Feature   Defense News

Isolation System the Latest in DOD Medical Transport Advancement

May 1, 2020 | BY David Vergun , DOD News

Air Mobility Command aircrew and medical personnel conducted the first operational use of the Transport Isolation System to perform an aeromedical evacuation of three U.S. government contractors who tested positive for COVID-19, the coronavirus disease, from Afghanistan to Ramstein Air Base, Germany.

Upon arrival April 10 at Ramstein, the patients were transferred to Landstuhl Regional Medical Center for treatment.

Airmen wearing personal protective gear walk down the open ramp of a large transport jet.
Aircraft Exit
Three airmen exit a C-17 Globemaster III at Ramstein Air Base, Germany, following the first operational use of the Transport Isolation System, April 10, 2020. The TIS is an infectious disease containment unit designed to minimize contamination risk to aircrew and medical attendants, while allowing in-flight medical care for patients afflicted by a disease - -in this case, COVID-19.
Photo By: Air Force Staff Sgt. Devin Nothstine
VIRIN: 200410-F-BT441-2099A

The mission marked the first operational use of the TIS since its development during the 2014 Ebola outbreak in West Africa, and the first movement of COVID-19 positive patients aboard Air Force aircraft. The TIS is an infectious disease containment unit designed to minimize risk to aircrew, medical attendants and the airframe, while allowing medical care to be provided to patients in-flight.

The Defense Department has a long and storied history of medical transport service developments.

Up until the Civil War, horse-drawn wagons called ambulances, were the most advanced way to move sick or wounded soldiers to hospitals or field treatment stations.

A World War I-era ambulance sits in a field with soldiers milling about.
Ambulance Drivers
Americans volunteered to go to France as ambulance drivers. Shown here is an American volunteer helping French soldiers in the spring of 1916 at the Battle of Verdun. America officially entered World War I a year later.
Photo By: Department of Veterans Affairs courtesy photo.
VIRIN: 160407-O-ZZ999-001C

Although horse-drawn wagons continued to be used up until World War I, the Civil War ushered in the first ambulance trains in the U.S. The first ambulance trains were used a few years earlier for the first time during the Crimean War.

These Civil War ambulance trains were converted boxcars or passenger trains. Some of the more advanced ones had rubber slings to hold litters to minimize shock from vibrations. Some also had a medical staff, dressing station and even kitchens.

Also during the Civil War, the first hospital steamships were used to transport casualties. They were especially useful in the western theater on the Mississippi River and its tributaries and they were also used on the Atlantic Seaboard as well, along with sailing vessels. 

A Civil War-era steamship is docked along a river bank.
Hospital Steamship
The Army hospital steamship Nashville is shown at Vicksburg, Miss., on the Mississippi River sometime in 1861.
Photo By: Library of Congress courtesy photo
VIRIN: 610707-O-ZZ999-001C

The Union Army and the Navy each had their own fleet. The Confederate States also had a few hospital ships, some of which doubled as blockade runners.

Ships and railroads continued to play a major role in the transport of the sick and wounded, particularly during World Wars I and II. 

Hospital trains were also used during the Korean War, 1950-1953, both in Korea and in the U.S. The Army discarded its last hospital trains in the 1970s. 

Troops load injured soldiers onto a World War I-era train
Hospital Train
U.S. Soldiers load wounded men aboard a hospital train at Horreville, France, April 27, 1918, just days after the U.S. entered World War I.
Photo By: National Institutes of Health courtesy photo
VIRIN: 180427-O-ZZ999-001C

The Navy still has two hospital ships, the USNS Comfort and Mercy. Both have been used in the fight against COVID-19.

Following the use of steamships and trains as patient delivery modes, the next big development took place during World War I, when trucks went into ambulance service.

Although the first instances of airplanes being used as ambulances was during World War I, those instances were extremely rare. During World War II airplanes were used by the U.S. Army for medical evacuation much more frequently.

Patient on litter is loaded into a helicopter
Air Lift
A wounded American is lifted onto a helicopter at the 21st Infantry Regiment collecting station at Painmal, Korea, one mile south of the 38th parallel, for evacuation to a base hospital, April 3, 1951.
Photo By: U.S. Army
VIRIN: 510403-O-ZZ999-001

The introduction of helicopters to evacuate the wounded during the Korean War made it possible to quickly extract casualties from the battlefield to the point of care. In Vietnam, this trend accelerated with excellent results. Today, helicopters are still used by DOD to evacuate the ill and wounded.