I n t e g r i t y - S e r v i c e - E x c e l l e n c e The Center for Sustainment of Trauma and Readiness Skills Cincinnati Division of Trauma and Critical

I n t e g r i t y - S e r v i c e - E x c e l l e n c eThe Center for Sustainment of Trauma

and Readiness Skills Cincinnati

Division of Trauma and Critical Care

Department of Surgery

The University Hospital of Cincinnati

Cincinnati, Ohio

AE OVERVIEW

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Overview

Traditional AE aircraftNon-traditional AE aircraft

Capabilities Safety features and in-flight emergency

information

Ground operationsCrew Coordination


C-130

• Oxygen • No onboard therapeutic

oxygen for pt use• Portable Therapeutic

Liquid Oxygen (PTLOX)

• Communication system• Loud aircraft• Communicate through

MCD/loadmaster

• Electrical Systems• Seven 28VDC• Three 115 VAC@ 400Hz• Required use of

Frequency Converter and ECAS System


C-130

• How do you load the patient?• Cargo ramp (feet first)

• How many patients can I put onboard?• 70-74 litter patients• 92 ambulatory patients in evans seats• Maximum of 15 floor loaded patients


C-130C-130Emergency Exits Emergency Exits

Primary Ground Exits• Crew Entrance Door• Paratroop Doors

Secondary Exits• Pilot/Copilot Clear view

Windows• Side Escape Hatch – Avoid

Fish, Fan, Flame• Ramp - only if open and

unobstructed

Primary Ditching Exits• Fwrd Overhead Escape Hatch • Cntr Overhead Escape Hatch

Aft Overhead Escape Hatch

Chopping Locations• Have no hydraulics, electrical,

or oxygen lines in these areas• Chop in and inverted U


= Only if opened and unobstructed

=Ditching Evacuation

=Secondary Exits

=Secondary for Ground and Ditching

=Ground Evacuation

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 7


C-17

• Stand-alone capabilities = 9 Litters (in 3 stanchions)• Patient Support Pallet (PSP) expands litter capabilities • Floor Load

• 48 Litters in cargo compartment • Additional 12 litters can be floor loaded on ramp

• 102 Seats for Ambulatory and AECMs• Loading/unloading

• Ambulatory: crew entrance door• Litters: cargo ramp (feet first)


C-17AIRCRAFT SYSTEMS

Oxygen• Two 75-liter LOX Converters on

board• Minimum 100 L before leaving

home stationo Therapeutic Oxygen

5 outlets all located on the right side

o Emergency Oxygen Dixie-cup diluter mask pull lanyard to start flow available at each potential

litter space on stanchions 60 masks on sidewall additional 48 for

centerline seats if/when installed

Electrical• frequency converter is NOT

required• twelve 115VAC 60hz outlets on 6

panels– 3 located on each side (forward, mid-

cabin, aft)

• twelve 28V DC plugs– No PMI application


C-17AIRCRAFT SYSTEMS

• Lighting• Controlled by

loadmaster (LM)• On/Off/Dim

• Communication• Controlled by LM• All briefings done by

LM

• Environmental• Heating/cooling

controlled by LM

• Comfort Items• Crew Lavatory

o Forward Left side of AC

• Galleyo Forward Sectiono Convection Oveno Refrigerator / Freezer

• May have Comfort Pallet


• Emergency Exits (12)• Flight Deck:

o Pilot/co-pilot sliding windowso Maintenance/ditching hatch

• Cargo Compartment:o Crew entrance dooro Forward emergency escape

dooro Four overhead ditching

hatches Flotation Equipment

Deployment System (FEDS)

o 2 troop doors (rt/lt aft aircraft)o Cargo dooro Chopping locations (4)

C-17EMERGENCY INFORMATION



C-17


CCATT In-flight

Evaluate all patients when at altitude

Maintain situational awareness at all times

Utilize critical thinking skills

Utilize closed loop communication

Utilize crew resource management (CRM)

TEAMWORK-TEAMWORK-TEAMWORK!

