Command and control: prescription for aeromedical evacuation success
SCOTT AIR FORCE BASE, Ill. (USTCNS) --- Medical emergencies are, unfortunately, a fact of life. Battlefield injury or illness are threats to men and women deployed around the world supporting the Global War on Terrorism. When those threats turn into reality for American and even coalition forces, the Air Force has an extensive aeromedical evacuation network at the ready to ensure wounded warriors are rapidly transported to a medical facility to get the care they need.
The expansive network of personnel from Air Mobility Command's Tanker Airlift Control Center, the U.S. Transportation Command's Global Patient Movement Requirements Center, both at Scott Air Force Base, and countless numbers of medical professionals at facilities around the world work together to plan and accomplish every patient movement.
Together, the team becomes the prescription for aeromedical evacuation success.
Planning
The first step in conducting an aeromedical evacuation begins long before a Soldier, Sailor, Airman or Marine is injured in combat.
"When officials at U.S. Central Command begin planning a military operation, the number two most sought after support is aeromedical evacuation missions," said Capt. Tim Smith, a member of AMC's TACC planning team who specializes in sourcing and tasking of personnel for AE missions. "They want to make sure that if someone gets wounded, they have a means to get them the medical attention they need as quickly as possible."
To plan for this, USCENTCOM officials determine how many AE missions are required based upon the anticipated number of casualties. They then provide their requirement to USTRANSCOM at Scott AFB, who in-turn communicates with TACC officials to schedule missions and crews.
While the framework for moving patients exists, not one patient is aerovaced without an official request, initiated in the theater of operations. There an attending medical provider determines the clinical status of the patient and the need to move that patient to a facility that's able to provide the next level of treatment.
"A clinical staff of nurses, medical administrative personnel and a validating flight surgeon works together to validate and classify each patient," said Lt. Col. Judy Daly, TACC AE Division chief at Scott. "Patients are classified as urgent, priority and routine.
Allocation of resources
Based on the clinical description of the patient, Colonel Daly said officials at one of the Patient Movement Requirements Centers at Hickam AFB, Hawaii, Ramstein Air Base, Germany, Scott AFB, or the Joint Patient Movement Requirements Center at USCENTCOM determine the movement precedence as either routine, priority or urgent. "They also determine means of transportation - airlift, ground, or even sealift when the hospital ships are utilized," she said.
At TACC's Global Operations Center, operations directors like Lt. Col. Bob Davis work to align aircraft with specific missions. They'll communicate with maintenance, aerial port and units who have an aircraft sitting in alert status.
"We give AE missions a very high priority. First we look at all suitable aircraft already in the theater available to move the patients. If nothing is available, there is an aircraft sitting in alert status we can fall back on," said Colonel Davis. "The patients are the real priority, so we'll go after the task with everything we've got."
"The directors will go after the aircraft best suited for the patient. If the alert is used, units will begin working to get another one ready to replace it as soon as possible," said Colonel Daly.
Close communication among all agencies has been and continues to be the reason the Air Force has had such great success in expeditious patient movement worldwide.
AE journey
Within the AE environment, the goal is to have routine patients start the journey within 72 hours of receipt of the movement request. However, that doesn't mean it will only take 72 hours to get the patient from the theater to their home town back in the United States.
"At each leg of a patient's journey a clinical re-evaluation is accomplished," said Colonel Daly. "This is because each leg of the mission, each patient movement, ensures the 'next level of care' and the patient is re-evaluated to determine if their clinical needs have changed. The 72 hours begins once the next leg of their journey is requested.
"The 72 hours, however, isn't the norm," she said. "We normally move the patient faster, within 24 to 48 hours."
The goal for priority patients is to start transport within 24 hours of receiving a request. The most critical, urgent patients are moved on the first available aircraft to save life, limb or eyesight. For those high-priority patients, cargo and passengers may be redirected.
"We've had generals change their itinerary so the aircraft they're on can be used to move patients to the treatment they need," said Tech. Sgt. Kathy Bredbury, an AE mission controller for TACC.
One of the biggest challenges in patient movement is communication within the system, especially for those unscheduled missions.
"When we have to select a specific aircraft to move a patient that wasn't scheduled, it takes a tremendous amount of communicating with multiple agencies to make it happen," said Sergeant Bredbury, whose Aeromedical Evacuation Cell team recently moved into USTRANSCOM's Deployment Distribution Operations Center so they could communicate face to face with the GPMRC, the agency responsible for oversight of the entire patient movement system.
While the challenges are great, the successes are constant. One such success occurred when Sergeant Bredbury helped with bringing an injured Iraqi child to Hungary on a humanitarian mission. The child's injuries were so severe that waiting for a scheduled mission wasn't an option. Getting the airlift for the child "was a great success," she said.
"Those in the AE community will never accept failure," said Captain Smith. "Each request for patient movement means we're dealing with a person, and we make it happen every time."
