FALLS CHURCH, Va. --
The Air Force accomplished an unprecedented mission in August 2019 when medics from across the force came together for an 8,000 mile, non-stop evacuation of a critically injured Soldier.
With a C-17 Globemaster III crew and refueling aircraft positioned along the way, 18 medics, including a Critical Care Air Transport Team, moved the patient direct from Bagram Airfield, Afghanistan, to Brooke Army Medical Center in San Antonio, Texas.
At every stage and under strenuous conditions, Airmen delivered exceptional care to save a life. While the length of this mission was challenging and unprecedented, this is the type of mission the Air Force prepares to execute every day, delivering ready medical support to operational forces. Air Force medics stay ready to answer that call and “fight tonight” by maintaining clinical currency and proficiency through treating patients and readiness training.
To keep Airmen in the flight, the Air Force’s core capabilities are aeromedical evacuation, battlefield medicine, and aerospace medicine.
“Air Force medics not only deliver deployed medicine in the back of a plane and downrange, they also support Airmen who fight from U.S. bases,” said Brig. Gen. Mark Koeniger, Air Force Medical Readiness Agency commander. “Our challenge is keeping our medics ready to complete those missions.”
Air Force Medicine mission
For Capt. Michael Ferraro, a family physician with the Operational Medicine Clinic at Holloman Air Force Base, New Mexico, caring for operational Airmen means getting out to the flight line regularly.
Ferraro works in a neck and back clinic for pilots and understands their medical issues and needs. Rather than wait for his patients to come to him once they are injured, he goes to them to keep them in fighting form.
“Pilots, like those who fly the F-16, are under high stresses and have conditions equivalent to what we see in high performance athletes,” said Ferraro. “As an osteopath, I help pilots with preventative care, mitigating the impact years of flying has on their body.”
Brig. Gen. Robert Marks, command surgeon, Air Mobility Command, explains medical Airmen deliver the same exceptional care on an airplane as they do in a clinic.
“We have medics who are experienced at taking care of patients inside a facility,” said Marks. “What makes us unique is we translate that capability to a dark, noisy aircraft at 35,000 feet.”
This is true for Lt. Col. Valerie Sams, the trauma medical director at Brooke Army Medical Center at San Antonio, Texas. Sams was one of the surgeons on the unprecedented 20-hour aeromedical evacuation flight. She and her team were ready within two hours of getting the call to fly out to Bagram and bring the Soldier home.
“Practicing at a level 1 trauma center in my daily, in-garrison job allows me to maintain the proficiency and resiliency needed to perform when called upon,” said Sams. “During the flight, we provided continual renal replacement therapy, which the Soldier needed to withstand the 20-hour flight and ensure he would not suffer a cardiac arrest or other significant event during the flight.”
Sams not only had all the necessary critical equipment, but she was also equipped with her trauma surgery experience.
Medics also deliver care downrange in austere environments and are often ready to deliver care that would normally exceed their traditional medical role. This was the case for Senior Airman Colleen Mitchell, a medical technician assigned to Wright-Patterson Air Force Base, Ohio. In January, she was deployed to a forward operating base in Kenya when Al Shabab militants attacked the airfield at Manda Bay. As patients came in, Mitchell took over as lead medic, triaging and treating patients while coordinating a makeshift team to care for injured service members.
“Working in an austere environment required me to think on my feet and improvise with the equipment and materials I had available,” said Mitchell. “I triaged and treated patients with the very Airmen I trained for such situations.”
As Chief Master Sgt. G. Steve Cum, Medical Enlisted Chief and Enlisted Corps Chief, explains, Mitchell and her ability to respond to the attack is indicative of the type of skills and capabilities medical Airmen need downrange.
“Airman Mitchell went above and beyond expectations to deliver care and take lead of the situation,” said Cum. “That’s what we train and prepare for, the worst case scenario, and medics like her are the foundation of why we are successful.”
