21st Century Aeromedical Evacuation

USAF personnel of the 320th Expeditionary Aeromedical Evacuation Squadron on a C-17A Globemaster III with two patients injured in an aircraft crash in Afganistan. They are arriving at Ramstein Air Base, Germany where the patients will be offloaded for treatment, 13 June 2002.

USAF Organizational Alignment for Air Evacuation

USAF C-17 Globemaster III flexible airlift aircraft, the replacement for the C-141B Starlifter.

A major factor in aligning the Aeromedical Evacuation (AE) organizational structure took effect 1 October 2000, when the Tanker Airlift Control Center (TACC) stood up an AE cell designated TACC/XOGA. Major benefits in scheduling, improved response time, and decreased cost were realized almost immediately as the cell implemented various recommendations. The cell began working mixed cargo and AE missions on Atlantic Express C-17s and used air-refueling missions, when appropriate, as well as Patriot Express passenger missions for patient movement. These mixed missions resulted in an overall increase in AE mission reliability. C-141 AE missions continued to be scheduled, but their reliability remained an issue.

The Air Force provided two examples of the benefits of TACC and AE cell interface, working with the theaters to meet their patient-movement needs:

1. An August 2000 mission involved a C-17 reconfigured after a repatriation mission from Pyongyang, Korea, in an urgent attempt to save a five-day-old baby girl. The AE crew, made up of active duty and Reserve personnel, flew the 14-hour return leg from Yokota AB, Japan, to the United States, refueling in-flight from a KC-10 Extender, which was also carrying an urgent-care patient.

2. A C-17 cargo mission moved a litter patient from the Pacific to CONUS. In the past, this would have utilized an AE channel mission costing approximately $81,000. In this case, space was purchased for $1,415, a savings of $79,585.

The reengineered AE system focused on requirements-based scheduled support by purchasing seats and pallet spaces on the most appropriate aircraft rather than paying for entire airplanes. Government-contracted commercial augmentation use, complemented by scheduled routes based upon CINC-driven theater requirements, form the construct, within which a variety of aircraft will be available to support AE. During contingencies, the staging of AE crew members and en-route ground-support units at any airhead where AE requirements may be generated, rather than tying them to specific aircraft bed-down locations, will allow increased flexibility.

With the institutionalization of this new AE vision, changes to AE aircrew training and qualification were imperative. Unlike most crew members, AE crews will not be limited by qualification on specific airframes. A broad-based flight-qualification program was developed, using simulators to train and qualify AE crew members on all potential airframes. In keeping with the flexible and expeditionary approach of the Air Force, AE will be a part of the mission portfolio of all appropriate aircraft, either integrally or by maximizing the use of portable AE equipment suited to all airframes. AE crews are as flexible as the aircraft they use.

In June 2001, the AE "Tactics, Techniques, and Procedures" was published through the USAF Doctrine Center, followed by approval of the AE Doctrine Template by the Air Mobility Command (AMC) commander in July 2001. The use of the approved template in updating various joint and allied publications resolved long-standing joint and service doctrinal issues.

Retirement of the C-9A Nightingale

Consistent with the new mixed mission vision, the C-9A Nightingale ended its distinguished role as the only aircraft in the USAF inventory specifically designed for the movement of litter and ambulatory patients. It continued its service in a designated versus dedicated capacity. In February 2001, the Air Force Chief of Staff directed the removal of the red cross markings from the C-9A AE fleet. The C-9A continued to be a primary AE asset, but with flexible use of the aircraft in transporting duty and space-available passengers, as well as nonmedical supplies and equipment. Removing the red crosses avoided risking violation of domestic or international law.

Air Evacuation Operations in Afghanistan and Iraq

Better training, more advanced equipment and aeromedical evacuation procedures that are constantly being improved helped save thousands of lives of troops wounded in Iraq and Afghanistan during Operations Iraqi Freedom and Enduring Freedom. Casualties received medical treatment faster and closer to the point of injury than ever before as the military medical system positioned its assets closer to the front lines. When a patient's condition required evacuation to receive more advanced care, the aeromedical evacuation system moved them as quickly and safely as possible to the life-saving care they need. Patient movements from the theater to U.S. hospitals that typically took 45 days during the Vietnam War were reduced to as little as 36 hours, with continuous medical care delivered throughout travel.

The Air Force steadily improved its performance from the beginning of the global War on Terror, evacuating more than 4,500 troops with battlefield wounds from Afghanistan and Iraq to Landstuhl, Germany and more than 25,000 total patient movements from 2001-2005. For patient care during the five-hour flight from Balad Air Base in Iraq to Landstuhl, the flying hospital was equipped with life-support equipment ranging from ventilators to heart monitors. Aeromedical evacuation teams, which typically included two flight nurses and three aeromedical evacuation technicians hover over casualties, monitor their condition, help reduce their pain level, and continue treatment that began when they were on the ground.

The C-17 Globemaster III was employed for the medical evacuation flights, an aircraft with a cargo bay able to move up to 70 patients at a time, including as many as nine with critical injuries. The C-17 is quieter, vibrates less, and has better temperature control than the C-141 Starlifter it replaced, designed for its medical role.

The ability to evacuate serious cases quickly and effectively for advanced treatment, combined with Kevlar helmets, improved body armor and up-armored vehicles brought case fatality rates for wounded to about one-half of what they were during the Vietnam War.

Patient Support Pallets for Aeromedical Evacuation

New aeromedical evacuation technology, called patient support pallets, transports patients aboard aircraft not normally used for aeromedical evacuation. The patient support pallet, developed at the USAF Human Systems Center in San Antonio, TX, is built on a standard cargo pallet and provides support for six litters or a combination of three airline seats and three stretchers. The Air Force uses the patient support pallets on KC-135s, KC-10s and C-17s airframes.

The Air Force began using C-130s and KC-135s aircraft for aeromedical evacuation within CONUS on 7 August 2003. The KC-135 missions ran cross-country to Scott AFB and end at Travis Air Force Base, CA, and C-130 routes ran from each of the three areas: Andrews Air Force Base, MD, Scott AFB and Travis AFB, to transport patients to their final destinations.

Recommended Book about Aeromedical Evacuation

• Aeromedical Evacuation

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