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CCATT delivers critical care in the air

U.S. Airmen assigned to the 455th Expeditionary Aeromedical Evacuation Squadron repack AE equipment and supplies after an AE mission aboard a C-17 Globemaster III aircraft at Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES Airmen are charged with the responsibility of evacuating the sick and wounded from Central Command to higher echelons of medical care. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Airmen assigned to the 455th Expeditionary Aeromedical Evacuation Squadron repack AE equipment and supplies after an AE mission aboard a C-17 Globemaster III aircraft at Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES Airmen are charged with the responsibility of evacuating the sick and wounded from Central Command to higher echelons of medical care. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Critical Care Air Transport Team members check on a patient prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Critical Care Air Transport Team members check on a patient prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Capt. Deann Hoelscher, right, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, and U.S. Capt. Jason Frias, left, 455th EAES CCATT critical care nurse deployed from the 60th Medical Group at Travis Air Force Base, California, ensure a patient is properly secured prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Capt. Deann Hoelscher, right, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, and U.S. Capt. Jason Frias, left, 455th EAES CCATT critical care nurse deployed from the 60th Medical Group at Travis Air Force Base, California, ensure a patient is properly secured prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Senior Airman Natalie Hives, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, sets up her equipment and checks on a patient prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Senior Airman Natalie Hives, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, sets up her equipment and checks on a patient prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Capt. Jason Frias, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team critical care nurse deployed from the 60th Medical Group at Travis Air Force Base, California, checks in equipment bags for supplies during an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere.  (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Capt. Jason Frias, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team critical care nurse deployed from the 60th Medical Group at Travis Air Force Base, California, checks in equipment bags for supplies during an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Senior Airman Natalie Hives, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, relays her patient’s oxygen statistics prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Senior Airman Natalie Hives, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, relays her patient’s oxygen statistics prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Capt. Deann Hoelscher, left, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, Senior Airman Natalie Hives, center, 455th EAES CCATT respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, and Senior Airman Margaret “Maggie” Mathewes, 455th EAES AE technician, prepare equipment and supplies before an AE mission at Bagram Airfield, Afghanistan, Aug. 8, 2015.  The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Capt. Deann Hoelscher, left, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, Senior Airman Natalie Hives, center, 455th EAES CCATT respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, and Senior Airman Margaret “Maggie” Mathewes, 455th EAES AE technician, prepare equipment and supplies before an AE mission at Bagram Airfield, Afghanistan, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Capt. Deann Hoelscher, right, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, Senior Airman Natalie Hives, left, 455th EAES CCATT respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, review a patient’s chart prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Capt. Deann Hoelscher, right, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, Senior Airman Natalie Hives, left, 455th EAES CCATT respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, review a patient’s chart prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Capt. Deann Hoelscher, left, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, U.S. Capt. Jason Frias, center, 455th EAES CCATT critical care nurse deployed from the 60th Medical Group at Travis Air Force Base, California, and Senior Airman Natalie Hives, right, 455th EAES CCATT respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, ensure a patient’s is ready to move prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Capt. Deann Hoelscher, left, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, U.S. Capt. Jason Frias, center, 455th EAES CCATT critical care nurse deployed from the 60th Medical Group at Travis Air Force Base, California, and Senior Airman Natalie Hives, right, 455th EAES CCATT respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, ensure a patient’s is ready to move prior to an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 8, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Capt. Deann Hoelscher, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, checks on a patient’s status during an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere.  (U.S. Air Force photo by Maj. Tony Wickman/Released)
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U.S. Air Force Capt. Deann Hoelscher, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, checks on a patient’s status during an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

U.S. Air Force Capt. Deann Hoelscher, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, checks on a patient’s status during an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere.  (U.S. Air Force photo by Maj. Tony Wickman/Released)
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U.S. Air Force Capt. Deann Hoelscher, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician deployed from the 60th Medical Group at Travis Air Force Base, California, checks on a patient’s status during an aeromedical evacuation mission aboard a C-17 Globemaster III aircraft from Bagram Airfield, Afghanistan, to Ramstein Air Base, Germany, Aug. 9, 2015. The 455th EAES’ CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist. The CCATT is charged with providing critical care to the sick and wounded as they are moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere. (U.S. Air Force photo by Maj. Tony Wickman/Released)

BAGRAM AIRFIELD, Afghanistan -- When U.S. military members are critically injured or severely ill on the combat frontier, it becomes the mission of the 455th Expeditionary Aeromedical Evacuation Squadron to get them moved thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere.

