An official website of the United States government
Here's how you know
A .mil website belongs to an official U.S. Department of Defense organization in the United States.
A lock (lock ) or https:// means you’ve safely connected to the .mil website. Share sensitive information only on official, secure websites.

Aeromedical Evacuation teams keep patients moving

  • Published
  • By Maj. Tony Wickman
  • 455th AEW Public Affairs
Located among the myriad of buildings on the Bagram Airfield flightline, it’s easy to miss the simple looking building with the letters “AE” hanging on the outside of it.

Chances are, though, if Service members must be moved from the battlefield to a medical facility outside of Afghanistan, the Total Force Airmen in this building will be the critical link between them getting from the combat zone to higher-level medical care elsewhere in the U.S. Central Command’s area of operations or in Germany.

The 455th Expeditionary Aeromedical Evacuation Squadron is a small, tightknit medical team that takes critically ill or injured servicemembers in Afghanistan and fly them thousands of miles onboard U.S. cargo aircraft to receive full-time care elsewhere.

The standard AE team consists of five people: a medical crew director, a flight nurse, a charge medical technician and two aeromedical evacuation technicians. They ensure the aircraft is prepared to fly patients and tend to patients’ medical needs in flight. If critically injured or severely ill patients are onboard, the AE team supports the assigned critical care air transport team, a three-person specialized team that includes a physician trained in an emergency or critical care specialty, a critical care nurse and a respiratory therapist.

“The mission of AE and CCATT is to work as a seamless team. The CCATT provides critical care capability to the aeromedical evacuation system, while AE support the needs of CCATT and cares for patients that are more stable than critical care patients,” said Col. Diane Difrancesco, 455th EAES commander deployed from the Air Force Reserve’s 315th Aeromedical Evacuation Squadron at Joint Base Charleston, South Carolina.

According to Maj. Jonathan Freeman, 445th EAES medical crew director and flight nurse deployed from the North Carolina Air National Guard’s 156th AES, no one AE movement is exactly the same as the next.

“Every mission is either routine, priority or urgent. We plan our mission around the requirements of the patient,” said Freeman. “We follow our checklists to keep us on target and make sure our guys and girls are taken care…from one hospital to the next.”

According to Tech. Sgt. Russell “Rusty” McLamb, an AE technician also deployed from the North Carolina Air National Guard’s 156th AES, every AE team member has a specific duty to perform to get ready for a patient movement.

“We all have specific jobs that we perform to get the aircraft ready. It all starts with a crew brief to go over what we will do to get the aircraft ready and take care of the patients,” said McLamb. “The MCD is on the ramp to control movements and interact with the aircrew, the flight nurse gets reports from the medical facility, and the technicians make sure the medical equipment is good to go. After the aircraft and equipment are ready, then we can bring on patients and start our patient assessments. Once we’re in the air, our focus is patient care and we all perform that duty.”

According to Master Sgt. Mary Troja, 455th EAES AE technician deployed from the 315th AES, AE technicians rotate duty positions on each flight, but all are responsible for patient care under the supervision of the flight nurse.

“The charge medical technician is responsible for the supervision and management of the AETs to perform duties on the mission. The CMT has the overall responsibility to ensure medical supplies and equipment is operational,” Troja said. “The CMT is also responsible for all AE operations on the ground as well as on the aircraft, and receives directions from the MCD.”

Every AE mission starts with an alert, which is a notification that patients need to be moved out of the theater of operations. That kicks the AE team into gear to begin mission planning to support the operation.

The AE crew begin each mission by considering the type of aircraft they will use and plan the specific types of medical equipment, power requirements and litter configurations for that aircraft. The C-130 Hercules and the C-17 Globemaster III aircraft are primarily deployed to execute these missions, but virtually any cargo aircraft can be arranged for these missions.

According to Capt. Derek Martindale, 455th EAES flight nurse deployed from the 315th AES and a prior enlisted C-17 loadmaster, knowing the type of aircraft is crucial to ensuring a successful movement.

“Knowing the limits of aircraft systems on the different airframes is a challenge. Although the primary aircraft we use for AE at Bagram are the C-130 and C-17, we're also familiar with the systems on the KC-135, KC-10, C-5 and C-21,” said Martindale. “The oxygen and electrical capabilities are especially important concerning AE. You can imagine the undesirable events that would ensue if we improperly calculated the patient oxygen requirement or overloaded the aircraft's electrical system with our medical equipment.”

Before going to the aircraft, the AE team conducts a pre-flight check of their equipment and supplies, including monitors, oxygen tanks and other life-sustaining equipment and supplies that will be needed to care for their patients, to ensure availability when needed and compatibility with the aircraft.

“We go through the details like what equipment we need to bring, where we are putting our equipment and where we are putting the patient on the aircraft. We make a detailed plan down to the smallest thing for everything we do before we even get out to the is that important,” said McLamb. “We don’t want to get out to the aircraft and find out the equipment is broke.”

Once on board the aircraft, the AE technicians go about converting the cargo plane into a flying intensive care unit that the flight doctors and nurses use to care for servicemembers as they are moved to waiting hospitals. Once installed, the crew perform a function check on their equipment.

“Our pre-flight checks are very in depth, but once on board we do the function checks quickly to receive patients and get in the air,” said McLamb. “We have to make sure we setup the crew’s lifesaving equipment and then establish the requirements for the patients. It’s the last step before we bring the patient into the airplane.”

After declaring the aircraft ready to receive patients, a medical transport brings them from the Craig Joint Theater Hospital to the flightline. Patients on litters are securely loaded onto the recently erected stanchions, their vital signs are checked and the aircrew is told everyone is ready for onward movement.

Once airborne, the patients are constantly monitored and patient care continues throughout the flight until they reach their next destination. At that point it becomes mission complete for the AE crew and they being the long journey back to Bagram to wait for the next call.

“Our mission is successful when the patient’s care isn’t compromised…that we maintain that level of care they need and deserve safely and quickly,” Freeman said. “When people are in pain and moved by air, our job is to provide care and make it comfortable for them.”

There are more than 30 AE units in the Air Force stationed around the world who provide this critical capability, and most of them are run or staffed by the Air National Guard and Air Force Reserve.

“Aeromedical evacuation is the true meaning of ‘Total Force;’ it’s a multi-component of Reserve, Guard and active-duty Airmen. All formal training is ‘Total Force’ integration and standardized; the way we train is the way we deploy…the system works,” said Difrancesco. “One branch cannot complete the mission requirements alone; we need each other to make it all work. The 455th EAES is a showcase of what ‘Total Force’ can do in a deployed location.”