BALAD AIR BASE, Iraq — It’s nearly midnight, the crew of military doctors, nurses and medics has flown thousands of miles from Germany to Iraq, and their mission has only just begun.

They have an hour to turn the cabin of a C-141 cargo plane into a flying ambulance able to carry patients suffering from gunshot wounds to appendicitis. But the veteran crew with the 791st Aeromedical Evacuation Squadron is ready in minutes for the first wounded Marine.

“This is actually a light load for us,” Maj. Brian Hubbard said of the nearly 30 patients the team transported from central Iraq to Ramstein Air Base in Germany last Thursday. “This is unusual.”

The unit has flown more than 14,000 patients since the squadron’s inception in February 2003.

Some crewmembers have made more than 100 similar trips since the Sept. 11, 2001, terror attacks and can set up frames for stretchers and run oxygen tubes without uttering a word to each other.

The missions last between 16 and 28 hours. But as mentally and physically taxing as the flights can be, crewmembers find the job rewarding.

Senior Airman Kim McCuiston, 22, of Indiahoma, Okla., has done 123 evacuations in the past year. She remembers the parting words of one of her first patients.

“One of the boys that we were bringing home rolled over and he just had tears in his eyes and he said, ‘Thank you for everything you’ve done,’ ” McCuiston said. “And that just kind of humbled me because, you know, here this kid is going home and he’s not the same, and he’s thanking me for doing the job that I love.”

Transporting critical patients by air is nothing new, but today squadrons like the 791st quickly whisk wounded troops from front-line hospitals and aid stations to hospitals in the United States and Germany, where they receive specialized care.

By using ordinary cargo planes to carry patients, a critically injured troop can be at a U.S. military hospital in the States in less than 48 hours.

“We’re better than FedEx,” said Lt. Col. Mike Dankosky, the 791st commander.

Patients’ ailments on Thursday ranged from eye injuries and broken limbs to facial burns. Most of the ill and injured were what the team calls “walkie talkies,” those able to walk onto the planes with little or no help.

Airmen loaded 13 patients onto the plane on stretchers, hoisted onto frames and put on top of one another. In the C-141, they can stack patients four high and carry as many as 103, forcing nurses to climb on top of seats or other stretchers to provide care.

They carried the most critical patient, a servicemember with a gunshot wound to the neck, onto the plane with 66 pounds of medical equipment fastened to his stretcher.

Oxygen tubes and wires relaying instant vital information help the critical-care team keep the man alive for what would be a five-hour flight from the desert of Iraq to Germany.

The goal is to “stabilize” the most seriously injured patients and keep them alive long enough so doctors or specialists on the ground can continue the care needed to save the servicemember’s life.

Capt. Pamela Joseph, 45, a flight nurse with the Oklahoma-based 137th Aeromedical Evacuation Squadron, said a crucial duty is keeping the patients comfortable.

The silver-haired divorced mother of two teenage boys introduces herself to patients as “Pam,” but crewmembers call her “mom.”

Joseph, who joined the Air National Guard at 39, said she often is impressed at how the patients who are wounded the worst sometimes have the best attitudes. But she finds it heartbreaking that many are oblivious to the severity of their life-changing injuries.

“They don’t really realize until they get back to the States how it’s going to affect them, but it will,” said Joseph, 45, a civilian nurse of 23 years.

Talented, trained crew makes sure patients make it

Flying wounded soldiers and Marines from Iraq to Germany is a delicate procedure and wouldn’t be possible without specially trained doctors, nurses and medics.

They have to brace patients for the stresses of flight, monitoring changes in barometric pressure as well as patients’ vital signs. Turbulence can cause the plane to shake. And cabin temperatures can fluctuate, going from near freezing to extremely high temperatures.

It can make a simple procedure, such as administering intravenous fluid, tricky at 30,000 feet. Changes in altitude could cause air trapped in the skull or chest to expand, possibly resulting in additional damage.

“All of the changes of flight can impact our patients,” said Maj. Brian Hubbard, an active-duty trauma nurse with the 791st Expeditionary Air Evacuation Squadron.

An aeromedical evacuation crew typically consists of three people: one flight nurse and two medics. But missions to the Persian Gulf include a crew of seven because they often take between 20 and 50 patients.

Most are either Air Force Reserve or Air National Guard members.

A Critical Care Air Transport Team, or C-CAT, also is on board to handle the most seriously injured or ill patients. This intensive care unit in the sky includes a doctor, a critical-care nurse and a respiratory technician.

Crews have the benefit of some of the most advanced medical gear, including mobile liquid oxygen units.

“It’s state-of-the-art equipment,” said Lt. Col. Mike Dankowsky, commander of the 791st. “A typical [emergency medical technician] on an ambulance would kill for this stuff.”

If a patient were to worsen in flight, the crewmembers could divert to a place such as Turkey in an emergency.

Although that has happened, the 791st has not lost a patient in the air.

— Scott Schonauer

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