After a six-year hiatus, the Air National Guard is back in the Critical Care Air Transport Team (CCATT) business.
“As the Guard migrated into the homeland defense mission, we got away from the CCATT mission,” Air Force Colonel Brett Wyrick – air surgeon for the Air National Guard – told participants in a Department of Defense “Live Bloggers Roundtable” on 11 January 2011. “However, recently what we discovered is that there is a need for the Air National Guard in the CCATT mission, and also we … [have] quite a bit of expertise in the Guard and in the Reserve that allows us to meet the demands of the mission and take some of the strain off the active-duty … [forces] who have been stretched quite thin by the ongoing conflicts.”
The CCATT concept was introduced by the Air Force surgeon general about 10 years ago to meet a need for transporting the most critically injured patients by using the aeromedical evacuation system. “This is a mission where we actually bring … everything that you would find in an intensive care unit to the air frame,” Wyrick said. “And it gives us the ability to move injured and wounded Soldiers and Airmen, Marines … from the forward areas of the battlefield back to a tertiary-care facility either in Europe, the Pacific, or the [continental] United States.”
A CCATT consists of an intensive care physician, a critical care nurse, and a respiratory technician. The first Air Guard CCATT team is currently on alert at Ramstein Air Force Base in Germany. If there is a need “downrange,” Wyrick said, the team “can deploy forward from Ramstein into Iraq, Afghanistan – or even into the African continent, if there’s a need for that, and then they … [are transported with] the patients back to the United States or back to Europe, wherever the mission [dictates].”
Eighteen CCATTs & a “Constant and Persistent Line” After the CCATT mission requirement was validated, it took less than six months for the Air Guard to field its first team – with the help of the Air Force Expeditionary Medical Skills Institute’s Center for Sustainment of Trauma and Readiness Skills at the University of Cincinnati.
“We’re going to have a constant and persistent line in the AEF now … [and] for the next two years out of Ramstein,” Wyrick said. The Air Guard plans to stand up 18 full CCATTs from 17 states, he added. Many of them have already started training, and are expected to reach full operational capability within the next two years.
The Air Guard also has volunteers from all 54 U.S. states and territories who would be available to augment the teams if and when needed. “There’s a number of Guardsmen out there from various states who want to participate in the mission, who have the medical training and qualification to participate in the mission,” Wyrick commented, “and we’re … accepting them as volunteers.” The members of the team at Ramstein are Colonel Bruce Guerdan, the state air surgeon for the Florida Air Guard, Lieutenant Colonel David Worley, a nurse from the Kentucky Air Guard, and Master Sergeant Jody Nitz, a respiratory therapist from the Michigan Air Guard. “So, we did combine … people from all over the country to put these volunteer teams together,” Wyrick pointed out.
The doctors on the team will rotate every 30 days or so, and the nurses and respiratory technicians will average about 60 days – but at least one nurse has volunteered to do six months. All of these Air Guard medical personnel have one major asset in common – experience. According to Wyrick, the average Guard physician has at least 15 to 20 years in medicine, much of that time in primary care; most also have an active-duty background. After leaving the military, the team members typically upgrade their skills by either re-specializing or sub-specializing.
A Multi-Talented Total Force Partner The full CCATT roster includes “a lot of critical care physicians, a lot of surgeons, anesthesiologists,” Wyrick continued. “Guys who have literally written the book on modern medicine are residing in the Air Guard. And by putting them in the CCATT mission, we bring years of experience and … years of knowledge that make us a good Total Force partner for the Air Force.” Many of the volunteers already have CCATT experience, while others bring their experience as specialists in the civilian health care world and therefore are readily trainable for the CCATT mission.
In addition to carrying out its federal mission, a CCATT could also be used for emergency responses in the United States itself. “If we had a situation on the Gulf Coast where a big hurricane rolls up on shore and you need to evacuate civilian patients from a civilian hospital in the hurricane’s path,” Wyrick pointed out, “that would be another use for the CCATT teams.” Reactivation of the CCATTs “gives you a way to transport … critically injured patients from the strike zone to areas of safety,” he said. “So it’s not just battlefield and combat casualties; it could also be in humanitarian roles or in a disaster situation.”
