JOINT BASE PEARL HARBOR-HICKAM, Hawaii: Each C-17 Globemaster III flight out of here in which tons of cargo are loaded, delivered and off loaded to a customer in some corner of the Pacific, deserves the crew’s undivided attention to detail. However, when the cargo is a servicemember clinging to life, the crew’s awareness can become even more intense.
This was evident recently when a servicemember on a remote island in the South Pacific needed medical attention not available in his location. The medical clinic identified the patient as needing more advanced critical care than they were equipped to handle. Thus, a phone call started a chain reaction of events.
Members of the Theater Patient Movement Requirements Center-Pacific here received a call for support. The TPMRC-P is a unit that has a nurse and technician available 24-hours a day to receive information about patient referrals. Staffed by trained medical personnel from the Air Force, Army and Navy, the TPMR-P provides joint, theater-wide medical regulating services to include clinical validation of patient movement requirements in the U.S. Pacific Command.
Aeromedical evacuations in the Pacific theater are complex orchestrations requiring coordination across many operational and medical disciplines to include civilian, military and foreign nations. TPMRC-P’s area of responsibility encompasses 1.05 million square miles serving more than 450,000 active-duty members and their dependents, Department of Defense civilians and other beneficiaries.
“The Pacific is a huge place to operate in,” said Maj. Melony Valencia, the TPMRC-P patient movement clinical coordinator. “The challenge is anything can and will go wrong. There is so much space to work in; you have to be ready for anything.”
Coordination and communication are the key to success for the TPMRC-P. Once the call comes in, the determination of viable patient movement is made and the coordination process begins. From the time the patient is picked up to the point of delivery to the hospital, every contingency has to be weighed and considered.
There are many questions and concerns that surround these medical movements: What happens if the plane breaks in the air and they have to be diverted to another location? What is the flight path? What kind of medical equipment is needed to keep the patient stable and how will it react to in-flight conditions?
The medical professionals
During the recent American Samoa evacuation, nearly everyone capable of a patient movement of this magnitude was unavailable, including dedicated Joint Medical Attendant Transport Teams.
Because of this, Major Valencia reached out to a year-old agreement with the Hawaii department of Health and Human services Disaster Medical Assistance Team. The DMAT consists of an emergency room doctor, intensive care unit nurse and paramedic, who everyday citizens practicing emergency medicine or providing patient care in intensive care units. They have been trained and federalized to provide medical care in a military transport aircraft during emergency situations.
“(Medical movements like this) are a very complicated dance,” said Col. David O’Brien, the 13th Air Force surgeon general. “We did not have a critical care transport team available because they were moving a patient out of Guam to (Hawaii).”
DMATs are designed to be a rapid-response element to supplement local medical care until other federal or contract resources can be mobilized or the situation is resolved. DMATS can deploy to disaster sites with sufficient supplies and equipment to sustain themselves for a period of 72 hours while providing medical care at a fixed or temporary medical care site. They augment Air Force and Coast Guard teams.
“(DMATs) allow us to have that high level of critical care in the air and have experienced medical personnel that know how to set up that intensive care unit in the back of the airplane,” Colonel O’Brien said.
This was the first time the DMAT has been called into service by the Air Force since the creation of the federalized team.
“It was seamless,” Major Valencia said. “The agreement we have with them spells out how things are supposed to happen and everything fell into place like it was supposed to.”
The battle is not over for the medical teams once they have delivered a patient from the plane to the hospital. Constant communication, from traffic patterns to patient and flight updates, are critical to team movements. The ground transport teams work meticulously to transition patients with the same level of care needed to sustain life until they reach the hospital.
The flying ICU
Getting an available medical team is only a portion of the problem. Since there is not a dedicated airframe for medical movements, the TPMRC-P officials reached out to find available and suitable transport for the patient movement out of American Samoa.
Help was found in the 535th Airlift Squadron when a local training mission was diverted to support this medical evacuation mission.
The C-17’s versatility transformed the tactical airlift vehicle into a flying intensive care unit, complete with a federalized DMAT and delivered the patient under the watchful eyes of the medical technicians.
The C-17 is set up and designed to be a multifunction airlift airframe with the inherent flexibility of aeromedical movements in mind, said Maj. Patrick Winstead, the 535th Airlift Squadron director of operations.
The C-17 is capable of rapid strategic delivery of troops and all types of cargo to main operating bases or directly to forward bases in the deployment area. The aircraft can perform tactical airlift and airdrop missions and can also transport litters and ambulatory patients during aeromedical evacuations when required.
“There is a lot of space and a lot of light back there,” Major Winstead said. “It’s a little bit more comfortable in the (main) compartment and they have a lot more room to work. We can also carry other things while we are ‘air-evacing’ folks.”
In the Pacific area, with the long distances over water, there isn’t much time to waste to respond to a patient because of the time taken to travel long distances to get there. Short notice taskings are nothing new for the C-17 community. Major Winstead and his crew were scheduled to fly a local training mission when a call came in for the aeromedical evacuation.
“A lot of times, it’s a short notice (mission), this person is critical, or this person will be critical if we can’t get them to some care within a certain amount of time,” he said.
Major Winstead said it’s very satisfying to help someone in need, especially someone with a medical need using the C-17. When C-17 aircrews are airdropping inanimate equipment, they know it’s important. It’s when they are transporting and airdropping passengers, including airdropping paratroopers into a drop zone, the crews sense of making sure everything is perfect goes up 200 percent.
“It’s the same thing when you have passengers, it’s not just mine or my crew’s rear end on the line,” Major Winstead said. “Now, you add to it someone who has a medical condition with a lot of water to (pass over). You want to make sure everything is right.”
“It makes you feel good to know that the military will go through all kinds of lengths to save one person,” said Master Sgt. Joshua Sweester, the 514th Aeromedical Staging Squadron at Joint Base McGuire-Dix-Lakehurst, N.J. “No matter what the outcome may be, the (DOD) will do whatever it takes to get you back to the United States as safely as possible.”
