Navy Medicine in Araby (Episode 8, the Final)

In seven previous episodes, I’ve told the story of combat casualty and general medical care given our sailors in conflicts in “Araby”, starting with 19th century battles against the Barbary States and finishing with our current military activities in Iraq and Afghanistan. Herewith is the final episode, in which I describe the truly innovative aerial ICUs of the U.S. Air Force.

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The final 21st century iteration of an earlier concept is the Air Force’s Critical Care Air Transport Team. The first reported aeromedical evacuation was during the Franco-Prussian War of 1870-71, when 160 French casualties were evacuated by observation balloons from Paris, then under siege. Fixed wing aircraft soon followed, and by the end of WW I, the British were using aircraft specifically modified for medical applications. The United States Army Air Corps created Medical Air Ambulance Squadrons starting in 1942, and by the end of WW II more than a million patients from both theaters of war had been evacuated by these means. The concept of critical care evacuation – that is, transporting medically unstable patients requiring such support as respirators and intensive physiological support (IVs, transfusions and blood pressure sustaining drugs and the like) – evolved quickly after Operation Desert Storm, when it was discovered that such a capability simply did not exist. This lack of capability at the time forced the Army and Navy to utilize huge and semi-permanent Field Hospitals in or near the theater of operations. Prior to 1994, aeromedical transport teams typically consisted of two or more nurses, sometimes with critical care training, and several medical technicians. In 1994, the Air Force launched a formal Critical Care Air Transport Team program. These teams include critical care physicians, critical care nurses, respiratory therapists and the required medical supplies to support what are essentially flying ICUs. This concept has permitted medical planners to reduce the size of in-theater medical facilities while enhancing their flexibility and mobility to keep them as close as possible to zones of combat. [1],[2] Once wounded warriors receive emergency stabilizing surgeries, they can be rapidly evacuated to more definitive care settings in Kandahar & Bagram in Afghanistan, or to Landstuhl Germany or even to the specialty care facilities like the Brooke in San Antonio.

flying ICU.jpg

Intensive Care Unit in an Airplane (Credit: http://www.dodlive.mil)

In conclusion, there really is no comparison between the medical care offered our sailors in the Barbary Wars and that provided today. Hippocrates, the Greek father of western medicine wrote in ‘On the Surgery”, “He who desires to practice surgery must go to war”, and it is cliché’ nowadays to say that the surgical art and science advance with every war. The evolution of that art is clearly seen in this story of Navy medicine across three centuries. From bleeding and purging to antibiotics and transfusions, from amputations in the cockpit to damage control surgery in the field and intensive care in airplanes, the sophistication of knowledge and the resources brought to bear for the care of combat casualties are beyond comparison.

The one common thread throughout this story, however, is the dedication of medical people to the care of their sick and wounded military compatriots.

[1] Air Transport of the Critical Care Patient, http://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=57ab806b-df57-42d7-85b4-5f96907faf92, accessed 5 October 2016.

[2] U.S. Air Force Website, Gulf War Created Need for Better Critical Care, http://www.af.mil/News/ArticleDisplay/tabid/223/Article/643126/gulf-war-created-need-for-better-critical-care.aspx?source=GovD, accessed 5 October 2016.

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