Medical response team trains for wounded warrior transport

by Stefan Alford
LRMC Public Affairs

A select group of health care professionals at Landstuhl Regional Medical Command are part of the only military team in the world that flies with a specialized piece of medical equipment to save wounded warriors’ lives on short notice.

It’s a huge responsibility, but the key to responding to emergencies that require a patient to receive Extra-Corporeal Membrane Oxygenation is simple: training — and lots of it, said Capt. Elizabeth Hoettels, an intensive care unit and Critical Care Air Transport team nurse.

To that end, the ECMO team has changed the way they prepare with a balanced emphasis on classroom training and hands-on simulation.

“Previously, it’s all been didactic training,” Hoettels said. “This was our first official simulation training.”

That training took place Dec. 21 and will now be provided on a quarterly basis, said Maj. Michelle Langdon, the lead nurse for the CCAT and the Acute Lung Response Team lead.

The ECMO procedure is used when a patient has a condition that prevents the lungs or heart from working properly. It involves a machine that will take over the work of these organs until the patient’s body is able to heal enough to resume those functions.

Langdon developed the objectives for the ECMO simulation, planned the scenarios, operated the SIM Man 3G (simulator mannequin) and evaluated the team’s performance. She has the most experience, having worked with ECMO in the pediatric ICU at Wilford Hall Medical Center in San Antonio from 1999 to 2003. LRMC was the first Department of Defense medical facility to use ECMO in adult patients when the program was initiated here in 2009.

“This procedure is for patients who are too sick to travel by standard CCAT teams,” she said. “The pulmonary or cardiac demands of their illness or injury are beyond the capabilities of the equipment, supplies or training for CCAT.”

That’s when the ALRT is called to assist with a variety of ventilation therapies, including ECMO, if necessary. This allows the patient to be transported to LRMC for the specialized care required.

“Without the treatment options offered by this team in the past, the patients stayed at the Role III hospitals (i.e., deployed hospitals in Afghanistan) until they either recovered enough to be transported by CCAT or passed away,” Langdon said.

Last year, the ALRT transported 16 wounded warriors from downrange, placing seven of those patients on ECMO for the flight. The majority of these patients obtained maximal recoveries, she said.

Also overseeing the recent simulation training were ECMO Director Lt. Col. (Dr.) David Zonies and ALRT NCOIC Staff Sgt. Raquel Sullivan. They helped train two ECMO teams during each of the four-hour simulations. A team is made up of two providers (trauma surgeons and critical intensivists), two registered nurses and two respiratory therapists.

“They essentially trained for hands-on responses to worse-case scenarios, giving them the opportunity to troubleshoot situations,” Hoettels said. “Every member must be able to respond immediately to any emergency or change in patient status that may threaten life. There is no time to wait for help.”

The simulation was a valuable tool in being able to work with the equipment, said Sgt. Matthew Carpenter, one of the team’s lead respiratory therapists.

“My role was to set up the ventilator, make sure the patient’s vitals remained stable and assist the doctor in cannulating (inserting a small tube) the patient for ECMO,” he said. “This simulation training is important because it mimics real-life situations where things can go wrong. With the training, we can be better prepared on a real mission. Even though it’s training, it’s still experience.”

The training paid dividends almost immediately, as just nine days later on Dec. 30 the team responded to a call and successfully placed an injured service member on ECMO for transport from Afghanistan back to LRMC.