The critical care air transport experience

Abstract

There have been over 8000 documented patients transported by US Air Force critical care air transport teams (CCATT) since the beginning of US military involvement in Iraq and Afghanistan (Ingalls et al. in JAMA 149:807–13, 2014). As part of the joint service, integrated and multi-tiered aeromedical evacuation system (AES), critically ill or injured service members are transported by CCATT on tactical (short range, within a theatre of operations) and strategic (long range, between theatres of operation) missions. Within the AE system, patients move through five echelons of care, beginning with care at the point of injury and culminating at major military medical centers in the United States. Patients with critical injuries sustained during support of Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) are first transported to Landstuhl Regional Medical Center (LRMC) in Germany where they are further stabilized for transport back to US facilities. Flight times between evacuation hospitals within the theatre of operations and LRMC can be as long as nine hours. During transport, CCATT monitor patients and continue ongoing resuscitation and treatment plans. Teams are equipped and prepared to intervene should emergent care be required. Critical patients transported to LRMC will often undergo further surgery and frequently require ICU level care with CCATT for transport from LRMC back to the USA. During the peak of conflicts in Iraq and Afghanistan, aeromedical evacuation of critical patients from the point of injury back to the US typically took 2–4 days (Dorlac et al. in J Trauma 66:S164–71, 2009). The paradigm of transporting “stabilizing” patients, even those with severe traumatic injuries over transcontinental distances and often just hours after initial damage control surgery, is supported by a 0.02 % en route mortality rate and a 98 % survival rate among individuals wounded in OIF/OEF that are transported back to LRMC (Ingalls et al. in JAMA 149:807–13, 2014). The long-range transport of critical patients in the austere environment of a military aircraft creates unique challenges for the transport team and is a vital part of the evolving globally mobile medical support apparatus. This article describes both the role of Air Force CCATT within the context of the integrated military AES and the CCATT mission experience in the deployed environment. The role of specialized transport teams and the expanding role of CCATT in a variety of noncombat operations will also be discussed.