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Total force team makes last-minute medical mission a success

January 21, 2005 -- When Capt. Linda Sitton woke up her last morning in balmy Hawaii, she was prepared for a sleepy “deadhead” flight back to the mainland on an Air Force Reserve C-141 plane full of cargo. The nurse and Air Force Reservist from the 932nd Aeromedical Evacuation Squadron at Scott Air Force Base reported for duty, and less than an hour later, the plane had a critically ill heart bypass patient aboard. Even as it has become common to move critically ill casualties in the aeromedical evacuation system, it is still rare to move an adult who requires a heart bypass pump.
“Not until we arrived at the plane on the flight line did we learn we were now aeromedical evacuation for an urgent mission,” Captain Sitton said.
Her eyes widened and Captain Sitton’s adrenaline was then flowing nonstop, so there would be no rest till the plane landed at Los Angeles International Airport, more than six hours later.
She and a crew made up of Air Force active duty members, Air Force Reservists and an Air National Guard member took a tough, last-minute situation and medically-managed it all the way from Hawaii to California.
“I was told the patient and his wife and a flight nurse friend were loading up the previous morning to go surfing, when he complained of a funny feeling in his chest. The friend took his vitals and when he continued to not feel right, they loaded him up and off to the emergency room they went. Just 20 minutes after arriving, he coded,” she said.
Capt. Sitton and the other crew members arrived at the flightline, and there she saw a familiar face.
“Maj. Kathy Lowry is one of the nurses at the Theater Patient Movements Requirements Center (TPMRC) located at Hickam AFB, who approves and coordinates services for patient airlift for the entire Pacific inter-theater aeroevacuation needs. Major Lowry reviews patient movement requests and approves if a patient meets AE requirements for their diagnosis. Since this patient was given an ‘urgent’ description, the patient needed to be moved in a minimal amount of time to prevent loss of life,” said Captain Sitton.
Who better to make the decision than a former aeromedical evacuation reservist from Scott AFB?
Major Lowry was originally on active duty, then worked as an Air Force Reservist with the 932nd AES, and then decided to go active duty again and currently works at Hickam as a Patient Movement Clinical Coordinator for the Pacific. It was good to see her again at a time like this,” said Captain Sitton.
Major Lowry and Dr John Oh (TPMRC- Pacific Validating Flight Surgeon) went to the hospital when they got the initial call for the urgent movement of the heart patient. They knew that a lot of coordination would be required in order to expedite the AE mission. Obtaining the most up-to-date clinical picture, Major Lowry worked the waiver approval process for four critical pieces of medical equipment.
“All of this was required before the mission could even be approved to go. Dr. Oh and several others members of TPMRC-Pacific and the AE Cell (Pacific) got the ball rolling,” said Major Lowry, “I was impressed with the ‘total force’ teamwork utilized to see this mission through from start to finish.”
Active duty flight nurse Capt. Chris Thrasher from the 375th Aeoromedical Evacuation Squadron at Scott AFB was also impressed, but from a different angle, “None of the crewmembers ever flew a mission like this. We were mentally prepared for a cargo mission. As we received reports on the patient, Captain Sitton and I knew we had to configure the plane to meet the crew and patient’s needs.
“The patient decompensated when they tried to move him from the hospital to the ambulance. We waited until he stabilized. This was a concern because this was a six hour flight and we needed the patient stabilized, especially since our long flight was over water,” Capt. Thrasher said.
Major Lowry was busy updating the patient information as each waived piece of equipment was approved.
Ma.jor Lowry carried the most current information to the flight line and discussed the patient status with Captain Sitton and asked if she could think of anything else that needed to be checked. It was decided that a Heimlich valve would be needed and a call to the hospital confirmed one would be placed, but the AE crew would need to supply the clamps. They located some clamps and prepared for the patient.
“A brief rain fell at Hickam while we awaited the arrival of the ambulance. The ramp extenders became wet and slippery. The front end crew helped in any way needed and the loadmasters served as ramp safety monitors after marshalling and parking the ambulance,” said Capt. Sitton.
The critical care crew arrived with their medical gear. The team quickly determined what they would take versus what they could leave behind. The patient had to remain connected to several machines while entering the aircraft, so Captain Thrasher’s challenge was to coordinate a smooth transition.
“We had about 18 people on the ground willing to help. Eleven were actually needed to carry items and the patient, three were on the plane at the stanchions, and the additional ground personnel acted as safety monitors on the ramp extenders,” Captain Thrasher explained.
Boarding the patient onto the plane was a serious concern. The patient could not be disconnected from some of the equipment and both captains knew this was not a place for error.
“As we loaded the patient, Captain Thrasher was very good in getting everyone's attention and leading them step by step on how we wanted the patient lifted and moved up the ramp and into the litter stanchion,” said Captain Sitton.
