Flying wounded from combat zone is a life-saving advancement

  • Published
  • By Seth Robbins
  • Stars and Stripes
Stars and Stripes --  It was during World War I that an injured soldier was first evacuated by air, in a "Jenny" biplane modified to allow a single stretcher in place of the rear cockpit. And for nearly a century afterward, air evacuations of the badly injured out of the combat zone were the exception, not the norm.

Now, troops wounded in Iraq and Afghanistan are routinely flown to hospitals in the United States within three days. Some burn patients make it back within 24 hours, said Col. James King, the Critical Care Air Transport, or CCAT, theater medical director.

"We are moving patients thousands of miles," King said, "that some civilian trauma doctors would be reluctant to even put on an elevator."

Troops are treated at the front lines and then shuttled by helicopter to nearby combat support hospitals for life-saving surgeries, often within a critical one-hour window. The surgeons perform the minimum amount of operations to stabilize the patients, and then they are flown to hospitals in the U.S. or Germany, where they can receive more specialized care.

"It's like an orchestra," said Col. Paul Doan, chief of aerospace medicine at Joint Base Balad. "Everything has to work together for the smooth movement of a patient."

Flying puts unique stressors on the body that medical teams must work hard to counteract. "You don't get better as you fly," said Lt. Col. Gail Fancher, flight surgeon.

As a plane ascends, gas inside the body expands and air pockets left inside the chest cavity bulge and can cause the lungs to collapse. Changes in air pressure during takeoff and landing put pressure on the heart, increasing the risk of heart failure. Burn patients lose body heat through open wounds, so keeping the cabin warm is vital. Higher altitudes also make breathing more difficult. Even broken bones become much more painful during the rattle of a typical military flight.

The worst-injured are attended to by the Air Force's CCAT teams, the equivalent of flying intensive care units. The teams comprise a doctor, a nurse and a respiratory therapist, all trained in in-flight medicine. Created in the early 1990s, the teams travel with heart monitors, ventilators, defibrillators and suction instruments, among other devices compact and rugged enough to withstand the stress of flight.

"The technology is what allowed us to do this," Doan said.

Capt. Napoleon Roux, local CCAT director at Joint Base Balad, saying being prepared for what could happen is his biggest concern. "If I don't [prepare], it could be a very long and possibly deadly trip to Germany," he said.

The CCAT teams want to upgrade their equipment, to use more wireless technology that would allow them to monitor multiple patients on a single device. And they are constantly training and reviewing every evacuation flight, to refine their skills.

"We have to get it right," King said. "It's a very unforgiving environment to move patients in the air, and our people have to know how to provide care."

The strategy represents a quantum leap from the Vietnam era, when large hospitals were built near the front lines and patients convalesced there, sometimes for weeks, until they were stable enough to be sent home or return to battle. Maintaining such facilities required enormous manpower and logistical support.

"If you have a system that can move patients more rapidly," King said, "the medical assets can be smaller and more agile, and it's possible to get them closer to the fight."

Wars have always birthed medical advancements, and this system of air evacuation will likely be one of them, King said. In Iraq and Afghanistan -- where more than 90 percent of wounded servicemembers survive their injuries -- "the ability to move patients quicker and sooner has certainly played a part in the increased survival rate," he said.