Ready medical Airmen
Air Force hospitals and clinics, called military treatment facilities, serve as the primary platform for Airmen to maintain their currency and readiness. The Air Force uses the Comprehensive Medical Readiness Program, or CMRP, as a tool to establish standards and define requirements for each medical career field. This ensures medics’ training and currency requirements stay up to date.
“If a surgeon has to complete a certain number of specific surgical procedures within the year, you have to track that and find opportunities to ensure they meet that goal,” said Col. James Sampson, Chief Surgical Consultant to the U.S. Air Force Surgeon General. “If a surgeon is not on track to meet annual requirements, his or her leadership works to provide additional opportunities through civilian partners.”
Nurses are no different. Capt. Katherine Abbott, nurse and element leader at Wilford Hall, Joint Base San Antonio-Lackland, Texas, worked with her leadership to ensure she had inpatient care experience prior to her most recent deployment. Abbott, who primarily delivers outpatient care, worked at nearby Brooke Army Medical Center to get more inpatient experience to supplement her clinical capabilities and enhance her readiness to deliver care downrange.
“Outpatient care is quite different than delivering care in a deployed setting,” said Abbott. “While deployed, I relied on my readiness training all the time. I treated patients with traumatic injuries, including amputations, paralysis, burns, and internal organ damage. Litter training helped when I had to unload seriously injured patients. I also received experience with head traumas, which helped out tremendously treating patients injured from explosions or other traumatic events.”
Members of Critical Care Air Transport Teams, like Senior Master Sgt. Matthew Worsham, the 18th Medical Operations Squadron superintendent at Kadena Air Base, Japan, remain ready and current to ensure their training and patient care skills come together to deliver critical en route care.
“My first CCATT deployment was just one month after I finished the CCATT basic course, moving a young Army medic who was injured in the field rescuing his team members,” said Worsham. “He had been at Walter Reed Army Medical Center for months and endured countless surgeries. We flew him home with his mother by his side. That moment put it in perspective, the gravity of my responsibility to bring service members home safely.”
While trauma and critical skills are vital to deployed medicine, medics are also ready to deliver a broad range of care, relying on the skills they maintain in their MTF.
“When we think about care needed in a combat environment, we tend to think about trauma,” said Koeniger. “While that is important, the reality is that most of the care we have delivered downrange are things like non-battle injuries and illness. I am a family practice doctor and the bulk of patients I see downrange need the same type of care I provide in clinic back home.”
The Air Force Medical Service establishes partnerships or training affiliation agreements with civilian, government and international health system for medics to access additional opportunities to keep their skills current. These partnerships let Air Force medical personnel treat a higher volume and complexity patients than they would typically see on base.
“The Air Force is forward thinking on training affiliation agreements,” said Lt. Col. Joshua Tyler, 81st Surgical Operations Squadron Institute for Defense Robotic Surgery Education director at Keesler Air Force Base, Mississippi. “Maintaining currency in my specialty and getting the skills I need to be deployable requires those partnerships.”
For surgeons like Tyler, many of his patients come from the civilian population near Keesler Air Force Base, whom he treats through a local hospital. He finds this vital to maintaining currency in his colorectal surgery specialty.
“I maintain a high volume of rectal cancer surgery cases by treating the local population at the local hospital,” said Tyler. “Rectal cancer surgery is considered a high risk procedure and I am able to exceed the patient volume I need because of this civilian partnership.”
These civilian partnerships also provide crucial training opportunities that target the specific skills needed prior to deployment.
The Center for Sustainment of Trauma and Readiness Skills strengthens clinical and readiness skills required during deployment. Managed by the 711th Human Performance Wing at Wright-Patterson Air Force Base, C-STARS has been assigning and integrating medical Airmen into civilian trauma centers in Baltimore, St. Louis and Cincinnati for the past 20 years.
