When U.S. Marine Cpl. Michael Meyer woke up at University of Iowa Hospitals and Clinics in early May, he remembers being told, “You’re in Iowa.” His first thoughts were “Where?” and “Why?”  Iowa, Meyer would find out, was a key destination on a road to recovery from severe respiratory failure that nearly took his life. How he ultimately came to the UI is a story of personal strength, family devotion, and the collaboration between UI Heart and Vascular Center specialists and medical personnel from the U.S. Army, Navy, and Air Force.  For the 23-year-old Meyer—a bright, dedicated, and physically fit Marine from Florida who could easily finish a 15-mile run while he was stationed at Camp Schwab on the island of Okinawa, Japan—what had begun as a cough in early March quickly progressed to a serious lung infection. During a training mission on March 13, Meyer felt winded to the point where he could barely stand. Immediately he was evacuated to U.S. Naval Hospital Okinawa.

“I sat down in a wheelchair, and they started taking off my boots. The next thing I know, I was being sedated,” Meyer recalls. “I went from an oxygen mask to anesthesia. I don’t remember a whole lot after that.”  Despite being placed on a ventilator (breathing machine) and receiving powerful antifungal and antibiotic medications, Meyer’s health grew worse. His condition was critical, according to his mother, Laurie Meyer Cox, of Pensacola, Fla. The Marine Corps had contacted Cox and Meyer’s father after the Marine was hospitalized and arranged travel visas and transportation for the parents to be at their son’s bedside.

“Being a nurse myself, I knew what the vent settings meant,” Cox says. “Michael needed a lot of oxygen. He was fighting for his life, yet he continued to get sicker and sicker.”  Several days later, Meyer “blew a hole in his lung,” Cox says, referring to a pneumothorax, or collapsed lung. It was the first of several serious complications that had the hospital staff working around the clock to keep Meyer alive. 

The aeromedical evacuation of a U.S. Marine, March 26, who suffered complications from pneumonia marked the first ever extracorporeal membrane oxygenation, or ECMO, transfer performed with an adult in the Western Pacific region. An ECMO provides cardiac and respiratory oxygen support to patients with damaged or diseased heart and lungs that can no longer function for themselves. To complete an ECMO a surgeon inserts tubes into the large blood vessels of the patient. With the help of blood thinners to prevent clotting, the machine will then pump blood through the patient with a membrane oxygenator, removing carbon dioxide and adding oxygen, returning it back into the patient. The Marine was being cared for at the Lester hospital Intesive Care Unit, Camp Lester, Okinawa, for several days before being transferred to Kadena Air Base and then boarding a C17 that would take him to recieve specialized treatment in Hawaii. The medical team transporting the victim was composed of not only Air Force critical care air transportation nurses, but also Army soldiers who are part of theTripler Army Medical Center joint medical attendant transport team.  Although the medical team members did not belong to the same branch of service as the patient, they came together to perform what needed to be done to help save his life.  

Aviation Week & Space Technology
Jim Mathews
Monday, 28 July 2014
http://aviationweek.com/defense/usaf-s-care-air-exceeds-expectations
USAF’S ‘CARE IN THE AIR’ EXCEEDS EXPECTATIONS
U.S. armed forces quietly made medical history in March, when statisticians recorded zero combat-related fatalities among American service members deployed in Afghanistan. To be sure, the pace of operations has slowed from its peak a few years ago and that can partly account for the drop, but forces continue to engage and troops continue to be in harm’s way. In fact, during that record-setting March, seven American battle injuries were severe enough to require aeromedical evacuation. So far in 2014, 23 U.S. service members have died, and 93 suffered battle injuries that prompted an air evacuation.  Even so, the statistics for the duration of the wars show that the risk of dying in combat for U.S. military personnel wounded in Afghanistan and Iraq was almost half that faced by service members wounded in Vietnam in the 1960s and 1970s, and about 45% of that for World War II combatants. While there are many reasons for this—simple things such as soldiers’ improved self-care and buddy-care training along with widespread adoption of tourniquets play a role—perhaps the most decisive has been a shift in thinking about how to use helicopters, turboprop transports and long-range airlifters to project very sophisticated and complex medical care deeper into the battlespace than ever before, even to the point of injury.  We have spent 13 years developing the most complex and the most effective by far deployed trauma system in the history of warfare,” says Air Force Col. (Dr.) Mark Ervin, a general surgeon who oversees the medical aspects of three Air Mobility Command programs that fuse airpower with doctors, nurses, medics and technicians. The Critical Care Air Transport Team (CCATT) (see WWW.CCATT.INFO), the Tactical Critical Care Evacuation Team (Tccet) (see http://ow.ly/zt1zC) and En Route Critical Care programs send surgeons, trauma nurses, nurse-anesthetists, operating-room technicians and paramedics far forward to deliver care comparable to that received in an intensive-care unit or a Level I trauma center emergency room, either at the point of injury or in the air. It is difficult, complex and—until these conflicts—unheard of. “Part of why we’re so good today is [nearly] 14 years of practice,” says Air Force Brig. Gen. (Dr.) Kory Cornum, Air Mobility Command surgeon. Cornum, a pilot and an orthopedic surgeon by training, shares the concern of many in the military medical community that with the coming drawdown, maintaining that combined clinical and aeromedical evacuation know-how could be a challenge. 

