Army CAB flight paramedics, nurses advance battlefield medicine

Photo By Maj. Karl Cain | Cpt. Rachel Wilson, enroute critical care nurse (ECCN) with 7th General Support Aviation Battalion, 158th Aviation Regiment, 11th Combat Aviation Brigade (CAB), holds an infant while working with a Ground Surgical Team at an undisclosed location in the U.S. Central Command area of operations, 2022. The U.S. Army attaches ECCNs to Army aviation MEDEVAC units deployed to combat zones like 11th CAB, mobilized as Task Force Eagle, in support of the Combined Joint Task Force – Operation Inherent Resolve mission to advise, assist and enable partnered forces in the enduring defeat of Da’esh, the common Arabic term for IS or ISIS, within designated areas of Iraq and Syria. (Courtesy Photo)  

CAMP BUEHRING, KUWAIT

08.21.2022

Story by Maj. Karl Cain 

Combined Joint Task Force - Operation Inherent Resolve   

CAMP BUEHRING, Kuwait – Critical care medical providers with 11th Combat Aviation Brigade (CAB), Combined Joint Task Force – Operation Inherent Resolve (CJTF-OIR), advance battlefield medicine by increasing survival rates of ill, injured and postoperative U.S., coalition and partner patients during extensive helicopter medical evacuation transfers in Iraq, Syria and other U.S. Central Command areas.

11th CAB, deployed as Task Force Eagle, and patients throughout the Operation Inherent Resolve (OIR) Combined-Joint Operation Area (CJOA), including designated areas of Iraq and Syria, are the latest to benefit from U.S. Army initiatives to increase patient survivability. The 11th CAB medical evacuation system includes critical care flight paramedics (CCFP) and enroute critical care nurses (ECCN) integrated within the brigade. This combination serves as the realization of the 2013 U.S. Congressional mandate to increase Military standards for certification and training of in-flight care providers within hostile or combat areas.

The 2013 National Defense Authorization Act required Army service components to certify all F3 flight medics (68WF3) as nationally registered paramedics (NRP) before fiscal year 2025. By October 2021, 11th CAB mobilized with CCFPs for all medevac aircrews.

Years of U.S. military operations in areas like Afghanistan led to the developing of a “golden-hour” model for injured or ill personnel. This approach aimed to increase the survival odds of trauma patients by delivering them to surgeons within 60 minutes of their injury. After a medical response unit in the CJOA receives an air ambulatory request, the nearest available Army medevac crew prioritizes delivering critical patients from point-of-injury to a medical treatment facility for advanced care.

The reduced coalition presence in Iraq and parts of Syria leads to longer flight paths for medevac routes. In an environment where patients may go several hours without specialty care and minutes may mean life or death, the distribution of more trained and experienced medical providers is pivotal.

Army flight medics have limited experience and training to provide extended prehospital care during aerial transfers. Army regulations permit these “F3” medics to perform basic medical procedures, similar to stateside Emergency Medical Technicians. However, a legacy flight medic cannot use more complex techniques without additional training and validations by a flight surgeon.

Flight paramedics have fewer limitations in using more advanced lifesaving techniques and equipment. To reduce the skills gap and improve patient outcomes, the U.S. Army Medical Center of Excellence certifies experienced F3 flight medics as F2 flight paramedics (68WF2). These medical procedures, detailed in the Standard Medical Operating Guideline (SMOG), include limited surgical intervention, I.V. infusion pumps and treating ventilated patients before arriving at a medical treatment facility.

“As a CCFP, I’m expected to treat and handle ICU–level patients, in addition to my basic roles as a combat medic,” said U.S. Army Staff Sgt. Richson Nguyen, a CCFP with 11th CAB. “If the need arises, we’re also equipped to treat our canine service members.”

F3 medics attend the intense eight-week Combat Paramedic Course (CPC or “pipeline”) at Fort Sam Houston, Texas, for classroom training and real-world clinical experience before certification as F2 flight paramedics.

Before the 11th CAB’s mobilization, Army Reserve Aviation Command units in Colorado and Texas certified each assigned flight medic through CPC years ahead of the 2024 deadline. This initiative positioned air ambulatory crews from the 11th Expeditionary Combat Aviation Brigade throughout key areas in Iraq and Syria.

As early as 2010, the U.S. military enacted another measure to improve patient outcomes as declining forces deployed to austere and hostile locales. The Army integrated enroute critical care nurses within medevac teams to confront the challenges of longer patient holding times and extended aeromedical flights.

The Army Nurse Corps embedded these active-duty nurses with 11th CAB medical units at each primary medevac site across the OIR area to bring additional intensive care skills to aircrews tasked to transfer patients.

“During the extended, nonconventional critical care transports in theater, the CCFP can resource the ECCN’s knowledge and experience to provide the best care and outcome for all patients,” said U.S. Army Master Sergeant Derek Demoss, the senior flight paramedic with 11th CAB. “ECCNs bring additional knowledge and experience of in-hospital treatment of critically ill patients to air medevac platforms.”

To qualify as an ECCN, each Army nurse must attend the two-week Joint Enroute Care Course (JECC) managed by the School of Army Aviation Medicine at Fort Rucker, Alabama. During JECC, experienced nurses are trained and familiarized with Army aircraft operations to adapt their expertise to treating patients thousands of feet above the ground.

“JECC has supported the ECCN integration since 2010 and continues to evolve to meet the current mission downrange,” said U.S. Army Cpt. Rachel Wilson, an 11th CAB ECCN. “All ECCNs are critical care nurses in either the E.R. (66T) or ICU (66S).”

In addition to a persistent threat from adversaries, 11th CAB flight nurses and paramedics must also adapt to extreme work environments inside helicopters where temperatures exceed 120 F during summer and dip well below freezing in the winter.

“Air temperatures can drop 3.5 degrees with every 1000 feet gain of elevation,” said U.S. Air Force Staff Sgt. Dalton Sexson, with the 11th CAB staff weather office. “The temperature at flight altitudes have dipped as low as -12 degrees Fahrenheit or -24 degrees Celsius since 11th CAB began operations.”

The aircrew must wear hearing protection in-flight where noise levels exceed those at a construction site or live rock concert. Far from more sterile and stable hospital facilities customary for most nurses, ECCNs with Task Force Eagle rapidly acclimated to the harsher conditions.

“We had to look at a more EMS approach. We had to work with more limited capabilities that we aren’t used to,” said U.S. Army Maj. Ernest De la Cruz, 11th CAB’s chief ECCN. “The hospital setting provides us with a lot of materials and equipment to do our job. However, medics don’t have that access, so we need to learn how to operationalize our approach. The job entails supporting the flight paramedics and being a part of the MEDEVAC team in every way.”

After years of planning, budgeting and planning, 11th CAB deployed as the first Army aviation brigade with embedded flight paramedics and flight nurses to deliver prolonged prehospital care driven by the demands of modern conflict. Availability of these medical professionals remains critical to the coalition’s efforts to assist and enable partner forces in the enduring defeat of Da’esh—the common Arabic term for “I.S.” or “ISIS”—within designated areas of Iraq and Syria.

“The combined knowledge, competency and experience of the CCFP and ECCN provide the highest level of tactical medicine and en route critical care available across all services,” said DeMoss.

• Date Taken: 08.21.2022
• Date Posted: 08.27.2022 09:27
• Story ID: 428200
• Location: CAMP BUEHRING, KW