Airmen have the opportunity to rotate through the C-STARS program, which specifically focuses on learning and applying high-acuity skills required for deployment. Some medics also use C-STARS to complete their annual skills sustainment program. These Airmen are taught by Air Force medical personnel who are embedded and assigned into the care teams at these civilian hospitals.
“R Adams Cowley Shock Trauma Center in Baltimore is one of the highest volume trauma centers in the country,” said Col. Joseph DuBose, the Baltimore C-STARS director. “Medics who embed or rotate through this program are exposed to an environment where they can acquire and refresh the critical skills needed to perform their duties in support of optimal combat casualty care.”
Cases in C-STARS trauma centers are often representative of deployment casualties. The centers care for a high volume of trauma victims with severe blunt and penetrating injuries and treat them with the highest level of expertise.
“If you want to train and develop the best trauma providers in the military, you work with the best trauma providers in the civilian world,” said DuBose. “That is exactly what the Air Force and C-STARS have accomplished.”
DuBose’s own C-STARS experiences are rigorous.
“In just 24 hours, I had the opportunity to treat more than 30 severely injured individuals. Among them were several trauma victims with multiple gunshot wounds who arrived in unstable condition and required emergent surgical intervention to save their lives,” said DuBose. “This care was conducted by a combined team of civilian professionals, military C-STARS cadre and Air Force rotators.”
Medics embedded in C-STARS share their deployed experience and training with the Airmen who rotate through the program. Tyler, who deployed as part of a ground surgical team, received training at C-STARS Baltimore prior to deploying.
“You are learning from people who do trauma every day in their day-to-day deployed practice,” said Tyler. “They have also deployed as part of a ground surgical team. They have immense credibility in teaching you what to expect downrange.”
This was true for 1st Lt. Mariah Pruett, a Tactical Critical Care Evacuation Team nurse, who went through the Cincinnati C-STARS program. The C-STARS Cincinnati program focuses on advanced CCATT training.
“I participated in multiple high fidelity simulations, which helped to build muscle memory for high stress situations,” said Pruett. “We repeatedly trained at high altitude with simulated patients. I often found myself falling back on things I learned during this training.”
The Air Force is continuing to grow its partnerships with outside medical systems. One notable partnership is between the Air Force facility at Royal Air Force Lakenheath near Suffolk England, and the United Kingdom’s National Health Service.
“Our partnership with the NHS is an effective and efficient way for medics at RAF Lakenheath to sustain their clinical skills while also still being available to support contingencies at the base,” said Sampson. “I personally found working in an NHS hospital to be an incredible learning experience, and the same story can be told about our partnerships with other U.S. bases.”
“Embedding medics in civilian medical systems that have the volume and acuity of cases ensures proficiency in delivering high quality care in deployed and possibly denied environments,” said Col. Joseph Anderson, Air Force Medical Readiness Division chief. “This is increasingly important as we support current and future operations.”
Prepared medics for tomorrow’s fight
As the U.S. National Defense Strategy shifts focus to contingences involving peer adversaries, it is more important than ever to ensure medical Airmen are equipped with the skills necessary to provide care in operational environments. This includes battlefields very different from current U.S. conflicts.
“We have enjoyed great success in the last 30 years with improved combat casualty survivability, especially with our aeromedical evacuation capability to move patients to higher levels of care,” said Anderson. “This may not be the case in future contests where we may be fighting further away from our own bases, facing new challenges.”
The Air Force Medical Service is modernizing, building and expanding opportunities that provide Airmen with the skills needed no matter the location or circumstance.
“Our personnel are highly trained and multi-capable Airmen, equipped with diverse, high acuity experience,” said Sampson.
It is the dedication of these ready Airmen that make challenging missions like the 20-hour aeromedical evacuation flight successful.
“I know people talk about how great and miraculous this mission was, but this is the type of mission we train for today and something we practice 100 times over,” said Sams. “It is not something we are afraid to do because we have a team of dedicated Airmen ready and willing to do whatever it takes to get warfighters home.”
Peter Holstein and Laraine Thompson contributed to this article.