BAGRAM AIR FIELD, Afghanistan — A light rain fell on a runway in the early morning darkness as vans pulled up to what one officer calls the “Cadillac” of medical evacuation aircraft.
Dozens of service members began loading wounded comrades onto a huge C-17 military transport plane in a carefully choreographed process. As many as eight people carry a single patient, who often is connected to more than 100 pounds of advanced medical equipment.
The giant plane had been converted into a flying intensive care unit to evacuate the war zones’ most seriously wounded for advanced care in Germany and the U.S. The wounded travel under the watchful eye of Air National Guard Critical Care Air Transport Teams.
Army Spc. Adam Castagna was on one of those flights after suffering serious injuries in a roadside bombing in Afghanistan a week before Easter. The 37-year-old, whom younger comrades call “Pops,” had been evacuated to Germany. His family rushed to his bedside from New Jersey.
“He was on life support, he had internal bleeding; and I’ll be honest with you, we weren’t sure if he was going to make it,” his brother, Michael Castagna, said later.
But Adam Castagna was on his way back to the U.S. less than two weeks later, aboard a plane “with all of the equipment, the bells and whistles that you would expect to find in a civilian facility back in the United States,” said Col. Charles Chappuis, the physician on the critical care team that treated Castagna.
The critical care flights are part of a big evolution in getting wounded troops back to the U.S., which took about three weeks on average during the Vietnam War. That process can now take as little as three days, depending on the patient’s needs.
The Associated Press rode along on one of these special flights when Castagna and two other patients were flown from Germany home to the U.S.
Castagna’s trip began at Bagram, a sprawling U.S. base north of Kabul. More than 2,300 patients were brought into the post hospital’s bustling trauma center in the first three months of this year, according to Air Force Col. Guillermo Tellez, the hospital’s commander.
The wounded stay in Afghanistan as long as needed to be stabilized before being flown to Ramstein Air Base in Germany for the next level of care. The emphasis is not necessarily on moving them quickly, but when they’re ready.
“They just need to get home, closer to their family, closer to their loved ones, to do their rehab,” said Lt. Col. Kathleen Flarity, an Air Force Reserve nurse practitioner from Peterson Air Force Base, Colo., who commanded the aeromedical evacuation mission at Bagram until earlier this year.
Chappuis, the flight doctor, said the critical care teams get as much advanced treatment done on the ground as possible. The goal is to be able to spend the flight monitoring vital signs and keeping the patients comfortable instead of having to do something more complicated like putting in an intravenous tube. Once airborne, “there’s no consultant to call,” Chappuis observed.
The four critical care teams based at Ramstein fly about a dozen missions each week into Iraq and Afghanistan.
“They’re almost like the firemen,” said Dr. Raymond Fang, an Air Force lieutenant colonel and former trauma chief at the military’s Landstuhl Regional Medical Center in Germany. “You want them on the plane in case the patient has problems.”
Air Force Lt. David Worley, who was the critical care nurse on Chappuis’ team, and Tech. Sgt. Chris Howard, the respiratory therapist, watched over Castagna and two other patients on their eight-hour flight across the Atlantic Ocean.
They communicated over headsets with Chappuis, who said the three patients were given continuous infusions of painkillers and sedatives.
“If you’ll look at our patients, they seem to be very comfortable, because they are,” said Chappuis, a flight surgeon in the Louisiana Air National Guard who in civilian life is chief of surgery at University Medical Center in Lafayette, La.
Castagna spent some of the flight whispering to his younger brother, who stood watch over his bed, sometimes stroking his brother’s forehead.
“He said to me he didn’t think he’d survive the trip if I wasn’t here. I said, ‘I know you would, I’m just making it easier,'” said Michael Castagna, who added that his family jokingly gave Adam grief for forcing them to rush to see him in Germany.
As Chappuis stood nearby in an Air Force flight suit and a Nike baseball cap, Michael Castagna raved about the care his brother was receiving en route. “He’s surrounded by super soldiers. Basically, he’s their mission,” Castagna said.
Chappuis said there is no better mission, as he glanced back to check on the three patients.
“They’re very stable, which is good, and we’ll deliver them as such,” he said. “At least that’s our intention.”