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Saving Lives In The Future Battlespace
by U.S. Air National Guard Tech. Sgt. Kasey M. Phipps
November 14, 2019

In and out of emerald islands that dot the clear turquoise of the Caribbean Sea, a Texas Air National Guard C-130 Hercules from the 136th Airlift Wing out of Carswell Field, Texas, weaves close enough to see the windows of the colorful houses in the hills below as its crew executes low-level navigation during a training event at the U.S. Virgin Island of St. Croix, August 21-24, 2019.

As white caps glitter across the sea below and clouds lazily dance overhead, the Oklahoma Air National Guard Aeromedical Evacuation aircrew working within the fuselage of the C-130 hurriedly don their oxygen masks while preparing for rapid decompression.

“St. Croix is an exotic destination,” said Oklahoma Air National Guard (ANG) Maj. Chris Lane, director of operations for 137th Aeromedical Evacuation Squadron (137th AES) out of Will Rogers Air National Guard Base in Oklahoma City. “But we don’t really care what the destination is as long we can train there and back.”

The four-day event — which included two seven-hour flights to and from St. Croix, a four-hour ground training and evaluation meeting the second day, and a two-hour low- level flight the third day — was largely driven by an overhaul of career field-wide aeromedical evacuation training and evaluation standards.

August 21, 2019 - Oklahoma Air National Guard aircrews assigned to the 137th Aeromedical Evacuation Squadron out of Will Rogers Air National Guard Base in Oklahoma City prepare litter patients to be loaded onto a Texas Air National Guard C-130 Hercules assigned to the 136th Airlift Wing out of Carswell, Texas, before taking off toward the U.S. Virgin Island of St. Croix from Will Rogers during a training mission. (U.S. Air National Guard photo by Tech. Sgt. Kasey M. Phipps)
August 21, 2019 - Oklahoma Air National Guard aircrews assigned to the 137th Aeromedical Evacuation Squadron out of Will Rogers Air National Guard Base in Oklahoma City prepare litter patients to be loaded onto a Texas Air National Guard C-130 Hercules assigned to the 136th Airlift Wing out of Carswell, Texas, before taking off toward the U.S. Virgin Island of St. Croix from Will Rogers during a training mission. (U.S. Air National Guard photo by Tech. Sgt. Kasey M. Phipps)

“Our training is much more robust now,” explained Oklahoma ANG Tech. Sgt. Aaron Rickey, 137th AES standards and evaluations noncommissioned officer in charge. “Because it’s new, we’re trying to step into it — to see what it actually takes to get everything done, because we’ve never seen these types of requirements before.”

Aeromedical evacuation Airmen training requirements break down into two main categories: flying and clinical. Though the flying requirements, such as emergency flight procedures and aircraft configuration, remained largely unchanged through the overhaul, the more clinical or medical requirements steeply increased.

“There are only so many ways to put out a fire or prepare for a crash landing,” said Lane. “But the clinical requirements increased in volume. They surged about 20 percent in volume, and the density, or quality, of training increased a lot as well.”

Oklahoma ANG Staff Sgt. Avery Keller, a 137th AES aeromedical evacuation technician, used the pain management training requirement as an example.

“We used to talk about pain management for a bit to establish understanding and then we got the credit,” said Keller. “Now you have to know every single route of administration, you have to know benzodiazepine toxicity, narcotic toxicity, and every pump in detail. Each item is four to five times larger than it used to be, so instead of getting 20 items per flight checked off, you’re looking at three to four.”

Combining the more detailed training requirements with regular, semi-annual evaluation windows and the added stress of needing at least half of their requirements accomplished in the air as opposed to training on the ground, the aircrews necessitate more flights and more time on those flights.

“When we fly locally, we have very set and limited training times,” said Rickey. “When we do an off-station training event, we have seven hours there and seven hours back depending on the location. That affords us a lot more time to get requirements accomplished. Almost everyone who attended this event completed about 90 percent of the requirements they needed for their semi-annual evaluation period done — in a matter of a few days.”

