13 August 2009

The needs of the one...

In late July, a British Soldier deployed in Afghanistan sustained life-threatening wounds to the abdomen and chest. I alluded to him in this post, but his identity has not yet been made public.

The article quoted below describes the extraordinary (and to my knowledge unprecedented) efforts made to save his life. It is a testimony to the advancements made in the technological, logistical, and medical fields. But most of all, it is a testimony to the commitment of the many to care for the needs of the one.

Here is a summary of the medical, logistic, and air assets involved in this incredibly complex mission. It is almost certainly incomplete.

- One C-17 aircraft to get the medical team and equipment from Germany in place at the hospital in Afghanistan.
- One C-130 aircraft to fly a pulmonologist from a different hospital in Afghanistan to the Soldier's location.
- A second C-17 aircraft to fly the patient from Afghanistan to Ramstein Air Base in Germany.
- LifeBird German civilian medevac helicopter to fly the patient from Ramstein Air Base to Regensburg University hospital.

- Three C-17 aircrews; four sorties
- LifeBird helicopter aircrew

Medical Teams:
- British, Danish, US surgical team at the hospital in Afghanistan.
- A pulmonologist from a different hospital in Afghanistan flown to the facility where this Soldier was located.
- The Landstuhl Acute Lung Rescue Team (Specialized Critical Care Air Transport Team)
- The LifeBird medevac team in Germany
- The thoracic surgical and ICU teams at Regensburg University hospital in Germany, for the highly specialized treatment developed and available there.

Logistics Teams:
- Combined Air and Space Operations Center (SW Asia)
- Joint Patient Movement Requirements Center (within the CAOC above, SW Asia)
- Global Patient Movements Requirement Center (Scott Air Force Base, Illinois, USA)
- 618th Tanker Airlift Control Center (Scott Air Force Base, Illinois, USA)
- Landstuhl DWMMC (Deployed Warrior Medical Management Center)

A surgeon at work in an Afghanistan field hospital. At this hospital there is a general team of five surgeons, working with another three orthopaedic surgeons. With anaesthetists, emergency doctors and junior doctors, there could be 20 staff working on a single patient. Photo: Marco Di Lauro/Getty Images.

Air Force aeromedical evacuation teams give British soldier fighting chance

by Capt. Justin Brockhoff
618th Tanker Airlift Control Center Public Affairs

8/4/2009 - SCOTT AIR FORCE BASE, Ill. (AFNS) -- Three Air Force aircraft along with multiple aircrew, aeromedical evacuation teams, and agencies from around the world gave a British soldier a fighting chance at life in late July after the soldier sustained multiple gunshot wounds and had his blood supply replaced more than 10 times at a military hospital in Afghanistan.

According to officials, the soldier sustained multiple wounds to the abdomen and chest, and was transfused with 75 units of blood and another 75 units of platelets.

Emergency surgery was conducted to repair the soldier's liver and lung. After being stabilized by the medical teams on the ground, the patient's respiratory condition worsened and doctors determined that the patient had to be moved to upgraded care in Germany.

The Combined Air and Space Operations Center, staffed by U.S. Air Force, U.S. Army, U.S. Navy, U.S. Marine Corps and Coalition partners. Built at a cost of $60 million, the project created the most advanced operations center in history. It includes thousands of computers, dozens of servers, racks of video equipment and display screens, over 67 miles of high-capacity and fiber optic cable, and hundreds of people, working in satellite communications, imagery analysis, network design, computer programming, radio systems, systems administration and many other fields.

Officials at the Combined Air and Space Operations Center and Joint Patient Movement Requirements Center at an air base in Southwest Asia, and the Global Patient Movements Requirement Center and 618th Tanker Airlift Control Center at Scott Air Force Base, Ill., immediately started working to find the aircraft, aircrews and medical crews to airlift the soldier to further care.

"We received the call on our operations floor to airlift the British soldier from Afghanistan to Germany and immediately did what we could to make it happen," said Col. John Martins, the 618th TACC director of operations who led coordination efforts for the mission. "It was a complex move. Not only did we have to find a plane and crew to fly the patient out of theater, but also we had to find another plane and aircrew to get the right medical personnel and equipment into Afghanistan because we needed specialized medical teams to care for the patient in-flight."

