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Feature | Jan. 29, 2008

Aeromedical evacuation: Helping the wounded survive the journey home

By Tech. Sgt. D. Clare 332nd Air Expeditionary Wing Public Affairs

Editor's note: Staff Sgts. Jessica Reese Joan Sanchez and Senior Airman Ryan Jackson are deployed from the 1st Medical Operations Squadron at Langley.

The Air Force Theater Hospital's 98 percent survivability rate for injured U.S. servicemembers would be meaningless if the wounded were unable to survive their journey out of the combat zone.

Four years into the war, the process of saving lives and then safely transporting critically injured and ill troops out of Iraq has become one of the greatest military feats in modern history, according to Lt. Col. Beverly Johnson, chief nurse for the Contingency Aeromedical Staging Facility during the Air Expeditionary Force 9/10 rotation.

The CASF is a minor conglomerate of different functions. It's at once a ward for the sick and injured and a recreation center for those who are able enough. It's a passenger terminal where travelers get bandages changed and customs agents come to the bedridden.

Patients are assessed, pre-assessed and re-assessed. Lessons have been learned and are applied. How will altitude effect cranial swelling for a traumatic brain injury victim? Will an arm in a cast swell in midflight? Burn patients must stay warm, current prescriptions must be filled, care providers must anticipate every possible scenario before the patient goes by bus to the plane. Launch nurses pass on reports, other nurses pick the most critical patients up from the Intensive Care Unit at the hospital.

"By the time most patients get here, they might have some pain, but they're pretty happy," said Staff Sgt. Joan Sanchez, lead technician for the litter side of the CASF ward. "For many Soldiers, this is as nice as a facility as they have ever seen in Iraq."

CASF team members like Sergeant Sanchez act as care providers, terminal agents, and hospital logisticians. The team also has mental health professionals who monitor traumatic brain injury victims and support patients suffering from post-trauma stress.

On the ground, the team organizes its passenger load based on the configuration of outbound cargo aircraft. A C-17 Globemaster has to be reconfigured to become a flying hospital.

In addition to hosting the most comprehensive medical facility in Iraq, the Air Force Theater Hospital's CASF here acts as the hub for wounded troops being medically evacuated out of the country. If a coalition member anywhere in Iraq requires aeromedical evacuation from the theater, he will pass through the Air Force Theater Hospital and the hands of CASF team members enroute to follow-on care, said Lt. Col. Rene Bloomer, Air Expeditionary Force 1/2 rotation CASF chief nurse.

The 60-member CASF team represents more than a half-dozen specialties. They facilitate one of the hospital's top priorities -- clearing beds.

"Our number one goal is to get them here, quickly assess and stabilize them, and get them on an airplane," said Colonel Johnson.

Success at the hospital depends on a constant cycle. Staff members must always be ready to save new trauma victims and have enough empty beds for the next mass casualty.

Beyond the logistical achievement of maintaining constant airflow from Balad to Landstuhl Medical Center in Germany and to bases outside the combat zone, the aeromedical evacuation process has evolved and improved, said Colonel Johnson, a 15-year CASF member veteran.

Aeromedical evacuation has been a military asset since World War II, she said, though on a limited scale and with equally limited capabilities. The Korean and Vietnam wars saw increasing use of air power in medical evacuations. Neither those wars, nor the limited casualties in Desert Storm, however, truly tested the system.

It was the USS Cole incident and 1998 terror-bombings of a U.S. Embassy that showed the modern capabilities of critical care teams and aeromedical evacuations.

Colonel Johnson remembers a call she received in the 1990s when the system was being tested. "The European Command called saying, 'What would happen if we had to move 1,000 casualties in a day?' I said, we can't. We don't have enough aircrews to support that kind of movement. They've really built up the system and it's been seamless since I've been here."

"It's really been revolutionary for the Air Force," Colonel Johnson said. "It's always been a good system, but we've really put it to the test in this war and it has performed phenomenally."

On the flight line, seriously wounded and ill patients are transferred to the Critical Care Air Transport Team -- specially trained flight medics, nurses and physicians who set up and staff the trauma ward in the sky.

On a busy day, 50 patients will head out to Germany. On a slow day, 10 or 12 patients might be outbound. Rarely is there a day without an aeromedical evacuation. Nearly 600 to 700 patients move out from Balad every month, according to Colonel Johnson, which is a 20 percent decrease from what teams experienced during past rotations.

Aeromedical evacuation teams and CASFs in particular are not organic to stateside military medical facilities.

Airmen like Staff Sgt. Jessica Reese, a CASF medical technician, said the opportunity for additional training before her deployment and the ability to work outside of her normal clinical experience make the facility a rewarding place to work.

A dermatology technician at home, she said she knows she's making a difference in Iraq.

"I'm so proud of what I do. I feel good to be taking care of these troops who have made such tremendous sacrifices. It's an honor to be here for them, to take care of them and to send them home safe," Sergeant Reese said.

Her favorite part of the job comes after litters are loaded on the flightline.

"For the guys who can walk, we line up in two rows and applaud them as they walk onto the plane. I love that. It's our way of saying that we support you and you get to go home now," she said.