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Air Force ramps up flying ICU teams

The “High Bay” at the USAFSAM lab at Wright-Patterson Air Force Base, Ohio, April 25, 2018. The 711th Human Performance Wing trains new Critical Care Air Transport Team crew members using two C-130 and one C-17 training airframes. (U.S. Air Force photo by Richard Eldridge)

The “High Bay” at the USAFSAM lab at Wright-Patterson Air Force Base, Ohio, April 25, 2018. The 711th Human Performance Wing trains new Critical Care Air Transport Team crew members using two C-130 and one C-17 training airframes. (U.S. Air Force photo by Richard Eldridge)

U.S. Air Force Capt. Andrew Hersh, Critical Care Air Transport physician from Joint Base San Antonio, Texas; U.S. Air Force Capt. Matthew Thompson, CCAT nurse from Keesler Air Force Base, Biloxi, Miss.; and Senior Airman Alysia Bator, CCAT respiratory therapist from Westover Air Reserve Base, Chicopee, Mass., test their clinical skills during the two-week CCAT Initial Course inside the USAFSAM lab at Wright-Patterson Air Force Base, Ohio, Dec. 8, 2017. (U.S. Air Force photo by Michelle Gigante)

U.S. Air Force Capt. Andrew Hersh, Critical Care Air Transport physician from Joint Base San Antonio, Texas; U.S. Air Force Capt. Matthew Thompson, CCAT nurse from Keesler Air Force Base, Biloxi, Miss.; and Senior Airman Alysia Bator, CCAT respiratory therapist from Westover Air Reserve Base, Chicopee, Mass., test their clinical skills during the two-week CCAT Initial Course inside the USAFSAM lab at Wright-Patterson Air Force Base, Ohio, Dec. 8, 2017. (U.S. Air Force photo by Michelle Gigante)

U.S. Air Force Lt. Col. Greg Malone, Critical Care Air Transport medical director at the U.S. Air Force School of Aerospace Medicine, 711th Human Performance Wing, speaks to a CCAT team after evaluating their clinical skills during CCAT training inside the USAFSAM lab at Wright-Patterson Air Force Base, Ohio, Dec. 8, 2017. The students were being evaluated on preparing a simulated patient for flight. (U.S. Air Force photo by Michelle Gigante)

U.S. Air Force Lt. Col. Greg Malone, Critical Care Air Transport medical director at the U.S. Air Force School of Aerospace Medicine, 711th Human Performance Wing, speaks to a CCAT team after evaluating their clinical skills during CCAT training inside the USAFSAM lab at Wright-Patterson Air Force Base, Ohio, Dec. 8, 2017. The students were being evaluated on preparing a simulated patient for flight. (U.S. Air Force photo by Michelle Gigante)

Maj. Samuel AiKele (left), an anesthesiologist from the 99th Medical Group at Nellis Air Force Base, Nev., and Master Sgt. James Woods, a respiratory therapist from the 60th Surgical Operations Squadron at Travis Air Force Base, Calif., perform cardio-pulmonary resuscitation on a medical-training mannequin. The Airmen were participating in a two-week Critical Care Air Transport Team course at the University of Cincinnati Center for Sustainment of Trauma and Readiness Skills, Feb. 11, 2010. The course provides medical personnel total immersion in the care of severely injured patients in-flight. (U.S. Air Force by Maj. Dale Greer)

Maj. Samuel AiKele (left), an anesthesiologist from the 99th Medical Group at Nellis Air Force Base, Nev., and Master Sgt. James Woods, a respiratory therapist from the 60th Surgical Operations Squadron at Travis Air Force Base, Calif., perform cardio-pulmonary resuscitation on a medical-training mannequin. The Airmen were participating in a two-week Critical Care Air Transport Team course at the University of Cincinnati Center for Sustainment of Trauma and Readiness Skills, Feb. 11, 2010. The course provides medical personnel total immersion in the care of severely injured patients in-flight. (U.S. Air Force by Maj. Dale Greer)

FALLS CHURCH, Va. -- When the U.S. military needs to transport critically injured patients by air, it calls on Air Force Critical Care Air Transport Teams. The Air Force is increasing CCATT capabilities to meet the needs of the warfighter.

Training more CCATT crews required a shift in how the Air Force trains CCATT candidates. However, the training remains as rigorous and thorough as ever at teaching Air Force medics to deliver critical care in the air.

CCATTs transform aircraft into flying intensive care units. They augment standard Air Force aeromedical evacuation teams by adding three members – a critical care physician, a critical care nurse, and a respiratory therapist.

