"One of the best experiences in my life"

Published Dec. 17, 2010
By Col. Christopher Lentz
315th Aerospace Medicine Squadron

JOINT BASE CHARLESTON, S.C. -- It's 0500 ZULU and I am wake up to a cold snowy morning at Ramstein Air Base, Germany. I'm driving to Landstuhl Regional Medical Center with my respiratory therapist, Master Sgt. Danielle Romero, a deployed reservist from 934th ASTS in Minnesota. We got to the hospital to preflight the patients for tomorrows flight to Andrews AFB, Md.

Intensive care rounds begin promptly at 0700 Z and they usually start with the potential patients for transfer. Rounds are efficient ways to present complex patients with multiple specialists. Some of these are intensive care physicians, trauma surgeons, vascular surgeons, infectious disease specialists, pharmacists, dietitians, nurses and medical technicians. The staff is composed of active duty and reservists from all branches of service. I was surprised to see several civilian docs volunteering their time for 2-4 weeks through the American Red Cross. The range of specialty care is outstanding.

From 0800 - 1000 Z, I begin to plan the mission. Both myself and the validating flight surgeon discussed the patients to transfer. There were four patients to transfer with two arriving from down range for a total of six patients. I decided to activate a second CCATT team to manage the patients. After examining the patients and reviewing their charts, the rest of the day was spent planning the mission. I triaged the patients in order of severity to create a load plan. I also calculated the oxygen needs of the patients from Landstuhl to the flightline and from Andrews to the National Naval Medical Center in Bethesda, Md. and Walter Reed Medical Center, Washington D.C. I request any additional medication and equipment needs that we do not carry in our 550+ pound allowance. Finally, I communicate the plan to Global Patient Movements Requirement Center at TRANSCOM at Scott AFB, Ill. They are responsible for all the Department of Defense patient movement in the world.

Next, from 1100 - 1300 Z, it's time to stock up on personal supplies for flight. We stopped at the commissary to get food, drinks and snacks and any additional sundry items. Then back to the room to pack.

At 1500 Z, my nurse, Maj. Dianna Schulckers, a reserve emergency room nurse from the 920th ASTS at Patrick AFB, Fla. went to the hospital to reassess the patients and to see if there were any changes in the patients' condition. This is important because any status changes can possibly affect our medication, oxygen and equipment needs of our patients. It turns out that our final destination has changed to Brooke Army Medical Center, San Antonio. This adds an extra 3-4 hours to the mission time. I also needed to communicate this to change to all the personnel in the transfer chain.

We meet as a team one last time at 1900 Z at the restaurant in the German Flying Unit building to discuss the mission one more time to ensure nothing was missed. Then, off to bed to get a good night's sleep.....we had a long two days ahead of us.

The alarm goes off at 0500 Z as I get up to shower, eat and ensure I have all my gear. We make our way to the Aeromedical Evacuation Operations Team building to stage our equipment and separate what goes to the aircraft and what goes with us to package our patients. We then arrive at Landstuhl at 0700 Z to package our patients. I am told by the validating flight surgeon that one of the patients was too sick to fly and another patient needed to be placed back on a ventilator, but was stable for flight. As I go through all the medications and records, Maj. Schulckers and Master Sgt. Romero start loading the patients onto litters. We then add about 150 lbs of equipment to a litter holding a 200 lb soldier. They don't pay those Airmen enough to carry those loaded litters. By 1000 Z, all five patients are ready to go to the flight line.

As we take the ambus to Ramstein, we are met by medics from the 86th Contingency Aeromedical Staging Facility that help unload our patients. Our gear has already been loaded on the litter stanchions. The patients flying AE are loaded first, then our patients at the tail of the aircraft, the sickest toward the rear. The entire loading process takes approximately two hours. The C-17 is amazing. There is so much room for us to manage these sick patients. We have the rear one-third of the aircraft to create a flying intensive care unit. The AE crew from the 86th CASF at the Ramstein are flying with us. It's one of their first flights, but everyone was loaded safely and securely. One set of vital signs is taken on our patients and then we ensure they and the gear are secured for takeoff.