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Non-Traditional AE Aircraft


C-21

• Oxygen Capabilities• Portable D-cylinder oxygen tanks• Spectrum Unit has self-contained oxygen 3,500L

• Electrical Capabilities• Equipment battery• Power required:

o 28V DC AC power

• Electrical Output:o #2 115VAC/60hz o total 15 Amps


C-21

• Communication Capabilities• Easy (real small aircraft!)

• Loading/unloading• Crew entrance door (only option)• If Spectrum unit is in place, use patient loader

o Aluminum folding ramp that allows you to “slide” patient in


EMERGENCY EXITS

• Crew entrance door• 2 over wing exits


KC-10

• Oxygen Capabilities• Bring PT LOX

• Electrical Capabilities• Use pigtail of electrical cable assembly system (ECAS)

o Power source: 115vac/400hz

• Frequency converter can be used for 60 Hz equipment o Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary

panel/ galley outleto Total of 15 amps ( 1 amp to drive the unit, 14 amps remaining)

o Equipment On Battery

o PSP adds Litter Capabilities


KC-10

• Communication capability• Relatively easy to

communicate with one another• Use boom operator as a

runner/communication between aeromedical crew and flight crew

• Loading/unloading• K-loader• Lift truck• Patient loading system (PLS)



KC-135

• Oxygen capabilities• Bring PT LOX

• PSP adds Litter Capabilities• Electrical capabilities

• Use pigtail of electrical cable assembly system (ECAS)o Power source: 115vac/400hz

• Frequency converter can be used for 60 Hz equipment o Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary

panel/ galley outleto Total of 15 amps (1 amp to drive the unit, 14 amps remaining)


KC-135

• Communication capabilities

• Not that great, loud aircraft• Communication between

aeromedical crew and flight crew done through boom operator

• Loading/unloading• K-loader• Lift truck



C-5

• Oxygen capabilities• Bring PT LOX

o Requires extra 300 feet of oxygen hosingo Load may require PT LOX be in cargo compartment and oxygen lines be

strung up to troop compartment• Therapeutic oxygen manifold system (TOMS) may be used from

recharger hose• Portable oxygen cylinders

• Electrical capabilities• Modified Avionic frequency converter for 60 Hz equipment• Secured in the cargo compartment with ECAS to troop or courier

compartment• Arrange with the loadmaster


C-5

• Communication Capabilities• Relatively easy to communicate with one another• Communication between flight crew and aeromedical crew

done through loadmaster

• Loading/unloading• K-loader• Lift Truck• Catering Truck • Cargo Ramp (If patient is placed in cargo compartment –

ABSOLUTE LAST RESORT!)


CIVIL RESERVE AIR FLEET (CRAF) Boeing -767

US DoD maintains several civilian/commercial airlines with B-767’s that are capable of rapid transformation into AE aircraft

Crew Complement:

• Flight attendants have primary responsibility for:• Egress• Patient briefings• Serve meals


CREW COMPLEMENT

• AECMs have responsibility for:• Patient care • Assist with egress/ other emergencies

• 2 AE crews• 2 FN’s/3 AET’s each crew• One forward crew • One aft crew

• CCATT • Augment critical care capabilities as mission

dictates


EXITS

• 6 Exits• 2 doors in front of

aircraft• 2 overwing exits• 2 doors in back of

aircraft


CRAF Capabilites

• Small-body B-767– Configured to transport 87 litters and

37 seats (includes 2 MCD seats)

• Large–body B-767– Configured to transport 111 liters and

37 seats

• Top litter is about mid-chest• 18 inches between each litter• Aisles are 25 inches wide


MEDICAL OXYGEN SUBSYSTEM

• Consists of six 75- liter LOX in forward cargo compartment

(total of 450 liters)


