ANDERSEN AIR FORCE BASE, Guam --
The aircraft exhaust shimmers over the asphalt airfield and blows hotly into the goggled faces of the crew on the loading ramp.
Four bearers to each stretcher, the medical team hurriedly carried medical evacuation patients from a truck into the roaring belly of the U.S. Air Force C-130 Hercules, where medics and flight nurses in olive green flight suits strap patients to blood pressure cuffs and heart monitor defibrillators in preparation for transport.
The team knows every minute counts when lives are at stake.
“We do the basic set up for patient transport and provide basic patient care,” said Royal Air Force Leading Aircraftwoman Chantel Gibson, a medic with No. 3 Aero-Medical Evacuation Squadron. “If the patient is responsive, we find out where they come from, how they feel and what their pain level is and relay any necessary data and observations to the nurses and doctor.”
After Gibson and her teammates get patients placed in the aircraft and take initial vitals, they complete a final check around the patients to make sure they are comfortable and then continue to conduct routine assessments to track patient conditions.
Luckily, all injuries the teams treated were only simulated through moulage to heighten training realism. The medical evacuation of patients was part of the humanitarian assistance and disaster response portion of exercise Cope North 16, a multilateral exercise including the U.S. Air Force and air forces from across the Indo-Asia-Pacific region.
“Cope North offers very realistic training with its large-scale contingency HA/DR scenario,” said U.S. Air Force Tech. Sgt. Sarah Lopez, CN16 mission-critical coordinator and aeromedical evacuation technician with the 18th Aeromedical Evacuation Squadron. “It provides a lot of good training for all our AE crews. It helps those of us who have never been in an actual contingency environment, and provides that realism of transporting a patient so that we can safely evacuate them from the disaster area.”
During the HA/DR portion of the exercise, Air Force medical personnel work side by side with their counterparts from Australia, Japan, New Zealand, the Philippines and South Korea to learn the ins and outs of expeditionary acute care. The goal is to prepare the international airmen to treat injuries they would see during a response to natural disasters.
“It is really important for us to understand how each country functions, so that when we do have to come together for joint disaster responses, we can do it smoothly and effectively and have the best outcome for the people who are in need of help,” said RAAF Flight Lieutenant Emma J. Dingle, a flight nurse with No. 3 AES and CN16 AE liaison. “The best part about working with service members from a different country is learning things that can add to your own process. We debrief every action and have already learned from each other what we can do better during mass casualty evacuation situations.”
EMEDS team works hand-in-hand
On Rota, the teams also trained in set-up and operation of the Expeditionary Medical Support - Health Response Team, a mobile hospital with numerous treatment areas, including the emergency room, operating rooms and patient care areas.
Receiving a steady stream of notional typhoon victims, medical teams were kept on constant alert. As patients arrived at the intake and triage tent, medics gathered around and prioritized the patients according to severity of their injuries. Emergency medical providers know that time is of the essence in all they do. Each person has a job, and rushed to perform specific duties.
Under the clean white of the tent roof and light from fluorescent bulbs, airmen unrolled gauze and bandages, prepped IV bags and used a mobile, collapsible X-ray unit to practice real-time care procedures on victims with simulated injuries ranging from burn wounds to open fractures.
“We have a large variety of scenarios and throw various patient cases at the responders,” said Tech. Sgt. Lorylee Willis, an EMEDS medical readiness cadre and CN16 exercise evaluator. “From severe trauma to psychological stress and shock, the teams never know what will come at them next.”
Elevating care through evacuation
The time patients can stay in the expeditionary facility, however, is limited given the limited space and supply resources, Dingle said. Whether in combat or during peacetime natural disasters, when severely injured patients need to receive a higher echelon of care, AE specialists are responsible this happens safely and expediently, while continuing lifesaving patient treatment during transport.
“We can stabilize, but not maintain,” Dingle said. “As soon as the patient is stabilized, we transfer because they can only stay there for a limited amount of time.”
As comfortable with stethoscopes as with radios and spreadsheets, the flight nurses are the link between flight operations and hospital providers. To process patients leaving the clinic, the AE team also works directly with medical administrators at the center of the EMEDS tents.
“This exercise already gives me a better understanding of organization,” said U.S. Air Force Capt. Sarah Green, an 18th AES flight nurse and Dingle’s fellow CN16 AE liaison team member. “We know what the AE team is looking for but are not actually flying the mission like we usually do. Instead, we ensure all the organizations are properly functioning so that when we’re ready to take the patient out to the flightline they’re good to go.”
By mid-day, the teams had already completed four evacuations. Yet they approach each like the first — every patient is unique and has different needs. Calmly, nurses and medics work together and ready another batch of patients for flight.
“We pay attention to the safety our crew and most importantly our patients,” Lopez said. “Our priority is to move our patients safely but also quickly so they can receive the higher level of care. That’s why being a medic is so rewarding — I enjoy working and talking with patients and making sure we’re taking them to the help they need.”
Then the team receives another call via radio: The next C-130 is ready to evacuate the next group of patients. Under the direction of the liaison nurses, service members grab stretchers and again head for the flightline where another C-130 waits with engines idling and a crew comprised of airmen from more then four nations, working in sync.
“It is actually quite easy to communicate and integrate with our international partners,” said LACW Katherine Ruwhiu, a flight medic with the Royal New Zealand Air Force. “There are a lot of similarities between our nations. The main reason I joined is to help people in need, and we all have that in common. This exercise really helps solidify our training and helps us gain hands-on experience. It’s been quite successful and fun working in the joint teams.”
Evacuation with the patient in mind
Even when compared to her recent real-world deployment to Afghanistan, Dingle said Cope North scenarios succeed in simulating severe situations that challenge the responders to dig deep.
“The pace here is intense; we’re doing this really fast paced and seeing a lot of patients in quick succession,” Dingle said. “At the end of the day, we are there to help the patient get to a safer place.”
Moments later, the team reaches the aircraft. As stretchers disappear over the loading ramp, nurses shout instructions to hurried medics. Despite minor difference between the team members’ accent, uniform or gear, at the center is the care for the patient.
“The focus of this whole exercise is the patient,” Dingle said. “It is really important for us to understand how each country functions, so that when we do have to come together for joint disaster responses, we can do it smoothly and effectively and have the best outcome for the people who are in need of help.”
Then, the C-130 takes off into the clouds, taking patients to follow-on care beyond the horizon. The flightline goes quiet and medical teams return to the hospital tent to repeat the cycle — only faster and more confidently than before.