By 1330 Z, we are taking off. The acceleration of this aircraft is huge. The litters rock, but the sedated patients are comfortable and the gear remains secure. Once we are at altitude, it's time to check the patients. Each hour, we measure their vitals signs, record outputs and check the patients from head to toe. One of our patents was having trouble oxygenating at altitude, but with a few maneuvers on the ventilator, and suctioning, we were able to improve him. By about 1530 Z, it was time to start all the medications that were due. At one point, we needed to replace a monitoring catheter on someone when it stopped working. So I had to place a new arterial line catheter so we could continue to measure how well the patient was doing on the ventilator. The procedure is straight forward, but the added vibration of C-lift made it slightly more challenging.

The care that we provide is pretty much essential routine care that happens in any ICU in the world. The difference is that we are doing it at 36,000 feet! The key to success is good pre-flight preparation and anticipating any potential changes in a patient's medical condition, both as a result of their injury or disease and the effects on the body flying at a cabin pressure of 8,000 feet. The next key to success is to blur the boundaries between the team members. We each sometimes function as a doc, nurse and respiratory therapist. And the key for us to do each other's job is constant communication. This is facilitated by noise reduction headsets.

About half way to Andrews AFB, the patients were all stable. One of the respiratory therapists cooked bratwurst and sauerkraut for dinner. There is comfort palette that has a kitchenette equipped with a convection oven. I'd have to say, it was better than flying commercial first class. After a quick lunch, it was back to work.

Despite the minor condition changes, all the patents did well as we landed at Andrews at 2300 Z. As they opened the back ramp of the C-17, we were greeted by multiple people to help off load the patients. Of course, our patients remained on board during the two hour ground time. Our challenge was to keep them warm since it was 30 degrees and snowing in Washington, DC.

At 0134 Z on Dec. 14, we lifted off for San Antonio. By the time we landed at 0500 Z, we were hungry. We have now been en route for 16 hours. We still needed to off load the patents and transfer them to BAMC. The reception at San Antonio was not as huge as Andrews, but there was a friendly civilian crew and ambus. The ride to BAMC was tough as we moved through traffic to get to the hospital. Part of the problem was the change from the vibration of flight to the swaying in a large bus headed for the hospitals with lights flashing. Meanwhile, our sedated patients are sleeping peacefully. We off loaded the patients to three different areas in the hospital. Once finished, we had to get back to the flightline to lift off for Jackson, Miss. to spend the night (if you call four hours a night). My clever nurse has friends all over the U.S. from multiple deployments. When we arrived in San Antonio, she arranged for someone to meet us at BAMC with 30 bean and cheese burritos. It was simple, but the warm food was heaven!

We reloaded the aircraft and took off at 0800 Z and headed for Jackson. We landed and checked into lodging at 0400 local time. I felt a little delirious, but satisfied that our first mission went so well. I slept for about 4 hours, and then got up to have lunch. It was one of the most uncanny feelings I've ever had. Yesterday, I was in Germany, Washington DC, San Antonio, TX then Jackson MS. It felt like morning, but was really lunchtime. Between 3 US Sates, 2 Countries and 8 time zones, I wasn't quite sure where I was. We then left to fly back to Ramstein at approximately 1700 local (2300 Z).

When we got to the aircraft, it was loaded with palettes of supplies and equipment. Our "giant" sky hospital and ICU was converted to a garage. We had no problem converting it into a hotel by placing mattresses and sleeping bags on the floor to get some sleep. It is essential to sleep going home to readjust to the Germany time zone. The flight home was shorter because of a good tail wind. But we need to make one stop to pick up a patient and AE crew at Andrews. Luckily, the AE crew did not need our help with that patient.....I was really tired. I put on my headphones and listened to Fortunate Son by Credence Clearwater Revival as I fell asleep.

We arrived at Ramstein at 1500 Z. We unloaded our equipment and stored it in the AEOT building. There is always tomorrow to restock the equipment. After two days, we went out to a Chinese restaurant in Landstuhl for dinner and beer. I got in bed reflecting on the past 40 hours. Three people in my team, never having worked together, coming from all sorts of different backgrounds and levels of experience, functioned essentially seamlessly. It was amazing how we were able to do this mission with its complexity and fatigue without compromising the safety of our patients.

I've heard many people talk about their deployment experience commenting that they could not tell any difference between guard, reserve and active duty. It really is true. The training that we receive, and the emphasis on functioning as a team, facilitates mission accomplishment and success. This first mission was one of the best experiences in my life. Now, I have to go....I'm flying again in a few days!

medevac

medevac

"One of the best experiences in my life"