Aeromedical Evacuation
Written by Kelly Fodel
TECHNOLOGIES TO SAVE LIVES
“Basically our job is to bring the wounded home [from the battlefield], to save their life and limb,” said Major Andrea Ramey, chief, Standardization and Evaluation, for the 375th Aeromedical Evacuation Squadron at Scott Air Force Base. “We [also] take them from Andrews to different parts of the states where they get further care or rehab or whatever they need. Or, we will take them home.”
The standard aeromedical evacuation team usually has a five-man crew, consisting of two flight nurses and three aeromedical evacuation technicians. They are trained to work and adapt to a number of different aircraft, depending upon the scenario in which they are working.
There is also the CCATT (Critical Care Air Transport Team), which consists of respiratory techs, a flight nurse and a CCATT doctor. This team handles the higher risk, intensive care patients. “Our loads can be anywhere from five, up to 50 or 60 [patients],” Ramey said. “We are a flying hospital.”
Every individual on the aeromedical evacuation team carries his or her own standard medical equipment on each mission. The CCATT teams may carry a few extra pieces of equipment, depending on the specific needs of that mission. One of the key pieces of equipment is a Zoll M Series critical care transport defibrillator. This biphasic defibrillator weighs just 26 pounds and also keeps track of vital signs. Additionally, it features external pacing, a multiple application printer and a large full-color display in a single portable unit. “It is kind of a ‘one machine has all’ sort of thing,” Ramey said. “It can handle pediatric patients or adult patients, and it runs off battery. It is a great little machine.”
Zoll also produces a few other products that could be of use to the aero evac team. The Power Infuser fluid resuscitation pump has been deemed “safe to fly” by the Air Force. Medics can use the miniature rapid infusion pump for life-saving intravenous fluid resuscitation while transporting patients in fixed wing aeromedical evacuation aircraft. “It is the size of a deck of cards, can run on six AAA batteries, and can deliver up to a liter of fluid in 10 minutes,” said Andy Fleischacker, director of business and market development for Zoll. “It is currently deployed in all branches of the military and has been very well received.”
“One of the challenges with delivering fluid on aeromedical evacuation missions is an increase of air bubbles due to the altitude,” said Brenda M. Butler, vice president of government sales for Zoll. “This pump is unique in that it will eliminate air bubbles through a filter, making it safer to deliver.” This means the pump can be placed anywhere, even on the floor of a crowded aircraft, and still perform safely.
In addition, Zoll’s AED Pro automated external defibrillator offers medics realtime feedback, allowing them to see and hear how well they are performing the rate and depth of chest compressions during CPR. AED Pro’s “See-Thru CPR” technology allows the medic to view a patient’s underlying cardiac rhythm by filtering CPR artifact during resuscitation efforts and eliminates the need to stop compressions to see if defibrillation was successful. This device has also been certified as air worthy.
The 375th Aeromedical Evacuation Squadron also carries another monitoring device besides the Zoll M Series CCT. The Propaq Encore 206 can monitor ECG, NIBP, temperature, impedance pneumography respiration and features tolerant pulse oximetry. The unit is specially made to withstand challenging environments— like air transport—with motion tolerance and a long battery life.
“Then we carry our suction equipment, of course,” Ramey said. “We carry the Impact brand for that.” She is referring to the Impact 326M portable suction unit. It is a multifunction, continuous and programmable intermittent suction unit, built around Impact’s ultra-light vacuum pump. The 326 may be used for oropharyngeal, tracheal, wound drainage and abdominal or thoracic decompression procedures. Its supplied accessories permit continuous use from AC or DC power, and internal rechargeable batteries provide power for several hours of transport or emergency backup.
Of course, there is always the need for oxygen. “We have a PTLOX [Portable Therapeutic Liquid Oxygen System], which provides oxygen on aircraft that do not have an integral oxygen system, like the KC-135 or the 130, which we do a lot of transports on,” Ramey said. The PTLOX carries 104 liters of liquid oxygen. Ventilators and face masks can be hooked to the PTLOX depending upon the needs of the patient. Even on aircraft that can generate oxygen for patients, the aero evac team will still carry their oxygen systems, particularly if they have more than five CCATT patients.
A number of companies have developed portable oxygen generators that could be of use in an aeromedical evacuation setting. Guy Hatch, CEO of OnSite Gas, says his company’s portable oxygen generator system (POGS) has been deployed in Iraq and Afghanistan, and was used by FEMA, Homeland Security, and several states for disaster relief and emergency prepared-ness. POGS can generate 33 liters per minute of USP 93 percent oxygen, or 30 LPM of medical air to operate anesthesia equipment and ventilators. “Our system is designed so that it can be easily repaired by someone with readily available parts,” Hatch said. An added benefit is that this system can indefinitely generate oxygen, as opposed to canisters that have a finite supply of oxygen.
Sequal has produced a portable ambulatory oxygen system known as the Eclipse HT. “The Eclipse is our flagship product,” said Pam Jackson, military expert for Sequal. “With our technology, we are able to scale it down so it is very efficient and can work on batteries. It is designed to be extremely robust at altitude, so at altitudes of up to 4,000 meters, you know you are producing the purity and quality of medical oxygen that somebody might need.”
Sequal markets the Eclipse as the only oxygen concentrator on the market today that provides continuous flow or pulse dose option in a 24/7 portable device. This allows oxygen-dependent patients to be ambulatory, without having to make special arrangements for cumbersome oxygen cylinders.
Jackson says the Eclipse HT just passed testing for the Army’s air worthiness certification. “As long as you have access to power, you can make medical grade oxygen,” Jackson said.
The 375th Aeromedical Evacuation Squadron uses a Uni-Vent Eagle Model 754M ventilator. This self-contained ventilator/ compressor/blender weighs just over 12 pounds. It has a comprehensive alarm system that monitors power, gas supply, patient disconnect, airway pressure and the ventilating system. It also has a fast start-up mode, which allows medics to begin operation in as few as three steps, which comes in handy during in-flight emergencies.
With so many pieces of equipment, the power source is obviously an important factor. Ramey says her team uses an avionics electrical frequency converter, which allows them to take aircraft power, which is 400 Hz, and convert it down to 60 Hz, which is basic hospital-grade power. They also use an electrical cable assembly system, which can be threaded out across the plane from one end to the other to provide easy access to electrical power.
“We use the IVAC Medsystem III to run any kind of IV fluids or drugs we may need to run for the patient,” Ramey said. The Medsystem III multi-channel IV pump provides three independent fluid delivery systems in the space of one. Its compact size is helpful in the aircraft, simplifying patient transport. It can accommodate multiple delivery methods, including intravenous, intra-arterial, subcutaneous and epidural.
“In our in-flight kit, we have nearly any supply that you can think of,” said Ramey, listing important equipment. “We have PCA pumps [for pain management] that we carry that run off of battery. We have Stryker Wedge Turning Frames that allow us to carry patients that may have spinal injury.”
Ramey says her team can do almost anything, despite the limitations of the aircraft, thanks to their training, equipment and the advances of technology. “I have seen surgery go on up there. It is an environment where you don’t want to do a lot of invasive things, but we have the capability of doing it if it is a life-saving measure.” ♦