With the additional capability these crew members bring, CCATTs can move patients with serious injuries or illness to higher levels of care for additional treatment. The ability to transport patients out of combat theaters, from as close to the point of injury as possible, contributes greatly to the unprecedented high survival rate of combat injuries over the last 20 years.

“CCATT keeps our downrange medical footprint smaller and farther forward,” said Lt. Col. Alan Guhlke, the Air Force Surgeon General CCATT consultant, and deputy chief, En Route Care Training Department at the U.S. Air Force School of Aerospace Medicine. “It used to take weeks for a seriously injured patient to get back to the U.S. for care. Now we can have a patient home from Iraq or Afghanistan in 72 hours.”

Reducing the medical footprint in combat zones is vital for the future of Air Force Medicine. Large theater combat hospitals are expensive to set up, staff and protect, and may not always be feasible for U.S. forces to deploy. CCATTs can land at small forward airfields, take on critically injured patients, keep them stable during flight, and deliver them to a hospital across the world for further treatment.

As the Air Force adjusts its forces to meet unknown future adversaries, the ability to project medical care forward via CCATT will grow more important.

“The Air Force is the only component that offers capability like the CCATT,” said Col. Colin Smyth, director, Expeditionary Medical Policy and Operations for the Air Force Surgeon General. “Our combat commanders value that capability, so we are building more CCATTs to meet that demand.”

CCATTs candidates must already be experienced providers, currently performing critical care in their day-to-day practice.

There are two stages to CCATT training CCATT Initial takes place at USAFSAM at Wright-Patterson Air Force Base, Ohio. The Center for Sustainment of Trauma and Readiness Skills at the University of Cincinnati hosts the CCATT Advanced course. CCATT Advanced is required for new CCATT crew members and as a refresher course for CCATT crew members every three years.

Each course normally take place over two weeks. Candidates get a mix of classroom learning, simulation, and hands-on experience with the CCATT platform. Candidates get to practice their skills on several types of airframes, including C-17s, C-130s, and a 767 refitted to simulate a KC-135.

The courses are refreshers on less commonly practiced trauma skills, like burn care, but CCATT candidates are already skilled critical care practitioners.

“Our training doesn’t teach CCATT candidates to be critical care providers,” said Guhlke. “We teach them to apply those skills in a new environment.”

As far as environments go, the back of a plane is not an ideal place to care for critically injured patients. CCATT candidates have to learn how to treat patients with limited resources and support, far different from a fully staffed and stocked hospital.

“When you’re on a plane, you only have what you bring with you,” said Guhlke. “In flight, you are the team. There’s no lab, no blood bank, no other support services that providers are accustomed to.”

CCATTs also have to account for conditions in flight. Turbulence can increase patients’ discomfort or dislodge equipment. Changing pressure can affect wounds and bandages. Space is limited, especially since many CCATT flights share space with other passengers or cargo. The temperature can vary greatly during flight.

CCATT training helps candidates adapt their critical care skills to these surroundings.

“Communication is a real challenge in-flight,” said Guhlke. “It’s loud and dark, so it’s hard to monitor your patient and talk to fellow crew members. The candidates learn to rely on other senses, like using touch to see if they need to change a bandage.”

In the past, CCATT candidates did not take the two CCATT training courses back-to-back. To speed up the training without losing any valuable instruction, the Air Force now requires first-time trainees to take the courses in quick succession.

“To surge our CCATT capacity, we streamlined the existing CCATT courses,” said Smyth. “All our new teams are staffed with existing resources. It was just a matter of training more efficiently.”

Building new training facilities and adding new trainers takes time and money. To meet the demand from combatant commanders, the CCATT instructors at USAFSAM and Cincinnati C-STARS got more creative.

“By putting the classes back to back, new CCATT candidates can focus on practicing the skills they need for the in-flight environment,” said Guhlke. “CCATT Advanced courses had refresher material covered in CCATT Initial. Since that material is still fresh for candidates taking the redesigned courses, we can shorten the training. It still preserves the simulation and hands-on learning that really prepares CCATT crews for deployment.”

As the Air Force looks to the future of combat, CCATT capability is likely to become more and more vital. As battlefield care and aeromedical evacuation pushes farther forward on the battlefield, the Air Force Medical Service will keep looking for innovative new readiness solutions to support the warfighter.

“The value of the CCATT platform is far reaching, for the Air Force, the U.S. Military and the nation as a whole,” said Guhlke. “Quickly transporting seriously wounded, ill and injured patients away from the battlefield saves lives, and helps service members recover faster and return to the fight.”