AE team
With upwards of 1,650 scheduled and 350 unscheduled AMC aeromedical evacuation missions each year, most Soldiers, Sailors, Airmen, Marines, and just as important, their families, would never realize what it takes to make AE happen. To make it all come together like a well-oiled machine, the AE team is composed of aircrew and medical personnel, including the Air National Guard and Air Force Reserve. It's because of the knowledge, experience and passion required of the command-and-control personnel to provide the best possible care to every patient that medical professionals are strewn throughout all facets of the AE community.
"The TACC has medical personnel assigned to the planning, allocation and execution directorates, and all are extremely well versed in the AE system," said Colonel Daly. "We have flight nurses, aeromedical technicians and aeromedical administrative personnel who are each an integral piece of each AE mission."
The biggest part of the AE mission in the network of medical, flying and command and control professionals are members of the Guard and Reserve, who account for 87 percent of the AE community.
"When we look to task aircrews and medical teams, we first look to the Guard and Reserve," said Captain Smith. "If they can't support, we'll task the active duty personnel, and as a last resort initiate a partial mobilization."
Initially, individuals like Tech. Sgt. Mark Major, a member of the TACC AE Allocation Division, will reach out to Guard and Reserve Airmen who want to support the mission. "When it comes to getting the patient where they need to go, we'll always start with volunteers," he said. "We could never do it without the Guard and Reserve, and fortunately we rarely experience a shortage of people wanting to do the job."
Success can be measured in many different ways, but for those who plan, allocate and accomplish an aeromedical evacuation mission, it's only achieved when they do their part to ensure patients are given the best care possible and are either returned to their family or returned to their calling of defending the United States.
"Mission complete" happens when patients reach their final destinations and ultimately the AE crews and their equipment return to their deployed theater ready to perform the next mission. According to those making aeromedical evacuation happen, that's one of the most satisfying feelings in the world.
AE by the numbers
* 31 aeromedical evacuation squadrons in the Air Force (four active
duty)
* 87 percent of all AE forces are from the Air National Guard or Air Force Reserve Command.
* Two expeditionary aeromedical evacuation squadrons are deployed as intra-theater units in U.S. Central Command. These units perform the mission within USCENTCOM only.
* One intertheater EAES in Germany supports AE missions across more than one command.
* The Air Force supports 100 percent of all "fixed wing" AE missions
* Air Mobility Command conducts about 1,650 scheduled and 350 unscheduled Air Mobility Command AE missions are conducted each year.
* 3,200 AE missions have supported worldwide patient movements through the AMC Global AE system in the past year. This includes, but is not limited to, Global War on Terrorism support.
* On average there are 350 AE team members deployed in support of the GWOT. This number has been higher in the past, but has decreased slowly to align with mission requirements.
The expansive network of personnel from Air Mobility Command's Tanker Airlift Control Center, the U.S. Transportation Command's Global Patient Movement Requirements Center, both at Scott Air Force Base, and countless numbers of medical professionals at facilities around the world work together to plan and accomplish every patient movement.
Together, the team becomes the prescription for aeromedical evacuation success.
Planning
The first step in conducting an aeromedical evacuation begins long before a Soldier, Sailor, Airman or Marine is injured in combat.
"When officials at U.S. Central Command begin planning a military operation, the number two most sought after support is aeromedical evacuation missions," said Capt. Tim Smith, a member of AMC's TACC planning team who specializes in sourcing and tasking of personnel for AE missions. "They want to make sure that if someone gets wounded, they have a means to get them the medical attention they need as quickly as possible."
To plan for this, USCENTCOM officials determine how many AE missions are required based upon the anticipated number of casualties. They then provide their requirement to USTRANSCOM at Scott AFB, who in-turn communicates with TACC officials to schedule missions and crews.
While the framework for moving patients exists, not one patient is aerovaced without an official request, initiated in the theater of operations. There an attending medical provider determines the clinical status of the patient and the need to move that patient to a facility that's able to provide the next level of treatment.
"A clinical staff of nurses, medical administrative personnel and a validating flight surgeon works together to validate and classify each patient," said Lt. Col. Judy Daly, TACC AE Division chief at Scott. "Patients are classified as urgent, priority and routine.
Allocation of resources
Based on the clinical description of the patient, Colonel Daly said officials at one of the Patient Movement Requirements Centers at Hickam AFB, Hawaii, Ramstein Air Base, Germany, Scott AFB, or the Joint Patient Movement Requirements Center at USCENTCOM determine the movement precedence as either routine, priority or urgent. "They also determine means of transportation - airlift, ground, or even sealift when the hospital ships are utilized," she said.
At TACC's Global Operations Center, operations directors like Lt. Col. Bob Davis work to align aircraft with specific missions. They'll communicate with maintenance, aerial port and units who have an aircraft sitting in alert status.
"We give AE missions a very high priority. First we look at all suitable aircraft already in the theater available to move the patients. If nothing is available, there is an aircraft sitting in alert status we can fall back on," said Colonel Davis. "The patients are the real priority, so we'll go after the task with everything we've got."
