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Care in the Air: Active, Reserve exercise enhances medical transit

Capt. Thomas Ross, exercise trainer and an 81st Medical Group Critical Care Air Transport Team registered nurse (left) and Capt. Shartia Bowers, a CCATT registered nurse (right) work inside a C-130J Super Hercules aircraft during an exercise March 10, 2019, at Keesler Air Force Base, Miss., involving the Air Force Reseve Airmen of the 403rd Wing's 36th Aeromedical Evacuation Squadron and the 815th Airlift Squadron and active duty Air Force service members of the 81st MDG CCATT.  All three military units are at Keesler Air Force Base, Miss. (U.S. Air Force Photo by Lt. Col. Ryan Mihata).

Capt. Thomas Ross, exercise trainer and an 81st Medical Group Critical Care Air Transport Team registered nurse (left) and Capt. Shartia Bowers, a CCATT registered nurse (right) work inside a C-130J Super Hercules aircraft during an exercise March 10, 2019, at Keesler Air Force Base, Miss., involving the Air Force Reseve Airmen of the 403rd Wing's 36th Aeromedical Evacuation Squadron and the 815th Airlift Squadron and active duty Air Force service members of the 81st MDG CCATT. All three military units are at Keesler Air Force Base, Miss. (U.S. Air Force Photo by Lt. Col. Ryan Mihata).

Capt. Sharita Bowers, a registered nurse with the 81st Medical Group's Critical Care Air Transport Team, checks an IV line for a simulated patient during a training exercise March 10, 2019, onboard a C-130J Super Hercules aircraft at Keesler Air Force Base, Miss. The exercise involved the Air Force Reseve Airmen of the 403rd Wing's 36th Aeromedical Evacuation Squadron and the 815th Airlift Squadron and active duty Air Force service members of the 81st Medical Group's CCATT. All three military units are at Keesler Air Force Base, Miss. (U.S. Air Force Photo by Lt. Col. Ryan Mihata)

Capt. Sharita Bowers, a registered nurse with the 81st Medical Group's Critical Care Air Transport Team, checks an IV line for a simulated patient during a training exercise March 10, 2019, onboard a C-130J Super Hercules aircraft at Keesler Air Force Base, Miss. The exercise involved the Air Force Reseve Airmen of the 403rd Wing's 36th Aeromedical Evacuation Squadron and the 815th Airlift Squadron and active duty Air Force service members of the 81st Medical Group's CCATT. All three military units are at Keesler Air Force Base, Miss. (U.S. Air Force Photo by Lt. Col. Ryan Mihata)

KEESLER AIR FORCE BASE, Miss. --

The C-130J Super Hercules flight had one reality for the flight crew and a completely different training reality for the military medical professionals in the cargo hold of the same aircraft March 10.

The 815th Airlift Squadron flight crew took off from Keesler Air Force Base flew to Lakeland, Florida, then to Pope Army Airfield in Fayetteville, North Carolina before returning to Keesler AFB. However, for the military professionals in the C-130 cargo hold, it was a medical mission in Afghanistan.

“This was a cross training exercise between the 36th Aeromedical Evacuation Squadron which is an Air Force Reserve unit and the active duty 81st Medical Group’s Critical Care Air Transport Team made possible by the 815th AS here at Keesler AFB,” Maj. Mark Dellinger said.

Dellinger serves as a flight nurse in the 36th AES and was part of the exercise with the 81st MDG CCATT, whose personnel sharpened their skills onboard the C-130J aircraft in actual flight conditions.

“We simulated we were a five person aeromedical evacuation crew with a CCAT team onboard for an urgent mission from Bagram Air Base to fly to Shindand Air Base in Herat, Afghanistan to pick up a patient load,” Dellinger said.

These specialized AE teams include a medical crew director, flight nurse and three aeromedical evacuation technicians who routinely move critically ill or injured troops after they've been stabilized or received damage-control surgery. AE personnel frequently work with CCATT, which consists of a doctor, intensive care nurse and respiratory therapist.