Within those days, the squadron accomplished an estimated 415 individual training items (out of the 1,800 required by the entire squadron in a six-month evaluation period) and hundreds of hours of total training for the 16 aircrew members within the 16.5 hours of combined flight.

“To be able to maximize and concentrate that training into one event is huge for us,” said Lane.

Staying current in training is especially important for members of the 137th AES when considering their deployment rotations, which fall under three categories. The first is their regular Air and Space Expeditionary Forces (AEF) rotation that occurs every 15 to 17 months. The second is focused on domestic operations or disaster response, in which the unit is “on- call” for hurricane season. The third is week-long operational missions that occur at least every quarter, during which the crews fly live patients returning from combat zones.

“Our rotations vary,” said Lane. “The tempo is always high, and the missions vary. That’s okay. That’s what we want.”

Along with frequent and overlapping rotations, the 137th AES is faced with another challenge that events like the one in St. Croix help with — the lack of an intrinsic airframe — which often puts the squadron “at the mercy” of aircrews and their flying requirements.

“We’re universally qualified, which means we can fly and operate on several different U.S. Air Force airframes,” explained Lane. “Developing relationships with other units, like with the 136th Airlift Wing that we worked with in St. Croix, is important. We don’t want to paint ourselves into one corner with one airframe, especially one that we’re not using in contingency environments. Combining those resources is best for everyone.”

An anticipated and trending change in those contingency environments is, in fact, what drove the overhaul in the aeromedical evacuation career field in the first place.

“So for that last 20 years in operations in Afghanistan, it’s been in a non-traditional battlespace,” said Lane. “Although we’ve had a constant flow of patients, the volume of the patients has been pretty low. An average flight from Afghanistan to Germany would have maybe 20 patients with a mixture of acuity, such as sick, not sick, ambulatory and litter-bound.”

Looking into the Air Force’s future operational plans, that non-traditional battle space shifts to more peer-to-peer environments.

“When we model those out and look at what engagements with those kinds of adversaries look like, the volume of patients significantly increases,” said Lane.

A typical aeromedical evacuation aircrew is made up of two nurses and three medics, but when you pair those crews with 200 or even 500 patients on a large aircraft with limited medical support, the aircrew must be more reliant on themselves and their medical knowledge.
“In order for us to meet the growing needs of the Air Force in that type of environment, we need to be more clinically competent,” said Lane.

So, not only are crews required to accomplish more training on the clinical side, but they’re also required to maintain the knowledge they already have.

“It’s just like adding 10 percent more knowledge on the 90 percent you already have,” explained Keller.

In flight, aircrews must know and recognize details ranging from patient accountability and wellness to properly facing patients in order to compensate for airflow in case of a contagion. Having live patients, such as those in the St. Croix event, and the added pressure of the time limitations of the front-end crews builds an element of reality to the already hands-on training.

“You have to have a really good working knowledge,” explained Keller. “It all has to be muscle memory because you can’t just pull out your checklist every time a patient codes. You can’t develop that memory on checklists alone. That’s why these flights are so important.”

Caring for patients in the air has its own complications. Lack of oxygen, too much noise, too little light, too much vibration and too little space all complicate tasks that would normally be routine on the ground.

“When we use live people, not only can they show a grimace, pain and alertness, but they also remind us to think about comfort,” said Lane. “The small things make people feel like you care about them, whether you’re in a hospital, with your family or in the back of a plane.”

The St. Croix training event was also unique in that it utilized Airmen from around the Oklahoma Air National Guard base as patients, which not only helped to save resources, but also allowed members of the base to be face-to-face with the 137th AES’s mission.

“Everybody knows that the aeromedical evacuation squadron is here on base, but people rarely get to see what they do,” said Oklahoma ANG Senior Master Sgt. Thomas Verdine, 137th Special Operation Wing Inspector General superintendent. “They have the additional tasking of not just medical professionals, but also fliers. They care for, load, unload and navigate patients through in-flight emergencies for hours at a time.”

“We really are moving service members out there,” said Lane. “If you ask any of us, the reason we do this job is because we want those service members on the ground to know that we’re there for them no matter what. I think that’s universal. The Air Force will launch an entire crew for one person who’s injured, and that’s important to us.

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