Casualty care in the air

Published April 8, 2011
By Tech. Sgt. Emily F. Alley
451st AEW Public Affairs

KANDAHAR AIRFIELD, Afghanistan -- The trip home can be long for many wounded people, but can be better with the medics from the 451st Expeditionary Aeromedical Evacuation Squadron at Kandahar Airfield.

Different medical teams are available depending on the severity of the wound. Aeromedical Evacuation teams are the core of the flying hospital and lay out the aircraft. They are present on all medical flights, even with even less severe categories, caring for people often called the walking wounded. For the severest cases a Critical Care Air Transport Team, essentially an Intensive Care Unit, will fly along as well. These are patients so severely wounded, said Technical Sgt. Nicole Costigan, a respiratory technician and CCATT member, that if they were in the United States they would not even be moved between wings of a hospital, let alone loaded on an aircraft and flown between cities.

A CCATT has three members: a critical care doctor- who is often the team leader, a critical care nurse, and a respiratory technician. Costigan said her job was often necessary because the patients are attached to ventilators. In addition to patients, the team will load several litters full of emergency equipment that weight hundreds of pounds. If, for some reason, they had to land in some obscure location without power, or medication, or any number of other emergency scenarios, they would be prepared.

The 451st EAES team's day may start at any time they are called; they will show up at the Role 3 hospital at Kandahar Airfield and meet their patients. Some may be conscious, most are not. They load the patient onto a narrow rolling stretcher clipped full of tubes and beeping, blinking equipment.

On a mission on April 6, Sergeant Costigan leaned over a conscious patient, offering him water on the bus ride to the plane out of Kandahar. She winced with him as they went over each bump on the rough road.

She's struck, she said, by how young many of her patients are. As a National Guardsman, out of New Hampshire, her civilian job is working at a hospital as a respiratory technician. Most of her patients at home are older people who are suffering from years of smoking.

"It's a drastic change," Costigan described. "They all seem like kids."

She stood at the patient's side during the several hours of flight, talking and handing him ice cubes to chew. The critical care nurse, Capt. Sparkle Graham, sat nearby filling out charts, periodically giving injections and replacing bags of fluids. After the C-130 landed, the back door opened as the plane lumbered into a parking spot. The critical care doctor, Maj. Andrew Hsing, pulled out his stethoscope and quickly looked over the patient in the sunlight before volunteers appeared to help carry him out to the waiting bus.

The doctor, like any team leader, is responsible for the overall health of the patients. He is a critical link in determining how and when to move patients. It's a serious responsibility, he said, because the position demands an understanding of the delicate balance between patient health and logistical impact of requesting aircraft to move them.
The responsibility of the team ends when the patient is finally wheeled into the receiving hospital and the hands of its own capable medical team. A cluster of medical staff lifted the man from the litter and moved him onto a larger hospital bed at Bagram Airfield. They refastened the beeping equipment as Sergeant Costigan and her team watched from a few feet away. Dr. Hsing stepped aside to fill out paperwork, but before they left, the patient pulled Costigan in for a hug goodbye.

"I just take care of these people for fewer than 24 hours," she reflected. "Very quickly you get emotionally invested."

They left the hospital in Bagram with handfuls of cords and equipment. Often, her team is left to find a flight back to Kandahar Airfield among the cargo that's already scheduled to travel there. Other teams are in place to take the next patients. Costigan is content to find her way back as a lower priority, because it means that her team is less busy and there are fewer wounded.

"Then the medevac helicopter will land and we'll start all over again," she described, then considered the patients she's cared for who aren't conscious. "The people I take care of, hopefully they'll never remember this part of their mission."

After her team has flown them out, they may be able to wake up at home, with their families.