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After The Battle: The flying ICU

Members of the of the 455th Expeditionary Aeromedical Evacuation Squadron assist patients on a C-17 Globemaster III medical transport flight out of Bagram Airfield, Afghanistan, March 21, 2013. With help from the Critical Care Air Transport Team, the crew can turn a regular medical transport aircraft into a flying intensive care unit, making it possible to move severely injured or gravely ill servicemembers by air. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the of the 455th Expeditionary Aeromedical Evacuation Squadron assist patients on a C-17 Globemaster III medical transport flight out of Bagram Airfield, Afghanistan, March 21, 2013. With help from the Critical Care Air Transport Team, the crew can turn a regular medical transport aircraft into a flying intensive care unit, making it possible to move severely injured or gravely ill servicemembers by air. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team and the Craig Joint Theater Hospital intensive care unit prepare to transport patients at Bagram Airfield, Afghanistan, March 21, 2013. The CCATT crew will unplug the patient from the hospital’s power and respiratory machines and connect to mobile units that are positioned along with stretchers for transport to a medical aircraft. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team and the Craig Joint Theater Hospital intensive care unit prepare to transport patients at Bagram Airfield, Afghanistan, March 21, 2013. The CCATT crew will unplug the patient from the hospital’s power and respiratory machines and connect to mobile units that are positioned along with stretchers for transport to a medical aircraft. (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Mario Ramirez, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician, monitors a patient’s vital signs at the Craig Joint Theater Hospital intensive care unit on Bagram Airfield, Afghanistan, March 21, 2013. The CCATT crew will unplug the patient from the hospital’s power and respiratory machines and connect to mobile units that are positioned along with stretchers for transport to a medical aircraft. (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Mario Ramirez, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team physician, monitors a patient’s vital signs at the Craig Joint Theater Hospital intensive care unit on Bagram Airfield, Afghanistan, March 21, 2013. The CCATT crew will unplug the patient from the hospital’s power and respiratory machines and connect to mobile units that are positioned along with stretchers for transport to a medical aircraft. (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Suzanne Morris and Maj. Michael Mackovich, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team nurses, connect a patient to CCATT medical equipment at Bagram Airfield, Afghanistan, March 21, 2013. A CCATT crew consists of a physician, intensive care nurse and a respiratory therapist, making it possible to move severely injured or gravely ill servicemembers by air.  (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Suzanne Morris and Maj. Michael Mackovich, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team nurses, connect a patient to CCATT medical equipment at Bagram Airfield, Afghanistan, March 21, 2013. A CCATT crew consists of a physician, intensive care nurse and a respiratory therapist, making it possible to move severely injured or gravely ill servicemembers by air. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the Contingency Aeromedical Staging Facility and 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team assist patients onto C-17 Globemaster III at Bagram Airfield, Afghanistan, March 21, 2013. The CASF is the relay between the Craig Joint Theater Hospital and aeromedical evacuation missions throughout Afghanistan. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the Contingency Aeromedical Staging Facility and 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team assist patients onto C-17 Globemaster III at Bagram Airfield, Afghanistan, March 21, 2013. The CASF is the relay between the Craig Joint Theater Hospital and aeromedical evacuation missions throughout Afghanistan. (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Mario Ramirez and Capt. Suzanne Morris, members of the 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team, confirm a patient's identity and prepare to administer a blood transfusion during a flight out of Bagram Airfield, Afghanistan, March 21, 2013. A CCATT crew consists of a physician, intensive care nurse and a respiratory therapist, making it possible to move severely injured or gravely ill servicemembers by air.  (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Mario Ramirez and Capt. Suzanne Morris, members of the 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team, confirm a patient's identity and prepare to administer a blood transfusion during a flight out of Bagram Airfield, Afghanistan, March 21, 2013. A CCATT crew consists of a physician, intensive care nurse and a respiratory therapist, making it possible to move severely injured or gravely ill servicemembers by air. (U.S. Air Force photo/Senior Airman Chris Willis)

Senior Airman Delton McClary, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team respiratory therapist, performs an arterial blood gas sampling during flight out of Bagram Airfield, Afghanistan, March 21, 2013.  The results will be used to monitor the patient's hemoglobin and electrolyte levels and guide further resuscitation during the flight.  (U.S. Air Force photo/Senior Airman Chris Willis)

Senior Airman Delton McClary, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team respiratory therapist, performs an arterial blood gas sampling during flight out of Bagram Airfield, Afghanistan, March 21, 2013. The results will be used to monitor the patient's hemoglobin and electrolyte levels and guide further resuscitation during the flight. (U.S. Air Force photo/Senior Airman Chris Willis)

Maj. Michael Mackovich, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team nurse, prepares to administer intravenous medication during flight out of Bagram Airfield, Afghanistan, March 21, 2013. The CCATT crew is constantly on their feet during the flight to observe and interact with the patients for any signs of medical need. (U.S. Air Force photo/Senior Airman Chris Willis)

Maj. Michael Mackovich, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team nurse, prepares to administer intravenous medication during flight out of Bagram Airfield, Afghanistan, March 21, 2013. The CCATT crew is constantly on their feet during the flight to observe and interact with the patients for any signs of medical need. (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Suzanne Morris, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team nurse, discusses a care plan with a patient before they depart the aircraft on Ramstein Air Base, Germany, March 21, 2013. The CCATT crew is constantly on their feet during the flight to observe and interact with the patients for any signs of medical need. (U.S. Air Force photo/Senior Airman Chris Willis)