"The directors will go after the aircraft best suited for the patient. If the alert is used, units will begin working to get another one ready to replace it as soon as possible," said Colonel Daly.
Close communication among all agencies has been and continues to be the reason the Air Force has had such great success in expeditious patient movement worldwide.
AE journey
Within the AE environment, the goal is to have routine patients start the journey within 72 hours of receipt of the movement request. However, that doesn't mean it will only take 72 hours to get the patient from the theater to their home town back in the United States.
"At each leg of a patient's journey a clinical re-evaluation is accomplished," said Colonel Daly. "This is because each leg of the mission, each patient movement, ensures the 'next level of care' and the patient is re-evaluated to determine if their clinical needs have changed. The 72 hours begins once the next leg of their journey is requested.
"The 72 hours, however, isn't the norm," she said. "We normally move the patient faster, within 24 to 48 hours."
The goal for priority patients is to start transport within 24 hours of receiving a request. The most critical, urgent patients are moved on the first available aircraft to save life, limb or eyesight. For those high-priority patients, cargo and passengers may be redirected.
"We've had generals change their itinerary so the aircraft they're on can be used to move patients to the treatment they need," said Tech. Sgt. Kathy Bredbury, an AE mission controller for TACC.
One of the biggest challenges in patient movement is communication within the system, especially for those unscheduled missions.
"When we have to select a specific aircraft to move a patient that wasn't scheduled, it takes a tremendous amount of communicating with multiple agencies to make it happen," said Sergeant Bredbury, whose Aeromedical Evacuation Cell team recently moved into USTRANSCOM's Deployment Distribution Operations Center so they could communicate face to face with the GPMRC, the agency responsible for oversight of the entire patient movement system.
While the challenges are great, the successes are constant. One such success occurred when Sergeant Bredbury helped with bringing an injured Iraqi child to Hungary on a humanitarian mission. The child's injuries were so severe that waiting for a scheduled mission wasn't an option. Getting the airlift for the child "was a great success," she said.
"Those in the AE community will never accept failure," said Captain Smith. "Each request for patient movement means we're dealing with a person, and we make it happen every time."
AE team
With upwards of 1,650 scheduled and 350 unscheduled AMC aeromedical evacuation missions each year, most Soldiers, Sailors, Airmen, Marines, and just as important, their families, would never realize what it takes to make AE happen. To make it all come together like a well-oiled machine, the AE team is composed of aircrew and medical personnel, including the Air National Guard and Air Force Reserve. It's because of the knowledge, experience and passion required of the command-and-control personnel to provide the best possible care to every patient that medical professionals are strewn throughout all facets of the AE community.
"The TACC has medical personnel assigned to the planning, allocation and execution directorates, and all are extremely well versed in the AE system," said Colonel Daly. "We have flight nurses, aeromedical technicians and aeromedical administrative personnel who are each an integral piece of each AE mission."
The biggest part of the AE mission in the network of medical, flying and command and control professionals are members of the Guard and Reserve, who account for 87 percent of the AE community.
"When we look to task aircrews and medical teams, we first look to the Guard and Reserve," said Captain Smith. "If they can't support, we'll task the active duty personnel, and as a last resort initiate a partial mobilization."
Initially, individuals like Tech. Sgt. Mark Major, a member of the TACC AE Allocation Division, will reach out to Guard and Reserve Airmen who want to support the mission. "When it comes to getting the patient where they need to go, we'll always start with volunteers," he said. "We could never do it without the Guard and Reserve, and fortunately we rarely experience a shortage of people wanting to do the job."
Success can be measured in many different ways, but for those who plan, allocate and accomplish an aeromedical evacuation mission, it's only achieved when they do their part to ensure patients are given the best care possible and are either returned to their family or returned to their calling of defending the United States.
"Mission complete" happens when patients reach their final destinations and ultimately the AE crews and their equipment return to their deployed theater ready to perform the next mission. According to those making aeromedical evacuation happen, that's one of the most satisfying feelings in the world.
AE by the numbers
* 31 aeromedical evacuation squadrons in the Air Force (four active
duty)
* 87 percent of all AE forces are from the Air National Guard or Air Force Reserve Command.
* Two expeditionary aeromedical evacuation squadrons are deployed as intra-theater units in U.S. Central Command. These units perform the mission within USCENTCOM only.
* One intertheater EAES in Germany supports AE missions across more than one command.
* The Air Force supports 100 percent of all "fixed wing" AE missions
* Air Mobility Command conducts about 1,650 scheduled and 350 unscheduled Air Mobility Command AE missions are conducted each year.
* 3,200 AE missions have supported worldwide patient movements through the AMC Global AE system in the past year. This includes, but is not limited to, Global War on Terrorism support.
* On average there are 350 AE team members deployed in support of the GWOT. This number has been higher in the past, but has decreased slowly to align with mission requirements.
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