| BALAD AIR BASE, Iraq, Jan. 29, 2008 – The Air Force Theater Hospital's 98 percent survivability rate for injured U.S. servicemembers would be meaningless if the wounded were unable to survive their journey out of the combat zone.
Four years into the war, the process of saving lives and safely transporting critically injured and ill troops out of Iraq has become one of the greatest military feats in modern history, according to Air Force Lt. Col. Beverly Johnson, chief nurse for the Contingency Aeromedical Staging Facility here.
The CASF is a minor conglomerate of different functions. It's at once a ward for the sick and injured and a recreation center for those who are able enough. It's a passenger terminal where travelers get bandages changed and customs agents come to the bedridden.
Patients are pre-assessed, assessed, and reassessed. Lessons have been learned and are applied. How will altitude affect cranial swelling for a traumatic brain injury victim? Will an arm in a cast swell in mid-flight? Burn patients must stay warm, current prescriptions must be filled, and care providers must anticipate every possible scenario before the patient goes by bus to the plane. Launch nurses pass on reports; other nurses pick the most critical patients up from the hospital’s intensive care unit.
"By the time most patients get here, they might have some pain, but they're pretty happy," said Air Force Staff Sgt. Joan Sanchez, lead technician for the litter side of the CASF ward. "For many soldiers, this is as nice a facility as they have ever seen in Iraq."
Sanchez and other CASF team members act as care providers, terminal agents and hospital logisticians. The team also has mental health professionals who monitor traumatic brain injury victims and support patients suffering from post-traumatic stress.
On the ground, the team organizes its passenger load based on the configuration of outbound cargo aircraft. A C-17 Globemaster III transport jet has to be reconfigured to become a flying hospital.
In addition to hosting the most comprehensive medical facility in Iraq, the Air Force Theater Hospital's CASF here acts as the hub for wounded troops being flown out of the country. If servicemembers from anywhere in Iraq require aeromedical evacuation from the theater, they will pass through the Air Force Theater Hospital and the hands of CASF team members en route to follow-on care, said Air Force Lt. Col. Rene Bloomer, Air Expeditionary Force CASF chief nurse.
The 60-member CASF team represents more than a half dozen specialties and facilitates one of the hospital's top priorities -- clearing beds.
"Our No. 1 goal is to get them here, quickly assess and stabilize them, and get them on an airplane," Johnson said.
Success at the hospital depends on a constant cycle. Staff members must always be ready to save new trauma victims and have enough empty beds for the next casualties.
Beyond the logistical achievement of maintaining constant airflow from Balad to Landstuhl Regional Medical Center in Germany and to bases outside the combat zone, the aeromedical evacuation process has evolved and improved, said Johnson, a 15-year CASF veteran.
Aeromedical evacuation has been a military asset since World War II, she said, though at first on a limited scale and with equally limited capabilities. The Korean and Vietnam wars saw increasing use of air power in medical evacuations. Neither those wars, nor the limited casualties in Desert Storm, however, truly tested the system, she said.
But the simultaneous bombing of three U.S. embassies in East Africa in August 1998 and the terrorist attack on the USS Cole in a Yemeni harbor in October 2000 showed the modern capabilities of critical care teams and aeromedical evacuations. Johnson recalled when the system was being tested In the 1990s.
"The European Command called saying, 'What would happen if we had to move 1,000 casualties in a day?' I said, ‘We can't. We don't have enough aircrews to support that kind of movement.’ They've really built up the system, and it's been seamless since I've been here. It's really been revolutionary for the Air Force. It's always been a good system, but we've really put it to the test in this war, and it has performed phenomenally."
On the flight line, seriously wounded and ill patients are transferred to the Critical Care Air Transport Team -- specially trained flight medics, nurses and physicians who set up and staff the trauma ward in the sky.
On a busy day, 50 patients will head out to Germany. On a slow day, 10 or 12 patients might be outbound. Rarely is there a day without an aeromedical evacuation. Johnson said 600 to 700 patients move out from Balad every month now, a 20 percent decrease from what teams experienced during past rotations.
Aeromedical evacuation teams in general and CASFs in particular are not common in stateside military medical facilities. Airmen like Staff Sgt. Jessica Reese, a CASF medical technician, said the opportunity for additional training before her deployment and the ability to work outside her normal clinical experience make the facility a rewarding place to work.
A dermatology technician at home, she said she knows she's making a difference in Iraq.
"I'm so proud of what I do. I feel good to be taking care of these troops who have made such tremendous sacrifices. It's an honor to be here for them, to take care of them and to send them home safe," Reese said. Her favorite part of the job comes after litters are loaded on the flightline.
"For the guys who can walk, we line up in two rows and applaud them as they walk onto the plane. I love that. It's our way of saying, ‘We support you, and you get to go home now,’" she said.
(Air Force Tech. Sgt. D. Clare serves in public affairs with the 332nd Air Expeditionary Wing.)
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