Capt. Suzanne Morris, 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team nurse, discusses a care plan with a patient before they depart the aircraft on Ramstein Air Base, Germany, March 21, 2013. The CCATT crew is constantly on their feet during the flight to observe and interact with the patients for any signs of medical need. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the of the 455th Expeditionary Aeromedical Evacuation Squadron assist patients on a C-17 Globemaster III medical transport flight out of Bagram Airfield, Afghanistan, March 21, 2013. With help from the Critical Care Air Transport Team, the crew can turn a regular medical transport aircraft into a flying intensive care unit, making it possible to move severely injured or gravely ill servicemembers by air. (U.S. Air Force photo/Senior Airman Chris Willis)
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Members of the of the 455th Expeditionary Aeromedical Evacuation Squadron assist patients on a C-17 Globemaster III medical transport flight out of Bagram Airfield, Afghanistan, March 21, 2013. With help from the Critical Care Air Transport Team, the crew can turn a regular medical transport aircraft into a flying intensive care unit, making it possible to move severely injured or gravely ill servicemembers by air. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the 455th Expeditionary Aeromedical Evacuation Squadron and the Contingency Aeromedical Staging Facility at Ramstein Air Base assist patients on a bus bound for Landstuhl Regional Medical Center, Germany, March 22, 2013.  LRMC provides state of the art care, using sophisticated invasive/non-invasive medical equipment and is the only tertiary intensive care unit within the European theatre.  (U.S. Air Force photo/Senior Airman Chris Willis)
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Members of the 455th Expeditionary Aeromedical Evacuation Squadron and the Contingency Aeromedical Staging Facility at Ramstein Air Base assist patients on a bus bound for Landstuhl Regional Medical Center, Germany, March 22, 2013. LRMC provides state of the art care, using sophisticated invasive/non-invasive medical equipment and is the only tertiary intensive care unit within the European theatre. (U.S. Air Force photo/Senior Airman Chris Willis)

Members of the 455th Expeditionary Aeromedical Evacuation Squadron and the Contingency Aeromedical Staging Facility assist patients inside Landstuhl Regional Medical Center, Germany, March 22, 2013.  LRMC provides state of the art care, using sophisticated invasive/non-invasive medical equipment and is the only tertiary intensive care unit within the European theatre.  (U.S. Air Force photo/Senior Airman Chris Willis)
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Members of the 455th Expeditionary Aeromedical Evacuation Squadron and the Contingency Aeromedical Staging Facility assist patients inside Landstuhl Regional Medical Center, Germany, March 22, 2013. LRMC provides state of the art care, using sophisticated invasive/non-invasive medical equipment and is the only tertiary intensive care unit within the European theatre. (U.S. Air Force photo/Senior Airman Chris Willis)

BAGRAM AIRFIELD, Afghanistan -- Three critically injured patients need immediate transfer to a medical facility outside of Afghanistan. One has a shot to the head, the other has missing limbs and the last has an open abdominal wound. Without a mobile intensive care unit, these patients will not make the flight out.

For members of the 455th Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team, this is go-time.

A CCATT crew consists of a physician, intensive care nurse and a respiratory therapist. Together they can turn a regular medical transport aircraft into a flying intensive care unit, making it possible to move severely injured or gravely ill servicemembers by air to Landstuhl Regional Medical Center in Germany.

Starting with the aeromedical evacuation of the patients from forward operating bases, to treating them at the Contingency Aeromedical Staging Facility and then transporting them out of the country through a C-17 Globemaster III "Reach" mission to LRMC, moving patients throughout the area of responsibility takes a working team with multiple parts.

At the Craig Joint Theater Hospital on Bagram Airfield, the CCATT crew unplugs the patient from the hospital's power and respiratory machines and into mobile units that are positioned along with stretchers. Then with the help of the hospital staff and the CASF crew, the patients are moved to the flightline where an aircraft awaits, already configured for their needs.

Once on the aircraft, each patient is attached to the central air and power supply and prepared for take-off. Since the majority of the CCATT's patients are unconscious during the trip, great care is given to monitor their vitals and wellbeing.

"We make a promise to these men and women that no matter what happens, we will do everything in our power to bring them home," said Capt. Mario Ramirez, CCATT physician. "Being a part of CCATT is a great honor and allows me to help fulfill that mission."

While other passengers are getting some rest, the CCATT crew stays constantly on their feet observing the patients and watching for any signs of immediate medical need.

"It's all about these guys and girls who put their life on the line for us, the least we can do is give them the most optimum care we can provide," said Senior Airman Delton McClary, CCATT respiratory therapist. "If we can get them from Afghanistan to Germany with no problems and better than when we received them, then we did our job."

Every CCATT mission has its own unique challenges and is different than anything that exists in civilian medicine. They are trained to be a medical, surgical and trauma multi-specialty team, all in the back of an aircraft with limited resources.

"I work with an outstanding team, and together we are able to give these troops the same level of care they would get in America's best intensive care units," said Ramirez.

Pre-mission planning and good team communication is vital to the execution of CCATT mission, the job cannot be done by just one or two members of the team.

"We have learned to trust each other," said Capt. Suzanne Morris, CCATT nurse, "During a mission there is a lot going on and you have to rely on your teammates if you want to succeed."

Flexibility is also very important when it comes to the CCATT missions. They can be flying to an unexpected location to pick up an unexpected patient, or flying a mercy mission to reunite an injured servicemember with their families.

"Every mission has a particular place in my heart, some with great endings...some not," said McClary. "But even more importantly, we get the patients to their family and that's the feel-good part of my job that I love to do."

Even though the patients have a far longer journey to go for full medical recovery, they are now out of Afghanistan and at a higher level of care, thanks to the men and women of the 455th Air Expeditionary Wing.

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