Photo By Lt. Col. Ellen Krenke | Dr. (Col.) Bruce Guerdan, the air surgeon for the Florida Air National Guard, is the...... read more read more
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LANDSTUHL MEDICAL CENTER, Germany - The Air National Guard will contribute much-needed medical expertise to the Critical Care Air Transport Team mission, the top trauma doctor here said, Jan. 10.
“More and more in the Air Force active duty side, the opportunities to take care of … patients in our day-to-day job are becoming more limited, because many of our facilities are downsizing,” said Air Force Lt. Col. Raymond Fang, the trauma director here at Landstuhl.
“We don’t have busy, comprehensive intensive care units anymore. Other than the people here at Landstuhl and the big medical centers in San Antonio … there’s not a wealth of critical care experience on the active duty side all the time.”
Since Air Guard medical personnel do this work in their civilian careers, their experience is invaluable.
“They bring, I think, much appreciated manpower, because CCATT has become what they call a high density, low demand capability and to be honest with you the active duty side … is just getting heavily stressed continually manning all these positions,” Fang said. “So having another pool of personnel who are capable and willing to help man the positions that are needed is welcome.”
In September, Fang spent two weeks at the University of Cincinnati for critical care training along with two members of the Air Guard’s first CCATT.
“I think it is a wonderful thing,” Fang said. “The Air Guard brings a lot of enthusiasm, and they bring a huge amount of personal expertise and experience to the mission.”
As a former CCATT member, Fang said the most challenging part of the job is planning for any contingency.
“You are trying to provide critical care without all the resources you are accustomed to when you are in a fixed hospital,” he said.
At a hospital, if you need a cardiologist or any other medical specialist, all you have to do is call him. When you are flying 35,000 feet over the Atlantic Ocean, you can call a specialist for advice, but they are not coming to the bedside to help you.
“You have to take a very complicated medical situation – taking care of an intensive care patient - which is very challenging on the ground and then you multiply the challenge several fold by putting them on an aircraft where they are isolated without all the resources that you are used to,” Fang said.
Pharmacy, laboratory and X-ray are also services that you take for granted at hospital.
“For a CCATT mission, you have to plan ahead,” Fang said. “You have a suitcase full of medications, which are all commonly used medications or very specific emergency use medication … if you think you might need something you need to plan ahead and bring it.”
Fang said they try to hold patients with head and lung injuries at facilities downrange.
Flight for patients in both these categories will exacerbate their medical issues. The noise and bumpiness of flight can agitate a patient with a severe head injury, and taking to altitude where the air is thinner can endanger a patient with a severe lung injury.
“Those can be very challenging patients even for very experienced and skilled critical care physicians,” Fang said.
Patients who need blood transfusions can be held at Landstuhl until their condition improves, but in the middle of a battle patients at a Level 2 facility have to be moved if possible.
“Some of the patient challenges are reflective of the location they are originating from,” Fang said.
A lung rescue team has been formed at Landstuhl for patients who are too sick for a standard CCATT to move.
“Sometimes we will launch from Landstuhl down to get them and bring more equipment and more expertise and experience than a typical CCATT has,” he said.
In these instances, Fang said he also looks to the Air Guard personnel for their expertise. “Many of them see very sick patients in their private civilian practices than you might see in the active duty Air Force side. They will again bring a wealth of information, support and experience and capability to some of these very sick patients in the future.”
The main benefit of having a CCATT to move patients is that it allows there to be a smaller footprint downrange, Fang said. “It means less medics have to be deployed … because you aren’t managing huge hospitals. You don’t have to bring the kitchen sink downrange and have a huge vulnerable target – a hospital.”
On the other hand, “we really don’t know what all the effects are of moving patients so rapidly,” he said. “We may move patients because we have to and because we can, but we don’t always know that moving a patient at exactly one day after an injury is the best thing for the patient.”
Fang said if we knew that it was great to move patients so quickly then we would put a runway next to every hospital in the United States, throw patients onboard and fly them around for a couple of hours.
“But we don’t do that, because we don’t know if it is good for the patients,” he said. “We do it because we have to, because the facilities downrange are smaller and because we can.”
Finally, Fang said the biggest misperception about the CCATT is that it is a flying intensive care unit. However, a typical ICU is painted white and has lots of flashing lights. That is not the case in the back of an aircraft.
“We have taken a very challenging patient care situation and put it in the aircraft and done it with great success and a great safety record … we do it because we have to,” Fang said. “I think the people who do this mission deserve a lot of credit for enabling the military medical system to function in this way over all these years.”
They also enable the medical community to continue to learn from their actions. “There is a lot of push to … take [these experiences] and put them to use on the civilian side,” Fang said.
For example, in rural Wyoming, a patient could be stabilized at a small hospital and then moved by a CCATT equivalent to a big city hospital, where more resources are available.
“I think there is a lot of what we do which will be translated, but it isn’t just doing what we do on the ground.”
| Date Taken: | 01.10.2011 |
| Date Posted: | 01.13.2011 15:43 |
| Story ID: | 63494 |
| Location: | LANDSTUHL MEDICAL CENTER, BW, DE |
| Web Views: | 153 |
| Downloads: | 0 |
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