The Flying Emergency Room
One reason more soldiers are making it home alive.
- By Michael Klesius
- Air & Space magazine, November 2012
USAF / Senior Airman Ryan Crane
(Page 3 of 3)
Flying directly from Balad to the States was highly unusual. “Most missions do not fly direct from the AOR [area of responsibility; Iraq, in this case] back home, due to the required aerial refueling and extended-duty day,” says Major Corbett Bufton, the Globemaster’s command pilot. But aerial refueling is always available if the mission is critical enough, as was deemed the case with Powers.
Two refuelings were scheduled: one over Turkey and another over the United Kingdom. Powers was loaded on, and swaddled in padding to protect his head from turbulence and engine vibration. At the last minute, a soldier with a gunshot wound to the neck was brought aboard as well. A seven-member critical care transport team for each patient boarded, plus a total of three and a half tons of medical equipment. Bufton was told to avoid turbulence. But he was also told to set the cabin pressure equivalent to an altitude of just 4,000 feet above sea level (the most common cabin pressurization is closer to 8,000 feet). This would reduce the risk that Powers’ frayed blood vessels would reopen, that his brain might swell further, or that tiny pockets of air trapped in his head might expand. Bufton would have to fly the airplane below 26,000 feet, well down from its optimal level—around 35,000 feet—and right into the thunderstorms forecast for eastern Europe that night. “It’s easier to pressurize it to a lower altitude if the aircraft is at a lower altitude,” says Lieutenant Colonel Andrea Gooden, deputy chief of aeromedical evacuation clinical operations and training at Scott. Furthermore, while an emergency depressurization at 26,000 feet could be bad for Powers, it would not be as bad as one at 38,000 feet.
The airplane took off. Diplomatic clearances paved the way through airspace above Iraq, Turkey, Bulgaria, Romania, Hungary, the Czech Republic, Germany, the Netherlands, and the United Kingdom. As it waded through the relatively thick air at 26,000 feet, the Globemaster burned more fuel per hour than normal. “The biggest issues that pilots must deal with in evac scenarios are time and fuel,” says Bufton. “As far as time, we made sure that all air traffic controllers were aware that we were a time-critical medevac, and we were given priority.”
Then a glitch surfaced: A miscommunication occurred between the tanker and the Tanker Airlift Control Center, so the rendezvous planned over Turkey for the first refueling couldn’t happen. Luckily, the mission planners had anticipated that possibility: In case one of the refuelings didn’t work out, they had had the airplane loaded “heavy” with fuel. “Since we had excess gas, we were able to continue without the first upload, and met the second tanker over the U.K.,” says Bufton. “It could have been an issue if we had not switched to an extended-range jet out of Al Udeid [Qatar].”
Fourteen hours after takeoff, and 20 hours from the moment he was stabbed, Powers touched down at Andrews. It was 4 a.m., July 4. Still in critical condition, Powers was rushed the 20 miles to the Naval Medical Center in Bethesda, Maryland.
Following surgery and a month-long stay at Bethesda, Powers returned to his wife Trudy and his home, near Fort Bragg, North Carolina. Amazingly, his vision, cognition, and memory are intact. He had balance difficulties, but several months of therapy overcame them. Two years later, he was back with his unit, making a parachute jump.
As for the C-17 crew who flew him to Washington, they were given 18 hours to recover. The next morning they flew to Dover Air Force Base in Delaware, where they took on 17 pallets of cargo and headed to Ramstein, Germany, then back to Qatar. “The return put us back in the system flying regularly scheduled cargo across the pond, just like any other mission that C-17s normally fly,” says Bufton.
It’s never ideal to put a gravely ill person into a potentially unstable environment like an airplane fuselage, but now, military aircraft can be so well equipped and the crews attending the injured so well trained that the patient can receive almost hospital-level care. Today, aeromedical evacuation crews average 10 potentially life-saving missions a day. Says Captain Kathleen Ferrero, a spokeswoman with the Air Mobility Command, “We move patients 3,000 miles that a civilian entity wouldn’t consider moving 50 miles.”
Michael Klesius is a former Air & Space/Smithsonian associate editor.