Global Patient Movement:
Moving America’s Ill and Injured Warfighters
Safely, Securely, and Soundly

By MR. MICHAEL P. KLEIMAN, U.S. Transportation Command

Every day, the U.S. military conducts an average of 35 aeromedical evacuations, transporting sick and wounded active duty service members, as well as other patients from around the world, to locales with appropriate medical treatment facilities.

Serving as the Department of Defense’s (DoD’s) single manager for global patient movement, one of its five Unified Command Plan responsibilities, United States Transportation Command (USTRANSCOM) executes this critical mission through the U.S. Air Force’s aeromedical evacuation system, which provides safe, secure, and sound in-flight health care to the ill and injured transiting the skies.

“Global patient movement and warfighting readiness go hand in hand. For example, our aeromedical evacuation professionals comprehensively assist more than 500 patients with various levels of medical care per month,” said U.S. Air Force Col John Andrus, Director, USTRANSCOM Command Surgeon Directorate. “Similar to a symphony orchestra that consists of numerous musicians playing in harmony to generate incredible sounds, the global patient movement process also features many moving parts, which come together in unity to enable and ensure superior in-transit medical support to America’s warfighters.”

The initial phase of the global patient movement process begins with a decision by the treating medical team that a patient needs to move to a higher level of care. Next, the involved senior medical authority requests patient movement through the USTRANSCOM Regulating and Command and Control Evacuation System, the DoD’s automated, electronic information tool utilized by the three USTRANSCOM patient movement requirements centers. These facilities are known as the Theater Patient Movement Requirements Center (TPMRC) – Americas, Scott Air Force Base, IL; TPMRC – East, Ramstein Air Base, Germany; and TPMRC – West, Joint Base Pearl Harbor-Hickam, HI.

Then, the appropriate TPMRC receives and validates the requested requirement. During the validation process, a flight surgeon determines the individual’s capability to fly and if allowed to do so, ensures the availability of an attending physician and a bed at the destination. The team also addresses flight specifics, including altitude restrictions, patient positioning, and special equipment. In addition, the servicing TPMRC coordinates other support, such as enroute care and ground transportation to the accepting medical treatment facility.

A standard aeromedical evacuation flight crew consists of two flight nurses and three technicians. To ensure America’s ill and injured warfighters are transferred safely, securely, and soundly, a Critical Care Air Transport Team (CCATT), specialized in transit support, is utilized. This team is comprised of one physician, one intensive care unit nurse, and one specially-trained respiratory technician. The CCATT can assist up to four patients.

“A majority of our patient movement requirements come from U.S. Central Command, U.S. European Command, U.S. Indo-Pacific Command, and U.S. Northern Command. We’re responsible for management of these patients globally. On the other hand, for patients located in austere places, a contract conveyance, such as International SOS, provides aeromedical evacuation support,” said U.S. Air Force Lt Col Sean Wilkinson, Chief, Global Patient Movement Integration Cell, USTRANSCOM Command Surgeon Directorate. “The TPMRC ensures the appropriate level of care is maintained throughout the global patient movement system. For example, we make sure an advanced cardiac life support ambulance is waiting at the destination for an in-transit, critical care patient.”

In his position, Wilkinson, a 28-year career Airman and advanced practice nurse, serves as a unifying hub in the global patient movement system, connecting information generated by the three TPMRCs and subsequently relaying the data to the USTRANSCOM director of operations and to Andrus for their decision(s). As the connector of the system’s (global patient movement) many moving parts, he likens his role to that of a conductor leading an orchestra as per Andrus’ quoted example.

Wilkinson is also the lead global patient movement planner for defense support of civil authorities. Following Hurricane Dorian’s devastation of the Bahamas in September of 2019, he assisted in preparing MacDill Air Force Base, FL, and Scott Air Force Base, IL, to host aeromedical evacuation personnel, aircraft, and equipment from seven different bases readied to respond, but the call for support from U.S. Northern Command did not come.

Nevertheless, the global patient movement system continues to respond—every 90 minutes—in transporting America’s ill and injured warfighters safely, securely, and soundly wherever and whenever needed.

“The U.S. government will spare no expense to get patients back for definitive medical care,” Wilkinson stated. “The global patient movement system is not replicated anywhere else.”


USTRANSCOM exists as a warfighting combatant command to project and sustain military power. Powered by dedicated men and women, it underwrites the lethality of the joint force, advances American interests, and provides our nation’s leaders with strategic flexibility to select from multiple options and create multiple dilemmas for adversaries.