Gulf War created need for better critical care

Gulf War created need for better critical care

Operation Desert Storm was a turning point in the US Air Force Medical Service’s Critical Care Transport Teams.

Image: Medical personnel use litters to transport Cpl Richard Ramirez, 1st Marine Division, and other wounded to a C-141B Starlifter aircraft for medical evacuation from Al-Jubayl Air Base, Saudi Arabia, to Germany for treatment of wounds received during Operation Desert Storm (USAF)

By Kevin M. Hymel, US Air Force Surgeon General Public Affairs

January 2016 marked the 25th anniversary of Operation Desert Storm. It also marks a turning point in the US Air Force (USAF) Medical Service’s Critical Care Transport Teams (CCATT).

“We were not serving the Army as well as we could have in the Air Force,” explained Lt Gen. (Dr) Paul K. Carlton, a former USAF surgeon general who had been working on the concept of CCATT since the 1980s.

As the US military and its allies assembled in the Middle East in the summer and fall of 1990 (Operation Desert Shield) in response to the invasion of Kuwait by President Saddam Hussein of Iraq, then-Col Carlton set up the 1,200-bed USAF 1702nd Contingency Hospital in combination with a US Army combat support hospital outside of Muscat, Oman. Yet, as Desert Shield turned to Desert Storm on 19 January 1991, the hospital only took in 42 patients, and those were only from surrounding bases. “We did not get any war wounded,” said Carlton, who offered beds to the CENTCOM surgeon in an effort to better utilise the facility.

To make the case for his hospital, Carlton travelled to the battlefield to offer assistance. “I picked up a couple of air-evac missions just to let more people know we existed,” he said. “I told Army commanders to send anyone to us.” But it soon became apparent the Air Force could not meet the Army’s needs. “We could not take people with catheters or tubes, much less needing a ventilator.”

Instead of relying on the Air Force, the Army built large hospitals closer to the front. “The Army built up just like they did in Vietnam,” said Carlton. “They had a very big footprint.”

The leadership of the Air Force Medical Service wanted smaller hospitals connecting back to the US, but to do that, they needed a modern transportation system. Although Carlton and other colleagues had been working on improvements to patient transportation since 1983, air evacuations were still very restrictive. The equipment needed to keep a patient alive was new and untested. “Modern ventilators blew out lungs all the time,” explained Carlton. “We needed to work the kinks out and we needed the opportunity to work in the modern battlefield. We needed critical care in the air.”

When the war ended in late February, Carlton and other AFMS officers returned home and brought their CCATT ideas to the Air Training Command. “The war was not an aberration,” Carlton said, “we had to modernise our theatre plans to be able to transport patients.”

Carlton and his colleagues trained three-person crews to work with new and improved ventilation equipment onboard planes. “That was the long pole in the tent,” he explained. “When you take a critical care patient you say ‘we can ventilate that patient,’ and you better be able to.”

With the new programme up and running, the AFMS made CCATT available to the other services.

CCATT gained momentum when, in 1993, Carlton and his colleagues travelled to Mogadishu, Somalia, for an after-action brief on the US Army’s ‘Blackhawk Down’ engagement, and explained CCATT to the Joint Special Operations Command (JSOC) surgeon. He, in turn, handed Carlton a check and said: “I want that as soon as you can make it.”

The turning point came in 1995 during the Bosnian War, when a US soldier riding a train to Bosnia was electrocuted by an overhead wire and fell off the train. He was immediately transported to Landstuhl Regional Medical Center, Germany, where doctors wanted him transferred to the burn unit at Brooke Army Medical Center in San Antonio, Texas, US. When Maj. (Dr) Bill Beninati picked up the patient for the flight to the US, he was still very unstable. Somewhere over Greenland, the patient went into septic shock and Beniniati and his team resuscitated him. When they touched down in San Antonio some 12 hours later, the patient was in better shape than when he left. “That’s when the Army took notice,” said Carlton. “We had convinced them that we could do what we said.”

Soon, the USAF surgeon general at the time, Lt Gen. Alexander Sloan, approved the CCATT concept. Later, with the strong endorsement of USAF Surgeon General Lt Gen. Charles Roadman II, CCATT became a formal programme.

CCATT proved invaluable in the next conflict, Operation Iraqi Freedom, where casualty evacuation became a vital necessity, as well as in Afghanistan. Carlton is proud of CCATT. “We have developed a modern transportation system to go along with the modern battlefield for the Army, Navy, and the Marines.” Today, CCATT is considered a vital component of the Air Force Medical Service, but it took a war to liberate Kuwait some 25 years ago for the military to realise how badly it was needed.