By Donna Miles
American Forces Press Service
Oct. 2, 2009 - Minutes after the hulking C-17 transport jet rolled to a stop on the tarmac here Sept. 28, two oversized ambulances backed up to its rear loading ramp to receive its precious cargo: 23 wounded warriors and sick or injured servicemembers in need of advanced medical care. Most of the patients arrived from Iraq and Afghanistan after being stabilized at Landstuhl Regional Medical Center in Germany.
Several had serious combat injuries. A soldier who had been in a helicopter crash in Iraq was headed to the National Naval Medical Center in nearby Bethesda for specialized care for his head and other injuries. Another, suffering serious musculoskeletal injuries from a mine-resistant, ambush-protected vehicle accident outside his forward operating base in Afghanistan, was en route to Walter Reed Army Medical Center in Washington for treatment.
Another patient, severely wounded in a rocket-propelled grenade attack in Afghanistan, remained on the aircraft to be flown directly to the burn unit at Brooke Army Medical Center in San Antonio.
But most of the patients -- those who were in stable condition and didn't require critical care -- walked off the plane and onto a bus that stood ready to whisk them off for an overnight stay at the 779th Medical Group's Aeromedical Staging Facility. After getting a hot meal and a good night's sleep under the watchful eyes of the facility's medical staff, they would be flown to other treatment facilities throughout the United States.
The little-known 779th Aeromedical Staging Facility, tucked within the base's Malcolm Grow Medical Center, serves as the gateway for patients returning to the United States for specialized care, explained Air Force Capt. Nicole Stoneburg, the facility's acting commander.
Three flights arrive here each week bearing sick or wounded soldiers, sailors, airmen and Marines, as well as Defense Department civilians, contract employees and military family members. So far this year, 5,230 patients have transited through the facility, Stoneburg reported.
Patients with the most serious conditions immediately move on to next-level treatment facilities. But about three-quarters of the arriving patients remain overnight to rest before continuing to their ultimate destinations.
Ensuring inbound patients get the care they need and treatment they deserve begins long before the flights -- most flown by the Mississippi Air National Guard -- arrive from Ramstein Air Base in Germany.
Critical-care air transport teams -- made up of a doctor, a critical-care nurse and a respiratory therapist -- are forward-deployed to Germany to accompany every inbound flight, explained Air Force Maj. Ron Jones, deputy commander of the 779th Medical Operations Squadron's Critical Care Flight. The team monitors patients' conditions and delivers care as needed during the eight-hour flight.
Meanwhile, the 779th ASF's medical administration team at Andrews tracks every inbound patient's medical status and knows exactly what care they need and what treatment facility they're headed to. Airman 1st Class Chelsey Morgan and her team call themselves the "brains of the operation," keeping their eyes glued to a computer-based global patient tracking system to ensure no detail falls through the cracks.
Thirty minutes before the Sept. 28 flight's arrival, the facility staff bustled with final preparations. Ambulance crews readied to meet the aircraft. A forklift prepared to offload patients' bags. Litters and wheelchairs were moved into position.
"What we do is very much a team concept," Stoneburg said. "We work very closely together to coordinate all the details of our missions, both the inbound and outbound flights."
Driving their efforts is a recognition that every minute counts when getting patients, particularly those with the most serious conditions, to care.
Combat troops typically arrive here within 72 hours of suffering a severe battlefield injury -- a vast improvement over past conflicts, Stoneburg explained. During Operation Desert Storm in 1991, it took 10 days. The average was 21 days during the Vietnam War.
Today, patients categorized as "urgent" are moved even faster. "These are patients that, if you delay, you lose a life. If you delay, you lose a limb. If you delay, they lose their eyesight," explained Air Force Col. Steve Cramer, the 779th Aerospace Medicine Squadron commander. "So the faster we're able to move, the better their outcomes will be."
That concept drives the staff as they offload critical-care patients with choreographic precision and transfer them onto ambulances against the backdrop of roaring C-17 engines.
"This is America at its best," said Air Force Col. (Dr.) Richard Niemtzow, a 779th Medical Operations Squadron physician who boarded the aircraft as soon as it landed to greet the patients. "You see sergeants carrying colonels and colonels carrying sergeants. You see African-Americans carrying Caucasians. You see Mexican-Americans carrying Chinese-Americans. Everyone is one team, all working together for each other."
