CCATTs continue life saving missions

Published Aug. 6, 2013
By Staff Sgt. Corey Hook
59th MDW/PA

JOINT BASE SAN ANTONIO-LACKLAND, Texas -- A 20 year old United States Army soldier has sustained serious injuries from a roadside bomb in Afghanistan - 70 percent of his body is badly burned, and he has lost one of his legs.

An Air Force pararescue team flew him from the point of injury to the nearest forward operating base in Afghanistan for immediate medical care. His journey back to the states relies on Critical Care Air Transport Teams, and so does his life.

In critical condition, he will be flown by CCATT to the Afghanistan theater hospital at Bagram Air Base, and roughly 19 hours later he'll be in a hospital bed at Landstuhl Regional Medical Center in Germany - the nearest treatment center for wounded warriors coming from Afghanistan. Sixty-one hours later he is done with the transatlantic flight and at the San Antonio Military Medical Center, with all flight care conducted by CCATTs while en route.

During the Vietnam War, it took an average of 45 days to return patients to the states and only 75 percent of wounded warriors survived. The Air Force's CCATT capability allows service
members to be transported from the point of injury to a stateside hospital in less than 3 days and 98 percent survive their injuries.

The concept of CCATT was developed in the early 1990s at the 59th Medical Wing by retired Maj. Gen. P.K. Carlton and retired Col. Chris Farmer in an effort to expand the Air Force's aeromedical critical care transport capabilities. Carlton and Farmer created the first written concept of operations, a table of allowances and a plan of action for formalizing the CCATT program.

The 59th Medical Wing initiated the CCATT proof-of-concept in 1994. It also created the CCATT Pilot Unit which was responsible for making recommendations for training, equipping and utilization of CCAT teams; a mission that the 59th Medical Wing Pilot Unit continues to perform to this day. Already in 1995, CCAT teams from the 59th Medical Wing and the 81st Medical Group (Keesler AFB) were deploying in support of overseas contingency operations. Following the completion of the two-year proof-of concept period in 1996, CCATT was formally approved and adopted into the USAF Aeromedical Evacuation System.

Earlier this year, an Army and Air Force team made history by successfully transporting a critically ill woman on an extracorporeal membrane oxygenation system (ECMO) from the San Antonio Military Medical Center to New York City. ECMO is a heart-lung bypass system that circulates blood through an external artificial lung and sends it back into the patient's bloodstream.

Very recently, another milestone was achieved - the first transatlantic ECMO patient transfer in history. CCATT's mobility and specialized en-route care are allowing critically ill or injured patients to survive the transport to world-class stateside facilities where more definitive care is available.

Maj. William Moore, former 59th Medical Wing CCATT Pilot Unit Coordinator, and retired Col. James King, former CCATT Pilot Unit Leader, have more than 50 years of combined Air Force service - both have been instrumental in the progression of the Air Force's CCATT capability.

"Full implementation of CCATT began in fiscal year 1998," King said. "In addition to the creation of new CCAT teams throughout the Air Force, a formal CCATT training course began at the U.S. Air Force School of Aerospace Medicine. The course was the first attempt to standardize training for the highly specialized CCATT mission. Personnel from the 59th Medical Wing augmented the CCATT course faculty in training Air Force active duty and Air Reserve component doctors, nurses, and technicians would go on to support worldwide AE operations."

Moore said some have asked him how the survival rate for wounded warriors can be 98 percent.

"Tourniquets are back in action, troops downrange always have them. Sometimes we see patients with 4 tourniquets with one being on each extremity. Our medics are close to the action and within 15 minutes (of injury) are performing damage control surgery on the wounded warrior, opening them up and looking for internal bleeding," Moore said. "CCATTs are fundamental to the 98 percent survival rate - without them, patients couldn't get the next level of care they need to survive."

Traditional aeromedical evacuation only provided intercontinental transport for stable patients. Leaving the critically ill in the war zone would increase the need for facilities and supplies to care for those patients until they were stable for flight. The creation of CCATTs changed this.

"We were routinely responsible for at least 4 patients on a lot of the missions I flew at the beginning of Operation Iraqi Freedom," King said. "On one mission, we flew 5 ventilated patients on a C-130 Hercules."

"There is some difficultly flying on a C-130 because of power and oxygen limitations, CCATTs require support from the AE crews that configure the aircraft with portable liquid oxygen and power converters as well as oxygen hoses and special power cords. It all gets pretty technical," King added.

With the addition of special medical equipment that is part of the allowance standard brought on each mission, CCATTs can turn almost any airframe into a flying intensive care unit within minutes.

One of Moore's four deployments was in 2004 to Balad Air Base, Iraq where he worked with the Army's 31st Combat Support Hospital (CSH), serving as critical care nurse on one of only two CCATTs.

"Head injuries from improvised explosive devices (IED) were very common during my deployment working with the CSH," said Moore. "Back in 2004, we didn't have mine-resistant ambush protected vehicles. We had normal Humvees that would often fly 20 feet in the air after hitting an IED. Even body armor was scarce, which led to plenty of injuries."

"Today we have more protection out in the field, which increases safety for everyone ultimately preventing serious injuries and resulting in fewer patients for CCATTs," added Moore.

Although CCATTs have evolved dramatically since its inception, continual improvements are underway in order to deliver the best possible care.

"We have a 59th Medical Wing CCATT Pilot Unit nurse who collects transportation information on all CCATT missions worldwide," King said. "If red flags come up on the care provided, a process is set up for review."

"Another care improvement initiated by the 59th Medical Wing is the En Route Care Research Center. Studies are being done within the center to improve how CCATT care is delivered," King said.

The En Route Care Research Center is part of the Air Force Combat Casualty Care Center located at Ft. Sam Houston, Texas. It serves as the focal point for studying clinical knowledge gaps related to the en route continuum of care to include Medical Evacuation (MEDEVAC), Aeromedical Evacuation, Critical Care Aeromedical Transport Team, and Burn Flight Team.

Training in trauma and critical care for U.S. Air Force physicians, nurses and technicians is conducted at the Center for the Sustainment of Trauma and Readiness Skills (CSTARS). Every team member undergoes training at CSTARS before they are deployed to perform CCATT missions. Most of the training and protocol functions for CCATTs today are based upon the experience gained throughout Operation Enduring Freedom and Operation Iraqi Freedom.

"CSTARS is like a CCATT check ride. CCATT members are required to manage intensive scenarios based on actual missions and the CSTARS faculty employ computer driven mannequins to create high-fidelity simulations." King said. "The course is critical to ensure that when CCATT members deploy, they are ready to provide critical care under very unforgiving conditions."

On every single day for more than ten years, Critical Care Air Transport Teams have been deployed in support of contingency operations, and the U.S. Air Force is saving more wounded warriors now than ever in our nation's history.

USAF. (U.S. Air Force Graphic by Rosario "Charo" Gutierrez)