The evolution of aeromedical evacuation capabilities help deployed medicine take flight Published March 15, 2018 By Shireen Bedi Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- Evacuating patients injured in combat and transporting them to higher levels of care requires a team of trained medics with the capability to keep patients stable in-flight. The Air Force’s Aeromedical Evacuation system has been a staple of transporting wartime casualties since World War II. In that time, AE capabilities have expanded and improved to safely transport more patients, fly longer distances, provide in-flight critical care, and enable AE teams to anticipate the needs of future conflicts and AE requirements. In the 1940’s, the U.S. Army Air Corps used C-47s and C-54s aircraft to implement an Air Ambulance squadron. This system, while largely successful at moving patients rapidly, presented in-flight challenges, such as aircraft vibration and hypoxia. Due to these in-flight factors, only very stable patients were able to be transported at this time. By the Korean War, the Air Force Military Air Transport System took over transporting patients from Japan to the U.S., with flights staffed by trained Air Force AE crews. Relying on Air Force AE crews to safely transport casualties contributed to the decreased death rates during wartime. The Vietnam War, incorporated helicopters into the AE system to provide rapid transport patients from closer to the battle space. In 1965, realizing the need for improved AE capabilities, the Air Force started developing the C-9A aircraft. This was a dedicated platform designed for AE. The addition of this aircraft significantly modernized AE capabilities and improved in-flight medical care during the Vietnam War and beyond. The C-9A was fitted with electrical and oxygen systems, hydraulic ramps, increased capacity for litter and ambulatory patients, and specially designed interiors to help decrease the negative effects of altitude on patients. During the 1980’s, in anticipation of potential conflict scenarios, the Air Force worked to increase airlift capabilities, as well as increase the number of air transportable hospitals. Additionally, staging facilities were developed to hold and triage patients awaiting evacuation. These staging facilities could be fully functional within 5 days and could hold up to 250 beds. During the Gulf War, the Air Force Medical System began its largest deployment since Vietnam. Anticipating an increase in patient transport, the Air Force deployed air transportable clinics and hospitals that could be fully functional in the field within 24 to 48 hours. These clinics were vital for rapid mobility, and deployed immediately with their squadrons. Battlefield casualty rates in the Gulf War were much lower than in previous conflicts, and effective preventative medicine helped in minimizing loss to disease. From August 1990 to March 1991, AE teams were able to move up to 3,600 casualties per day, and completed 12,632 total patient evacuations during that time. In addition to the C-9A, the Air Force used converted cargo aircrafts. This allowed AE crews to transport more casualties. Only Air Force nurses and medical technicians were onboard the aircraft with patients, limiting the types of care possible in the air. Air Force physicians at military hospitals mainly worked to ensure patients were stable and ready for transport. This changed in 1996 with the adoption of Critical Care Air Transport Teams, which added flying intensive care capabilities to the AE system. CCATTs included a critical care physician, critical care nurse, and a respiratory technician. Designed to augment an AE crew when needed, CCATT quickly became, and remains, a vital AE platform for transporting combat casualties, providing humanitarian assistance, and aiding in peacetime patient transport. Testing AE capabilities dramatically increased with the wars in Iraq and Afghanistan. For 15 years, the Air Force had significant patient movement requirements as they adjusted to the War on Terror. This conflict was fought mainly as smaller, unit-level engagements, which reduced the size of forward health facilities. Air Force AE teams have transported a higher volume of patients requiring higher levels of care than ever before. As the Air Force prepares for to meet future AE needs, the focus remains on maintaining and developing flexible systems that meet the needs of combatant commanders. The long history of significant improvements to the AE system has helped revolutionize battlefield medicine. This is not likely to change in the future, as AE capabilities keep evolving, and come closer to reaching the same standard of care in the air as on the ground.