Aeromedical Evacuation Saves Lives in Afghanistan

By Donna Miles

American Forces Press Service

BAGRAM AIRFIELD, Afghanistan, May 6, 2011 – An aeromedical evacuation capacity unrivaled anywhere in the world is saving the lives of wounded warriors in Afghanistan, said the officer here who oversees the effort at the combat theater’s busiest aeromedical evacuation point.

Equipment and procedures are being improved continually to move wounded warriors to progressively more sophisticated levels of care in Afghanistan and ultimately, in the United States, said Air Force Lt. Col. Kathleen Flarity, commander of the 455th Expeditionary Aeromedical Evacuation Flight’s operations here.

During the Vietnam War, it typically took more than a month to move wounded troops to advanced treatment facilities in the United States, she said. Today, it’s down to as little as three days.

“That’s not the goal, to get them home,” she said at her office in her unit’s compound, known as “Evac-istan.”

The goal is “to get them what they need, when they need it,” said Flarity, an Air Force Reserve nurse practitioner deployed from Peterson Air Force Base, Colo. “That is huge, and that has changed a lot.”

Flarity attributed much of that change to initiatives adopted since 9/11: the use of multiple air platforms to move wounded warriors; state-of-the-art medical equipment able to operate in demanding conditions and high altitudes; and critical care air transport teams specially qualified to transport even the most critically wounded warriors, among them.

Air Force HH-60G Pave Hawk helicopters, operated by elite Air Force expeditionary rescue squadrons, have joined Army “Dustoff” helicopter crews -- nicknamed for their motto, “Dedicated, Unhesitating Service to Our Fighting Forces” -- to evacuate wounded warriors from remote forward operating bases and combat outposts.

And gone are the days when aeromedical evacuation crews had to wait for a specific air platform to fly patients for care at Landstuhl Regional Medical Center in Germany and then on to facilities in the United States. Now, they can use a variety of aircraft: the C-17 Globemaster III, C-130 Hercules and KC-135 Stratotanker.

“We are universally qualified” on the different platforms, Flarity said. “So essentially, any time there is an aircraft available, we can take our teams and our equipment and jump onto any aircraft. … This opens up a lot more aircraft availability.”

The C-17, with its large cargo bay and ability to move the most patients, is a favorite among aeromedical evacuation crews. Specifically designed to include aeromedical evacuation in its mission set, “it’s big, bright and spacious,” Flarity said, with many built-in amenities such as medical-grade oxygen and buttons patients can push to call for assistance.

Although built for air-to-air refueling, KC-135s have become aeromedical evacuation workhorses in Afghanistan. They don’t provide the temperature control of C-17s and require crews to carry aboard green boxes of liquid oxygen that converts to gaseous oxygen, Flarity said, but the KC-135s offer much-welcomed and much-needed capacity.

New medical equipment has improved the process. A pump introduced during the initial stages of the Iraq war enables patients to administer their own pain medication, within prescribed limits, and locally administered anesthesia is provided through strategically placed catheters.

A new liquid oxygen system is among new technologies being explored to give aeromedical evacuation crews additional capability.

In these and other improvements, Flarity said, the emphasis has been on common systems across the services that don’t need to be changed as patients move through different levels of care. “That way, I can take your pump and give you back mine, instead of changing out all the tubing and pieces and parts,” she explained.

The presidentially mandated electronic health record system is another development making steady progress across the aeromedical evacuation system. The transition has been relatively smooth for long missions to Ramstein Air Base in Germany and Joint Base Andrews in Maryland, Flarity said. But during 20-minute flights between forward operating bases in Afghanistan flown under low-light conditions, she acknowledged, it poses more challenges.

Challenges are nothing new to aeromedical evacuation crews, Flarity noted. Operating in conditions that include noise, vibration, air-pressure fluctuations, turbulence, and sometimes enemy fire, today’s crews are the most experienced and battle-tested the Air Force has ever seen, she said.

Flarity called these “rainbow crews” -- a mix of active-duty, Air Force Reserve and Air National Guard members -- the backbone of the system committed to doing what it takes to get wounded warriors home safely.

“Ultimately, what we do is about those soldiers, sailors, airmen, Marines [and] Coast Guardsmen … is for the warrior at the battlefront,” she said. “And because we are here, it allows them to focus on their mission, … knowing we have their backs.”

Air Force Tech. Sgt. Latresia Pugh, the mission management technician on a recent aeromedical evacuation flight to Andrews, said she feels honored to be able to provide that support. “These are our brothers and sisters, and we want to take care of them,” she said.

“These guys are risking their lives for us, and we have to get them back to their families safely,” agreed Air Force Staff Sgt. Napolean Gifford, a critical care air transport respiratory therapist from Douglas, Ga. “That is the very least we can do for them.”

Air Force Maj. Gerry Martinez, a flight nurse deployed to Ramstein from Lackland Air Force Base, Texas, said he’s often touched to hear his patients express appreciation to the aeromedical evacuation crews.

“They are so grateful that we are here taking care of them,” he said. “But what I say to them is, ‘Thank YOU.’ These guys are the ones making the ultimate sacrifices.”

Air Force 1st Lt. Donna Olson, a Mississippi Air National Guardsman who served as medical crew director during a recent mission transporting 24 patients from Ramstein Air Base, acknowledged that transporting wounded warriors, many younger than her own children, can sometimes be emotionally tough.

“But I love this job, and wouldn’t trade it for anything in the world,” she said. “I have the gratification of helping them through all this and returning them home so they have the opportunity to live full lives.”