Medics at War: Patriot Medstar Tests System Readiness
By Douglas J. Gillert
American Forces Press Service
WESTOVER AIR RESERVE BASE, Mass., Jun. 27, 1997 With temperatures outside in the sweltering 90s, the air-conditioned, air transportable hospital felt cool as a shady oasis.
Most of the time the field hospital remained a quiet, cozy place, boring even for the staff of two physicians, seven nurses, five physician assistants and 15 medical technicians. But not always.
"The [air transportable hospital] is a terrifying place when we have lots of patients," said hospital commander Dr. (Col.) Norman Bos.
"The hospital's immediate area, or emergency room," added chief nurse Capt. Sina Linman, "can be very intense, because everybody brought in has something badly wrong with him."
Or so it would be if this were war with real battles and real wounded. It isn't war, but that didn't dissuade the participants in Patriot Medstar from striving for as much realism as they could muster in training to perform wartime medical skills. June 7-27, more than 3,000 active duty and reserve airmen, soldiers, sailors and Marines practiced assessing, treating, staging and evacuating "wounded" soldiers from a fictional Southwest Asia battleground.
From medical units nationwide, they deployed here and to Fort Devens, Hanscom Air Force Base and Worcester Municipal Airport in Massachusetts; Stratton Air National Guard Base in Scotia, N.Y.; Fort Indiantown Gap, Pa.; and Andrews Air Force Base, Md. The exercise tested their ability to deploy to a combat theater and establish and sustain medical operations.
Like Bos, who deployed from the Air Reserve Personnel Center in Denver, and Linman, from the 710th Medical Squadron, Offutt Air Force Base, Neb., most participants came from reserve units. Collectively, they exercised the complete medical evacuation system for the first time since Desert Storm, moving patients within the simulated war zone and to distant hospitals.
"This is the largest joint medical field training exercise in DoD history," exercise director Col. Jim Kottkamp said midway through the second week of training. "We go to where the patients are in the field and evacuate them to Army field hospitals. The field hospitals feed patients who need to be evacuated to the air transportable hospital.
"Once evacuation is scheduled, we take the patients to the mobile aeromedical staging facility," continued Kottkamp, director of aeromedical operations at Air Force Reserve Command headquarters, Robins Air Force Base, Ga. "We've got four mobile aeromedical staging facilities, each capable of handling 160 patients a day."
Action at Westover began with the arrival of patients by tactical aircraft near the air transportable hospital, located at the end of the runway. Camouflaged C-130 transports could taxi to within 100 yards of the tent-like structure to offload simulated battlefield casualties. The medics would rush aboard to lift and carry litter-borne patients or assist ambulatory patients from the aircraft to a triage tent outside the hospital. There, physicians and nurses would check the soldiers' conditions and guide them to an appropriate area of the medical shelter. Linman would oversee much of the activity.
"For life-threatening conditions -- chest wounds, for example -- we'd send them to the immediate area for whatever lifesaving measures are needed," she said. In this particular hospital, sent to Westover from Whiteman Air Force Base, Mo., the immediate area had room for four litters and a staff of five physician assistants. Larger units, like ones used during Desert Storm, have space for up to 12 litters, Linman said.
Patients with less serious conditions were routed to an area similar to a normal hospital ward. Those needing only minor treatment went to the minimal care area. Since this area is adjacent to the dental area, the dentists typically administered first aid to these patients when they weren't simulating emergency dental surgery.
Some patients arrived with wounds they couldn't survive. "We put these people in the 'expectant area' and brought in a chaplain for them," Linman said.
A surgical suite and recovery room resided at one end of this hospital. Normally, surgical suites are contained in hard shelters attached to an opening in the tent walls of the hospital. Hard shelters also house laboratories, Linman said. Here, however, all activities collided in the partitioned, but at times frenzied, atmosphere of the desert-tan tent hospital. For example, adjacent to a row of litters in the ward, a stainless steel refrigerator housed polyurethane bags of imitation blood, delivered here as real blood would be sent to battle-zone hospitals.
"We set up a blood trans-shipment center in a hangar, here," said Technical Sgt. Mike Cornia of the 939th Medical Squadron, Portland, Ore. "We got the blood from the Joint Service Blood Collection Point (there's one at McGuire Air Force Base, N.J., and another at Travis Air Force Base, Calif.). These huge warehouses store blood in giant freezers.
"At Westover, we broke the blood out and shipped it to field hospitals," continued Cornia, in charge of the blood program for Patriot Medstar. The blood was shipped in Styrofoam-lined cardboard boxes. Each box held 30 units, cooled with ice. "The blood units can be kept in the boxes 48 hours," Cornia said. Aircraft loadmasters managed the blood in-transit, adding fresh ice after 24 hours.
The compact refrigerator here held 50 units (pints) of blood, enough to meet the hospital's immediate needs and until it got busy, again, with new patients. During a lull, some of the medical staff crawled onto empty litters to take naps or read books, patiently waiting out the boredom until the next onslaught of fury.
"We train in the air transportable hospital so that we are ready for worldwide mobilization," said Reserve Dr. (Col.) Baltazara Lotuaco, senior flight surgeon, from the 442nd Medical Squadron at Whiteman. "I clear all the patients for airlift, certifying them as medically able to fly."