“Aeromedical evacuation has a vital mission here at Bagram; it’s a significant part of our nation's airpower and mobility resources,” said Col. Diane Difrancesco, 455th EAES commander deployed from the 315th Aeromedical Evacuation Squadron at Joint Base Charleston, South Carolina. “The 455th EAES is the sole AE hub in the Afghanistan theater of operations. We serve as a specially trained team to sustain human life. We’re mission critical for patient movement to a higher level of care.”

When the service members being moved need critical care in the air, they will come to rely on a critical care air transport team to tend their needs.

The CCATT is a three-person, highly specialized medical team consisting of a physician who specializes in an area of critical care or emergency medicine, a critical care nurse and a respiratory therapist.

“We take and transport patients who need that next level of care, and as CCATT we’re there for patients who in certain contingencies might need critical care in the air,” said Capt. Jason Frias, 455th EAES CCATT critical care nurse deployed from the 60th Medical Group at Travis Air Force Base, California. “We’re the linkage between our battlefield hospital and that next level of care.”

According to Capt. Deann Hoelscher, 455th EAES CCATT physician deployed from the 60th Medical Group at Travis Air Force Base, California, the sooner injured Service members get to medical care, the better chance they have at recovery.

“The hospital here is outstanding with great medical people, but they don’t have certain types of medical capabilities in theater. So it’s vital that we get those critically injured patients back to the next level of care as quickly as possible,” said Hoelscher. “As CCATT, that is what we provide. The injured Service members get initial treatment here and what we do is continue that care until they get to their next stop.”

Hoelscher said CCATT brings the ability to care for critically injured patients who may have needs that range from airway support to possible invasive medical procedures.

“Patients might decompensate in flight and require us to act. CCATT allows us to care for those patients who need that higher level of care while in transport,” said Hoelscher.
No patient movement is attempted, though, until the planning and pre-patient checks are complete.

“There is a lot of planning that goes on for each CCATT mission. We plan for each worst case scenario every time, every mission. We do our best to think of everything before we go on a mission. We’re almost paranoid of thinking of all the things that could go wrong and then we plan around that,” said Frias. “When the worst drama is looking in a bag for something you might need, then we did our job right…we planned appropriately for the mission.”

According to Hoelscher, the CCATT team gets a brief outline of a patient, their medical history, what procedures have been done to date and they make their plans from there. If the patient is located at Bagram, the CCATT members will go to the hospital and do an evaluation.

“We then get together as a team and talk about what we need to do to care for the patient. We talk about what kind of medications we need, we talk about blood products, about their injuries and about what could go wrong,” said Hoelscher. “We talk about if they have airway issues and if their oxygen saturation is high enough to be safe for flight. We talk about if we need to have the aircraft fly with altitude restrictions to compensate for the oxygen saturation.”

For Senior Airman Natalie Hives, 455th EAES CCATT respiratory therapist deployed from the 60th Medical Group at Travis Air Force Base, California, her planning includes making sure a patient gets the right amount of oxygen.

“I’m a respiratory therapist and I’m in charge of the airway. I make sure patients are breathing, and if they are on a ventilator I make sure the machine is delivering each breath for the patient,” said Hives. “Based on different patient factors, I’m able to determine how much I want to deliver to a patient along with a rate of delivery. It’s my responsibility to make sure the patient is oxygenating and relay my findings. There are so many variables when it comes to patient care, and delivering too much of a breath or too little can affect the big picture."

After the patient is moved from the emergency room to the flight line, they are loaded on a waiting cargo aircraft that was turned into an airborne intensive care unit by an aeromedical evacuation team. Once airborne, the patients are constantly monitored and patient care continues throughout the flight until they reach their next destination.

“CCATT is critical care in the air, just like the name says. In the back of that plane, the team is trained and outfitted with the skills and equipment to act as an ICU,” said Frias.

According to Hoelscher, the benefit of having a doctor onboard is that there is someone right there who can make the decision to intervene with a patient instead of waiting or having to call back to explain the situation or get guidance. It’s these kinds of mission that caused Hoelscher to join the Air Force.

“One of the reasons I joined the Air Force was to be able to take care of Service members who were injured serving our country,” said Hoelscher. “I’m proud to help take care of those who sacrificed while doing their job. It’s a challenge doing this job because not only are we taking care of the sickest patients, but we are doing so in a tight space in the back of a plane with all the vibrations and noises which makes that care even more difficult.”

The sentiment of pride is shared by Hives and Frias.

“Critical care is trauma and CCATT is bringing our guys and girls home that much quicker,” said Hives. “I like that I have control, that I specialize in something and that I’m part of a team. I like what I do…it’s a humbling experience to do this.”

“What I like about my job is being able to use my training and skills to get our injured military members back home. It really is an honor to be able to get someone back within 36 hours from the time of their injury to get them treatment and get better,” said Frias. “All the things we go through to do this…I’m proud to do this mission. We actually make a difference for someone when we do this mission.”















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