Air Guard Team Provides Critical Care Transport

WASHINGTON — After a six-year hia­tus, the Air Nation­al Guard is back in the crit­i­cal care air trans­port team busi­ness.
“As the Guard migrat­ed into the home­land defense mis­sion, we got away from the CCATT mis­sion,” Air Force Col. Brett Wyrick, air sur­geon for the Air Nation­al Guard, told par­tic­i­pants in a “DOD Live” blog­gers round­table Jan. 11.

“How­ev­er, recent­ly what we’ve dis­cov­ered is that there is a need for the Air Nation­al Guard in the CCATT mis­sion,” he said, “and also we’ve got quite a bit of exper­tise in the Guard and in the Reserve that allows us to meet the demands of the mis­sion and take some of the strain off the active-duty sources, who have been stretched quite thin by the ongo­ing conflicts.” 

The Air Force sur­geon gen­er­al intro­duced the con­cept about 10 years ago to meet a need for trans­port­ing the most crit­i­cal­ly injured patients in the aeromed­ical evac­u­a­tion sys­tem. “This is a mis­sion where we actu­al­ly bring … every­thing that you would find in an inten­sive care unit to the air frame,” Wyrick said. “And it gives us the abil­i­ty to move injured and wound­ed sol­diers and air­men, Marines … from the for­ward areas of the bat­tle­field back to a ter­tiary care facil­i­ty either in Europe, the Pacif­ic or the Unit­ed States.” A crit­i­cal care air trans­port team con­sists of an inten­sive care physi­cian, a crit­i­cal care nurse and a res­pi­ra­to­ry tech­ni­cian. The first Air Guard team is on alert at Ram­stein Air Force Base, Germany. 

“If there’s a need down­range, they can deploy for­ward from Ram­stein into Iraq, Afghanistan or even into the African con­ti­nent if there’s a need for that,” Wyrick said, “and then they … [are trans­port­ed with] the patients back to the Unit­ed States or back to Europe, wher­ev­er the mis­sion [dic­tates].”

After this require­ment was val­i­dat­ed, it took less than six months for the Air Guard to field its first team with the help of the Air Force Expe­di­tionary Med­ical Skills Institute’s Cen­ter for Sus­tain­ment of Trau­ma and Readi­ness Skills at the Uni­ver­si­ty of Cincinnati. 

“We’re going to have a con­stant and per­sis­tent line in the [aeromed­ical evac­u­a­tion flight] now … [and] for the next two years out of Ram­stein,” he said. Wyrick said the Air Guard plans to stand up 18 full teams from 17 states. Many of them have begun train­ing, and they are expect­ed to reach full oper­a­tional capa­bil­i­ty with­in the next two years. 

The Air Guard also has vol­un­teers from all 54 states and ter­ri­to­ries who would like to aug­ment these teams when need­ed, he said. “There’re a num­ber of Guards­men out there from var­i­ous states who want to par­tic­i­pate in the mis­sion, who have the med­ical train­ing and qual­i­fi­ca­tion to par­tic­i­pate in the mis­sion,” Wyrick said. “And we’re accept­ing them as volunteers.” 

The cur­rent team con­sists of Col. (Dr.) Bruce Guer­dan, who is the state air sur­geon for the Flori­da Air Guard, Lt. Col. David Wor­ley, a nurse from the Ken­tucky Air Guard, and Mas­ter Sgt. Jody Nitz, a res­pi­ra­to­ry ther­a­pist from the Michi­gan Air Guard. 

“So, we did com­bine … peo­ple from all over the coun­try to put these vol­un­teer teams togeth­er,” Wyrick said. The doc­tors will rotate about every 30 days, and the nurs­es and res­pi­ra­to­ry tech­ni­cians will aver­age about 60 days. At least one nurse has vol­un­teered to serve for six months. All of these Air Guard med­ical per­son­nel have one thing in com­mon: experience. 

“If you look at your aver­age Guard physi­cian, he’s got at least 15 to 20 years in med­i­cine,” Wyrick said. “Many of those are in pri­ma­ry care. And when you look at it … most of us have an active-duty back­ground, and then after they leave the mil­i­tary, then they go back out and they respe­cial­ize or they subspecialize. 

“So, we’ve got a lot of crit­i­cal care physi­cians, a lot of sur­geons, anes­the­si­ol­o­gists — guys who have lit­er­al­ly writ­ten the book on mod­ern med­i­cine are resid­ing in the Air Guard,” he con­tin­ued. “And by putting them in the CCATT mis­sion, we bring years of expe­ri­ence and we bring years of knowl­edge that make us a good total force part­ner for the Air Force.” Many of the vol­un­teers, he said, have crit­i­cal care air trans­port team expe­ri­ence, but “a lot of them, by virtue of the fact that there are already spe­cial­ists in … the civil­ian health care world, they bring that expe­ri­ence and they’re read­i­ly train­able to the CCATT mission.” 

