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Precious Cargo: Aeromedical Evacuators Operate Pacific

By Douglas J. Gillert
American Forces Press Service

YOKOTA AIR BASE, Japan, July 11, 1996 – The huge, gray Air Force C141 transport aircraft sat at the end of the taxiway, poised for takeoff. The highpitched wail of its four jet engines drowned out conversation on board.

Inside, medical air crew members scurried back and forth between patients seated forward or lying aft, preparing them for the eighthour flight to Hickam Air Force Base, Hawaii. The patients, who numbered less than a dozen, and duty and spaceavailable passengers tried to get comfortable for the long flight ahead.

The screaming engines suddenly went quiet, and the aircraft's public address system squawked before the voice of the medical crew director came on to inform the group of a 30minute delay: One of the litterbound patients was having difficulty breathing and would be removed from the aircraft.

An ambulance soon arrived and medics removed the patient, then resealed the hatch. Later engines still silent the medical crew director advised the passengers of another change: Medics on ground had restabilized the patient and would return her to the aircraft for evacuation to Tripler Army Medical Center in Hawaii.

Finally, more than an hour after the scheduled takeoff, the C141 left the ground and pointed east into the now nighttime skies.

It costs money to delay aircraft missions, but patient needs always come first. "After all, we carry precious cargo," said Col. Mary Ann Cardinali, commander of the 374th Aeromedical Evacuation Squadron here. "We have a responsibility to get them to the medical care they need, and we take that responsibility seriously."

The 374th provides aeromedical evacuation for the entire Pacific Theater from the West Coast of the United States to the east coast of Saudi Arabia, and from North Pole to South Pole. They primarily use Air Force C9 Nightingales, dedicated to aeromedical evacuation, C141s and C130s.

Reserve medics augment active duty crews, ensuring a smooth flow of patients throughout the theater and, when necessary, back to facilities in the continental United States.

In the Pacific, their primary customers are the 14 Army, Navy and Air Force medical treatment facilities in Hawaii, Guam, Japan (including Okinawa) and Korea. Constant training, Cardinali said, keeps the 374th ready to fly at the ring of the phone.

Highly trained nurses and medical technicians make up the medical flight crew. Numbers vary according to mission, but the typical configuration is two nurses and three medical technicians. Once airborne, they continuously monitor their patients, administering required medications and handling any medical emergencies. On long flights, they serve hot meals, and cold drinks and snacks always are available.

Training also prepares them for dealing with aircraft emergencies, including crash landings and since they operate over vast expanses of ocean ditchings. The pilot commands the plane, but the medical crew director commands everything aft of the cockpit.

Four active duty squadrons conduct aeromedical evacuation worldwide. Besides Yokota, they are at Travis Air Force Base, Calif.; Pope Air Force Base, N.C.; and Ramstein Air Base, Germany. More than a dozen Air National Guard and Air Force Reserve units augment them. Their customers include members of the armed forces, family members and retirees.

All medical air crew nurses and technicians must first complete training at Brooks Air Force Base, Texas. "At the Flight Medicine School, we learn the physiological aspects of flying," said Staff Sgt. Armando Orozco. "Then, they put us through survival training, where we learn to read maps and compasses, how to forage for food, even how to use a safety pin to catch fish. As medical crew members, we need to know how to save ourselves if we're going to be able to save our patients."

Once they arrive at their unit, they begin a lengthy period of qualifying on each of the three aircraft, beginning with the C9.

"It takes seven to nine months to fully qualify [on all three aircraft]," Cardinali said. "After they qualify, they have to maintain currency and pass additional evaluations every year and face occasional nonotice flight checks." The goal of such rigorous and constant training is patient safety, she said.

In the Pacific, some 4,500 patients are airlifted annually, said Maj. Dean Tano, officer in charge of the Joint Medical Regulating Office at Yokota. Although located in the same building as the aeromedical evacuation squadron, the regulating office reports to the U.S. Pacific Command surgeon's office at Camp H.M. Smith, Hawaii.

Tano's office determines where medical evacuation patients will go, based on treatment required, hospital capability and bed space. Enlisted representatives from the Army, Air Force and (beginning this fall) Navy, work with air evacuation officers at each facility. Their common information source is the Defense Medical Regulating Information System, a computer data base employed worldwide.

"Our goal is to send patients to the nearest possible facility," Tano said. "We try to keep them in [the Western Pacific]. If that's not possible, we look next to Tripler in Hawaii, and finally, to facilities in the continental United States."

A large number of the squadron's peacetime patients are newborn children with serious health problems, Cardinali said. But if war broke out on the Korean Peninsula, for example that would change quickly. "We train for the possibility of such a war," the colonel said.

Wounded combatants first would be delivered from battalion aid stations to a mobile aeromedical staging facility, which the 374th would operate "far forward," she said. Air Force C130s carrying cargo to Korea would pick up patients and medics (if medics aren't already aboard) and fly either to a DoD contingency hospital at Kim Hae, South Korea, or to a facility in Japan. Nightingales also would airlift patients from Kim Hae to other military hospitals in the Pacific for eventual transfer by C141 to Hawaii.

The plan appears to be sound, based on a test of the operation last year during Full Eagle, a DoDRepublic of Korea combined exercise in Korea. "We participated in the exercise for the first time, setting up a [mobile aeromedical staging facility] at a small base, and evacuating 'wounded' soldiers by C130 to Kim Hae," Cardinali said.

At the contingency hospital, the Air Force medics taught Republic of Korea soldiers how to remove patients from the C130 and load them onto a waiting C9. The C9 then flew to Kadena Air Base, Okinawa, and the soldiers spent the night in a 50bed, airtransportable hospital erected for the exercise.

The squadron will participate in Full Eagle again this year, this time deploying with new, 2.5ton vehicles and a transportable water tank they acquired since the last exercise.

"The most important thing is, we are on call and mission ready at all times," Cardinali said.

Senior Airman Jeffrey Gregor, who lines up medical crews and locates aircraft, finds the squadron's mission rewarding. "The long hours we put in are worthwhile," he said, "because we carry patients who really need our help."

Patients, Cardinali reiterated, who are precious cargo.

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Click photo for screen-resolution imageAir Force Capt. Cathleen Madge practices evacuating a C-9 during a simulated ditching of the aircraft at sea. An Air Force Reserve flight nurse from Sacramento, Calif., Madge was at Yokota Air Base, Japan, for annual training with the 374th Aeromedical Evacuation Squadron. Reservists and members of the Air National Guard assist the squadron in performing its mission throughout the Pacific Theater. Douglas J. Gillert  
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Click photo for screen-resolution imageDuring training on board a C-9 aircraft, an Air Force medical technician monitors his litter-bound "patient" at Yokota Air Base, Japan. Members of the 374th Aeromedical Evacuation Squadron train constantly for peacetime and wartime missions. Douglas J. Gillert  
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Click photo for screen-resolution imageGround crews tow an Air Force C-9 Nightingale to its parking place on the ramp at Yokota Air Base, Japan. The 374th Aeromedical Evacuation Squadron uses C-9, C-130 and C-141 aircraft to transport patients to medical facilities throughout the Pacific and, if necessary, back to the mainland United States. Douglas J. Gillert  
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