The physician on the training exercise, Lt. Col. Ryan Mihata, surgical squadron commander, 81st Surgical Operations Squadron, recalled working beside Dellinger when their deployments to Afghanistan overlapped. 

That prior familiarity illustrates how the Air Force Reserve, where Dellinger serves, and the active Air Force, where Mihata serves, combines personnel for deployment missions.  

The value of training exercises for active and Reserve Airmen to train alongside each other prepares them for deployments where they could work together, as Mihata and Dellinger had previously done.

“It allowed us to integrate,” Mihata said.

Many CCATTs serve in medical facilities like base hospitals or clinics on solid ground, so training in a C-130 aircraft expands their medical skills by coping with flight conditions. But, the AE teams get to provide medical care in an aviation setting as part of their duties.

New CCATTs do not always get to train with AE before deployments. However, AE is always on a flight when a CCAT team is present on an aircraft, but a CCATT does not always work with AE.

“Most CCAT teams that I’ve encountered, usually get their first real AE flight once they deploy instead of having the opportunity to have training flights prior to deploying,” Dellinger said.

Master Sgt. Bonnie McKinley, a CCATT coordinator and flight chief for Cardiopulmonary Services, 81st Medical Operations Squadron, has deployed several times. She was part of this training but knows the demands in extreme conditions that can include incoming fire at the aircraft. 

Among McKinley’s first impressions was the CCATT’s “choreography” of inflight medical care. 

“My first deployment on a CCATT was incredibly eye opening because it is such a well-rehearsed experience to get patients on and off the aircraft into a hospital,” McKinley said.

Rehearsals come in the form of the training like this exercise that better prepares CCATT and AE teams.

“Anytime you put the team, whether it be the AE team or the CCATT, on the back of an aircraft with patients and stress them by giving them training scenarios like patients who are going into cardiac arrest, it allows them to do things in an environment that is not the hospital but in an aircraft that’s bouncing around, in flight, and very noisy making it tough to communicate,” Mihata said.

McKinley agrees and describes a specific example.

“When you intubate a patient on the ground, we can listen to make sure their breathing appropriately and that the breathing tube is in the right place, but you can’t do that on a noisy aircraft in flight,” McKinley said.

The 81st MDG helps prepare its CCATT personnel for aspects of military flight conditions on the ground with a “medical flight simulator.” It’s a small room stocked with inflight medical care equipment and a full sized patient transport litter.

That approximates the limited space onboard a flight, but they also play actual C-130J in-cabin aircraft sounds at high volume. The “simulator” conditions include cutting off the room’s bright fluorescent lighting so personnel are acclimated to functioning in the lower light environment of military tactical flights.

This training, in addition to the March exercise on the C-130J prepares both 81st MDG’s CCAT and 36th AES personnel for their real-world missions.

This combined training has been conducted before at Keesler AFB but this was the first time Mihata had the chance to participate in the training here, but he had certainly done the CCAT mission during his deployment to Afghanistan.

“I haven’t flown this type of mission since 2015 and as one of the older CCATT doctors, it was an opportunity for me to pass on some of the knowledge I have to these younger folks who will be doing this mission for us,” Mihata said.

Passing on practical experiences prepares the next generation of active and Reserve medical professionals for their future deployments together, in part because they train side-by-side.

Dellinger said he sees it as a win-win exercise in cross-training between Air Force Reserve and the Air Force, which increases the odds of saving lives.  

“We can really complement each other’s efforts in the air. The positive opportunity was that everybody got additional training and experience they may not have seen before,” Dellinger said.

Despite the different reality for the 815th AS flight crew on a stateside flight, even as the 36th AE and 81st Medical Group’s CCATT’s training scenario in the cargo hold was a medical mission in Afghanistan, the single reality was vital cross training among dedicated active duty and Air Force Reserve Airmen.