8,000 FEET ABOVE CHARLESTON, S.C. — The hum of the plane's engines gave way to a flurry of activity in the back of the C-130H Hercules.
A team of flight nurses and technicians surrounded the "patient," frantically compressing his chest and pumping air through his mouth while readying medical equipment.
All the while, other airmen gave directions or evaluated the performance while steadying themselves within the rocking plane.
The airmen, members of the 43rd and 36th Aeromedical Evacuation Squadrons, were training for the worst.
Overseas, it will be their job to transport wounded or ill soldiers, airmen, seamen or Marines from combat hospitals to larger medical facilities.
Some of the airmen taking part in the training recently returned from deployment. Others were preparing to head overseas for a third or fourth time.
Aeromedical evacuation is one of the three tenets of the Fort Bragg-based 440th Airlift Wing, along with airlifts and air drops.
But if current Air Force plans are approved, the aeromedical evacuation mission, like the 440th Airlift Wing, eventually will leave Fort Bragg's Pope Field.
On Monday, the C-130H left Pope Field and headed north to Raleigh, then veered toward the coast.
There, the crews said the plane took the "Lighthouse Tour" down the coasts of the Carolinas before heading back to Fort Bragg.
Monday's training was meant to mimic real-world scenarios from Afghanistan, said Air Force Col. Tom Hansen, commander of the 36th Aeromedical Evacuation Squadron.
The crews transported a mix of training dummies and airmen playing the roles of the injured — from a mental health emergency to a gunshot or an improvised explosive device victim.
"This is essentially what you'd see if we were on the ramp at Bagram," Hansen said shortly before takeoff.
Hansen, a Reservist, lives in Gig Harbor, Wash., and works as a family nurse practitioner when not in uniform.
He said the C-130H was able to carry as much, if not more, medical equipment as an ambulance.
"We're closer to a flying emergency room," Hansen said.
Inside the dimly lit belly of the plane, stretchers and equipment took up the center aisle, with more patients laid out on the floor near the rear door.
The medical crew poured over documents using tablet computers. Others looked over medical records while using a generator as a desk.
On the training flight, crews had to fend off a mock fire while protecting patients, solve a pressurization problem and respond to health emergencies while monitoring their patients and doling out medication.
When one airman, acting as a patient, began mimicking seizures, her colleagues stepped in to keep her from flailing.
When another patient suffered a pneumothorax — trapped air that separates the lung from the chest wall and interferes with breathing — the crew stepped in to perform lifesaving techniques.
"We have many years of people who have translated real life into these scenarios," Hansen said. "We need to be ready for multiple emergencies."
"Train like you fight," he said. "It's what we want to do."
Capt. Missy Dassinger is a flight nurse with the 43rd Aeromedical Evacuation Squadron. Monday's training was helping to prepare her for a four-month deployment to Afghanistan, set to begin in about two months.
"We pride ourselves on having the most realistic training," she said.
The 440th Airlift Wing is a composite wing, meaning it includes active-duty, Guard and Reserve airmen.
The 36th Aeromedical Evacuation Squadron is a Reserve unit. The 43rd is an active-duty unit. But the two groups often train together.
An aeromedical evacuation training unit is also located at Pope Field, officials said. It brings in about 200 airmen each year for training.
Air Force leaders have briefed members of Congress who represent Fort Bragg that the 440th is set to be deactivated.
If so, Fort Bragg would lose its only Bragg-based Air Force planes. It also likely would lose those units, like the aeromedical evacuation squadrons, that depend on those planes.
Brig. Gen. Jim Scanlan, commander of the 440th Airlift Wing, has said the possible deactivation has his airmen in an unusual position.
On one hand, they must continue to train for their ongoing missions. On the other, they are preparing for a future where they may be forced to move or leave the Air Force.
Scanlan said his airmen also continue to prepare for the possible arrival of the newer C-130J planes that were earmarked for Pope by a 2013 law.
Those plans have been abandoned. And Air Force plans to scrap its older C-130H fleet has the unit reeling from last week's announcement of possible deactivation.
An estimated 1,400 airmen and 300 civilians would be affected by deactivation, officials have said. They also estimate the unit's economic impact at about $78 million.
Those numbers, and the unit's role in working with Fort Bragg's airborne units, have many hoping lawmakers and local leaders can lobby the Air Force to save the unit.
To do that, the 440th would have to get either C-130Js or newer C-130Hs.
The latter would likely only be a stopgap, officials said.
"If we just keep the H's, we'll be having the same conversation in a year or so," a unit spokeswoman said.