MEDICAL OXYGEN SUBSYSTEM

• Therapeutic oxygen outlets located at each potential litter space

Oxygen outlets


AIRCRAFT PASSENGER EMERGENCY OXYGEN SYSTEM

• Diluter-type masks from overhead consoles


ELECTRICAL POWER DISTRIBUTION SUBSYSTEM

• Subsystem consists of 6 electrical converters• Converts to 115 VAC 60 hz• Supplied to electrical outlets at

each stanchion• Outlets labeled #1, #2, and #3• Power strips not to exceed 20

amps


ELECTRICAL POWER DISTRIBUTION SUBSYSTEM

CAUTION

When switching from ground to aircraft power, power may be interrupted

momentarily in any aircraft

Closely monitor all critical equipment


LOADING/UNLOADING

High Deck Loading Platform System (HDLPS)• Holds 24 Patients• Patients placed 4-high• Raised/lowered to aircraft


High Deck Loading Platform System

37


High Deck Loading Platform System

38


LOADING/UNLOADING

Patient Loading System (PLS)• 50-foot length ramp • Can be assembled and rolled to

aircraft• Patients enplaned head

first/deplaned feet first• May have 2 units (one forward on

each side of aircraft)• Ground personnel enplane up ramp

and exit out aft stairs



CCATT Onload

41


CCATT On-load

Ensure emergency litter is located under most critical patient

Set up airway/Advanced Cardiac Life Support bags

Ensure all medications/blood products are enplaned

Are patients adequately sedated-give boluses prior to take-off

Quickly re-evaluate all patients prior to take-off

42


CCATT On-load

Ensure emergency litter is located under most critical patient

Set up airway/Advanced Cardiac Life Support bags

Ensure all medications/blood products are enplaned

Are patients adequately sedated-give boluses prior to take-off

Quickly re-evaluate all patients prior to take-off

43


Is all equipment secured?

44


Hang Supplies for Easy Access

45






Stresses of Flight

G: G-Forces

H: Decreased Humidity

O: Decreased Partial Pressure of Oxygen

S: “Shakes”/Vibration

T: Thermal Changes

B: Barometric Pressure Changes

A: And

N: Noise

• All of the stresses of flight result in fatigue for both you and your patient

50


CCATT Preflight/Packaging

Preflight: CCAT team reviews Patient Movement Request, discusses pt needs and anticipates needs for flight-GAME PLAN!

Pre-Hospital: Have someone designated to do specific jobsDetermine patient load plan

Oxygen calculations/electrical requirement

Extra equipment/supplies neededVacuum Spine Board

Extra IV Pumps

Extra ventilator circuits and batteries

Sign out narcotics

51


CCATT In-flight

Evaluate all patients when at altitude

Maintain situational awareness at all times

Utilize critical thinking skills

Utilize closed loop communication

Utilize crew resource management (CRM)

TEAMWORK-TEAMWORK-TEAMWORK!

52


CCATT Post-Flight

Patient off-load is a critical phase of the missionCCATT crews are tired and have high risk factors for making a

mistake

Transportation from aircraft to the hospital is on a bus without electrical capability

Perform team huddle to discuss off-load game plan

Provide a thorough hand-off to accepting team

Perform a debrief with your team: strengths, weaknesses of mission and areas of improvement

53


SAFETY CONCERNS

• Secure loose bags/gear before take off

• No gloves when handling oxygen

• Avoid patient care activity during take off/landing• Alert AE if you need to stand during these times

• If pt is unstable, you can be secured to the pt litter while standing

• When 3 patients are transported per litter tower, each litter position is rated to hold 320 lbs• Considerations with OSL (Over-Size Litter)• OSL can be tier loaded but consider floor loading


SAFETY CONCERNS

• Airframe• Do not open crew entrance door on C-17 unless gauge

on door is in the “green”

• Patient• Do we have to remove all the rollers in the cargo

compartment?

• Crew/CCATT• What is our role during an aircraft emergency?


Questions?

Documents

I n t e g r i t y - S e r v i c e - E x c e l l e n c e The Center for Sustainment of Trauma and Readiness Skills Cincinnati Division of Trauma and Critical