Aeromedical Evacuation in the 1990s

Flight nurse Lt. Col. Karen Wolf (center) with two other flight nurses at Tuzla Air Base, Bosnia, 27 February 1997. The personnel from 61st Airlift Squadron ("Green Hornets"), Little Rock AFB, AR, made daily flights between Ramstein AB, Germany and Tuzla aboard C-130 Hercules Air Transports in support of Operation Joint Guard.

Today in WW II: 9 Jul 1940 Battle of Calabria [Battle of Punta Stilo, the toe of Italy] fought between the Italian Royal Navy and the British/Australian Royal Navies, 30 miles [48km] east of Punta Stilo. More ?

9 Jul 1943 US-British invasion of Sicily begins [night of 9-10 Jul].
9 Jul 1944 British and Canadian forces capture Caen from the Germans, a critical post-D-Day objective in Normandy, France.
9 Jul 1944 US forces reach the northern end of Saipan, finding thousands of Japanese civilian men, women, and children who commit suicide by leaping off the cliffs rather than be captured.
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USAF Reorganization in the 1990s

Personnel from the 1st Mobile Aeromedical Staging Flight, Pope AFB, NC, load Major Joe Stephenson in a stretcher rack aboard a USAF C-141 Starlifter, enroute from Mogadishu, Somalia to Landstuhl Army Regional Medical Center, Germany, 1 December 1993.

In a reorganization with profound implications for Aeromedical Evacuation (AE), Military Airlift Command, Strategic Air Command, and Tactical Air Command were deactivated 1 June 1992, replaced by two new organizations:

Air Combat Command (ACC)
Air Mobility Command (AMC)

Air Mobility Command was developed from the elements of the deactivated commands but AMC quickly divested itself of infrastructure and forces not directly related to Global Reach. Among the units affected were C-130 airlift squadrons and Aeromedical Evacuation (AE) squadrons at Rhein-Main AB, Germany, which transferred to United States Air Forces in Europe (USAFE), and similar squadrons at Yokota AB, Japan, which transferred to PACAF. In addition, the majority of active and Air Reserve Component (ARC) C-130 airlift squadrons, the active-duty AE squadron at Pope AFB, NC, and 19 AE squadrons gained from the ARC all went to ACC in order to align all theater combat support under one command. However, in 1997 these same assets were transferred back to AMC.

In 1996 the Global Patient Movement Requirements Center (GPMRC) was established within the US Transportation Command to facilitate and streamline patient validating and regulating. Theater Patient Movement Requirements Centers also stood up in US European Command and US Pacific Command. These centers were responsible for definition and management of patient movement requirements, patient in-transit visibility, and collaboration with their respective theater or joint-task-force movement control agency to coordinate bed and lift plans.

Aeromedical Evacuation Training Programs Established

Because of lessons learned in Desert Shield/Desert Storm, an Aeromedical Evacuation Contingency Operations Training (AECOT) course was developed and fielded at Sheppard AFB, TX, in September 1998. The course trains AE personnel in a standardized manner regarding general philosophy, capabilities, organization, operations, C2, and support required to provide full-spectrum AE capability during contingencies.

In 1999 a Critical Care Air Transport Team (CCATT) course was developed at Brooks AFB, TX, to prepare teams of physicians, nurses, and technicians to provide structured en-route care for critically ill and injured patients whenever and wherever required. The course includes a detailed review of the CCATT mission, equipment, and organization, as well as familiarization training with AE aircraft, orientation to the stresses of flight, and refresher training through a fundamental critical-care support course.

Aeromedical Evacuation Operations After the Gulf War

Throughout the 1990s, AE units continued to be engaged in a variety of contingency operations covering multiple theaters. AMC and AMC-gained units deployed sixty medical personnel for ninety days in the fall of 1994 to manage an air-transportable hospital in support of Operation Uphold Democracy in Haiti. Those medical personnel were responsible for treating and aeromedically evacuating, if necessary, all military personnel deployed. In addition, Air Force medics deployed to remote locations throughout Haiti to take part in the humanitarian assistance program.

Additionally, active duty and ARC AE forces joined to support operations in Kenya, Rwanda, Saudi Arabia, Kuwait, Bosnia, Somalia, and Kosovo. AE evacuated many critically injured Rangers and special operations forces to Ramstein AB, Germany, after the 3 October 1993 "Bloody Sunday" firefights in Mogadishu, Somalia. AE personnel supported Operation Allied Force with crews and mobile aeromedical-staging facilities. Moreover, those same personnel concurrently supported Operation Shining Hope, humanitarian aid to Kosovar refugees in 1999. The first four AE missions flown out of Tirana, Albania, were on C-17 Globemaster IIIs, demonstrating the effective use of opportune airlift. In each operation, the presence of AE forces ensured the prompt and safe aeromedical evacuation of military personnel who needed more care than was available locally. Finally, AE units supported humanitarian civic action operations in various locations throughout Central and South America during this period. With the adoption of a new casualty replacement policy and a smaller presence in overseas contingency theaters, AE became even more important as the twentieth century closed.

Challenges of A Changing AE Environment

By the late nineties, AE faced new and daunting challenges. Modern conflict, routinely characterized by rapid, short-duration, high-intensity combat, resulted in casualty generation with very little lead time. As a result, there was often no opportunity to set up en-route contingency hospitals, and critically ill patients frequently had to be evacuated long distances to reach comprehensive medical care. This necessitated the movement of "stabilized" -- not fully stable -- patients, who often required intensive care during evacuation.

In December 1998, during an internal review of AE posture, AMC identified a number of critical issues with significant potential to affect future AE operations. These included:

Evolution of the USAF into the expeditionary aerospace force (EAF) concept and air expeditionary force (AEF) structure
Iimplementation of TRICARE
Evolving doctrine and command relationships
Changing patient-movement requirements
Impending retirement of the core strategic AE aircraft:
- C-141, performing the majority of peacetime inter-theater AE missions
- C-9A, dedicated intra-theater AE platform

The AE system of the 1990s was designed for a world that no longer existed and change was required for AE to adapt.

By the end of 2000, a Tiger Team appointed to consider these issues had determined peacetime and wartime AE requirements. In peacetime, with the changeover to TRICARE medical coverage, the need to move patients had declined in the CONUS from approximately 69,700 patient movements in 1995 to 19,500 movements in 1999, with only one percent classified as priority or urgent. In the overseas theaters, the requirements remained steady. Outside the US, TRICARE was not so significant and the closing of O-CONUS medical facilities after the Cold War required the movement of patients to CONUS facilities. With regard to wartime requirements, the overall wartime casualty projections were 30–55 percent less than projections made in 1996. The projections were based on changes in war-fighting concepts, evacuation policies, theater medical capabilities, and the smaller numbers of soldiers at risk.

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