DVIDS – News – Army CAB Paramedics and Nurses Advance Battlefield Medicine

CAMP BUEHRING, Kuwait – Critical medical care providers with the 11th Combat Aviation Brigade (CAB), Combined Joint Task Force – Operation Inherent Resolve (CJTF-OIR), advance battlefield medicine by increasing rates ill, injured, and postoperative U.S. life support, coalition, and partner patients during extensive helicopter medical evacuation transfers in Iraq, Syria, and other U.S. Central Command areas.

11th CAB, deployed as Task Force Eagle, and patients throughout the Operation Inherent Resolve (OIR) Joint Area of ​​Operations (CJOA), including designated areas of Iraq and Syria, are the last to benefit from US military initiatives to increase patient survivability. The 11th CAB medical evacuation system includes critical care flight paramedics (CCFP) and en route critical care nurses (ECCN) embedded within the brigade. This suit serves as fulfillment of the 2013 U.S. Congressional mandate to increase military standards for the certification and training of in-flight care providers in hostile or combat areas.

The National Defense Authorization Act of 2013 required Army service components to certify all F3 Flight Physicians (68WF3) as Nationally Registered Paramedics (NRPs) by FY2025. In October 2021, 11 CAB mobilized with CCFPs for all Medevac crews.

Years of US military operations in areas like Afghanistan have led to the development of a “golden hour” model for injured or ill personnel. This approach aimed to increase the chances of survival for trauma patients by delivering them to surgeons within 60 minutes of their injury. After a CJOA Medical Response Unit receives a request for an air ambulance, the nearest available Army Medical Evacuation Team prioritizes delivery of critical patients from the point of injury to a medical treatment facility for advanced care.

The reduced coalition presence in Iraq and parts of Syria results in longer flight paths for medical evacuation routes. In an environment where patients can spend several hours without specialist care and where a few minutes can mean life or death, the deployment of more trained and experienced medical providers is essential.

Army flight doctors have limited experience and training in providing extended prehospital care during air transfers. Army regulations allow these “F3” medics to perform basic medical procedures, similar to emergency medical technicians in the United States. However, a former flight doctor cannot use more complex techniques without additional training and validations by a flight doctor.

Flight paramedics have fewer limitations in the use of more advanced lifesaving techniques and equipment. To reduce the skill gap and improve patient outcomes, the U.S. Army Medical Center of Excellence certifies experienced F3 flight physicians as F2 flight paramedics (68WF2). These medical procedures, detailed in the Standard Medical Operating Guideline (SMOG), include limited surgery, IV infusion pumps, and treatment of ventilated patients before arriving at a medical treatment facility.

“As a CCFP, I am expected to treat and manage ICU-level patients, in addition to my basic roles as a combat medic,” said U.S. Army Master Sgt. Richson Nguyen, CCFP at 11th CAB. “If the need arises, we are also equipped to care for our canine service members.”

F3 medics attend the intensive eight-week Combat Paramedic Course (CPC or “pipeline”) at Fort Sam Houston, Texas for classroom training and real-world clinical experience before certification as F2 flight paramedics .

Prior to the mobilization of 11th CAB, Army Reserve Aviation Command units from Colorado and Texas certified every CPC-assigned flight medic years ahead of the 2024 deadline. This initiative positioned air ambulatory crews from the 11th Expeditionary Combat Aviation Brigade in key areas in Iraq and Syria.

As early as 2010, the US military took another step to improve patient outcomes as declining forces deployed to austere and hostile locations. The Army has embedded critical care nurses en route as part of medevac teams to meet the challenges of longer patient hold times and extended aeromedical flights.

The Army Nurse Corps has embedded these active-duty nurses into 11th CAB medical units at each primary medevac site in the OIR area to provide additional critical care skills to crews tasked with transferring patients.

“During extended and unconventional critical care transports in theatre, CCFP can draw on the knowledge and experience of ECCN to provide the best care and outcomes for all patients,” said Staff Sgt. U.S. Army Derek Demoss, senior paramedic with 11th CAB. “ECCNs bring additional knowledge and experience of inpatient treatment of critically ill patients to aeromedical evacuation platforms.”

To qualify as an ECCN, every Army nurse must complete the two-week Joint Enroute Care Course (JECC) run by the Army School of Aviation Medicine at Fort Rucker, Alabama. During the JECC, experienced nurses are trained and familiarized with Army air operations to adapt their expertise to treating patients thousands of feet above the ground.

“The JECC has been supporting ECCN integration since 2010 and continues to evolve to meet the current downstream mission,” said U.S. Army Cpt. Rachel Wilson, an 11th CAB ECCN. “All ECCNs are Critical Care Nurses in Emergency (66T) or Critical Care (66S).”

In addition to a continued threat from adversaries, 11th CAB nurses and paramedics must also adapt to the extreme working environments inside helicopters where temperatures exceed 120 F in the summer and dip well below freezing. in winter.

“The air temperature can drop 3.5 degrees with every 1,000 feet of elevation gain,” said Air Force Master Sgt. Dalton Sexson, with the 11th CAB Weather Office. “The temperature at flight altitudes has dropped to -12 degrees Fahrenheit or -24 degrees Celsius since 11 CAB began operations.”

Aircrew should wear hearing protection in flight when noise levels exceed those of a construction site or a live rock concert. Far from the more sterile and stable hospital facilities usual for most nurses, Task Force Eagle’s ECCNs quickly acclimated to the harshest conditions.

“We had to consider a more EMS approach. We had to work with more limited capabilities that we are not used to,” said U.S. Army Maj. Ernest De la Cruz, ECCN chief of 11th CAB. “The hospital environment provides us with a lot of materials and equipment to do our job. However, doctors don’t have that access, so we have to learn how to operationalize our approach. The job involves supporting flight paramedics and being part of the MEDEVAC team in all respects.

After years of planning, budgeting and planning, 11th CAB deployed as the Army’s first aviation brigade with embedded paramedics and flight nurses to provide patient-driven extended pre-hospital care. demands of modern conflict. The availability of these medical professionals remains critical to coalition efforts to assist and enable partner forces in the sustained defeat of Daesh – the common Arabic term for “IS” or “ISIS” – in designated areas of Iraq and from Syria.

“The combined knowledge, skills and experience of CCFP and ECCN provide the highest level of tactical medicine and en-route critical care available across all departments,” DeMoss said.