Individual states now have access to Air Force equipment in the event of a disaster, because many previous barriers no longer exist. In the wake of Hurricane Katrina, Wyrick noted, there was “a lot of crosstalk,” followed by “a lot of planning, and we [now] have access to the equipment and supplies that we need when we need them.”
Among the equipment used by the Air Guard CCATTs are life-support systems and devices that have been tested and verified as being both safe and airworthy. “When you are talking about transporting patients through the air, you know,” Wyrick commented, “what you have is what you bring with you. And those systems have to be super-reliable, there [must] be redundancies in there, and they have to be safe … for flight.”
Fully Equipped, Ready to Fly & Always Alert The typical CCATT patient will arrive “fully equipped,” so to speak, with a stretcher, a monitor, and intravenous pumps, as well as a ventilator (to maintain the patient’s respiration throughout the course of the mission). In addition to the equipment, the CCATTs fly with a full aeromedical evacuation crew, most members of which are providing care for the less critical patients also being transported. However, depending on whether the mission has been previously scheduled or is a last-minute assignment, the CCATT may not always have an aeromed crew along on every flight.
“In a pinch, these guys can convert anything into … [an] airevac platform,” Wyrick commented. He said that the Air Force has shifted away from the original aeromedical evacuation mission concept insofar as the specific air frame required. CCATTs are the “back-end medical crew. As far as the aircraft goes, the CCATT teams can use an aircraft of opportunity and, while everybody prefers to have a C-17 [Globemaster transport aircraft] – because of the design and the room … we also fly missions from the theater far forward in Afghanistan back to the United States in KC-135s [aerial refueling aircraft], or we can also … [use] a C-5 [Galaxy transport aircraft] or whatever aircraft is designated as the aeromedical evacuation platform.”
Only the most critical patients will require use of a CCATT team. “What we’re doing,” Wyrick explained, “is we’re taking patients that otherwise wouldn’t be candidates for the aeromedical evacuation system because … we really are talking about the most severely injured patients there [at Landstuhl, Germany, headquarters of a U.S. Army regional medical center].”
Each CCATT can handle up to four patients – who usually are flown directly from Landstuhl back to Andrews Air Force base just outside of Washington, D.C., and from there they are taken by ambulance to the Walter Reed Army Medical Center in D.C. or to the National Naval Medical Center a few miles away in Bethesda, Maryland; some patients, though, will be taken directly to the burn center at the Brooke Army Medical Center in San Antonio. How quickly a patient is transported back to the United States usually depends on the needs of the individual patient.
Wyrick notes that patients from the forward areas often require additional surgery. “After they’ve undergone the combat resuscitation and stabilization, then when they get to Landstuhl, there could be … other procedures that are done where they take the patient back to the [operating room] … and then it might be several days or even weeks before the patient is actually ready for transport back to the United States.” A patient who has suffered a serious burn, though, he added, would usually be transported almost immediately to San Antonio.
The first of the reactivated Air Guard CCATTs was scheduled for its first flight back to Andrews on 11 January 2011, but there were no critical-care patients waiting for transport from Landstuhl back to the United States. “That’s actually … a good thing,” Wyrick commented. “Because the fewer injured patients there are for the United States military, the better things are going. So they’re sitting alert right now, and they’re ready.”
The preceding article is adapted with permission from the National Guard’s web posting “http://www.dodlive.mil/index.php/2011/01/air-guard-ccatt-ready-to-care-for-critical-service-members/ccatt_003/”
Air Force Lieutenant Colonel Ellen Krenke is a public affairs officer currently assigned to the National Guard Bureau’s Office of Public Affairs and Strategic Communication. She has held many positions at the bureau, including duty as chief of command information. Krenke also has served as a desk officer for the Office of the Secretary of Defense-Public Affairs. Before joining the Air Force she was a sportswriter for the Arkansas Democrat-Gazette in Little Rock. Krenke has received numerous awards from Arkansas press associations for her in-depth reporting, investigative reporting, and sports feature writing. She also has been selected as the NGB’s Journalist of the Year.