The group slowly moved several inches at a time, some with arms locked together, as a human train, going very carefully up the ramp and on to the plane.
Once the patient was on board, the doctors and nurses worked on making sure he was stable and the AE crew worked on tying down and securing all of the equipment. Capt. Sitton was busy with paperwork, running relays of what was needed in the way of temperature control and getting all the equipment plugged in correctly. The medical attendants worked on transferring the vented patient from portable oxygen to aircraft oxygen.
“The C-141 engineer reviewed with me when to expect change of power and then I relayed to the RT and docs so they would know when to be specifically watching the equipment. We did have a slight moment when we went to connect the vent, the oxygen had been turned off to remove the flow meter,” she added.
“Great team spirit was seen throughout the plane as TSgt Alex Rosario from the 146th Air National Guard and TSgt Lisa Hassell from the 433rd AES split time in the Aeromedical Evacuation Technician position on the urgent mission from Hickam to LAX. TSgt. Jason Read and SrA. Jahaz Shine from the 375th AES did their part securing equipment with litter straps and cargo tie downs and making sure each of the medical attendants understood personal actions to take in the event of any aircraft emergencies ,” said Captain Sitton.
The AE crew worked together doing their assigned jobs and keeping each other updated on readiness for taxi and takeoff.
“Coordination, safety and documentation were my main jobs as Medical Crew Director. The flight nurse was in charge of loading and unloading the patient and all attached equipment and the Aeromedical Evacuation Technicians were just great in making sure all equipment was secured and supplying items from our flight bags for the attendants,” said Capt. Sitton.
Equipment was placed so attendants could easily see them and work on the patient. Blocks were placed to help secure the anesthesia cart and various equipment on wheels. Seven medical drips were running on the Intravenous Multi Channel Infusion Pump used to regulate fluids, blood and/or medications.
“It all worked so smoothly that not until I was seated for take off did I even see the blocks under the anesthesia cart. Technical Sgt. Read, the charge aeormedical technician, had taken the initiative to block all the items on wheels and kept them secure,” said Capt. Sitton.
His training paid off.
“One thing we are taught from the beginning of initial upgrade is use your Crew Resource Management (CRM) and know when to lead and know when to follow. On missions like these or when you fly into combat, it is a team effort and coordination that makes mission like these successful. This is where Capt Sitton was able to delegate and mission manage to make this mission successful,” said Sergeant Read.
Capt. Sitton said it was a smooth flight to California and the only problem mentioned was that the patient was running a low grade fever. The temperature in the aircraft was adjusted to meet the patient’s needs. She was also in charge of making sure the bypass tubing did not kink throughout the flight.
During the off load in California, everyone worked together to safely move the patient. The weather was a cold 48 degrees and blowing rain at Los Angeles, but the team made sure the patient had several blankets to stay warm.
“Off load went smoothly, and again, Capt. Thrasher was on the job and talked everyone through the slow movement down the ramp. We are all very proud to have been part of the AE crew that moved this patient. We just happened to be in the right place at the right time with an aircraft equipped to move patients. In less than 5 minutes our frame of mind went from just taking a long ride home to making sure everything was in place to move an urgent patient,” added Captain Sitton.
“Capt Sitton did a fabulous job. The MCD is ultimately responsible for the mission. The AE crew all knew our crew roles and performed them as we should. Capt Sitton’s role required her to supervise and manage the mission to ensure it went off smoothly. Obviously, she did that very well. I have flown with her in the past and when I found out she was on my crew, I knew we’d have a good mission no matter what,” added Captain Thrasher.
Lt. Col. William Beninati, 15th Aeromedical-Dental Squadron Commander at Hickam, flew aboard the mission as the critical care physician and was impressed by what he saw too: “The AE crew was fabulous. They didn't turn a hair at any of the mountain of equipment we brought on board, they just got the patient and us tucked in safely and stayed ahead of anything we needed to do. It was a young crew, but mature beyond their years. This could have been a high-stress, chaotic mess, but it was smooth sailing thanks to their level heads,” said Lt. Col. Beninati.
Indeed. Total force skills used on this day equaled a total team effort for the Air Force and a patient in need of critical care.
Col. Deborah Dodson, commander of the 932nd Aeromedical Evacuation Squadron was proud of all the airmen who contributed.
“It’s on missions like this, that the experience and skills of our members really shine. Managing and executing a complicated, life-saving mission, requires great confidence, organizational skills, and calmness.
“The coordination of the patient movement, the waiver process for the non-standard equipment, and the constant communication required between the medical personnel and the flight crew is really why aeromedical evacuation crews are there on these missions,” said Colonel Dodson.