State Health Services leaders check out evacuation aircraft

LACKLAND AFB, Texas -- In the ongoing effort to ensure prompt and appropriate response to major emergencies, Texas Department of State Health Services (DSHS) officials came here Feb. 7 to learn more about the C-17 aircraft and aeromedical evacuation operations. 

It was an interesting coming together of state civil authorities, the Air Force Reserve Command (AFRC) and Texas Military Forces (TXMF). 

The AFRC's 433rd Airlift Wing at Lackland served as host for the C-17 and its crew from the AFRC's 326th Airlift Squadron, which flew to Texas from Dover AFB, Del., as part of a training mission. 

Col. (Dr.) Connie McNabb, Joint Surgeon for Texas Military Forces (and former medical group commander for the Air National Guard's 149th Fighter Wing next door to the 433rd AW), arranged for four key members of the DSHS to receive briefings on - and accompany the training mission in - the C-17, one of the primary aeromedical evacuation aircraft in the Air Force inventory. While the Texas ANG does have C-130s based in Fort Worth, it doesn't have any C-17s. 

Colonel McNabb said she wanted the guests, in addition to becoming more familiar with the C-17, "to better understand how the system works ... and to realize the timelines to put things in motion" when such an aircraft is requested to respond to a natural or manmade disaster. 

Because the National Guard has a state as well as a federal mission, TXMF can mount a strong initial response to a disaster. However, in a large-scale disaster, state civil authorities will turn to federal resources for help. Only when a "federal disaster" is declared can Air Force or Air Force Reserve units and their aircraft come into play. 

As TXMF Joint Surgeon, Colonel McNabb serves as senior medical liaison and medical planner between the TXMF and the DSHS. Her guests included Dr. David Leroy Lakey, DSHS commissioner; Evelyn Delgado, assistant DSHS commissioner for Family and Community Health Services; Dr. Adolfo Miguel Valadez, assistant DSHS commissioner for Prevention and Preparedness Services; and Rick Bays, DSHS Response and Recovery Unit director. 

Chief Master Sgt. Rodney Christa, superintendent for the 433rd AES, pointed out advantages of using C-17 aircraft for medical evacuation, compared to C-130 or KC-135 aircraft, which are also used. The C-17 is fast, well lighted inside and equipped for connecting oxygen to patients, and it requires a shorter runway and has better temperature control, to the benefit of special-needs patients, according to Chief Christa.
The aircraft can easily accommodate up to 36 patients on litters, which are stacked three high on easily installed stanchions, each with a utility panel for connecting electrical and oxygen lines from the aircraft's systems to the litter patients. 

An evacuation flight includes (in addition to the flight crew) an Aeromedical Evacuation (AE) Crew, consisting of two flight nurses and three AE technicians. When intensive care level patients are on board, the flight also includes a Critical Care Air Transport Team, consisting of a physician, a respiratory specialist and a critical care specialist, which can handle up to three ICU-level patients. 

Chief Christa said that while a C-17 is expected to be ready to respond to a disaster in 72 hours, it can be ready in fewer than 24 hours. 

After their initial briefings and a walk-through of the C-17, the DSHS VIPs stayed on board for a four-hour training mission, during which the aircraft flew over New Mexico and the Texas Panhandle before returning to San Antonio. While only nine litters were installed, the guests observed 17 433rd AES Airmen set up the equipment and respond to various in-flight emergencies, including a broken collarbone, a broken leg and even a fire, all simulated of course. 

"The patient care exercises conducted during the flight gave the DSHS commissioner a unique appreciation for the extremely high level of professionalism and dedication needed to save lives in an aerospace environment," said Colonel McNabb. "All the DSHS leaders were impressed by the very high level of medicine and nursing care capabilities."
Colonel McNabb also hoped they came away with a better picture of "all the things that have to happen" to get a C-17 and its medical crews and equipment to where they are needed before, during or immediately after a disaster. 

"During the event, we're in Austin [at the State Operations Center]," said Dr. Lakey. "This gave us a better understanding of the tools out in the field." 

The others in the party seemed to agree. 

"Learning air evacuation procedures, capabilities and limits gives me a better understanding of what we're asking for when we make a request," said Dr. Valadez. "This was a real eye-opener." 

Mr. Bays said he was amazed of all it takes to get a C-17 ready. "I want to take at look at how we can change our plans to meet the requirements of both the military and the local communities," he said. 

Mrs. Delgado, who noted that the State Operations Center "defines the needs" for disaster response, said that from her visit they can better prepare for evacuations during hurricanes and other disasters. 

"Now, when Colonel McNabb tells us the time it's going to take or what assets are available, I can see how this matches up," said Mrs. Delgado.