HomePlatformsAFMS Capability: Critical Care Air Transport Team
Graphic of an ambulance backed up to a plane for unloading

When U.S. service members are critically ill or severely injured, it is the mission of Critical Care Air Transport Teams to get them aboard aircraft and move them thousands of miles while delivering a high level of medical care in flight to return them home for full-time care.

A CCATT is a highly specialized and uniquely skilled three-person medical team that augments standard aeromedical evacuation crew members, and turns an aircraft into a flying intensive care unit.

  • A physician who specializes in an area of critical care or emergency medicine
  • A critical care nurse
  • A respiratory therapist

CCATTs supplement standard aeromedical evacuation aircrew when critically ill or injured patients require continuous monitoring, stabilization, or complex care while in-transit to a medical treatment facility - usually to get a higher level of medical care.

During the Vietnam War, it typically took about a month for wounded troops to reach treatment facilities in the United States. Today, the U.S. Air Force’s CCATT capability allows service members to be transported from the point of injury to a stateside hospital in less than three days.

Air Mobility Command is responsible for the CCATT mission.

Capabilities and Challenges

  • CCATT members are experienced in the care of critically ill or injured patients with multisystem trauma, head injuries, shock, burns, respiratory failure, multiple organ failure, and other life-threatening complications.
  • Some of the most common procedures and medications CCATT members administer in-flight include anti-blood clot medications, painkillers, and providing oxygen and ventilation.
  • The typical patient load for a standard CCATT is up to three critical patients, or up to six stabilized patients.

An aircraft in flight is not an ideal environment to deliver care. CCATT crew members learn how to treat patients aboard an aircraft with limited resources and support, far different from a fully staffed and stocked hospital.

  • CCAT teams adapt to in-flight challenges, such as turbulence, which can dislodge equipment, and changes in temperatures and air pressure, which can affect wounds and bandages.
  • CCAT teams adjust to space limitations, as teams and patients share space with other passengers or cargo.
  • CCAT teams are limited to the resources and equipment brought on the mission, and do not have access to support services, such as blood banks and labs they are accustomed to in a treatment facility.
  • CCAT teams overcome communication challenges, as most military aircraft are loud and have less light, making it more challenging to monitor and talk to patients and crew members.

CCATT training begins at the 711th Human Performance Wing, with advanced training at the University of Cincinnati Medical Center through the Center for Sustainment of Trauma and Readiness Skills program, which allows members to adapt their critical care skills to these surroundings.

“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.”

– Maj. Deann Hoelscher, CCATT physician

Patient Journey

Three images focusing on AFMS Capability: Critical Care Air Transport Team Patient Journey

 

A 20-year-old U.S. Army Soldier has sustained serious injuries from a roadside bomb in Afghanistan - 70% of his body is badly burned, and he has lost one of his legs.

 

A U.S. Air Force pararescue team flies him from the point of injury to the nearest forward operating base in Afghanistan for immediate medical care. His journey back to the United States relies on a CCATT, and so does his life.

While still in critical condition, a CCATT flies with him 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. The CCATT then prepares him for the transatlantic flight, while overseeing his care until he arrives at the San Antonio Military Medical Center, less than 72 hours after point of injury.

“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.”

– Capt. Jason Frias, CCATT critical care nurse

History

In an effort to expand the U.S. Air Force’s aeromedical critical care transport capabilities, the concept of CCATT was developed in the early 1990s at the 59th Medical Wing, Joint Base San Antonio, Texas, by retired Maj. Gen. P.K. Carlton and retired Col. Chris Farmer. 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 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 use of CCAT teams. By 1995, CCATTs from the 59th Medical Wing and the 81st Medical Group at Keesler Air Force Base, Mississippi, were deploying in support of overseas contingency operations. Following the completion of a two-year proof-of concept period in 1996, CCATT was formally approved and adopted into the USAF Aeromedical Evacuation System.

Since inception, CCATTs have participated in numerous operations: Operation Uphold Democracy, Operation Joint Endeavor, and Operations Enduring Freedom and Iraqi Freedom, to name a few.

Recognizing the increased role of CCATTs in aeromedical evacuation missions, the Air Force Surgeon General announced in 2018 that the U.S. Air Force would increase CCATT capabilities to meet warfighter needs. To surge our CCATT capacity, the AFMS has streamlined existing CCATT courses and resources, requiring CCATT candidates to take courses in quick succession. By putting the classes back to back, candidates can focus on practicing the skills they need for the in-flight environment. As the Air Force adjusts its forces to meet unknown future adversaries, CCATT capability is likely to become more and more vital.

Image of the 455th EAES creating a mobile ICU for in-flight care
“CCATT keeps our downrange medical footprint smaller and farther forward. It used to take weeks for a seriously injured patient to get back to the U.S. for care. Now we can have a patient home from Iraq or Afghanistan in 72 hours.”

– Lt. Col. Alan Guhlke, the Air Force Surgeon General CCATT consultant, and deputy chief, En Route Care Training Department at the U.S. Air Force School of Aerospace Medicine

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