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Some time Sunday, a C-9 Nightingale aeromedical evacuation aircraft will depart from Ramstein Air Base in Germany.

Its return flight Monday will mark the end of more than a decade’s worth of missions of ferrying patients from remote locations to military medical facilities in Europe and the States.

But the bad news isn’t causing health care officials to reach for any medication for themselves. They’ve been planning for the stoppage.

“It didn’t catch anyone by surprise,” said Air Force Dr. (Col.) James Rundell, executive director for Tricare Europe. “The Air Force approached us more than a year ago.”

So Tricare officials and commanders at military medical clinics in countries such as Turkey, Italy, Spain and Portugal have had a lot of time to adjust. There will not be a regular service to replace the flights, so other arrangements have to be made.

“We’ve been working hard at building up our local national care network,” said Col. Lee Payne, commander of the 31st Medical Group at Aviano Air Base, Italy. “If you’re sending all your patients in the medevac system and haven’t been [building up], then it might hit you harder.”

Rundell said Tricare officials have been coordinating efforts to prevent such a scenario. Most of the thousands of patients who took advantage of the flights needed emergency medical treatment or specialized medical care that wasn’t available in their local communities.

The emergency service is not going away. It’s now going to be provided by a fleet of C-21 aircraft based at Ramstein that will be available to transport patients within the European theater around the clock.

Rundell said Tricare — the health care insurer for many servicemembers, family members and civilians in Europe — has taken a three-pronged approach to provide alternatives for those who relied on the flights for specialized care.

The first was an analysis of the system’s Preferred Provider Network at the dozens of clinics where patients formerly relied on C-9 flights. When it was possible, local national specialists were evaluated and added to the system. A few times, the military assigned specialists to a particular clinic.

Tricare also looked at the number of circuit flights that were taking place.

“That’s where we take the doctor to the patients instead of taking the patients to the doctor,” Rundell said. “That program is in place and functioning.”

The third approach was to encourage local clinics to pool resources with those in neighboring communities. For example, patients who may not be able to get specialized treatment in Vicenza might be able to receive it in Aviano.

Payne said several ideas came out of a recent meeting in Italy, when commanders talked about the needs in various communities.

As a result, he said, he expects to see some patients flown from Sigonella, Sicily, to Aviano. And some doctors from Aviano may be making visits to Camp Darby.

“It’s kind of a complete new way of thinking about business since that [flight service] has gone away,” he said.

Cooperation among clinics isn’t necessarily new, though.

Expectant mothers from Vicenza have been having their babies at Aviano’s pediatric center in Sacile for years. And Master Sgt. Delton McClary, stationed at Aviano, is looking forward to receiving care for his ear at the Navy’s medical center in Naples.

But McClary, assigned to the 16th Air Force, will be one of those sorry to see the C-9 service disappear. He’s what some might call a frequent customer.

While he was stationed in Spain, his sons had to use the flights. One received tubes in his ears in Rota and another was treated in Germany for a hernia. McClary himself took the flights several times to get treatment for a cancerlike condition in one of his ears. Those flights went all the way to the States.

“[The C-9 service] has been there for my family and the needs we’ve had,” he said.

Now, he’s planning to see a Navy doctor in Naples for a follow-up visit for his ear. “I’ll just ride the train down and see the doctor,” he said.

Staff Sgt. Lina Berrio, the patient movement technician at Aviano, said she is not worried about sending experienced travelers such as McClary on commercial transportation. The concern is for younger, inexperienced airmen who are being sent to places they haven’t been before.

So, Berrio has taken on more travel agent duties. She makes sure patients have all the information they need about their travel routes before they get on a plane or train.

She said she’s been telling patients about the change for months. The most concern has come from a retiree who has used the C-9 service to get regular care at Landstuhl Regional Medical Center in Germany.

In such cases, there may be some seats available on the C-130 planes that stop a few times a week at the base. But their primary missions are to deliver cargo.

“There may be some other paths or they may just have to seek local care,” Payne said, admitting that it’s sometimes a hardship for retirees who often have to pay more for care on the economy.

In a way, the C-9s themselves have been helping patients get used to the end of the service. Berrio said there were as many as five weekly flights in the spring, serving about 50 people a week from Aviano. That’s been reduced to two weekly flights.

“Recently, there haven’t been as many [patients],” she said.

That number will drop even lower this weekend. After two stops in Turkey and three in Italy, the last Nightingales will be making their final flights across the Atlantic Ocean with retirement in their future.

(EDITOR'S NOTE: Civilians who are eligible to participate in Tricare are family members of active-duty servicemembers, military retirees and their families, and survivors of the servicemembers who are not eligible for Medicare.)

C-21 to be new hospital in the skies

Most military medical officials wouldn’t be making plans to replace the C-9 medical evacuation planes if they had a choice.

They don’t.

The Nightingales based at Ramstein Air Base in Germany have been in service since the late 1960s. The Air Force determined that it would cost too much to refit the planes or replace them. Besides being in need of some repair, they failed to meet some noise regulations at airports in Germany and the States.

So the planes are set to go to a scrap yard in Arizona after making their way across the Atlantic.

The C-9s were specially outfitted to serve as hospitals in the skies. Medical personnel could perform some treatment on board or stabilize patients en route to large medical facilities in Europe or the States.

The C-21, an aircraft normally used for cargo and passenger airlift, has been refitted for medical missions and will now serve as the primary air ambulances in the European theater. The 86th Aeromedical Squadron at Ramstein has been training on C-21 aircraft for months.

— Kent Harris

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Kent has filled numerous roles at Stars and Stripes including: copy editor, news editor, desk editor, reporter/photographer, web editor and overseas sports editor. Based at Aviano Air Base, Italy, he’s been TDY to countries such as Afghanistan Iraq, Kosovo and Bosnia. Born in California, he’s a 1988 graduate of Humboldt State University and has been a journalist for almost 38 years.

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