Critical Care
Air
Transport Teamsby Julio Lairet, DO, EMT-P
Maj, USAF, MC
Over the years there have been many advances
in military medicine. One of the notable
changes has been how injured servicemen are
transported back to the United States. When a U.S.
serviceman is injured abroad, there is a sophisticated
system that is called upon to move casualties to definitive
care facilities.
In most instances that mission can be carried out
by the Aeromedical Evacuation (AE) crews. These
crews are designed to transport stable casualties to a
higher level of care. They are made up of flight
nurses and medical technicians trained to perform
routine care to patients during transport. While the
AE system has been effective at moving casualties
through the system, for many years it did not have a
component capable of supporting the challenges of
en-route care for critically injured casualties. To fill
this void, the Critical Care Air Transport Team
(CCATT) concept was created1.
The CCATT mission is to conduct seamless ICU
level care of critically ill, injured, or burned patients
while transporting them to a higher level of care.
While CCATTs are now an integral part of the AE system,
it is important to note that they do not function
independently from AE crews. CCATTs augment
established AE crews, focusing on the care of casualties
who need this higher medical capability.
The composition of CCATTs includes a Critical
Care Physician who may be a General Surgeon,
Pulmonary/Critical Care Physician, Anesthesiologist,
Emergency Medicine Physician or a Cardiologist. The
other two members of the CCATTs are a critical care
nurse and a respiratory therapist.
Each CCATT has the capability of caring for up to
three ventilator patients or six less acute patients2.
This capability can be expanded up to five ventilator
patients by augmenting the primary CCATT with a
Medical CCATT Extender Team2. The Medical CCATT
Extender Team is comprised of two critical care nurses,
and it has been employed during OIF/OEF to
transport larger numbers of casualties from Landsthul
Regional Medical Center in Germany to Walter Reed
Army Medical Center, National Naval Medical Center,
and Brooke Army Medical Center in the United States.
Caring for patients in the back of an aircraft has
many challenges varying from high-noise environments
to low-light situations, and at times conditions
where access to the patients may be limited by
available space.1
The aircraft used do not have a primary mission
of medical care. These aircraft have a variety of missions
ranging from troop movements to cargo
transport. Because of this, all the equipment needed
to care for the patient must be brought aboard by
the CCATT. In effect, the end result is converting the
back of an aircraft into a flying ICU.
While the mission has its challenges, such as limited
lab capability by I-stat and only having blood
available if the crew brings it with them, it is truly
a rewarding experience. The level of care given to
these casualties is extraordinary and a testament to
advances within military medicine.
References:
1 Beekley AC, Starnes BW, Sebesta JA., Lessons
Learned from Modern Military Surgery. Surgical
Clinics of North America, 2007; 87: 157–184.
2 United States Air Force. Air Force Tactics, Techniques,
and Procedures, 3-42.51. Critical Care Air Transport
Teams. 7 September 2006.
Major Julio R. Lairet is faculty at Wilford Hall USAF Medical
Center, Department of Emergency Medicine. He is
Director of the Air Force Critical Care Air Transport Team
training (CCATT), Director of Emergency Medical Services
(EMS) at WHMC and is the Associate Program Director
of the EMS Fellowship at BAMC/WHMC. He is involved
in the training of 48 San Antonio Uniformed Services
Health Education Consortium (SAUSHEC) Emergency
Medicine Training Program residents. He is married to his
wife, Kimberly, who is a surgeon in the Army.
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