In less than six hours, a C-17 Globemaster III previously scheduled to fly a cargo mission was airborne with the required medical personnel and equipment from Ramstein Air Base, Germany, to Afghanistan.

"We were able to quickly identify a mission that was planned to fly into Afghanistan, and after coordinating with other agencies in the 618th TACC we were able to re-task the mission as an aeromedical evacuation flight," said Maj. Kris Rowe, an aeromedical flight manager. "At the same time, we needed a pulmonologist to be part of the AE team due to the trauma to the soldier's lungs. Working with our counterparts at the CAOC, we were able to get the pulmonologist from a different location in Afghanistan to the soldier's location on a pre-scheduled C-130 (Hercules) mission."

The pulmonologist arrived to the soldier's location and continued to care for him on the ground, while the C-17 carrying the medical teams and specialized lung equipment were still en-route on the eight-hour flight from Germany.

Because of crew duty day restrictions, safety regulations that dictate how long an aircrew can be on-duty before they're required to rest, the original C-17 aircrew couldn't stay the six hours it would take the lung team to prepare the soldier on the ground, and still fly the mission back to Germany. Instead, once they arrived, the C-17 and its crew were able to wait on the ground for just over an hour while nine other patients, in addition to two amputees previously picked up during a fuel stop, were on-loaded for a flight to Landstuhl Regional Medical Center, near Ramstein AB.

Once they had dropped off the medical crews and equipment to stabilize the British soldier, and its 11 new patients were prepped for flight, the first C-17 took off back for Germany. Its mission was complete.

A C-17 Globemaster III, like the one pictured here, aeromedically evacuated a British soldier in late July from Afghanistan to Ramstein Air Base, Germany. Before the soldier could be evacuated, an additional C-17 and a C-130 Hercules were needed to airlift specialized medical teams and equipment into place. U.S. Air Force photo/Senior Airman Clay Lancaster.

Enter the second C-17 and aircrew, assigned to the 385th Air Expeditionary Group, who were also previously scheduled to fly a cargo mission in Afghanistan. Officials at the 618th TACC delivered a similar notification that they'd been re-tasked to be involved in the lifesaving effort.

"The patient was loaded on the second C-17 and airborne within 22 hours of receiving the call for support at the 618th TACC," said Master Sgt. Keyser Voigt, an aeromedical evacuation mission controller at the 618th TACC. "When you look at the requirements we had, its awe inspiring to see how many people will come together to save one life. It took two airplanes to get the medical team and equipment in place, another to fly the patient to Germany, three aircrews, four sorties, AE personnel and many more coordinating on the ground to get this done. Including the fact that we had to fly in specialized teams and equipment from eight-plus hours away and it took a minimum of six hours on the ground to prepare the patient using that specialized equipment, everyone involved did absolutely everything we could to give this soldier the care he deserves."

At approximately 1 p.m. local time Aug. 2, the British soldier landed safely at Ramstein AB and was flown to further medical care at a university hospital by helicopter.

"It's a true testament to the aircrews, the medical crews, and the ground personnel around the world and at the airfield that we could get this soldier out of Afghanistan so fast," said Lt. Col. Duncan Smith, the 618th TACC's Aeromedical Evacuation Division chief. "It is truly amazing to see this coordination take place in such a short amount of time, because we're literally coordinating these moves from a world away. We are in the business of saving lives, and we will do everything we can to reach that goal."

As of press time, the soldier was still at the university hospital in Germany, where he was listed in critical condition.

This movement marked the 8,563 patient movement by U.S. Air Force aeromedical evacuation teams in 2009, and the 135,233 since April 1, 2003.

(emphasis added)

As of today, almost 10 days after this story was written, the Soldier remains in Germany where his condition is stable. He may be able to fly home to the UK soon.

The doctors say it's a miracle.

I'd say it's probably close to a thousand miracles: A miracle for each of the many who came together to meet the needs of the one...

Related, March 2010: A word about the UK Daily Mail / MailOnline story

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