AE process key to saving lives in Iraq

(From left) Airman 1st Class Debra Camacho, Staff Sgt. Fred Mathis, Tech. Sgt. Marsha Madsen, Senior Airman Bradley Cross and Staff Sgt. Raymond Wrentmore carry Navy Petty Officer 3rd Class Lorphy Bourque aboard a C-130 Hercules to fly him to Ramstein Air Base, Germany. The Airmen are assigned to the 332nd Air Expeditionary Wing here. (U.S Air Force photo by Senior Airman Tim Beckham)

By Master Sgt. Christopher Haug
332nd Air Expeditionary Wing Public Affairs

BALAD AIR BASE, Iraq -- In battle, one of the hardest challenges is saving the wounded. Medical professionals encounter injuries not normally seen in peacetime, and many times see multiple life-threatening injures requiring immediate treatment on the battlefield.

Another problem is moving patients across hot desert sands on bumpy roads in Iraq, which can be logistically challenging and uncomfortable for the patient. And there is always the danger of roadside bombs.

To solve these problems, military aeromedical planners developed what is now an efficient medical evacuation system that moves patients from where they were injured to definitive care quickly and safely.

Along the way, patients receive the best possible care, said Lt. Col. Jose Soto, chief nurse with the 332nd Contingency Aeromedical Staging Facility.

The initial patient movement is done immediately after an injury is reported. Usually an Army helicopter flies the injured troop to a field medical clinic.

“Many times what is done within the first hour of injury determines the chances a patient has for survival,” said Maj. David Ball, a 791st Expeditionary Aeromedical Evacuation Squadron flight clinical coordinator from Ramstein Air Base, Germany. “Historically, the medical community calls this the ‘golden hour,’ and we are trying to extend that.”

Service members in Iraq rely on a joint medical evacuation system using Army and Air Force medics spread out along the route. Aeromedical evacuation teams escort injured from Army clinics on the battlefield to the Air Force theater hospital here. The patients are stabilized for flight at the hospital, flown to Europe for further care and finally to stateside hospitals.

“The process is so efficient that we literally have been able to move patients within minutes of their injury to the first echelon of care at Army field clinics, and within hours to the Air Force theater hospital here,” said Lt. Col. Laurie Hall, chief nurse at the hospital.

“If we are able to stabilize the patient quickly enough, we can even have that patient on their way to more definitive care at Landstuhl (Regional Medical Center, Germany) within 12 hours, sometimes even less than that,” Hall said.

For Army Spec. Brian Scaramuzzo, of the 57th Transportation Company at Taqqadum, Iraq, the care is just “awesome.” Scaramuzzo, from Wakefield, Mass., sustained deep cuts in both legs when his 5-ton truck flipped on its side while driving in a convoy from Al Asad, Iraq, to Taqqadum.

“The helicopter was there to pick us up less than 25 minutes after the accident,” he said. “They flew us from one helicopter to the next until we reached the [Air Force theater] hospital.”

Sometimes stabilizing a patient requires a neurosurgeon to work simultaneously with an orthopedic doctor in the operating room -- even while another patient is having surgery in the next bed, Hall said.

Airlifting patients out of the war zone presents other challenges, coordinated by people assigned to the contingency aeromedical staging facility here.

Officials at the staging facility coordinate with several medical and aeromedical evacuation elements throughout the world to ensure each patient receives the proper care and movement throughout the theater. They ensure patients are medically and administratively prepared for intertheater flights.

Aboard the aircraft, aeromedical evacuation teams work with aircrews to configure the plane for patient movement and in-flight care. If there is a critically injured patient, critical care air transport teams join the mix.

“These [teams] are dedicated to care for the most critical patients,” Soto said. “The patient, equipment and CCATT are moved directly to the aircraft from the intensive care unit at the Air Force theater hospital. Each team has three members -- a doctor, an intensive care nurse and an enlisted respiratory technician.”

Sometimes, other critical care providers join the team.

While the process for evacuating patients has progressed over the ages, “never has military medicine been able to save so many as they can now,” Ball said.

This is because aeromedical evacuation is now lighter, more adaptable and able to use the best available airframe at any particular time and place, according to the Air Force Surgeon General’s office.

During the initial phases of Operation Iraqi Freedom, in an effort to move patients more quickly out of the battlefield and into facilities with definitive care, the Air Force moved away from dedicated airframes, such as the C-9 Nightingale or C-141 Starlifter.

They began to use the most readily available airframe in the flow. The Air Force Medical Service also moved toward lighter, more adaptable aeromedical evacuation equipment such as patient support pallets that could easily be moved from one aircraft to the next. The pallets were built on a standard frame that could fit onto all Air Force cargo and transport aircraft, from the C-130 Hercules to the C-5 Galaxy. And care teams carry much of their equipment in backpacks.

To find an available aircraft, the Air Force uses a system called the U.S. Transportation Command Regulating and C2 Evacuation System that came into the aeromedical evacuation inventory just before Sept. 11, 2001. It is administered in theater by the Joint Patient Movement Requirements Center and coordinated with an aeromedical evacuation control team.

This Department of Defense tracking system allows medical planners to decide which patients should fly out on what aircraft, what equipment is needed to support each patient, and what hospital they should fly to.

Air Mobility Command officials report, as of July 8, the aeromedical evacuation system has flown more than 27,681 patients out of U.S. Central Command contingency areas into Europe since the start of Operation Iraqi Freedom. Of these, only 4,982 were classified as battle injuries. About 79 percent of the battle-injured required critical care equipment and transport teams.