03 October 2008

Landstuhl Regional Medical Center’s Acute Lung Rescue Team: The "Delta Force of military medicine"

Here's more from Steve Mraz on Landstuhl's special lung team mentioned here. Although the vast majority of critical patients can be safely medevaced from theater by the highly specialized personnel of the Critical Care Transport Team, there are exceptions. That's when this team goes into action...

Unique mobile Landstuhl medical team brings expertise downrange

It’s like the Delta Force of military medicine.

Landstuhl Regional Medical Center’s Acute Lung Rescue Team travels downrange to treat and transport the most severely wounded and ill troops, who would otherwise be unable to be put on a medical evacuation flight.

The team’s expertise and specialized equipment, including advanced breathing machines and a device not approved by the U.S. Food and Drug Administration, set it apart from the military’s standard aeromedical evacuation and Critical Care Air Transport Teams. Only an extremely small percentage of wounded require the Landstuhl team’s services, but of the 19 times it has been called upon, 10 calls have come in the last year, said Air Force Lt. Col. (Dr.) Raymond Fang, a Landstuhl trauma surgeon.

Established in November 2005 by husband and wife Air Force Col. Warren Dorlac and Lt. Col. Gina Dorlac, the "ALRT team" (pronounced "alert") is one of a kind in the military and doesn’t have an official designation. Its personnel are doctors, nurses and specialists who generally work full-time in Landstuhl’s intensive care unit.

The Dorlacs, former Landstuhl doctors, are considered "the mom and dad" of the lung team, Fang said. Fang and Air Force Maj. (Dr.) Patrick Allan, a critical care pulmonary physician at Landstuhl, are the ALRT team leaders.

The Landstuhl team came about because doctors estimated there were a handful of wounded troops each year who could not be evacuated because of their grave conditions, Fang said.

"These 10 or 12 patients a year have to stay in Balad, Baghdad, Bagram, consume tremendous resources because they’re sick and they’re very labor extensive," Fang said. "And they just stay there until they get better — then they could be moved — or they die, which is not what we want."

When the Landstuhl team travels, it brings a surgeon, a pulmonary critical care doctor, one or two nurses and one or two respiratory therapists.

"You’re not sitting there on alert, waiting to go," Fang said. "You’re occupied in your job and then you get the call. You got to prepare. You got to fly down there. You got to stabilize the patient and then fly back. It is typically a 24-hour, constantly awake mission."

The Landstuhl team has been called 19 times, with 17 patients coming from Iraq and two from Afghanistan. Most suffered trauma wounds, but three were treated for eosinophilic pneumonia (see related story).

Because eight of the missions were canceled due to improvement in the patient’s health, or deaths prior to take off, the team has gone downrange 11 times. One patient died with the team at his bedside, but the 10 patients evacuated by the team have a 100 percent, seven-day survival rate.

"At least all these patients, we get them back to the States and back to their families, which is part of our goal — to get them back home as best as we can," Fang said.

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