Air Force accelerates change to save lives: How aeromedical evacuation mission advanced in 20 years

FALLS CHURCH, Va. — In the years following the attacks on September 11, 2001, U.S. Air Force medics accelerated advancements in medical care, specifically aeromedical evacuations, to save more service members’ lives.

The Air Force’s aeromedical evacuation capability is part of a joint medical evacuation system with the U.S. Army. This system allows injured service members to be quickly moved from the battlefield to a theater hospital where they receive additional care until they are ready for aeromedical evacuation. The Air Force’s aeromedical evacuation capabilities have been critical in significantly improving the chance of survival and leading to a record high survivability rate.

According to a 2014 research article published in the Journal of the American Medical Association, the ability for medics to move patients to higher levels of care has played a key role leading to historically low mortality rates compared to previous conflicts. During the Vietnam War, patient movements from the theater to advanced levels of care took approximately 45 days. This time has been reduced to as little as 36 hours.

“One of our key joint capabilities is aeromedical evacuation, and in the last 20 years we have seen rapid advancements of this capability like we have not seen before,” said Lt. Gen. Robert I Miller, U.S. Air Force Surgeon General. “Patients we would have never thought to transport on an aircraft in prior conflicts are now transported with advanced care. The incredible skills of our aeromedical evacuation and specialty teams, and their ability to push our capabilities even further, has saved more lives.”

From rapid advancement in skillsets of medical Airmen to advancements in en route medical technology, aeromedical evacuations have seen a remarkable evolution to ensure more service members can come home safely.

Uniquely capable Airmen

It is obvious the back of a cargo aircraft is nothing like a full-fledged hospital with all the support and materials most medical professionals are familiar with in a brick and mortar hospital or clinic. Despite the difference, Air Force medics are tasked with delivering the same, high-level care in the air as they are on the ground. These medics have to be prepared to treat patients with a wide range of medical concerns and severity of injury.

Air Force medics receive specialized training to expand their expeditionary medical skills and aeromedical skills to work within the challenging environment of an aircraft. Aeromedical evacuation crews have the skills, experience and training to consider the various challenges and limitations to treating a range of patients. Treating injured patients can be stressful at a fully staffed hospital, but aeromedical evacuation crews also deal with loud noises, varied elevation, turbulence, temperatures and limited space.

“We have been able to elevate our training platforms by providing our medical professionals with clinical experience at trauma centers throughout the United States,” said Chief Master Sgt. James Woods, 711th Human Performance Wing‘s senior enlisted advisor. “Improvements in medical simulator technology and access to various aircraft trainers have allowed the AFMS to provide top notch medical training and validation. In addition to classroom and simulation labs, we are now also able to run scenarios in almost any environment our medics could see themselves in.”

Woods also explains that advancements in training sharpened the skills of aeromedical evacuation medics, leading to much of the high survival rate seen in the past two decades.

“Experience, increased training and medical advancements have now made it almost routine to fly with patients with certain conditions that 20 years ago would be frowned upon in the en route care community,” said Woods.

Read more: Aeromedical evacuation: Helping the wounded survive the journey home

The ability to respond to immediate needs was particularly critical during Operation Allies Refuge when Air Force medics worked to get Afghan evacuees out while also attending to a wide range of medical concerns. Medics monitored Afghans who had dehydration and malnutrition. On one flight, one evacuee gave birth shortly before landing.

Read more: In-flight medical care key enabler to Afghan evacuation mission

Adaptability is key for aeromedical evacuation crews and critical care air transport teams. Medics are trained to deliver care on the C-17 Globemaster III, C-130 Hercules, as well as on aircraft usually designated for aerial refueling, like the KC-46 Pegasus and KC-135Stratotanker.

In July 2020, Airmen assigned to the 931st Air Refueling Squadron and the 22nd Air Maintenance Squadron took part in the KC-46 Pegasus’s inaugural aeromedical evacuation training. This flight included two flight nurses and three medical technicians, who learned how to configure this new aircraft and use their existing aeromedical evacuation skills to provide high quality patient care.

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“I have transported patients on multiple airframes to include rotary, small aircraft, large aircraft and other aircraft of opportunity,” said Col. Tory Woodard, U.S. Air Force School of Aerospace Medicine commander. “Throughout my 24-year career, I have seen the rapid increase in our capabilities and the survivability of the complex cases our en-route care teams support. I am continuously impressed by our medics and the amazing things they accomplish.”

Advancements in CCATT

The development of the critical care air transport team, or CCATT, in 1994 enabled the Air Force to bolster its aeromedical evacuation capabilities, allowing more critically ill or severely ill patients to be transported to higher levels of care.

“With about 750 pounds of high-tech medical equipment, the three-person teams…ensure there’s no lapse in care during transport,” said retired Lt. Gen. Charles B. Green, former U.S Air Force Surgeon General. “The teams speed up the patient movement to increasingly more advanced care.”

Read more: Improving combat survival rates

Working as highly specialized medics, CCATTs augment aeromedical evacuation teams and essentially turn any cargo aircraft into a flying intensive care unit. Each team includes a critical care physician, a respiratory therapist and a critical care nurse.

Read more: Aeromedical evacuation improvements saving lives

According to a 2014 study on Air Force CCATTs, despite having to transport more patients who sustained significant, critical injuries, the en route mortality rate was less than 1%. The researchers who published this study explained that the reason for this is the role CCATTs play as a component in the entire continuum of care, from the battlefield to more definitive care.

Read more: Aeromedical Evacuation knows no bounds

In 2019, a CCATT embarked on the longest aeromedical evacuation mission, moving a critically injured Soldier more than 8,000 miles, through a combat zone, from Afghanistan to Texas, aboard a C-17 Globemaster III. The CCATT completing this 20-hour, non-stop evacuation required the team to provide continuous monitoring throughout the flight. Additionally, this flight required refueling along the way, adding another challenge to the mission. Refueling during an aeromedical evacuation is uncommon since it can cause additional turbulence, but it was vital for the Soldier to get to specialized care as soon as possible. The strenuous conditions this team worked under to save a Soldier’s life is exactly what they are trained to do.