Evacuation team copes with increasing pace

(MILITARY TIMES)   BAGRAM AIR BASE, Afghanistan — Welcome to Evacistan, a state of mind.

It’s the determination of doctors, nurses and technicians to get the sick and wounded from the combat zone to a hospital as fast as they can — in theater, then back home to the U.S. by way of Germany.

These airmen, who declare allegiance to their mission by wearing a shoulder patch embroidered with the word “Evacistan,” have never been busier now that the focus is here instead of in Iraq.

While the Air Force will not release exact casualty numbers, the 455th Expeditionary Aeromedical Evacuation Squadron at Bagram — the hub for aeromedical evacuation in Afghanistan — had moved more patients by July than during all of 2008.

“One or two [flights] a day, [depending] on when somebody gets hurt,” said Maj. Cynthia Camp, the squadron commander. “That’s the driver for us — the sick and the wounded.”

The relentless pace is handled by fewer than 100 airmen in two locations, the 455th and the 451st Expeditionary Aeromedical Evacuation Flight at Kandahar Air Base.

Their days are not only physically demanding but emotionally draining. They see the human costs of war every time they show up to work.

“We get the sickest of the sick,” said Maj. (Dr.) Brian Zagol, a critical care physician with the Kandahar unit. “It’s tough on us because we get the worst-case scenarios, and some of them die.”


The long casualty-evacuation chain — stretching all the way to Andrews Air Force Base, Md. — usually begins on a hot, dusty battlefield in the desert or the mountains.

Army helicopters carry most of the wounded from remote locations, but three Air Force HH-60G Pave Hawks — part of the elite combat search-and-rescue team tasked to swoop in and save downed pilots — are at the ready when the soldiers need help.

One morning in their Kandahar operations center, the pilots and crew members — most from the California Air National Guard’s 129th Rescue Squadron, deployed as the 129th Expeditionary Rescue Squadron — sat around killing time while waiting for a mission.

They read magazines, played cards and checked their e-mail. An intelligence airman, Tech. Sgt. Jessica Vasconcellos, monitored her computer systems to track ongoing firefights — called troops in contact, or TICs — that might produce casualties. The pace usually picks up midmorning when patrols begin taking contact.

A small electronic bell rang on Vasconcellos’ computer, alerting her to a call for casualty evacuation by a unit of Afghan National Army soldiers. Maj. Tom Keegan, a Pave Hawk pilot and the squadron’s director of operations, hovered near the telephone, waiting for the official call from the Regional Command South headquarters.

The call came moments later, and Keegan gave the word to his crews:

“All right, guys! Scramble!” The crews — pilots, flight engineers, gunners and pararescuemen — ran out the door and jumped into two of the Pave Hawks.

The crews’ goal is to deliver the injured to the Kandahar hospital within an hour — sooner, if possible — of being called. The survival rate for wounded soldiers and Marines stands at 95 percent for those delivered to the hospital within “the golden hour.”

This time, those precious 60 minutes came and went. The landing zone was under fire and the Pave Hawks had to wait until it was relatively safe to sit down. When the helicopters finally landed in a riverbed northwest of Kandahar, they took small-arms fire from four positions. Just 20 or so meters from one of the helos, a rocket-propelled grenade exploded in midair.

The gunners on board returned fire, pumping more than 1,100 rounds into the enemy positions. They killed at least a handful of the fighters before delivering their casualties — five Afghan soldiers, one of whom was already dead.

After climbing out of the aircraft at the end of the mission, the crews shouted in excitement and exchanged fist-bumps.

“This is what we live for,” said one of the gunners. “No one shoots at my airplane and lives without a fight.”

The adrenaline eventually wears off, though, and the crews clean the casualties’ blood out of their aircraft and settle in to wait for their next mission.

They know it won’t be long.


A couple of days later, crews from the 451st waited for their own mission. Their job: to transport patients from Kandahar and smaller bases to the next level of medical care — usually back to Bagram first, then on to Ramstein Air Base, Germany.

By the time the 451st is called, the patients are stable enough to make the trip back to the U.S. In previous wars, casualties spent days or weeks recuperating in theater before being transferred stateside, but in Iraq and Afghanistan, many casualties arrive at Andrews Air Force Base within a couple of days of being wounded.

Today’s aeromedical evacuation crews bring everything they need to keep a patient alive in the air.

“We’re basically an [intensive care unit] in the sky,” said Zagol, the critical care doctor. “Anything they can do on the ground, we can do. There’s no step-down of care when we’re on the plane.”

It takes about 25 minutes for a crew to transform a C-130J cargo plane into a flying clinic, carrying on about 1,200 pounds of equipment loaded on five stretchers.

This Kandahar-to-Bagram mission has both an aeromedical evacuation crew — nurses and medical technicians who care for those with less severe wounds — and a critical care air transport team, made up of a doctor, nurse and respiratory technician. The CCAT team is carrying ventilators, defibrillators, heart monitors, suction tubes and nearly all the other basic equipment found in a civilian ICU.

As the patients — some walking, others unconscious and on stretchers — are loaded on, Tech. Sgt. Jodi Wortman, a medical technician, checks the vital signs of the less severe cases and makes sure their medication is up to date.

The CCAT team members hover over their patients, making sure their breathing is steady.

The environment makes the crews’ work difficult, said Lt. Col. Diane Murphy, the senior flight nurse at the Bagram unit.

“In a civilian aircraft you have issues with different stresses of flight,” she said. “In the back of a military aircraft they’re just going to be accentuated. The noise. Hydration is a major issue. Vibrations. Changes in barometric pressure. … There are all those factors that play into the patient care.”

Once at Bagram, the patients are taken to the hospital for as little as a few hours or as long as a few days. Then it’s onto a C-17 or KC-135, also converted into a flying ICU, for flights to Ramstein and the U.S. By moving most of the recovery process to the U.S., patients are able to be with their families sooner, and smaller base hospitals in theater can keep their bed spaces free for the most critically injured patients.

Though the job is stressful and emotionally exhausting, the crews said they are proud of the care they provide.

“It really is … a humanitarian mission,” said Camp, the Bagram squadron commander. “The operations group is here to fight and defend and provide security to the people of Afghanistan, and we’re here to provide medical care.”


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