Honing patient care skills at altitude

Story and photos by Master Sgt. Scott Wagers
Defense Media Activity

It seemed odd – a group of healthcare personnel bustling about the tail of a parked C-130 like they owned the place. If it weren’t for the medical badges embroidered on their jackets, one could’ve easily mistaken them for a gaggle of crew chiefs.

It didn’t take long, however, before the medical team removed any question about who they were and why they were there.

In fact, it was just under 20 minutes before the group of eight aerospace medical technicians and flight nurses on-loaded 1,500 pounds of medical equipment and rendered it fully operational before departure.

After takeoff, med techs and flight nurses, all assigned to the 86th Aeromedical Evacuation Squadron, unbuckled from their seats to run through checklists and interact with four life-sized mannequins strapped to suspended litters.

In the next three hours, there were five patient-care and aircraft-related

scenarios to respond to that involved 137 certifiable training events.

Tech. Sgt. Tommy Mattox choreographed and evaluated the team’s performance as the mission clinical coordinator. He said flight nurses and medical technicians, who are uniquely trained to transport patients on KC-135, C-130, C-21, and C-17 aircraft, must develop two different skill sets to be successful in their job.

“On one hand, you have all these medical skills you can call upon to take care of your patient,” said Sergeant Mattox, a 14-year veteran aerospace medical technician. “Then you’re responsible for all this aircraft stuff like knowing where your egress points are, knowing how to handle things in an emergency situation and knowing the limitations of the airframe.”

Capt. Troy Kinion said knowing how to transform a pallet-laden cargo bay into a “flying hospital” is crucial for missions downrange.

“Every member of this unit will eventually be flying to Iraq and Afghanistan where you land in the dark, the ramp comes down and you really don’t know what your patient load is going to be until you get there,” he said. “As soon as we learn the patient load, the (medical) crew goes into action.”

Captain Kinion, a one-year veteran flight nurse currently upgrading to become a flight instructor, said a seasoned med tech could fully ready a C-17’s oxygen and electrical systems for patient transport in 10 to 15 minutes.

“We don’t want to delay an airplane because we’re slow bringing on our equipment and getting it set up. That’s why we practice getting that equipment on board using time hacks,” he said.

To prompt the team into action during the training flight, Sergeant Mattox would hold up bold-lettered cue cards with phrases like “Rapid decompression – BOOM!” or “Medical emergency” instead of attempting voice commands over the roar of the plane’s engines. Medical aircrew, upon noticing the visual cues, acted out the

scenarios like a well-seasoned theater cast.

The team was a balance of veteran medical flyers with younger, greener healthcare officers – some flying the Hercules for their second time. A few senior medics mentored the less experienced ones. Others challenged their peer’s instructor skills by playing the role of junior apprentices in upgrade training.

One medical emergency scenario required a flight nurse instructor, who was evaluating another flight nurse’s teaching skills, to simultaneously feign an allergic food reaction.

After being prompted to drop her note pad and lay down in the plane’s web

seating, a white cue card with the words “Anaphylactic reaction” was displayed.

Within seconds, medical personnel were carrying her motionless body to a vacant litter.

“She’s unresponsive and her lips are turning blue,” Sergeant Mattox said.

This elicited an open dialogue about different ways to open up the lifeless victim’s airway, the appropriate medications to prescribe and the effect of the plane’s altitude.

Captain Kinion said the human body – especially one afflicted with a complex assortment of combat-related injuries – is completely different at higher elevations than it is on the ground because altitude affects disease in different ways.

“If you have four-out-of-10 pain on the ground, when you get up to altitude, because of stress, vibrations and decreased partial pressure of O2 (oxygen), your pain level is probably going to shoot up to a six or seven, if not higher,” he said.

Air transportation is also challenging for burn patients who have difficulty retaining body heat and fluids, eye and head injury patients susceptible to rapid changes in pressure and abdominal injury patients with trapped abdominal gas that expands and compresses the diaphragm, making it difficult to breathe, Captain Kinion said.

“So we have to treat patients on the ground with the anticipation that they’re going to get worse at altitude,” he said, adding that not all patients experience discomfort during transport. He also said a flying medical team’s efforts are not centered on treating or healing patients at altitude.

“We’re primarily focused on keeping patients stable during transport so that they arrive at point B the same way they left point A,” he said.

Soon-to-be flight nurse Capt. Pamela Banks, now one month shy of completing her upgrade certification, said the training is “very intense.”

She said she had 12-hour duty days divided between shadowing her trainer and reviewing nearly 600 pages of training manuals covering aircrew operations, equipment and patient care duties.

“I literally have no time because I’m in the books, in the regulations, all the time,” said Captain Banks, a former enlisted supply troop who said she always wanted to become a nurse. “But when you think about it, I want to be in the books, in the regulations, all the time because I don’t want to be up there with a crew and not know what I’m doing.”

As an ongoing part of her training, the 34-year-old native of Boca Raton, Fla., was scheduled to fly her second Reach Mission, which transports patients from Europe to the United States for continued medical care. She said experiences from her first Reach Mission taught her why she endures the difficult training process.

“What clicked it for me was seeing how the patients really appreciate you,” she said. “No matter what, they value that we’re there for them and that we’re there to get them safely home.”