Staff Sgt. Kelsiann Echavaria, an aeromedical evacuation crewmember with the 43rd Aeromedical Evacuation Squadron, gives the “thumbs up” to Capt. Tiffany Hubbard, a 43 AES flight nurse, on a Royal Canadian Air Force C-130J at Pope Field, N.C., on July 12, 2013. Aeromedical evacuation crewmembers use hand-and-arm signals to communicate within aircraft due to the deafening engine noise, and the “thumbs up” signal indicates to awaiting litter-bearers that the crew is ready to receive another patient. (U.S. Air Force Photo by Tech. Sgt. Peter R. Miller)

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Photo by: Tech. Sgt. Peter R. Miller |  VIRIN: 130712-F-LZ758-118.JPG