Saving lives at 40,000 feet

  • Published
  • By Master Sgt. Mark Olsen
  • 514th Air Mobility Wing Public Affairs


Charge Medical Technician (CMT) Staff Sgt. Jillian H. Moran kneels over severely injured Staff Sgt. Ana Nichols in the cramped space of a KC-135R Stratotanker over the Caribbean Sea.
Moran, a recent nursing graduate of the College of New Jersey, examines Nichols who fell because of aircraft turbulence. Her injuries are serious, possibly life-threatening; a gash on the forehead, and possible spinal cord complications due to how she fell.

Fortunately for Nichols, this is a training scenario. The day before it was Nichols who was the charge medical technician during this three-day training mission to St. Croix, U.S. Virgin Islands Aug. 25-27, 2017.

Fourteen members, including aeromedical evacuation technicians Moran and Nichols, with the 514th Aeromedical Evacuation Squadron (AES), 514th Air Mobility Wing, located at Joint Base McGuire-Dix-Lakehurst, N.J., are performing the joint training with the 77th Air Refueling Squadron, 916th Air Refueling Wing, which is assigned to Seymour Johnson Air Force Base, N.C. Both units are with Air Force Reserve Command.

During the mission, the flight nurses and aeromedical evacuation technicians will train and be evaluated on how they respond to a variety of patient and aircraft scenarios.

A major component of that training is the Stratotanker itself

The KC-135R as a training platform is significantly different compared to other aircraft; the space is more cramped, almost claustrophobic, the aircraft flies at higher altitudes – up to 50,000 feet, and finally, the cabin temperature can fluctuate between hot and cold.

"You have to ask yourself, what are the stresses of flight and how will they affect your patients," said Lt. Col. Rosa M. Ramos, flight examiner. "We emphasize if it is affecting you, your patients are already behind the power curve."

Because space is at a premium compared to the C-17 Globemaster III or the C-130 Hercules, the AES team has to efficiently set up their working area in the confined space. This includes building the stanchion litter system, which holds the patients’ litters; setting up the patient oxygen supply system, and connecting the frequency converters, which convert the aircraft’s voltage to that used by their medical equipment.

Also, flying at higher altitudes comes with additional complications. Rapid decompression at 40,000 feet is different than losing atmosphere at 20,000 feet; if the nurses and technicians don’t act fast, both they and their patients could die, or suffer irreversible injuries.

So the only way to learn is to train in the aircraft, when it’s flying and sometimes bouncing around in the air. No simulator can match the dynamics of the actual aircraft environment.

The KC-135 does comes with a bonus, for the duration of the flight, with the exception of take-off and landing, the entire flight can be devoted to training - the nurses and technicians are not competing with the flight crew for training time.

They make the most of that opportunity. Each Airman has a Mission Accomplishment Report Sheet - commonly referred to as the MARS form, which is a checklist of tasks and emergencies that each nurse and technician must be certified on to be deployable. This is intensive training because each nurse and technician has to be certified on these tasks every six months.

The training is based on the personnel that would actually be assigned to an aeromedical evacuation mission.

"The crew consists of five people,” said Master Sgt. Marc E. Godlewski, Medical Crew Coordinator. “A medical crew director, a flight nurse, the charge medical technician, and two additional technicians.”

The CMT is central to the operation and is responsible for assigning equipment responsibilities to other crew members during the pre-mission brief, as well as overseeing aircraft configuration, and caring for the patients.

"Everyone was getting checked off on various training tasks on this mission," said Senior Master Sgt. Jennifer R. Higgs, 514th Senior Flight Examiner and Noncommissioned Officer in Charge of Standards and Evaluations.

The training includes cardiac and respiratory emergencies, neck and eye trauma, burn trauma, chest trauma, pain management, and psychiatric management. The patient scenarios are based on actual medical cases and aircraft incidents from the Afghanistan and Iraq wars. What is important is knowing immediately what to do when something happens.

"We want to be a hive mind, we want to be on the same page," said Tech. Sgt. Michael Bellack, Mission Clinical Coordinator.

The nurses and technicians are required to train on all the aircraft that can be used to carry patients out of a combat theater to a location where they can get more advanced care. That means, during the course of a year, they will all train on the C-17, the C-130, and the KC-135R, collectively known as the "heavies."

"You always learn something every time you fly,” said Higgs.

On this flight, they had a simulated aircraft fire, which required moving the patients to safety, working with self-contained breathing apparatuses, and putting out the fire. They also had to contend with rapid decompression, and an aircraft fire on the ground, which required them to climb out on the wing and slide to the ground off of a lowered aileron.

“I am new to flying, so I learn a lot every flight,” said Moran. “On this flight I learned more about the flight nurse's responsibilities so I will be able to better assist them in the future should they need it.”

That training pays off, the 514th Aeromedical Evacuation Squadron has firmly established itself as a well-run unit.

"Higgs and I've flown with a lot of different units and as soon as they see our patch, they know we do it by the book,” said Ramos.

That well-earned reputation was demonstrated by the Airmen who were being trained and evaluated on this mission.

"I appreciate the wealth of information everyone from other career fields bring to this training," said Tech. Sgt. Tyra D. Everett, aeromedical evacuation technician.

The return flight on Aug. 27, 2017, has three simulated patients: A Soldier who suffered multiple skull fractures from a fall, an Airman with a femur fracture, and another Airman suffering respiratory distress caused by exposure to a chemical agent.

As the 77th flight crew readies the KC-135R for takeoff, Charge Medical Technician Moran announces, "Three souls (patients) onboard" as a reminder to the medical crew of the patients in their care.