Critical care teams focus on safe returns - Air Force News | News from Afghanistan & Iraq - Air Force Times

Critical care teams focus on safe returns

RAMSTEIN AIR BASE, GERMANY — When you work anywhere from 18 to 29 hours straight, uninterrupted sleep is something you relish.

Col. Charles Chappuis felt pretty good leaving here with eight hours of shut-eye under his belt.

Chappuis needed his rest because he didn’t know when he would be sleeping again.

He’s a physician for one of the four Critical Care Air Transport Teams, or CCATTs, based at Ramstein, and part of the only all-Air National Guard team.

Along with critical care nurse Lt. Col. David Worley and Tech. Sgt. Chris Howard, a respiratory technician, Chappuis is responsible for getting wounded troops back home.

On this trip, the Guard CCATT team cared for three critically ill patients during an eight-hour flight across the Atlantic. The CCATT handed off the patients to the medical staffs at Walter Reed Army Medical and the National Naval Medical centers. They then flew back to Ramstein to do it all over again.

It is work the airmen take seriously and give up their civilian jobs for a month or more to do.

“All of us volunteered to do this,” said Chappuis, who has completed 15 to 20 missions. “Nobody called us up and said, ‘Hey, it’s your turn.’ ”

Even more than his belief in the mission, though, is Chappuis’ commitment to providing injured service members with the best care he can, the kind he would want for his own family.

“If that’s my desire for my children,” the 30-year veteran surgeon said, “I should be willing to pony up and do it myself.”

Precious cargo

The official name is improvised explosive device. Boots on the ground say IED. Whatever you call it, the roadside bomb does serious damage to the human body. And the body’s ability to survive such devastating injuries depends on getting it the best care as quickly as possible.

In earlier wars, it could take from a week to a month to get a wounded warrior to the United States. Today, it can take only a little more than a day. And because of the greater speed, coupled with the high level of care being provided by CCATTs and other military medical professionals, more troops are surviving their injuries, said Lt. Col. Kathleen Flarity, commander of the 455th Expeditionary Aeromedical Evacuation Flight at Bagram Airfield, Afghanistan.

“We are giving them what they need, when they need it,” Flarity said of patients. “It took 30 days in Vietnam to get them home, now the goal isn’t to get them home. The goal is to get them what they need.”

The most critically injured service members, however, are heading back to the United States — to get them the best care possible and to keep hospital beds available.

There are simply too many wounded, Chappuis said, to keep them for long at the Craig Joint Theater Hospital at Bagram Airfield or at Landstuhl Regional Medical Center, Germany.

“If we don’t move them, we reach our choke point,” he said. “Our goal is to progressively move them until they’re back in the United States.”

Moving a burn victim or an amputee so soon after surgery takes meticulous planning.

A typical CCATT mission takes eight hours or more, but the CCATT starts its work long before it steps into the cavern of a C-17 or a KC-135.

The three team members go on hospital rounds to learn every detail they can about each patient. They must be certain they have every piece of equipment — all 750 pounds of it — they could possibly need for the flight over the Atlantic.

Once in the air, the mission might seem unexciting and that’s the way it should be, said Lt. Col. Raymond Fang, Landstuhl’s trauma director.

“Ideally it’s a standard ICU shift,” Fang said. “Most ICU shifts you don’t see people running around like crazy. You have a calm and there is a plan of care, and you engage it through the mission.”

Fang likened CCATT members to firefighters; you want them there, but you don’t want to have to put them to work.

“If there is something that happens with the patient — if they deteriorate — then you have access to the people who can then take care of the patient,” he said.

The importance of the mission isn’t lost on anyone, especially the airmen doing the flying.

Capt. Josh Christian, a pilot with the Mississippi Air National Guard, considers medevac flights rewarding but humbling.

“There is no more important a mission you can fly,” he said.

For Christian, the mission can be physically grueling because of the long hours. But when he leaves the cockpit to go see the patients, he gets his “attitude adjusted.”

“When you walk down here and take a look, you know that you’re looking at someone’s son, daughter, brother, sister, aunt or uncle,” he said.

Two soldiers’ stories

Spc. Dustin Morrison of the Iowa Army National Guard is the 20-year-old son of Kelli Pedersen, one of the parents who Christian thinks of when he looks in on the wounded.

Pedersen was at Landstuhl to see her son, who eventually was loaded on one of the flights from Ramstein to Joint Base Andrews, Md.

Morrison was injured while on patrol in Afghanistan, and his mother thinks he might have died if it hadn’t been for the care he received in Landstuhl, from the CCATT and doctors in the U.S.

“It’s overwhelming,” Pedersen said of all her son has been through. “But the people here have cared so well for him. I appreciate it so much.”

Michael Castagna, too, is grateful to all the medical professionals who have helped his older brother, Army Spc. Adam Castagna.

Castagna, 37, was just 14 days away from returning to Vilseck, Germany, when he and his platoon came under attack in Afghanistan’s Kandahar province. The attack injured his right eye and damaged his liver.

Michael Castagna, his mother and Castagna’s fiancé had rushed to Germany, not sure if they would be taking their loved one home alive.

“To be honest, we weren’t sure he was going to make it, but within 24 hours — the care was so exceptional — that he pulled a 180,” Michael Castagna said of his brother. “Literally, he was off life support, had multiple surgeries with 100 percent success.”

On this day, Castagna was loaded on a C-17 with two other critically injured patients. He was headed back to the U.S., though he wasn’t going straight back to his home in New Jersey.

Castagna, through his brother, told Air Force Times that he felt like he was “surrounded by super soldiers.”

“[CCATT members] are professionals,” Michael Castagna said. “He’s their mission, and he says there are hardly words to describe it.”

Care for the caregivers

Caring for what Landstuhl’s Fang calls “the sickest of the war” can take its toll.

The CCATT and aircrew members know it, too, and they take care of each other.

Compassion fatigue is something Flarity, the commander at Bagram, is always on the lookout for. She encourages her airmen to know the signs — compassion fatigue is similar to post traumatic stress disorder — and to have a strategy for coping.

“Everybody is different,” said Flarity, a reservist who is a nurse practitioner. “For me, exercise, family time, time with friends and colleagues helps.”

Guard members and reservists assigned to the medevac mission are able to step back from their emotions because the work is so similar to what they do in their civilian lives.

“Maybe the acuity is new,” Chappuis said. “But to folks like Lt. Col. Worley and myself, who have been in the medical field for a long time, there is some desensitization.”

Nonetheless, he said, it helps to have each other and to be able to talk with a chaplain if someone does become overwhelmed.

Flarity finds it’s often the young respiratory technicians and those who load and unload patients for transport who are most shaken by what they see.

“It can be emotionally draining,” she said. “My RTs — a lot of those are 20-, 21- and 22-year-olds, and they are seeing the sickest of the sick.”

Howard, the respiratory technician who works with Chappuis, is far from being in his early 20s. He has 18 years in the Air Force — eight years on active duty and 10 years in the Guard. He’s seen a lot, but he wouldn’t have it any other way.

“It’s a satisfying job,” said Howard, who hails from North Carolina. “… this [is] just my way to give back.”