CCATT brings ICU to battlefield, gives patients better chance in Afghanistan

Published Jan. 10, 2011
By Senior Airman Melissa B. White
451st Air Expeditionary Wing Public Affairs

KANDAHAR AIRFIELD, Afghanistan -- He walks into the Kandahar Role 3 Hospital with his medical bags in tow. Minus a few dusty footprints at the doorway from the outside environment, it resembles any other hospital complete with the clean, sterile smell -- a scent absent anywhere else on the airfield in Afghanistan which is noted for its infamous open sewage.

Capt. John Eggert, 451st Expeditionary Aeromedical Evacuation Squadron Critical Care Air Transport Team nurse, continues down a hall, through a door marked "Staff Only" and down another hallway until there is a break with a sign hanging above his head. The intensive care unit is to his left; the ward is to his right. He walks into the ICU first, where his patients are usually located, but then turns right around and walks into the ward instead, where patients are typically able to stand up and talk to their doctors.

"It's very unusual for us to pick up our patients from the ward ... it's been months since we've done that; I can't even remember the last time," said Maj. (Dr.) George Kotti, 451st EAES CCATT clinical doctor. "Usually our patients are young Soldiers or Marines with multiple amputations and other traumatic injuries who have required a large amounts of resuscitation or blood transfusions, and they usually need life support equipment and ventilators - a lot of tubes everywhere."

This time was different though. The patient was feeling a lot better after suffering from a stroke and was already on a promising path to recovery, but he was still assigned to have a critical care team transport him because if his condition worsened during flight, he would require life support. Luckily he didn't.

"We try to recreate an ICU environment in the back of an aircraft that enables us to do ICU-level care for the patient throughout the trip," said Dr. Kotti. "Our patients are stabilized by the time we transport them, but they're still critically ill and extremely tenuous, and we're there to give them the best medical care possible."

After evaluating their patient in the hospital, the team prepared their patient for an aeromedical evacuation via C-130H Hercules. First, they moved him to a litter so a team of medical Airmen could help load him onto an ambulance bus. The bus then drove right onto the flightline where the plane had taxied to a location right outside the hospital, making the transition from the hospital to aircraft quick and easy. As soon as they arrived at the rear of the aircraft, the Airmen opened the bus door letting in furious gusts of dusty air kicked up by the aircraft's propellers ... but medics didn't even overlook something as small as making sure their patients had goggles too. They were prepared to always provide the best care possible in whatever way they could.

The patient was on one of many litters inside the aircraft - some that could be used for other walking patients who may need it, but other unoccupied litters were stacked to the top of the cargo bay with necessary medical equipment piled on top of them. The CCATT team travels with more than 750 pounds of medical equipment valued at more than $1 million, three days worth of equipment to sustain six ICU patients or three patients on ventilators.

Once on the aircraft, the team connected their patient to medical devices to monitor his vitals during the flight.

"We have a pretty good idea of the injuries before we take the patient, so we think of what the worst possible thing that could happen to the patient and what we need to do to keep them alive in that kind of situation," said Dr. Kotti.

Upon completion of their quick setup and the loading of other ambulatory patients, the aircraft was ready for takeoff. Once they reached a cruising altitude, the plane was bustling with movement again as doctors checked up on their patients. The CCATT's patient was still doing well.

"The unfortunate side of our job is that we usually get the worst patients, but it's our job to take care of them," the doctor said. "And if we do it right, they won't remember us."

After a quick stop at a forward operating base to pick up more patients, the crew took off to complete their trip to Bagram Airfield in northern Afghanistan. Once there, the CCATT crew handed their patient off to medics at the Craig Joint Theater Hospital, completing a leg in the patient's trip to Germany or the U.S. for more advanced medical care and increasing his survivability.

"Once we get there, it's like a NASCAR pit crew takes over," said Master Sgt. Rich Pakula, 451st EAES CCATT respiratory technician. "Everything we put on the patient to get them there, they take it all off and start again. Everyone knows their job so well and they do it very quickly ... one person moves, the other person moves. They all work together."

The CCATT is a specialized medical team comprised of three specialists: a doctor, nurse and respiratory technician. Dr. Kotti's team is one of three CCATTs assigned to the 451st EAES. They are always on call and ready to respond at a moment's notice, whether they're alerted several hours or a matter of minutes before their plane takes off. Since his team arrived here in July, they have flown on about 40 aeromedical evacuation missions and transported nearly 100 patients safely. During peak times of the war operations during the late summer and early fall, CCATTs usually supported a mission every day and sometimes two. Now, they are running aeromedical evacuation missions at an interval of almost every three days

"It's nice to be able to take this level of care that you aren't even able to find in most cities and bring it to the battlefield," said Captain Eggert. "In most ICUs back stateside, they have one person assigned to their worst patient, but we're able to have three people watch over one patient. It's nice to be able to give something like that back to the young people who are putting their lives on the line every day."