Critical Care Air Transport Team



The Critical Care Air Transport Team (CCATT) is a unique, highly specialized medical asset that can create and operate a portable intensive care unit (ICU) on board any available transport aircraft during flight. It is a limited, rapidly deployable resource and a primary component of the Air Force's Aeromedical Evacuation (AE) System. The CCAT team is a three-person medical team consisting of a physician specializing in an area such as critical care, pulmonology, surgery, etc., along with a critical care nurse and a respiratory technician. The team is experienced in the care of critically ill or injured patients with multi- system trauma, shock, burns, respiratory failure, multiple organ failure and other life threatening complications. The complex, critical nature of the patient's condition requires continuous stabilization, advanced care, life-saving invasive interventions during transport, and life or death decisions.

Shifts in national military strategy have emphasized an "evacuate and replace" philosophy regarding the treatment and transportation of ill and injured personnel. This strategy has led to a significant reduction in the Air Force's forward, in- theater medical footprint, requiring the development of a robust patient movement capability. AE is now tasked to rapidly evacuate casualties from numerous, forward locations that are supported by small expeditionary medical units. This has created the need to shift from evacuating "stable" patients to evacuating "stabilized" patients, and developing the capability to care for critically ill and injured personnel during air transport. The single, key element in the success of this shift in our concept of operations is the capability of the Critical Care Air Transport Team.

The concept for developing the CCATT was initiated in the early '90s in an effort to expand the Air Force's aeromedical clinical transport capabilities. An aircraft-based critical care team would allow the early transfer of "stabilized" critically ill or injured medical and/or surgical patients by providing an intensive care unit (ICU) capability on-board any available transport aircraft. The CCATT pilot-program was initiated in May 1994 at the 59th Medical Wing, Wilford Hall Medical Center, Lackland AFB TX. By June 1996, CCATT was formally approved and adopted into the USAF Aeromedical Evacuation System, and has been established throughout the Total Force.  Since their inception, CCATTs have participated in numerous operations: Operation UPHOLD DEMOCRACY, Operation JOINT ENDEAVOR, the pullout of US troops from Somalia, the Khobar Towers bombing, non-combatant evacuation of the US Embassy in Liberia, the USS Cole incident, hurricane evacuations for Katrina, Rita, Gustav, and Ike, as well as numerous other peacetime and humanitarian missions.  Within days of the onset of Operation ENDURING FREEDOM, CCAT teams were present in-theater; and were saving lives and making history - bringing their level of medical capability closer to the battle than ever before, operating out of far-forward, austere airfields. This positioning has ensured vital critical care is within minutes of those who need it. They have also provided essential critical care in conjunction with Special Operations Forces - Medical Elements (SOF-ME) on-board SOF aircraft conducting evacuation of critically ill or injured patients.

On 1 Oct 2002, recognizing the increased role of CCATTs in AE missions, CCATT members became fully eligible to participate in Air Force flying activities under the designation of "Operational Support Flier." CCATT members must meet certain physical standards and complete altitude physiology chamber training to be eligible for OSF status, and are required to have the same Personal Protective Equipment as other in-flight members of the AE team.  Air Force CCATTs have performed superbly in Operations ENDURING FREEDOM and IRAQI FREEDOM, flying in combat on a wide range of aircraft and on missions that last from 30 minutes to more than 12 hours. Combining CCATT capability with far- forward surgical teams has proved to be a powerful combination.  To date, the CCATTs have cared for more than 4000 patients on life-support ventilation with a perfect record of no patient complications while in-flight. CCATT members recorded nearly tens of thousands of hours of flying time caring for critically ill or injured patients on-board military transport aircraft during tactical and strategic air-evac missions - very often flying into and out of hostile areas.  Presently, there are 92 CCAT teams allocated in the Air Force manning structure. 60 active- duty team allocations are assigned to 11 different bases across seven major commands, with an additional 32 Air Force Reserve CCATT allocations.  As the lead command responsible for aeromedical evacuation, Air Mobility Command (AMC), Scott AFB IL, has also been designated as the Manpower Equipment Force Packaging (MEFPAK) responsible command for CCATTs. As such, AMC is responsible for providing daily oversight, management, and coordination of all CCATT activities and issues across the Air Force including administrative support, logistical support, training requirements, aeromedical support, clinical matters, equipment funding and development, etc.  On a day-to-day basis, CCATTs are assigned to and work as clinical staff members in fixed medical treatment facilities, but are available for critical care air transport missions on an occasional basis. When called upon, they participate in flying activities on military aircraft performing essential, specific, medical care duties in flight as their primary mission. CCATT equipment and supplies are designed to supplement what the AE system already carries. Their equipment sets are man-portable and contain everything they need to create an ICU on an aircraft.  CCATT equipment is highly capable, lightweight, and battery operated. Some of the items include a life support respirator, cardiac/physiologic monitor, 3-channel computerized intravenous infusion pump, and laboratory testing equipment. CCATTs also carry advanced medications and procedure kits to manage patient complications if they arise.

Personnel identified as potential CCATT members must complete a 12-day CCATT Initial Course conducted by the US Air Force School of Aerospace Medicine, Wright-Patterson AFB. The course has been developed to provide training for active-duty, air guard, and reserve physicians, nurses, and respiratory technicians to prepare them for assignment to a CCATT position. The course teaches and tests operational concepts, flight and altitude physiology, and critical care knowledge as it applies to air and ground transport of the critically ill or injured patient.  CCATT members must also complete the CCATT Advanced Course conducted at the Center for Sustainment of Trauma and Readiness Skills (C- STARS), University Hospital, Cincinnati OH, prior to performing duties as CCATT. This 14- day course, which must be completed with a successful validation rating every 24 months, is designed specifically for personnel assigned to CCATT. The emphasis is on clinical care of the critically ill and injured patient during flight. Students are exposed to a diverse group of patients in both eh adult surgical and burn intensive care units at the University Hospital. There are also extensive didactics on the air-evac system as well as the physiology of transporting critically ill patients by air.  The course culminates in field exercises involving static clinical simulator training as well as a flight “check ride.”  Over the past decade, the Critical Care Air Transport Team has matured to become a true force-enhancement; giving war-fighters the confidence they will receive prompt evacuation and emergent medical care should the need arise.

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