Zach in Afghanistan: The Aeromedical Evacuation Shuffle


Categorie: Afghanistan, Air, Medical, Zach in Afghanistan, Zach Rosenberg |
Tags: ,

The war in Afghanistan has taken a bizarre turn. Afghan President Hamid Karzai, under foreign pressure to clean up corruption in his government, has apparently warned that he might just side with the Taliban instead. Meanwhile, down south major NATO combat operations continue to target Taliban strongholds. In the east, stretched-thin NATO troops struggle to build grassroots governance and security without much support from Karzai’s regime. Zach Rosenberg, War Is Boring’s youngest correspondent, heads into this morass to observe U.S. counter-insurgency operations up-close.

Patient loading

Patient loading. Zach Rosenberg photo.


This mission is extra-urgent. Instead of the usual hour given to Alpha alert launches, flight nurse Major Richard Foote and his Aeromedical Evacuation (AE) team have only a half hour to set up an airplane, receive four patients and get into the air. Foote’s AE team, composed of two flight nurses and three medical technicians assembles in the hut’s tiny conference room for a hasty briefing.

Nothing is known about the four patients, save that they are coming from Bagram’s base hospital and that one is accompanied by a Critical Care Air Transport Team (CCATT, or “C-cat”), required by only the least stable patients.  “It’s pointless to speculate, to try and guess about our patients,” Major Foote says.  Though the patients would normally be brought to the massive Landstuhl hospital complex in Germany, a volcanic ash cloud has shut down European airspace; the patients will instead be brought to Balad Air Base in Iraq. The team has never been to Balad and has no way back, but unusual destinations and uncertain conclusions are a fact of the AE life.

Today the team is in luck; a Charleston-based C-17 idles on the flightline outside of the hut. Though it was meant to haul an MP unit on its first leg home from a six-month deployment, AE has commandeered it. It is an abnormal occurrence: AE usually has a C-130 at their beck and call, an aircraft perfectly suited to their usual role of ferrying patients to Bagram from remote areas of Afghanistan. From there, a Ramstein-based AE team will fly down to pick them up. It is uncommon but not especially rare for a Bagram AE team to fly outside Afghanistan, depending on the circumstances — Foote has been to Germany seven times.  Because flying to Balad requires a long detour around Iran, the larger, faster C-17 is preferred for today’s mission. AE teams almost always have priority.

The AE team races through C-17 procedures — electrical outlet locations, potential emergency scenarios, etc. — and rushes to perform preflight checks on their equipment. The AE team carries equipment for nearly every scenario: stretchers, a stretcher rack, a defibrillator, two suction machines, IV machines, oxygen tanks — 600 pounds, in all. It is enough that AE can deal with most eventualities. The gear is not always the newest or most capable, but it is reliable.

The CCAT team brings another 900 pounds of gear. A CCATT comes along when a patient needs special care beyond what the AE team can provide. Whereas the AE team specializes in adapting aircraft for patients, CCATT is only focused on patient care. They always travel with an AE team for that reason.  A CCATT is composed of a respiratory nurse, a critical care nurse and a doctor in a specialized field. They train at civilian trauma centers in cities like Baltimore, Cincinnati, St. Louis.

An aircraft can be a dangerous environment for a wounded person. Pressure changes, turbulence, the shock of moving, limited supplies — these are all concerns, and though the AE and CCAT teams do their best to address potential issues, there is only so much to be done. In the civilian world, a patient is not usually moved by air until they are stable, no matter how grave the need. As Major Foote notes, “The idea of stable here and stable back home is different.”  Breathing problems, bleeding and high pain levels are no obstacle. “We never decline a patient from an FOB.”

There are three AE teams at Bagram that each fly three or four times a week.  There are three more AE teams at Kandahar, and a few more scattered around the country. Though Bagram is the clearinghouse for all casualties leaving Afghanistan, both Bagram and Kandahar have Level III trauma centers and various strengths. Kandahar also has a long runway and a major base; there are various theories about why patients aren’t flown directly from there to Ramstein.

Sergeant Brad Diecker, a medical tech on today’s Bravo alert, explains that they could, in theory, fly nonstop to the fabled burn unit at Lackland AFB. A law student at the University of Dayton, he joined the Air Force Reserves straight out of high school. Diecker tells me about the only patient he keeps track of: a Canadian soldier, energetic and humorous after being shot in a firefight. “Our job is different. We don’t want to work because it means someone’s been hurt.”

Supplies are unloaded into the C-17, and the crew sets up with the rapid ease of experience. Stretcher racks are set up, oxygen hoses and electrical cables are connected, everything is stowed. Within the half-hour time limit, everything is ready. The medical teams wait on the bus from the hospital.

The hospital bus arrives with all patients conscious. The first patient fell off a wall and broke his collarbone. The second is a Special Forces soldier with acute pancreatitis. A contractor with a heart attack is CCATT’s patient. There’s also a young Marine with a gunshot wound to the chest and grenade fragments in his arm. As soon as the last patient is strapped in they close the ramp and blast off.

Two days later, the medical teams have not yet returned from Iraq. In their absence, their AE squadron holds another of their frequent parties. Because the AE crews return from Germany bearing fresh fruit and milk which they trade with other squadrons for favors, tonight’s party features a band and BBQ, as well as fresh pineapple. An AE team from Kandahar is stranded in town; a Bagram team returns from a mission and joins the party.

The Alpha alert team is there, as always, and a C-130 awaits them on the ramp.

Zach in Afghanistan: The Lament of Reach 236
Zach in Afghanistan: Inside the Air Force’s European Air Ops Center
Zach in Afghanistan: The Mil Air Gods Frown
Zach in Afghanistan: Stuck in Germany
Zach in Afghanistan: Rota Layover


2 Responses to “Zach in Afghanistan: The Aeromedical Evacuation Shuffle”

  1. James says:

    Just FYI; A CCAT Team consists of a Critical Care Physician, Critical Care Nurse, and a Respiratory Therapist.

  2. Mike says:

    That guy in the flight suit making sure that no one falls off the ramp toe is awesome…

    Spoiler… its me :)

Leave a Reply