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Aeromedical Evacuation

In Mosul, Iraq, Soldiers walk patients on litters to a 777th Expeditionary Airlift Squadron C-130 Hercules for transport on an aeromedical evacuation mission to Joint Base Balad, Iraq, Feb. 27, 2009. (U.S. Air Force photo/Senior Airman Elizabeth Rissmiller)

Aeromedical Evacuation

An early air evacuation trainees pose for a photo at Bowman Field.

Aeromedical Evacuation

Nurses at Bowman Field, Kentucky, train with gas masks.

Aeromedical Evacuation

Members of the Air Force Reserve's 445th Aeromedical Evacuation Squadron conduct a training mission aboard a C-17 Globemaster II.

WRIGHT-PATTERSON AIR FORCE BASE, Ohio -- This year the Air Force celebrates 75 years of air evacuations and the scores of injured service members who have been safely flown from combat areas to higher echelons of care.

Although the Air Force didn’t graduate its first class of fully trained flight nurses until 1943, using air evacuation as a tool to transport injured soldiers actually started well before the current formal air evacuation system was established.

As early as World War I, planes were used to transport injured individuals. However, the concept of utilizing the care of trained nursing staff members while transporting the injured by air was not fully realized until 1932, when Lauretta M. Schimmoler, a nurse and a pilot, established the Aerial Nurse Corps of America.

It was Schimmoler’s vision that qualified nurses would be available to provide care specific to the demands of patients being transported by air.

While the U.S. military did not immediately recognize the value of such care in the air, as World War II raged on and the number of wounded and sick in both the European and Pacific theaters increased, the military began to look for a quicker method of evacuating patients.

In November 1941, the Medical Air Ambulance Squadron was started with the intent of transporting war casualties by air to improve survival rates. Initially, the U.S. Army Air Corps attempted to evacuate some casualties in B-17 Flying Fortress bombers before quickly learning that the B-17 was not suitable for carrying patients.

The Army Air Corps also recognized that patients being transported needed care providers in flight.

The first Air Surgeon, Brig. Gen. David Grant, encouraged the training and use of skilled nurses to transport casualties by air. It was known that patients transported by air were subject to stresses of flight that can impact the patient’s outcome and nurses and medics would need to be trained in this field.

The 349th Air Evacuation Group was established at Bowman Field in Louisville, Kentucky, in 1942. Under the group was the Medical Air Evacuation Training Squadron, which was tasked with training these “angels of mercy.”

Initially six weeks in length and later stretched to eight weeks, the training encompassed specifics of air evacuation as well as general military instruction.

Nurses participated in ground bivouac exercises, practiced emergency landing or ditching protocols and spent hours on training flights between Bowman Field and Camp Atterbury, Indiana. The first group of fully trained flight nurses graduated on February 18, 1943.

At the graduation, Grant noted that these nurses and medics accepted some of the highest risk of any military personnel. They would perform their duties on aircraft meant for cargo missions and would therefore not have the benefit of the red cross marker to signify a medical mission. Nonetheless, these brave men and women volunteered unselfishly for this job.

Once their training was complete, the flight nurses and medics were off to areas oversees to practice their skills at transporting the sick and wounded out of the area of combat and back to a higher echelon treatment facility.

Not only did their presence offer a timely transfer of the patients, it offered relief to the forward medical units busting with wounded soldiers. In flight, the nurse would be fully responsible for all the casualties onboard the plane with the assistance of one medic. If a flight surgeon was not available, the nurse would also be expected to assign priority to the evacuees being recovered on the ground.

These early missions were conducted on C-47 Skytrains, which could carry up to 24 patients after being converted into a hospital with straps to hold the litters.

The air evacuation nurse and medic would monitor the patients’ pulse and respirations, offer comfort measures and attend to wounds throughout the flight back to a hospital at a rear operation location or a base hospital.

The use of air transport had a huge impact on the war effort.
An October 1945 article in the Air Surgeon’s Bulletin entitled “Air Evacuation of One Million Patients: Review of Operations to VE-Day” lauded the success of air evacuation in saving lives noting that more than 350,000 patients were evacuated out of the European front between D-Day and VE-Day alone.

Hundreds of thousands more followed in the Pacific front leading to the headline number of one million patients transported by air evacuation.
Gen. Dwight Eisenhower said, “We evacuated almost everyone from our forward hospitals by air and it has unquestionably saved thousands of lives.” He went on to categorize the advent of air evacuation in the same class of impactful things as sulfa and penicillin drugs, blood plasma and whole blood products in decreasing the fatality rate of war casualties.

Air evacuation continued to be a valuable tool for the military in the wars that followed World War II. Hundreds of thousands of patients have been successfully transported back to higher echelons of care outside the combat area, decreasing the fatalities of each war or conflict to this day. The men and women who have served as flight nurses or air evacuation medics have risked their own lives to ensure the safe transport of others.

Today, the Air Force aeromedical evacuation system is an important part of the Air Force global mobility mission. The AE mission is to provide “time sensitive, mission critical en-route care to patients to and between medical treatment facilities. The AE system falls under Air Mobility Command and AE missions are carried out using C-17s, C-130s and KC-135s.

Now consisting of two registered nurses and three air evacuation technicians, the modern air evacuation crew can configure one of these aircraft into a temporary flying hospital which can serve as many as 97 patients at a time.

The bulk of the Air Force’s air evacuation mission is the responsibility of the Air Force Reserve. The Reserve has 18 AE squadrons across the nation. There are 10 Air National Guard units with AE squadrons. The active duty force has only four AE squadrons.

In addition to standing ready to provide timely air evacuation to the nation’s military men and women, the AE system also offers humanitarian relief when the need arises. AE squadrons have participated in air evacuation missions of individuals impacted by natural disasters such as hurricanes or earthquakes.

Following in the footsteps of the brave men and women who have performed the aeromedical evacuation mission for the past three quarters of a century, the Reserve Citizen Airmen who serve as flight nurses and air evacuation technicians stand ready to meet the nation’s needs in the area of air evacuation.

(Washington is a flight nurse assigned to the 445th Aeromedical Evacuation Squadron, Wright-Patterson Air Force Base, Ohio)