Providing Emergency Patient Care
... at Altitude

By MS. KIM KNIGHT, Staff Writer

Aeromedical evacuation (AE) can be unpredictable. No two patients have identical symptoms and no two flights are the same, which means medical personnel have to prepare for a wide variety of scenarios in various planes. That is precisely the type of training they get at the U.S. Air Force School of Aerospace Medicine (USAFSAM) at Wright-Patterson Air Force Base in Ohio. TSgt Anthony Shuty, Aeromedical Evacuation Technician Instructor, described the process.

“At USAFSAM, we train flight nurses, flight medics, and flight surgeons learning to clear patients for flight,” he said. “They review movement requests and conduct a pre-triage of sorts. After considering the treatments and status, as well as potential flight stress based on the diagnoses and condition, they determine whether a person is stable for flight.”

Shuty said there are AFIs, regulations, and protocols for dealing with patients, but there isn’t always a doctor on board. Thus, training must ensure that Aeromedical Evacuation Technicians can work independently, regardless of in-flight conditions.

“When they come to Wright-Patterson,” he explained, “our students are already experienced nurses and technicians trained in basic life support and advanced cardiac life support. We simply apply the stresses that may be encountered in flight to the medical care they are already familiar with providing. For example, we show them how to perform in places where the environment is not controlled like it is in a hospital, such as an area with little or no light or with changing conditions.”

According to Shuty, students gain qualification at the AEIQ (Aeromedical Evacuation Initial Qualification Course) after graduation from USAFSAM FN/AET course. AEIQ is the second part of the training pipeline for AE. They gain this experience because at Wright-Patterson, training occurs on actual C-130, C-17, and KC-135 fuselages that were operational previously. This helps ensure that when students get on those aircraft, things like the electrical and the oxygen ports are the same and they are comfortable with the layout.

The fuselage simulators do not move, but everything inside is functional. In fact, even the mannequins (which Shuty refers to as patients) are unusually realistic.

“We can assess the pupils on some of the new mannequins, making them dilate and contract,” he said. “Also, we can make patients respond appropriately to events such as a drug overdose, for example. They can seize and start shaking, and their face turns blue, as if not receiving oxygen. Our simulation operators can fit them with stumps of limbs to mimic amputations and they can bleed, which we control through real-life treatments. We can control the rise and fall of their chest to assess our CPR efforts.” Staff can even make the faux patients speak, sweat, and cry.

After graduation from USAFSAM, AEIQ incorporates aircraft emergencies such as simulated crash landing and ditching using colored lights and sounds. They play actual engine sounds so loudly that trainees must wear headsets and ear protection, as well as consider those for the patients. They simulate fires on the aircraft—including fire alarms, smoke, and extinguishers—forcing crews to react appropriately.

“These medical professionals are great at what they do,” Shuty continued, “but we put them into a new environment that is extremely realistic. They have oxygen masks and tanks like in a genuine airplane. They can see how fast they use their oxygen and then have to figure out how to refill it, all while there is a fire in the airplane. Adding layers to the simulation gets their adrenaline going, and it is interesting for us and for them to see how they respond under stress.”

TSgt Shuty added that instructors always include a strong emphasis on safety because conditions such as those presented sometimes cause tunnel vision or task saturation in real life, causing people to forget about safety. From day one, he said training involves crew resource management—teaching students to look out for each other and keep patient safety and crew safety front and center, no matter what happens.

“They are taught communication techniques, too,” he said, “where crew members step in to ask if they want to give this medication, deliver shock, check a pulse—things like that. So they are always communicating, keeping each other on task and giving appropriate treatments. Without a doubt, this hands-on training prepares attendees for real-life scenarios. Our aircraft simulators have the same equipment students will see in their squadrons, and we train for scenarios using the same checklist they will use when responding to actual emergencies. We teach them skills they will need throughout their career.”

In addition to aeromedical evacuation, the facility trains critical care air transport teams. Shuty said USAFSAM acquired a Black Hawk recently and will get an Osprey, as well, and hopes to bring in other branches of service for joint training.

“We want to be the center of excellence for all en route care training,” he concluded. With about 6,000 Department of Defense, international, and civilian students attending annually, it is well on its way to becoming just that.