Prospective observational study of United States (US) Air Force critical care air transport team operations in Iraq

Background: Current United States (US) military doctrine emphasizes rapid evacuation of casualties to fixed medical facilities remote from the theater of war. To support this strategy, the Air Force has formed Critical Care Air Transport (CCAT) teams consisting of a physician, nurse, and respiratory therapist. Study Objective: To describe the characteristics of US Air Force CCAT team operations at Balad Air Base, Iraq over a 1-year period. Methods: Balad Air Base was the primary collection point in Iraq for patients requiring evacuation outside of the country during the study period. The study authors deployed sequentially to Balad Air Base as CCAT team leaders. All patients transported by the authors were enrolled in the study. Injuries, illnesses, demographics, and in-flight data were collected prospectively. Results: There were 133 patients transported on 61 separate flights between Iraq and Germany. Trauma was present in 65% (87/133) of all patients transported. Lower-extremity injuries were the most prevalent among combat-related trauma patients. Cardiac conditions were the most common diagnoses among the medical patients. Fifty-seven percent of patients were mechanically ventilated. Hypotension was the most common in-flight complication, occurring in 17% (22/133) of patients. No flights were diverted or turned back due to an unstable patient. No patient died during flight or in the 24 h after the flight. Conclusions: US Air Force CCAT teams can safely transport multiple critical patients over long distances while providing intensive care interventions. Medical patients make up over one-third of patients requiring CCAT team transport.