Air Force provides Army burn flight team with critical care training Published Dec. 28, 2007 By Rudy Purificato 311th Humas Systems Wing BROOKS CITY-BASE, Texas -- American combat casualties conceivably have a greater chance to survive life-threatening burn and inhalation injuries as a result of the U.S. Air Force School of Aerospace Medicine's initiative to train U.S. Army burn flight professionals in Critical Care Air Transport Team operations. In December, respiratory therapists, flight nurses and other aeromedical professionals from the U.S. Army Institute for Surgical Research at Fort Sam Houston, Texas joined Air Force colleagues in a challenging course designed to prepare them for what the aeromedical evacuation community characterizes as "critical care in the air." Army burn flight teams consist of a general surgeon, a critical care registered nurse, a licensed vocational nurse, a respiratory technician and an operations Non-Commissioned Officer, he explained. "The CCATT course provides joint training in fixed-wing aeromedical transport of critically ill and injured patients that integrates real-world en route care lessons learned from Operations Enduring and Iraqi Freedom. No training platform (of this type) exists for tri-service critical care operations," Lt. Col. Fecura, Jr., CCATT course director, said. He also noted that it's the only DoD CCATT course. The joint training is especially important to the Army and Air Force aeromedical evacuation community because of the significant number of combat casualties suffered in Iraq and Afghanistan. Since Operation Iraqi Freedom began in March 2003, Army burn flight and Air Force CCATT teams have evacuated and treated hundreds of patients who've suffered burn and inhalation injuries primarily resulting from improvised explosive device detonations. According to an American Burn Association report written by Army physicians, evacuating burn victims within the first 24-48 hours is critical to patients' survival and recovery. The article explains: "Rapid global evacuation of burned soldiers has been a priority during this conflict in an effort to minimize infectious complication and organ failure, which can ensue without definitive treatment." According to Maj. Elizabeth Mann, an Army burn flight team registered nurse and CCATT course graduate, "Before Iraq, we did not fly patients who were not stable. Now we fly stabilized patients who could experience an adverse event in flight." Burn patients are most susceptible to infection. "The longer the burn goes untreated the worse the patient becomes," said Dr. Dax Holder, CCATT medical director. Dr. Holder explained that 15-20 years ago, patients who suffered burns to 50 percent or more of their body usually died. "Now we're saving their life with 90 percent of the surface area of their body burned," he said. CCATT and Army burn flight teams provide airborne intensive care to burn victims evacuated from the combat theater to Landstuhl Regional Medical Center, Germany. Burn casualties eventually receive specialized treatment from the Army Institute of Surgical Research at San Antonio's Brooke Army Medical Center, the only American Burn Association-verified burn center within the Department of Defense. "CCATT and Army burn flight teams (often) fly together," said Colonel Fecura, explaining that a joint interoperability, cooperation and training initiative promoted by DoD has led to curriculum improvements and accessibility by other services to the CCATT course. "We've had a synergistic relationship with the Army," Capt. Mark Gosling, CCATT course assistant director and former civilian paramedic, said. "They (ISR physicians) teach a two-hour burn lecture in the CCATT course. The captain said the course has been modified in recent years to reflect the reality of war: 15 percent of CCATT patients are burn victims. CCATT was created in response to a major shift in Air Force aeromedical evacuation doctrine following the first Persian Gulf War. Brig. Gen. Linda Stierle, former Director of Medical Readiness Doctrine and Planning, articulated this doctrinal shift when she wrote in a 1996 letter: "With our doctrine shifting from 'return to duty' to 'evacuate and replace,' it is imperative that we begin the process to develop training programs to care for stabilized patients in the aeromedical evacuation system." The aeromedical evacuation community had limited capabilities in transporting critically ill or injured patients prior to the doctrinal shift. Advances in aeromedical technology, combined with CCATT training, have given the Air Force aeromedical evacuation system enhanced clinical transport capabilities in caring for patients with potentially life-threatening medical conditions. "Today we're transporting sicker patients," said Capt. Sean Wilkinson, CCATT and Flight Nurse/Air Evacuation technician course instructor. "The goal is to get them to (specialized) medical facilities that can better care for them." CCATT emphasizes team work and focuses on aerospace physiology and trauma care. "The training is pretty realistic," observed CCATT student Dr. (Lt. Col.) Charles Lutin, a flight surgeon from Luke AFB, Ariz. "Battery life (for equipment) and oxygen consumption are key considerations, both not easily replaced on an aircraft." Maj. Mike Gonzalez, a CCATT alumnus who has deployed to Iraq and Afghanistan, praised the value of the joint training Army and Air Force medical professionals are receiving at Brooks City-Base. "This (CCATT) training is really reflective of the realism down range," Major Gonzalez said. He is a staff emergency medical physician at Wilford Hall Medical Center, Lackland AFB, Texas.