16 October 2012

Around the world in 80 beats per minute

Patients from Bagram’s Contingency Aeromedical Staging Facility are loaded onto a C-17 Globemaster II before departing for Ramstein Air Base, Germany. The Air Force's Strategic Transitory Care process ensures wounded warriors are kept safe and receive consistent care throughout the journey from Afghanistan through Germany to the United States. U.S. Air Force photo by Tech. Sgt. Shawn David McCowan.

From Regional Command East:

Around the world in 80 beats per minute

By U.S. Air Force Tech. Sgt. Shawn David McCowan, 455th Air Expeditionary Wing

BAGRAM AIRFIELD, Afghanistan - Consistent quality is always a priority when it comes to medical care. Successful innovations and greater efficiency can send a hospital's credibility and patient reviews to new heights. And medical emergencies in the military community can be more complicated than a civilian emergency due to the nature of the patient's injuries. But the Air Force has met the challenge, and organized a patient care and transport system that truly flies miles above any other.

Servicemembers injured on the battlefield do not have the luxury of easy access to emergency services. Careful and efficient coordination is often vital to a wounded warrior's survival and recovery. Once an injury occurs, on-scene medical technicians alert Bagram Airfield's state-of-the-art Craig Joint Theater Hospital. That contact begins a chain of events designed to ensure the wounded warrior gets the care needed at the facility best equipped to provide it. CJTH is widely recognized as the premier medical facility in Afghanistan. But they are not large enough to keep all incoming patients. In some cases, that means a patient must be cared for from the mountains of Afghanistan back to a hospital in America.

Patients are transported by Medical Evacuation helicopter to Bagram's CJTH. Once there, volunteers deliver them to either the emergency room or the Contingency Aeromedical Staging Facility. The Med Tech hands over any charts, notes and insight on the patient's current condition. That hand-off begins a series of transitions of care that might take the patient from the war zone to the United States. Med Techs and Registered Nurses assure the patient receives the best care possible all along the way.

Some patients can be treated entirely at CJTH. But some wounded warriors need additional care.

An Air Force Aero-Medical Evacuation aircraft is scheduled to transport those patients from Bagram to Ramstein, Germany. In the meantime, medical technicians at the CASF constantly make sure patients have required medications and remain stabilized until the flight. Other support personnel also track and coordinate the next leg of the Aerovac flight.

Some people might think caring for patients injured in a war zone may be highly stressful. But 1st Lt. Rachel Hinson, a Registered Nurse at Bagram's CASF, says she loves working right where she is.

"There's nowhere else I'd rather be working. It's so rewarding to work here, because we're taking care of people who have pulled through, and are about to start a flight back to the U.S.," said Hinson.

That flight to the States usually begins within a day or two of their arrival at Bagram. Then an aircraft arrives to move patients out of the country to advanced military medical facilities in Germany or the United States. Getting patients from Afghanistan to Germany and America requires a very special team of men and women assembled aboard a C-17 Globemaster II or C-130 Hercules. A medical team travels with patients during the flight, including a Flight Doctor, a Critical Care Nurse, a Respiratory Specialist, and several Med Techs. The team assembles at the aircraft, where nurses like Hinson turn patient information over to the in-transit team, making certain that care remains constant and seamless.

Aboard the aircraft a Medical Crew Director receives patients, medical equipment, and any information necessary to make sure they remain stable during the from Bagram to Ramstein Air Base, Germany. He and the team of airborne medical specialists become the sole source of care for as many as 30 patients during the eight-hour flight to Germany.

When the aircraft arrives at Ramstein, patients are either transported to Landstuhl Regional Medical Center for further treatment or sent to Ramstein's CASF. There, Maj. Maria Coppola, a director at the CASF, makes sure those in her temporary care are kept as comfortable as possible until their journey to the United States. As Coppola watched patients arrive with various degrees of injury, she reflected on the perspective her team has toward all who enter their care.

"Whether someone has lost limbs, taken a head injury, or come in with a cast or stitches, each person is equally important here. While they are here, they really are like family, because we're the only people they have to care for them right now. We do all we can to make sure they know how much we care," said Coppola.

One of the patients, Army Sgt. 1st Class Russell Allen was traveling in a Stryker 40 kilometers from Kandahar, Afghanistan, when the hatch he slipped from its catch, slamming onto his head. He sustained a head injury and nerve damage. He was hesitant to accept medical care, but his experience at Ramstein's CASF caused a change of heart.

"I saw a lot worse injuries out in the field, especially IED amputees. I thought I wouldn't be important enough to worry about. But I was blown away by the care here. I didn't expect this kind of reception or care. Everyone here is treated the same way, like we're all important," said Allen.

As another day passed, and a new flight arrived to take patients on the final length of their journey home, Coppola helped coordinate yet another transition for patient care. This time, her team turned over all patient information to another crew of in-flight caregivers. After the CASF personnel completed the transition to the aircraft medical team, Coppola pointed out that through each treatment, transition, and flight, one constant brought a great sense of pride to her and her team.

"It's so fulfilling to know that, even though this process take patients halfway around the world, through at least three medical facilities, and on at least three flights, the standard of care never changes. These men and women are getting the best care medicine can offer every step of the way. That really says something about what we accomplish," said Coppola.

Even though the next day would likely bring another several dozen injured military members in need of constant care, the CASF team left the flightline with smiles, knowing their efforts meant a safer, efficient, and more comfortable journey for wounded warriors on their way home.

Lots of great photos at the link.

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