CINCINNATI — The soldier on the military cargo plane struggles to breathe. He developed pneumonia while serving in Afghanistan and needs medicine now, but the pump to deliver it won't work properly. "I can't believe I'm still messing around with this pump," the nurse says, speaking on a headset because the three-person crew is surrounded by the constant roar of jet engines even as she struggles with the thin air at 30,000 feet. But those engines aren't real. The "plane" is a simulation center deep inside the University of Cincinnati Medical Center, the pump failure orchestrated from a control room next door. The patient is a mannequin. The whole thing, in fact, is a training exercise, with those in the control room recording every word and reaction. "There are communication issues for sure," said Air Force Maj. Daniel Cox after the training exercise is done. "(The doctor) has got to be more vocal." "The cadre," 17 Air Force trainers housed here at the University of Cincinnati, is charged with developing a new generation of war doctors, nurses and respiratory therapists. The university is one of three training sites for Air Force doctors, including those in the National Guard and Reserves, about to be deployed to Afghanistan or other active theater. The other training sites are in Baltimore and St. Louis. Once deployed, the doctors, nurses and respiratory therapists will treat injured service members being flown to other sites in theater or to an American military hospital in Germany. Most have backgrounds in critical care, but they often haven't seen the range of injuries common in America's 21st century wars: blast injuries, amputations, multi-trauma head injuries. "It can be a difficult transition," said Lt. Col. Elena Schlenker, deputy director of the training program, called C-Stars, or Center for Sustainment of Trauma and Readiness Skills.  There are all kinds of rules for pilots. How often can they fly? How far can they fly? But there are no rules for the people in the back of the aircraft. Richard Branson, University of Cincinnati surgery professor. Even for doctors and nurses active in the military, the stress, confined space and oxygen-deprived conditions in transport planes can be overwhelming, said University of Cincinnati surgery professor Richard Branson. The experiments hone in on how altitude affects not only the patients, but the caregivers and their equipment as well. "There are all kinds of rules for pilots," he said. "How often can they fly? How far can they fly? But there are no rules for the people in the back of the aircraft."

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BAGRAM AIRFIELD, Afghanistan — More than 70 years ago, the first flight nurse graduated from the flight nurse course on Bowman Field, Ky. These flight nurses trained to provide a higher level of care to patients while they traveled by aircraft to other medical facilities.  Today, the flight nurses and technicians of the 455th Expeditionary Aeromedical Evacuation Squadron keep that level of care going in the skies above Afghanistan.  The 455th EAES provides medical and nursing care in flight to ill or injured service members or Department of Defense civilians. They perform their mission on fixed wing aircraft, including the C-17 Globemaster III, C-130 Hercules and KC-135 Stratotanker, and can provide extensive critical care capability equal to the level of care that patients receive at the Craig Joint Theater Hospital here.  “Our job is to move the sick and injured through the area of responsibility of Afghanistan,” said Col. Edward Farley, 455th EAES commander. “We obviously don’t want to be very busy, because that means that something bad has happened, and we have to move our service members or our coalition partners to a higher level of care.”  Farley, deployed from Scott Air Force Base, Ill., leads 48 medical personnel with teams of four basic crews consisting of two flight nurses and three emergency medical technicians. All flight crewmembers received specialized altitude training to become universally qualified to move patients by aircraft. Tech. Sgt. Alejandro Rojas, 455th EAES medical technician, said the hardest part about his job is the uncertainty of the missions, but his team trains for the unexpected. “Each of our teams preps and configures all of our equipment the same way,” he said. “That way no matter what aircraft or patients we get, we are ready.”  He also said that even though his unit doesn’t always stay extremely busy, primarily during the winter seasons, the necessity to have them is unquestionable.  “We are like life insurance,” Rojas said.

SOUTHWEST ASIA - Eight members from the 379th Expeditionary Aeromedical Evacuation Squadron transported a patient from a forward deployed location in Southwest Asia, to Landstuhl Regional Medical Center in Germany, Dec. 6, 2013, aboard a C-17 Globemaster III.  The patient, a 54-year-old Army soldier, was suffering from respiratory failure when the aeromedical evacuation crew was notified to transport him to the nearest medical treatment facility. "When we landed near the patient's location, we immediately grabbed all of our medical gear and loaded in the back of a (Army medevac) Black Hawk to get to the pick-up site," said Maj. Matthew Pieper, a 379th EAES critical care air transport team physician deployed from Travis Air Force Base, Calif., and a St. Louis, Mo., native. "Riding in a helicopter was the quickest form of transportation to the patient." When the CCATT, also including Travis AFB airmen, Maj. Michele Suggs from Flint, Mich., and Tech. Sgt. Athena Sotak from Brownsville, Texas, arrived on scene with the patient, they quickly got him aboard the helicopter, began performing a medical assessment and started a medical ventilator, Pieper said. "Keeping a patient stable in the back of a helicopter is challenging," Pieper said. "There is less space to work, communication is difficult and we had to stay in our seats. We communicated directions with an Army medevac [technician] who was attached to a harness. He had a little more room to move and keep the patient stable." During the helicopter ride back to the C-17, the medical crew swapped out three oxygen tanks to keep the patient breathing through the ventilator. On the third oxygen tank, the patient's oxygen level began to dip as the helicopter was landing, Pieper said. "We ran the patient about 200 yards from the helicopter to the C-17," Pieper said. "The C-17 has more oxygen capacity than the helicopter so we needed to move him as quickly as possible."  Capt. Rebecca Wastart, a 379th EAES flight nurse from Scott Air Force Base, Ill., helped set up the plane to receive the patient said,