In addi­tion to its fed­er­al mis­sion, a team also could be used for emer­gency response here at home. “For instance, if we had a sit­u­a­tion on the Gulf Coast where a big hur­ri­cane rolls up on shore and you need to evac­u­ate civil­ian patients from a civil­ian hos­pi­tal in the hurricane’s path, that would be anoth­er use for the CCATT teams,” Wyrick said. “It gives you a way to trans­port crit­i­cal­ly injured patients from the strike zone to areas of safe­ty. So it’s not just bat­tle­field and com­bat casu­al­ties; it could also be in human­i­tar­i­an roles or in a dis­as­ter situation.” 

Wyrick added that the states have access to Air Force equip­ment in the event of a disaster. 

“There just aren’t the bar­ri­ers that there used to be,” he said. “After [Hur­ri­cane Kat­ri­na struck in 2005], there’s been a lot of crosstalk, there’s been a lot of plan­ning, and we have access to the equip­ment and sup­plies that we need when we need them.” 

Air Guard crit­i­cal care air trans­port teams use life-sup­port equip­ment that has been test­ed and ver­i­fied as being safe and air­wor­thy. “When you’re talk­ing about trans­port­ing patients through the air, what you have is what you bring with you,” Wyrick said. “And the sys­tems have to be super-reli­able, there has to be redun­dan­cies in there, and they have to be safe … for flight.” 

The team’s typ­i­cal patient will come with a stretch­er, a mon­i­tor, intra­venous pumps and also a ven­ti­la­tor to main­tain res­pi­ra­tion through­out the mis­sion, he said. In addi­tion to the equip­ment, the teams often fly with a full aeromed­ical evac­u­a­tion crew, which cares for the less-crit­i­cal patients. How­ev­er, the crit­i­cal care air trans­port team may not have an aeromed­ical crew with them on every flight. 

“It depends on whether it’s a rou­tine sched­uled mis­sion or whether it’s an emer­gency,” Wyrick explained. “In a pinch, these guys can con­vert any­thing into [an]… air evac platform.” 

Wyrick said the Air Force has moved away from the con­cept that aeromed­ical evac­u­a­tion is an air frame. Crit­i­cal care air trans­port teams are the “back-end med­ical crew,” he said. “As far as the air­craft goes, the CCATT teams can use an air­craft of oppor­tu­ni­ty, and while every­body prefers to have a C‑17 because of the design in the room, … we also fly mis­sions from the the­ater far for­ward in Afghanistan back to the Unit­ed States in KC-135s, or we can also do this in a C‑5 or what­ev­er air­craft is des­ig­nat­ed as the aeromed­ical evac­u­a­tion plat­form.” Only the most-crit­i­cal patients will require a crit­i­cal care air trans­port team, Wyrick said. 

“We’re tak­ing patients that oth­er­wise would­n’t be can­di­dates for the aeromed­ical evac­u­a­tion sys­tem, because … we real­ly are talk­ing about the most severe­ly injured patients [at Land­stuhl Army med­ical Cen­ter in Ger­many],” Wyrick said. 

Each team can han­dle up to four patients, who are flown direct­ly from Land­stuhl back to Wal­ter Reed Army Med­ical Cen­ter in Wash­ing­ton or Nation­al Naval Med­ical Cen­ter in Bethes­da, Md., or to the burn cen­ter at Brooke Army Med­ical Cen­ter in San Antonio. 

How quick­ly a patient is trans­port­ed back to the Unit­ed States depends on the patient’s needs, Wyrick said. “A lot of times when the patients come back from the for­ward areas, there’s more surgery to be done on them,” he explained. “And after they’ve under­gone the com­bat resus­ci­ta­tion and sta­bi­liza­tion, then when they get to Land­stuhl, there could be … oth­er pro­ce­dures that are done where they take the patient back to the [oper­at­ing room], and then it might be sev­er­al days, or even weeks, before the patient is actu­al­ly ready for trans­port back to the Unit­ed States.” 

He added that a patient who has suf­fered a burn could be shipped back almost imme­di­ate­ly to San Antonio. 

The Air Guard crit­i­cal care air trans­port team was sched­uled for its first flight back to Joint Base Andrews Naval Air Facil­i­ty Wash­ing­ton in Mary­land on Jan. 11, no crit­i­cal care patients need­ed move­ment from Land­stuhl back to the Unit­ed States. 

“So that’s actu­al­ly … a good thing,” Wyrick said. “Because the few­er injured patients there are for the Unit­ed States mil­i­tary, the bet­ter things are going. So they’re sit­ting alert right now, and they’re ready.” 

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

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