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Aeromedical Evacuation Improvements Saving Lives

By Donna Miles
American Forces Press Service

WASHINGTON, Aug. 10, 2005 – Better training, more advanced equipment and aeromedical evacuation procedures that are constantly being improved are helping save thousands of lives of troops wounded in Iraq and Afghanistan, Air Force medical officers told the American Forces Press Service during a Pentagon interview.

Air Force Lt. Col. Warren Dorlac, chief of critical care and trauma surgery at Landstuhl Regional Medical Center in Germany, described the extensive network of patient care that's helping reduce battlefield deaths and speed up patients' recovery.

Casualties are getting medical treatment faster and closer to the point of injury than ever before, Dorlac explained. The military medical system is moving its assets closer to the front lines to be more responsive to patient needs, and surgical teams are smaller, more capable and positioned closer to the troops they support, he said.

At the same time, the military is boosting know-how about treating combat casualties so all on the battlefield, regardless of their job specialty, know basic life-saving skills. Dorlac said it's not unusual for a patient to arrive at a forward surgical hospital in Iraq wearing a life-saving tourniquet that was applied by a comrade on the front lines.

When a patient's condition requires evacuation to receive more advanced care, an aeromedical evacuation system unrivaled anywhere else in the world moves them as quickly and safely as possible to the life-saving care they need, Dorlac said.

Patient movements from the theater to stateside medical hospitals that typically took 45 days during the Vietnam War have been reduced to as little as 36 hours, with continuous medical care delivered throughout.

It's a procedure the Air Force has improved upon steadily since the beginning of the global war on terror, evacuating more than 4,500 troops with battlefield wounds from Afghanistan and Iraq to Landstuhl, and more than 25,000 total patient movements since the war began.

During the five-hour flight from Balad Air Base in Iraq to Landstuhl, patients receive treatment in what amounts to a flying hospital, equipped with life-support equipment ranging from ventilators to heart monitors. Aeromedical evacuation teams, which typically include two flight nurses and three aeromedical evacuation technicians but are augmented as required, hover over them, monitor their condition, help reduce their pain level, and continue treatment that began when they were on the ground.

A new pain pump introduced within the last 18 months enables patients to administer their own pain medication, as needed, and locally administered anesthesia is provided through strategically placed catheters to reduce the need to put patients "under" or administer narcotics, Dorac said.

By the time they arrive in Germany, many patients already are showing signs of improvement. "In a lot of cases, they're better off at the end of the flight than when it started," Dorlac said.

Improved information flow and communication supports that effort. Aeromedical evacuation teams transporting patients from the theater now come armed with detailed information about the patients' medical history, medications, medical condition and any procedures or surgeries already administered so they immediately begin providing care, according to Air Force Maj. Francis Schlosser, a flight nurse with the 43rd Aeromedical Evacuation Squadron at Pope Air Force Base, N.C.

In addition, they're now able to transport patients - some on stretchers, some hooked to ventilators or intravenous drips -- on a larger variety of aircraft than in the past, no longer having to wait for a specific plane to arrive, he said.

The C-17 Globemaster III, with its large cargo bay and ability to move up to 70 patients at a time, including as many as nine with critical injuries, is a favorite among aeromedical evacuation crews. It's quieter, vibrates less, has more temperature control than the C-141 Starlifter it replaced and "was designed thinking of the medical role" it would play, Dorlac said.

But despite the most advanced equipment and procedures, aeromedical evacuations continue to be "extremely dangerous flights," Dorlac said. Moving critical-care patients from one ward to another in a standard hospital is dangerous enough. Adding a 6,000-mile flight to the equation only adds to the risk involved, he said.

Yet advances in medicine, medical equipment and aeromedical evacuation practices are reducing the lag between when an injury occurs and when patients are considered stable enough to transport. "The Air Force is now moving patients we would never have considered moving before," Dorlac said.

And despite the multiple steps involved and inherent risk, aeromedical evacuations have a near-100 percent success rate. No patient has ever died during the flight from Afghanistan or Iraq, and the staff has lost just one patient, during transport from Landstuhl Regional Medical Center to Ramstein Air Base for a follow-on flight to the United States, Dorlac said.

"No one in the world has the capability to move the number of critically injured patients that we move," he said.

As medical personnel fine-tune aeromedical evacuation procedures and planners incorporate lessons learned into doctrine, the aeromedical evacuation rate continues to climb.

Troops who in the past would likely have died from their wounds are living, thanks to Kevlar helmets, improved body armor and up-armored vehicles. Case fatality rates for wounded are about one-half of what they were during the Vietnam War.

Officials credit the speed with which wounded troops are rushed to expert medical care for the lowest death rate among wounded troops of any war in U.S. history.

"We've definitely made some great strides in the past 10 years," Dorlac said. "The military has done as incredible job in transforming how we do medical care."

The best measure of success, Dorlac and Schlosser agree, is the feedback they get from wounded troops and their families. Some families send notes updating them on the progress of their loved ones who were never expected to survive their injuries. Others send photos and words of thanks.

"The patients are the best reward," Schlosser said. "They are our heroes and represent so much to us. They're our success story."

But Schlosser stressed that there's still work ahead to improve on the aeromedical evacuation system. "We're not done. We continue to work daily on process improvement," looking for better communication, better equipment and better procedures, he said.

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C-17 Globemaster III
Landstuhl Regional Medical Center

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