BALAD AIR BASE, Iraq — Getting wounded troops back to the States quickly and safely is a relatively new military philosophy.

It requires a slew of highly trained doctors, nurses, medics and other personnel to safeguard patients against the hazards of travel while critically injured. But with those people on hand, seriously wounded troops in Iraq may find themselves getting treated on American soil within 48 hours.

The old way, said Air Force Dr. (Capt.) Phillip Mason, was to build a large field hospital and let patients recuperate for several days before shipping them out.

“The new doctrine is, patients that are critically injured, or injured at all — get them home,” said Mason, a physician with a Critical Care Air Transport Team at Balad, part of the 379th Expeditionary Aeromedical Evacuation Squadron.

Moving patients out quickly to permanent facilities like Landstuhl Regional Medical Center in Germany or Walter Reed Army Medical Center in Washington, D.C., provides a host of advantages, said Capt. James Polk, a critical care team nurse. Patients can recover in a much cleaner environment, they can reunite with family faster and by moving, hospital staff in Iraq can devote more time to the patients still in the war zone.

At Balad, all patients who require evacuation usually are on a flight within 48 hours, winging their way to Landstuhl on scheduled or arranged flights.

Air evacuation requires two types of medical teams to monitor patients during a flight: The aeromedical evacuation team, or AE, consisting of a flight nurse and two medical technicians, is responsible for patients with less than serious injuries. A critical air transport team, or CATT, tends to patients with more serious needs and includes an intensive care nurse, a respiratory therapist and a physician.

Because flying can affect a patient’s condition, all medical personal on board must be prepared for a sudden change in vital signs or condition.

The in-flight medics must determine if the changes are simply caused by flying or something more serious, said Tech. Sgt. Diego Santos, 34, an aeromedical technician in Balad, who is an Air National Guard member from Charlotte, N.C., where he is supervisor for a manufacturing company.

“They can come up short of breath, have problems with their heart,” said Capt. Chris Crawford, 44, a flight nurse from Ramstein Air Base, Germany, part of an aeromedical evacuation team in Iraq.

Mason, 31, who is from Lackland Air Force Base, Texas, said, “It’s just like taking you from sea level to Denver, 5,000 feet above sea level.”

The noise of the aircraft can cause problems for the medics, as well.

“You can’t hear the alarm [on the medical equipment] as easily,” said Polk, 35, who is also from Lackland.

That means they must anticipate changes and keep close watch for any problems.

After AE teams prepare and aircraft for the flight, patients are taken from the Contingency Aeromedical Staging Facility and put on board.

“That takes coordination,” she said of organizing patient movement. “It’s intense when you’re picking up the patients.”

AE teams may have more than two dozen patients in their care on one flight. They are responsible for the patients from the moment they are put on a plane in Balad until they are removed at Ramstein, where they are taken to the Landstuhl hospital.

The critical care teams usually have one patient each because of the severity of the patients’ conditions.

“We take them from the [intensive care unit] here to the ICU there,” said Mason.

Because their charges are in less serious condition, the AE teams often get to know them during the flight.

Crawford said, “Troops that I’ve brought out are in very good spirits. They compare wounds. They say [to one another], ‘Where did you get shot?’ ”

Polk said the CATT patients are different.

“You remember names. You have five hours with them,” he said. “They never remember us. They’re on a ventilator or they’re medicated.”

If the patients don’t remember the trip, he said, “I know I’ve done my job.”

Nonetheless, this is precious cargo. The medics aren’t the only ones who help patients on their journey. Volunteers carry most of the stretchers onto the aircraft. Flight line workers come by to help.

Even the pilots have come to the back of the aircraft to lend a hand.

Still, it is the patients who are the ones worthy of admiration.

“These guys inspire me to be a better nurse,” said Crawford.

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