Caring for patients on the fly: Medical professionals hone patient care skills at altitude

  • Published
  • By Master Sgt. Scott Wagers
  • Defense Media Activity - Ramstein
RAMSTEIN AIR BASE, Germany --  It seemed odd - a group of flight suit-clad healthcare personnel bustling about the tail of a parked C-130 like they owned the place. If it weren't for the medical badges embroidered on their jackets, one could've easily mistaken them for a gaggle of crew chiefs.

It didn't take long, however, before the medical team removed any question about who they were and why they were there. In fact, it was just under 20 minutes to be exact, that the group of eight aerospace medical technicians and flight nurses, there for a weekly training mission, had to on-load 1,500 pounds of medical equipment and render it fully operational before the plane departed for take-off.

Not only did the team, all assigned to the 86th Aeromedical Evacuation Squadron, successfully pull it off, they even found time to squeeze in a self-inflicted ground-egress emergency alarm scenario. This caused everyone to drop what they were doing and scurry to a rally point 600 feet behind the plane--before resuming the equipment duties. And they were just getting warmed up.

Once wheels left the ground, med techs and flight nurses unbuckled from their seats to run through checklists and interact with four life-sized mannequins strapped to suspended litters. There was no time to waste. In the next three hours, there would be another five patient-care and aircraft-related scenarios to respond to that involved 137 certifiable training events.

Tech. Sgt. Tommy Mattox, 86th Aeromedical Evaluation Squadron, much like the director of a play, choreographed and evaluated the team's performance as the mission clinical coordinator. He said flight nurses and medical technicians, who are uniquely trained to transport patients on KC-135, C-130, C-21, and C-17 aircraft, must develop two completely different skill sets to be successful in their job.

"On one hand, you have all these medical skills you can call upon to take care of your patient," said Sergeant Mattox, a 14-year veteran aerospace medical technician. "Then you're responsible for all this aircraft stuff like knowing where your egress points are, how to handle things in an emergency situation and the limitations of the airframe."

Flight medics are also required to know how life support hardware connects to a plane's electrical and oxygen systems. Most aircraft used to transport patients--except the C-17 Globemaster--have 400 MHz electrical currents that must be converted to the 60 megahertz used to power most medical equipment, the sergeant said.

Capt. Troy Kinion, 86th AES flight nurse, said knowing how to transform a pallet-laden cargo bay into a "flying hospital" is crucial for missions downrange.

"Every member of this unit will eventually be flying to Iraq and Afghanistan where you land in the dark, the ramp comes down and you really don't know what your patient load is going to be until you get there. As soon as we learn the patient load, the (medical) crew goes into action," he said.

Kinion, a one-year veteran flight nurse, currently upgrading to become a flight instructor, said a seasoned medical technician could fully ready a C-17's oxygen and electrical systems for patient transport in 10-15 minutes.

"We don't want to delay an airplane because we're slow bringing on our equipment and getting it set up. That's why we practice getting that equipment on board using time hacks," the captain said.

To prompt the team into action during the training flight, Sergeant Mattox would hold up bold-lettered cue cards with phrases like "RAPID DECOMPRESSION - BOOM!!" or "MEDICAL EMERGENCY" -instead of attempting voice commands over the roar of the plane's engines. Medical aircrew, upon noticing the visual cues, acted out the scenarios like a well-seasoned theatre cast.

The team was a balance of veteran medical flyers with younger, greener healthcare officers--some flying the Hercules for their second time. A few senior medics mentored the less experienced ones. Others challenged their peer's instructor skills by playing the role of junior apprentices in upgrade training.

One medical emergency scenario required a flight nurse instructor, who was evaluating another flight nurse's teaching skills, to simultaneously feign an allergic food reaction.
After being prompted to drop her note pad and lay down in the plane's web seating, a white cue card with the words "ANAPHYLACTIC REACTION" was displayed.
Within seconds, medical personnel were carrying her motionless body to a vacant litter.

"She's unresponsive and her lips are turning blue," warned Sergeant Mattox.

This elicited an open dialogue about different ways to open up the lifeless victim's airway, the appropriate medications to prescribe and the effect of the plane's altitude.

According to Captain Kinion, the human body--especially one afflicted with a complex assortment of combat-related injuries--is completely different at higher elevations than it is on the ground because altitude affects disease in different ways.

"If you have four-out-of-ten pain on the ground, when you get up to altitude, because of stress, vibrations and decreased partial pressure of O2 (oxygen), your pain level is probably going to shoot up to a six or seven--if not higher," he said.

Air transportation, according to Captain Kinion, is also challenging for burn patients who have difficulty retaining body heat and fluids, eye and head injury patients susceptible to rapid changes in pressure and abdominal injury patients with trapped abdominal gas that expands and compresses the diaphragm, making it difficult to breathe.

"So we have to treat patients on the ground with the anticipation that they're going to get worse at altitude," said the captain who added that not all patients experience discomfort during transport. He also said a flying medical team's efforts are not centered on treating or healing patients at altitude.

"We're primarily focused on keeping patients stable during transport so that they arrive at point B the same way they left point A," he added.

Learning to render patient care during flight, coupled with the need to safely and effectively operate life support equipment aboard four completely different aircraft, requires new med techs and flight nurses--fresh out of aerospace medicine and survival schools--an additional four months of upgrade training, said Capt. Kinion.

Soon-to-be flight nurse, Capt. Pamela Banks, 86th AES, now one month shy of completing her upgrade certification, labeled the training as "very intense."

She described 12-hour duty days divided between shadowing her trainer and reviewing nearly 600 pages of training manuals covering aircrew operations, equipment and patient care duties. Medical teams also fly weekly training sorties to sharpen their skills in between real world missions throughout Europe and across the Atlantic Ocean to the U.S.

"I literally have no time because I'm in the books, in the regulations, all the time," said Captain Banks, a former enlisted supply troop who said she always wanted to become a nurse. "But when you think about it, I want to be in the books, in the regulations, all the time because I don't want to be up there, with a crew, and not know what I'm doing."

Following a successful upgrade certification, Captain Banks will frequently serve as a "medical crew director" for patient transport missions, making her the flight crew's lead medical authority on matters concerning patient health and safety.

As an ongoing part of her training, the 34-year-old native of Boca Raton, Fla., was scheduled, the following week, to fly her second "Reach Mission" which transports patients from Europe to the U.S. for continued medical care. She said experiences from her first Reach Mission taught her why she endures the difficult training process.

"There were only five patients on that flight...but what clicked it for me was seeing how the patients really appreciate you. No matter what, they value that we're there for them and that we're there to get them safely home," she said.