Aeromedical evacuation changes to focus on requirements

By Tech. Sgt. Mark Diamond
Air Mobility Command Public Affairs

SCOTT AIR FORCE BASE, Ill. -- When the Air Force officially announced the retirement of the C-9A Nightingale on July 23, to some the announcement simply meant the end of an era in Air Force aeromedical evacuation.

To others, the retirement of the C-9A - the AE workhorse for the past 35 years - signaled the beginning of a new aeromedical evacuation environment; an environment where CONUS, peacetime AE missions become the exception, rather than the norm.  Or what Air Mobility Command officials are calling a "requirements-based" rather than "capacity-based" system.

According to AMC Command Surgeon Brig. Gen. (Dr.) Thomas J. Loftus, although the C-9 is going away, the mission of aeromedical evacuation will continue, but with noticeable changes. 

"In the past, we used a capacity-based system.  Many of our patients were transported from small medical facilities to larger medical facilities simply because we had a system in place (the C-9) dedicated to moving patients from one location to another throughout the United States," General Loftus said. 

Scheduling of the C-9 was comparable to commercial airlines, with mostly predetermined stops for any passenger needing to travel.  The only limit was the capacity of the aircraft. 

This capacity-based system was used extensively from the 1970s through the early 1990s.  However, the general said, the full implementation of TRICARE in the early 1990s led to a significant decrease in the number of CONUS, peacetime AE missions - from about 70,000 in 1990 to about 11,000 in 2001.  At that rate, the number could reach as low as 3,000 by 2005.

"The full implementation of TRICARE created a shift in healthcare to local medical facilities, which considerably decreased the number of patients who required in-flight medical care," said Loftus.

The general said more patients now receive medical care in their local area, which allows the change to the requirements-based system.  The Defense Department's TRICARE program has successfully created networks of local doctors and hospitals to take care of the medical needs of military personnel, retirees and their families.

Educating CONUS military treatment facilities on the new requirements-based AE system is a continuous process.  Part of that education will take place each time a patient movement request is made, according to Lt. Col. Duane Hill of the Global Patient Movement Requirements Center here.  The GPMRC handles AE mission requirements determination, validation and coordination.  Colonel Hill said the requirements-based system will be a mindset change for everyone involved in the AE process.

"We need to be sympathetic to the (patient movement) requests, but at the same time, our MTFs need to understand that the C-9 is gone, and the TRICARE network needs to be utilized," said the colonel.

Col. Darnell Waun, AMC's chief of healthcare operations division and the AMC command nurse, agreed that the new AE system will be a significant change for many because patient movement has traditionally been synonymous with the C-9.

"Now, [aeromedical evacuation] is just one way to move a patient," Colonel Waun said.  "Depending on patient needs they can be moved commercially, by ground, or as a space available passenger on military airlift.  Moving a patient from Point A to Point B does not necessarily mean (military) airevac, unless they require en route care."

Requirements-based, in essence, means urgent or priority (or patients needing in-flight care) aeromedical evacuation is needed and the Air Force aeromedical evacuation system will get them where they need to go.

Without the C-9, the Air Force's CONUS aeromedical evacuation mission will continue using other AMC airlift and tanker aircraft.

New AE technology, called patient support pallets, is making it possible to transport patients aboard aircraft not normally used for aeromedical evacuation.  The patient support pallet, developed at the Human Systems Center at Brooks City-Base in San Antonio, is built on a standard cargo pallet and provides support for six litters or a combination of three airline seats and three stretchers.  The Air Force's uses the PSPs on KC-135s, KC-10s and C-17s. 

The Air Force began using C-130s and KC-135s for AE within CONUS Aug. 7.  According to AMC officials, the KC-135 missions run cross-country to Scott AFB and end at Travis AFB, Calif.  There will be C-130 routes from each of the three areas, Andrews AFB, Md., Scott AFB and Travis AFB, to transport patients to their final destinations. 

AMC officials are confident that the new requirements-based AE system will work, but not without a few challenges.

"Anytime you make a change, there are challenges," said the general.  "We've been using the C-9 to transport patients around the United States for many, many years."

Although current usage of the C-9 is very low, Loftus said he realizes the retirement of the C-9 will affect some people who have relied on that system for a variety of reasons, including specialized medical care and space-available travel.

"This is all about taking care of patients," said the general.  "And that's what we're all about."

Col. George Tirabassi, deputy chief of AMC's Operations Management Division, AE, said the people who have been involved in AE operations for more than a few years know that the AE system has always been bigger than the C-9.

"The C-9 was undoubtedly the flagship of aerovac," Tirabassi said.  "But we know there is an awful lot of aerovac that goes on in the world that doesn't involve the C-9.  [During wartime operations], the Army medevacs patients using helicopters within the theater, and the Air Force moves patients using any available AE capable mobility aircraft. The wartime AE system has worked very well without C-9s."

AMC officials are confident a CONUS aeromedical evacuation system without C-9s will work equally as well.