Niemtzow or another colonel, as well as a chaplain, are part of an official party that welcomes every arriving patient to U.S. soil. "We tell them we're proud of them and appreciate what they have done," he said. "But we also assure them that they are going to continue to get the best-quality care available."
The official greeting sets the stage for a no-holds-barred effort to make patients as comfortable and relaxed as possible as they're transferred to their follow-on treatment facilities.
Army and Marine Corps liaisons greet patients from their services to resolve service-specific questions and issues.
"We're representing the entire Army in welcoming them back," said Army Col. James Conaway, who leads a three-person Army medical evacuation team that greets every arriving flight. The team offers the comfort of familiar-looking uniforms to the arrivals, 80 to 85 percent of them typically from the Army.
"We're here to make sure every Army soldier gets a proper greeting, gets proper care and gets an opportunity to bounce information off of us as we prepare to hand them off to the warrior transition units," Conaway said.
He presents all arriving patients, regardless of their service, pre-paid phone cards, funded through the Army Emergency Relief Fund. Battle-wounded soldiers get a $200 gift card to cover incidental expenses.
Non-critical-care patients who remain overnight at Andrews get the red-carpet treatment as they arrive at the 779th Aeromedical Staging Facility.
"When our wounded warriors come through the doors, they are greeted with the hero's welcome they deserve," said Air Force Col. Robert Miller, the 779th Medical Group commander. "We feel this facility is like a five-star hotel for them to rest and recuperate before they continue on with their journey home."
The ASF staff, augmented by a cadre of Red Cross volunteers, lives up to Miller's pledge from the minute they walk or roll patients in their wheelchairs or gurneys to their rooms and help them settle in. Each room holds two to four patients, and each bed has its own medical equipment, television and phone.
Air Force Lt. Col. (Dr.) Constance Jackson, the facility's medical director, and her team tend to the patients' medical needs and offer them assurance that they're in good hands.
"I want them to know we appreciate where they have been, and go the extra mile to take care of whatever it is they need," she said.
After settling into their rooms and getting their immediate medical needs tended to, most patients who physically are able prefer to move into the facility's common areas to relax. There, they can stretch out in oversized leather chairs enjoying a large-screen TV, or they can telephone home, check e-mail or access computer game stations.
Red Cross volunteers circulate with kind words and a cart of soft drinks and snacks. They check to ensure the patients have everything they need, and offer up toiletries, clothing, shoes and other items donated by local churches and other groups to ensure nobody goes without.
"We're here to help provide them the things that can bring them some comfort," said Ed "Smokey" Smolarsky, a retired Air Force senior master sergeant who runs the supply closet. "By being here, we feel that it's a way to give back. And these guys are definitely thankful for what we're able to do for them."
Shortly after the patients arrived, the staff serves up a hot meal of foods most troops say they've missed during their deployments: pizza, fried chicken and filet mignon, among them.
Air Force Airman 1st Class Angela Thoma, who spent hours helping prepare the meal, said comfort food goes a long way in helping the patients feel at home. "Their eyes light up as soon as they see the food," she said. "But there's another benefit. It fills them up and helps them relax. And that helps them sleep longer through the night."
As he stretched out in front of the wide-screen TV, Army Staff Sgt. Rosario Hernandez was having no trouble putting himself at ease. He was transiting through the facility before flying out the next day to his home station at Fort Bliss, Texas, for surgery to repair compressed nerves in his ankle and leg.
Three combat deployments, including the past five months in Iraq, had taken their toll on the 33-year-old's body. Hernandez had regrets about leaving his soldiers, but said he recognizes he's in no shape to lead them until his body is repaired.
Hernandez said he was impressed not just by the medical care, but also by the compassion he felt as he was evacuated out of Iraq, through Germany and back to the United States.
"At every step of the way, they treated everybody with complete kindness," he said. "It was culture shock to see how they treated everybody."
Based on his experience, Hernandez said, he's got nothing but reassurance for his fellow servicemembers in the event they're ever medically evacuated out of the combat theater.
"They'll be in good hands," he said. "I never imagined it was going to be this good."