Joint medevac team transports critically-ill Marine from Japan to Hawaii

  • Published
  • 13th Air Force Public Affairs
JOINT BASE PEARL HARBOR-HICKAM, Hawaii --  A joint military and civilian medical team evacuated a U.S. Marine via a C-17 Globemaster II from Japan to Hawaii who required urgent cardiac and respiratory care due to severely infected lungs, here March 26.

The 12-person Pacific Air Forces medical transport team, comprised of medical personnel from Tripler Army Medical Center, PACAF's Critical Care Air Transport Team Element-East and the Kapiolani Medical Center, provided the patient Extracorporeal Membrane Oxygenation during the transpacific flight-- medical treatment that provides both cardiac and respiratory support to patients whose heart and lungs are so severely diseased or damaged that they can no longer function.

"The patient remains critical but stable on ECMO," said Lt Col. (Dr.) Melissa Tyree, a staff neonatologist and neonatal/pediatric ECMO specialist at Tripler Army Medical Center." "He is responding very well to ECMO support and his lungs are already beginning the slow process of recovery nicely."

The U.S. Marine patient was initially MEDEVAC'd from a ship 13 days ago to the United States Naval Hospital Camp Lester, Okinawa, Japan, where he received initial stabilization and was cared for in the Intensive Care Unit. The patient was found to have a severe lung infection (pneumonia) that caused diffuse lung injury and a progressive challenge to exchange oxygen and eliminate carbon dioxide as the patient's heart pumped blood through the lungs necessitating the use of ECMO technology.

The ECMO is most commonly used in neonatal intensive-care units, for newborns in pulmonary distress; however this transport marks the Pacific theater's first-ever military "Adult" ECMO transport using a USAF "Grey Tail" (global airlift aircraft) with aeromedical evacuation system support.

"The ECMO system performed flawlessly during flight. The mission was complex, with many logistical and technical challenges, however the team was hand-picked to cover the full spectrum of required expertise so that every obstacle was overcome and the patient received seamless, safe world-class medical care," said Tyree.

There is no formal adult ECMO program -- or even one physician specializing in adult ECMO -- anywhere in Hawaii. According to Dr. Tyree, only a handful of the approximately 130 ECMO programs worldwide are set up to handle adult patients.

The ECMO system was one fraction of a very complex system that comprises the USAF aeromedical evacuation system infrastructure. In less than 24 hours, the medical team was organized, a C-17 was secured by the 613th Air Mobility Division's Aeromedical Evacuation Control Team, and multi-institutional equipment and supplies were all coordinated. In addition, a special ECMO stretcher, chock-full of tubes, wires and medical devices, was constructed for what one Soldier described as a successful mission.

"For us, a successful mission is any mission where we can retrieve a patient anywhere in the Pacific theater, bring them back here to Tripler Army Medical Center, without any degradation in patient condition and no adverse events before, during, or after the flight," said Staff Sgt. Brendan Beely, Joint Medical Attendant Transport Team non-commission officer in charge at Triple Army Medical Center.

The core medical transport team included perfusionists (a specialized health professional who operates the ECMO heart-lung machine), pulmonologists, a cardio-thoracic surgeon, registered nurses and respiratory therapists.

"The Critical Care Air Transport Teams are part of what has revolutionized air evacuation here in the United States and around the world," said Col. Paul Friedrichs, Pacific Air Forces command surgeon. "We now can provide the same level of care in the air that you can get in any intensive care units in the United States. This mission today is a great example -- this is the first time in the Pacific Air forces where we have been able to take a patient whose lungs were not working, put them on a lung bypass machine called an ECMO machine, fly them all the way from Okinawa to (Hawaii), and save their life."

The colonel added, "What's particularly impressive to me about this, that I'm so proud of, is that this is a joint team of medics. We've got Army, Air Force, and Navy medics as well as some of our civilian experts helping us provide state-of-the-art ICU care for this patient and we are making sure that wherever the warfighter goes he or she can get the best care in the world."

Aeromedical evacuation dates back to World War II where injured patients weren't transported by fixed wing aircraft until they were stable, requiring about 45 days on average during the Vietnam War to evacuate patients from Vietnam to the United States. Today, patients can be evacuated within three days from point of injury all the way through the air evacuation system and back to the United States.

Colonel Tyree, who previously worked in the neonatal/pediatric ECMO program at Lackland Air Force Base, Texas, says even when a patient dies despite the best efforts of a military medical team, "what gives families the greatest sense of peace is that the government cares - it's as if the President himself has reached out to them."

Tyree added, "This mission would not have been possible without the tremendous multidisciplinary effort put forth by so many including 13th Air Force, United States Transportation Command's Theater Patient Movement Requirements Center Pacific, 535th Airlift Squadron, TAMC, PACAF CCATT Element East, and the Hanuola ECMO program of Hawaii. The family greatly appreciates the special care taken by the US military to try to save their son."

The medevac team was led by Army Lt. Col. (Dr.) Erik Osborn, a staff pulmonologist and critical care specialist at Tripler Army Medical Center, Hawaii. Colonel Osborn's previous assignment was at Landstuhl Regional Medical Center in Germany where he has transported Wounded Warriors from Iraq and Afghanistan on Extracorporeal Membrane Oxygenation as a member on the Acute Lung Rescue Team.