Critical Care Air Transport Team mission to save lives Published Sept. 30, 2009 By Bekah Clark Air Mobility Command Public Affairs SCOTT AIR FORCE BASE, Ill. (AFNS) -- A critical care air transport team, or CCATT, with the 451st Air Expeditionary Wing at Kandahar Airfield, Afghanistan, received an urgent call the morning of June 24. A Marine had been severely injured by an improvised explosive device while on patrol in Afghanistan and needed immediate evacuation to Landstuhl Regional Medical Center, Germany. The Marine had arrived at the forward operating base hospital only six hours earlier in full cardiac arrest after sustaining the injury, said Maj. Brian Zagol, a critical care physician with the 451st Expeditionary Aeromedical Evacuation Flight at Kandahar. "The first responders and the surgical team did a remarkable job of resuscitating this patient and performing emergency surgery," Major Zagol said. "We were then called to get him aeromedically evacuated as soon as possible and get him to a much higher level of care." After performing multiple labs, blood transfusions, two procedures to evaluate an abdominal complication, as well as stabilizing his blood pressure while in flight, the CCATT delivered the Marine in critical, but stable, condition to Landstuhl less than 15 hours after his initial injury, Major Zagol said. Throughout the world, CCATTs, like the one in Kandahar, are saving lives daily as part of Air Mobility Command's aeromedical evacuation mission, said Lt. Col. Don Tweedel, director of the Air Force CCATT program at the AMC Surgeon General Office at Scott AFB. The CCATT's mission is to "operate an intensive care unit in an aircraft during flight, helping enable America to follow through on its promise to the critically wounded warrior." At a moment's notice, they need to be ready to mobilize and help save a service member's life, he said. CCATT members, who wear body armor and carry weapons while on missions, work under circumstances such as helping the Marine every day. The teams are made up of three members: a critical care physician, a nurse and a respiratory therapist. They can care for up to three critically injured, monitored patients, or up to six less severely injured patients, for 72 hours. A CCATT is a flying critical care unit responsible for caring for the most severely injured and ill patients while flying them from lower levels of medical care to higher levels of care, said Major Zagol. This includes flying patients from small forward operating base hospitals to larger medical facilities in theater, flying patients out of theater to Landstuhl, or flying patients from Landstuhl to the United States. Once alerted, the CCATTs must respond immediately. Additionally, CCATTs are positioned in Afghanistan and Iraq, so often there is no wait for a patient as they are already at the base hospital, brought in by helicopter. Occasionally CCATTs will need to travel to a small FOB, usually an hour away by air, to pick up a patient. While en route to the patient, the team will determine individual responsibilities and duties for the specific mission, discuss what information they'll need from the hospital staff and also establish what equipment and supplies they'll need. Once they arrive at the hospital where the patient is located, they'll receive medical updates and information directly from the hospital's critical care staff and then will prepare the patient for flight, said Maj. Colleen Treacy, a critical care nurse also with the 451st EAEF. Preparation includes removing the patient from the hospital equipment and placing him or her on equipment approved for flight to include a ventilator, cardiac monitor, IV pump, suction machine, vacuum spinal board and intracranial, or brain, pressure monitor. The diagnosis of the patient determines which pieces of equipment are necessary, said Major Treacy. "This process can be time consuming, so CCATTs must work with a sense of urgency, in cohort with the hospital, in order to get the patients to the aircraft in as short a period of time as possible," Major Treacy said. However, the CCATTs cannot do this mission alone. They rely heavily on the expertise of the aeromedical evacuation teams that are also positioned in theater to care for patients in flight. The AE team is responsible for configuring the aircraft to perform an AE mission to include setting up the litter stanchions where the patients will be held, as well as preparing oxygen lines and power sources, said Major Zagol. They are also charged with caring for any non-critical care patients who might be on the mission. "The AE team is vital to the CCATT mission, and no CCATT mission is done without an AE team," Major Zagol said. Though the CCATT mission involves long hours, as teams are sometimes sent immediately back to pick up another patient after finishing a mission, and involves lots of hard work, CCATT members agree that the hard work is worth it. "It is an honor to take care of these wounded military members. There is no patient more deserving, more humble, or more heroic than our wounded men and women in the military," said Major Zagol. "No matter what medical interventions we might do on the plane, just telling these severely wounded individuals that we are going to get them home seems to have the greatest impact." A CCATT is called in to care for the most critically injured patients, who may have extensive burns, lost limbs in a blast, or suffer from another serious injury or illness. "These teams do not necessarily train together, or even come from the same base," said Major Zagol. These often mixed teams do not interfere with mission capability, said Lt Col Debra Wilfong, the chief nurse and director of operations for the 451st EAEF. "The AE teams here are from many different units, but know the mission as if they were the same unit," she said. "Everyone is professional and knows their job, so it is relatively seamless," said Major Zagol. AMC leaders are responsible for the AE mission from beginning to end and supply the aircraft, the flight crews, the staging facilities and the medical and critical care teams for safely transporting wounded servicemembers, treating them en route and quickly delivering them to a higher level of care. Since Sept. 11, 2001, AMC teams have completed more than 27,659 aeromedical evacuation sorties and nearly 135,000 patient movements.