Once Lotuaco ordered a patient evacuation, the seven-member aeromedical evacuation liaison team from MacDill Air Force Base, Fla., began coordinating airlift. "Every military command that uses tactical and strategic airlift uses us," said team leader Capt. James Massey. "We use encrypted equipment to send high-frequency requests so the enemy doesn't know about the casualties or inbound aircraft."
A nurse on the team met with Linman and Lotuaco to ensure the patients were ready to fly and under what conditions. If Lotuaco's diagnosis dictated lower altitude, for example, Massey's radio operators passed that information to the aerial evacuation coordination center.
Under the current system, the Joint Medical Readiness Operations Center at Scott Air Force Base, Ill., receives all requests for aeromedical evacuation. "A-B-C" messages track patient movement.
"The Alpha message requests patient airlift; the Bravo message responds with where and when to have patients ready for airlift; and the Charlie message, generated from the mobile aeromedical staging facility, states who got off the ground," Massey explained.
But when the system's overloaded, the single point of contact produces a bottleneck. The Transportation Command Regulating and Command and Control Evacuation System -- TRAC2ES -- was designed to relieve the communications traffic jam. TRAC2ES gives evacuees in-transit visibility as they move from battlefield to field hospital to staging facilities and, ultimately, back to a stateside hospital.
The Global Patient Movement Requirements Center, TRAC2ES' home at Scott, sent Capt. Timothy Fitzgerald to Patriot Medstar to test the system alongside the current "A-B-C" message system. "TRAC2ES eventually will obviate the need for A-B-C messages," he said confidently. "[The Air Force] plans to use TRAC2ES in conjunction with the current system July-November, then in December turn off the old system and just use TRAC2ES," he said.
Each time operators in the air transportable hospital requested airlift, a team from the 622nd Aeromedical Evacuation Squadron, MacDill, tumbled into action in the Patriot Medstar aeromedical evacuation coordination center. "We review patient information; mission planners coordinate air flow; and we also coordinate with the Global Patient Movement Requirements Center to get beds for the evacuated patients at stateside hospitals," explained Reserve Master Sgt. Jean Hartmaier. For Medstar, Malcolm Grow Medical Center at Andrews served as the "stateside" destination. Reserve C-141 transports from the 459th Airlift Wing at Andrews flew daily, ferrying patients from Westover to Andrews. By 8 a.m. June 18, the unit had flown 14 evacuation missions and transported more than 220 patients.
Mobile area staging facilities were the final stop for the evacuees before boarding outbound aircraft. "We download patients from trucks and ambulances, triage them and search them for explosives or weapons," said Master Sgt. Kelvin Jones, NCO in charge of one of the facilities erected here. "Patients will be here anywhere from one minute to four hours before liftoff, depending on flight availability."
Jones said he and the staging facility staff are equally qualified to fly air-evac missions. "If we can't schedule a flight through the aeromedical evacuation system, we can divert an aircraft from another mission and travel with the patients," he said.
Jones and most of the staging facility staff deployed here from MacDill. Two active duty medics from the 86th Aeromedical Evacuation Squadron, Ramstein Air Base, Germany; an active duty flight nurse from the 43rd Aeromedical Evacuation Squadron, Pope Air Force Base, N.C.; and an Air National Guard medic from the 167th Aeromedical Evacuation Squadron, Martinsburg, W.Va., augmented the staff of 39.
"The 43rd is the only active duty air-evac squadron in the Air Force," said Capt. Anthony Karnavas. "So the Reserve benefits a lot from working with us. At the same time, however, they bring in a lot of fresh, new ideas, and we learn from these exercises how to work better together."
Nowhere was the joint-service aspect of Medstar more evident than in the joint task force headquarters set up for the exercise. There, Army, Navy and Air Force officers and NCOs tracked field operations and did their best to understand their separate service's doctrines.
"I'm doing my best to synchronize Army and Air Force doctrines so we can do what we're supposed to do during war, which is get our injured people to the health care they need," said active duty Army Maj. Marta Davidson. The joint task force Army surgeon for Medstar, Davidson normally serves as the medical regulating and patient administration consultant to the 3rd Medical Command, Atlanta.
Reserve Cmdr. Ann Adcook deployed from the Armed Services Blood Program in Washington to serve as the joint task force deputy surgeon. "Our biggest tasking is joint medical operations and interoperability," Adcook said. "Each of us brings information to the table that helps the surgeon make the best decisions possible."
"If we all communicate, problems will be minimal," said Col. Joe Curley, joint task force surgeon. "Patriot Medstar is truly 'joint,'" said Curley, representing the Air Force Reserve command surgeon's office. "The Navy is simulating a fleet hospital, and each service has its own area and hospitals for people coming off the battlefield. The joint task force makes sure everyone can understand each other.
"Budget constraints and downsizing are forcing DoD to develop greater efficiency in health care delivery," Curley said. "As a result, all the services are relying more heavily on reserve forces, and all are trying to do a better job of training their reservists. Patriot Medstar is the greatest test so far of our ability to work together to treat and transport injured troops."