, works in his civil­ian capac­i­ty as a car­diac catheter­i­za­tion lab nurse at a hos­pi­tal in Louisville, Ky. Air Force Tech. Sgt. Chris Howard, from the North Car­oli­na Air Nation­al Guard, works as a res­pi­ra­to­ry ther­a­pist for the team, and also as a civil­ian at Car­oli­nas Med­ical Cen­ter Pineville near Char­lotte, N.C.

“From a Guard stand­point, we bring a tremen­dous amount of expe­ri­ence from the civil­ian world,” Chap­puis said. “We do this almost every day at home, and it brings a tremen­dous amount of med­ical expe­ri­ence to the fight.” 

Air Force Lt. Col. Kath­leen Flar­i­ty, com­man­der of aeromed­ical evac­u­a­tion at Bagram, called incor­po­rat­ing the Air Guard into crit­i­cal care teams “a great idea.” The biggest plus, she said, is the wealth of clin­i­cal expe­ri­ence the Guards­men bring to the mission. 

“They are phe­nom­e­nal –- real­ly smart, tal­ent­ed peo­ple,” she said. 

Air Force Staff Sgt. Napolean Gif­ford, an active-duty res­pi­ra­to­ry ther­a­pist with the 10th Expe­di­tionary Aeromed­ical Evac­u­a­tion Flight, said he’s hap­py to work side by side with expe­ri­enced Guard crit­i­cal-care teams. 

“It real­ly helps, because they bring a lot of trau­ma expe­ri­ence from work­ing at large trau­ma cen­ters,” said Gif­ford, a Dou­glas, Ga., native. With a steady load of patients being trans­port­ed from the com­bat the­ater to Land­stuhl and on to Andrews, Fang wel­comed the expand­ed the pool of mil­i­tary pro­fes­sion­als qual­i­fied to con­duct crit­i­cal-care air trans­port mis­sions, not­ing that the num­ber of peo­ple with their expe­ri­ence is lim­it­ed, and the train­ing expe­ri­ence in the Guard broad­ens the pool of peo­ple qual­i­fied to serve on the teams. 

Devel­op­ing the clin­ic skills and abil­i­ties for crit­i­cal-care trans­port teams takes years, Chap­puis explained. Beyond the tra­di­tion­al crit­i­cal-care skill sets, it requires about five weeks of high­ly spe­cial­ized training. 

The train­ing cul­mi­nates with a demand­ing two-week Cen­ter for Sus­tain­ment of Trau­ma and Readi­ness Skills, or C‑STARS, train­ing at the Uni­ver­si­ty of Cincin­nati in Ohio, where sim­u­la­tion that repli­cates real­is­tic sce­nar­ios sub­jects trainees to the most extreme rig­ors they’ll face in crit­i­cal-care transport. 

“It is kind of like the ‘Wiz­ard of Oz,’ ” Chap­puis said. “There is some­body in the back room con­trol­ling the com­put­er and video­tap­ing every­thing, and then there is anoth­er per­son in the room actu­al­ly watch­ing you. And you are grad­ed every time you go through the simulation.” 

Suc­cess­ful com­ple­tion of C‑STARS is required before deploy­ing for CCAT duty. “By the time you com­plete the course, you have demon­strat­ed if you can cut it or not,” Chap­puis said. “If you don’t make the cut at C‑STARS, then you don’t deploy.” 

While the teams are trained and equipped to treat the most severe med­ical com­pli­ca­tions in the most chal­leng­ing in-flight sit­u­a­tions, Fang said, the goal is to ensure a calm, con­trolled air­borne experience. 

“They are almost like the fire­men,” he said of the crit­i­cal-care teams. “You want them on the plane if the patient has prob­lems, but ide­al­ly, it is a stan­dard ICU shift. And in most ICU shifts, you don’t see peo­ple run­ning around like crazy. You have it calm, and there is a plan, and you take care of the patient.” 

Mike Castagna praised the care the trans­port team and every oth­er mil­i­tary med­ical pro­fes­sion­al has pro­vid­ed since his broth­er was wound­ed. “The care he has got­ten every step of the way has been excep­tion­al,” he said. “It has far exceed­ed any­thing I have ever seen in a civil­ian hospital.” 

Castagna’s move­ment through his con­tin­u­um of care has­n’t been with­out its roller-coast­er moments. He received ini­tial care at the Kan­da­har Air­field Hos­pi­tal, then the Staff Sgt. Heathe N. Craig Joint The­ater Hos­pi­tal at Bagram before mak­ing the sev­en-hour aeromed­ical evac­u­a­tion flight her to get treat­ment at Land­stuhl. Dur­ing that flight, one of Castagna’s arter­ies burst, and a crit­i­cal-care trans­port team imme­di­ate­ly put him on life sup­port, his broth­er said. 

Castagna’s entire fam­i­ly and his fiancée flew to Ger­many to be with him, fear­ing the worst. But accom­pa­ny­ing his broth­er dur­ing the flight to Andrews, Castagna mar­veled at his progress since the live-sav­ing intervention. 

“Lit­er­al­ly, in a day and a half, he went from being on life sup­port to talk­ing with us,” he said. 

Guards­men say the chance to make a dif­fer­ence for wound­ed war­riors like Castagna makes then want to be part of the all-vol­un­teer mis­sion. “Nobody called us up and said, ‘Hey, it is your turn,’ ” Chap­puis said. 

Howard, at Ram­stein for a six-month deploy­ment, said he jumped at the crit­i­cal-care air trans­port oppor­tu­ni­ty as soon as the Air Guard adopt­ed the mis­sion. “It’s sat­is­fy­ing,” he said. “For me, it was a way to give back.” 

“The oppor­tu­ni­ty to come here and help kids get home is a great oppor­tu­ni­ty for me, and that is why I chose to do it,” agreed Wor­ley. “It’s a very good mis­sion. It’s what we would want for our own families.” 

That’s exact­ly what Chap­puis said he tells his wife when he explains why he volunteered. 

“I have grown chil­dren. If it was one of my chil­dren, I would want the absolute best care for them to make these mul­ti­ple flights from Afghanistan or Iraq back to the Unit­ed States,” he said. “And if that is my desire for my chil­dren, I should be ready to pony up and do it myself.” 

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

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