1. The Center for Sustainment of Trauma and Readiness Skills Cincinnati
AE OVERVIEW
The 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

2. Overview Traditional AE aircraft Non-traditional AE aircraft
Capabilities
Safety features and in-flight emergency information
Ground operations
Crew Coordination

3. C-130 Oxygen Communication system Electrical Systems
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 Hz
Required use of Frequency Converter and ECAS System

4. 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

5. C-130 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
1.        Emergency Exists
a)       Primary Ground Exits
(1)     Crew Entrance Door
(2)     Paratroop Doors

6. =Secondary Exits
=Ground Evacuation
=Ditching Evacuation
=Secondary for Ground and Ditching
= Only if opened and unobstructed

8. C-17 102 Seats for Ambulatory and AECMs Loading/unloading
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)

9. C-17 AIRCRAFT SYSTEMS Oxygen Electrical
Two 75-liter LOX Converters on board
Minimum 100 L before leaving home station
Therapeutic Oxygen
5 outlets all located on the right side
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

10. C-17 AIRCRAFT SYSTEMS Lighting Communication Environmental
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
Forward Left side of AC
Galley
Forward Section
Convection Oven
Refrigerator / Freezer
May have Comfort Pallet

11. C-17 EMERGENCY INFORMATION
Emergency Exits (12)
Flight Deck:
Pilot/co-pilot sliding windows
Maintenance/ditching hatch
Cargo Compartment:
Crew entrance door
Forward emergency escape door
Four overhead ditching hatches
Flotation Equipment Deployment System (FEDS)
2 troop doors (rt/lt aft aircraft)
Cargo door
Chopping locations (4)

13. C-17

14. 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!

15. Non-Traditional AE Aircraft

16. Electrical Capabilities
Oxygen Capabilities
Portable D-cylinder oxygen tanks
Spectrum Unit has self-contained oxygen 3,500L
Electrical Capabilities
Equipment battery
Power required:
28V DC AC power
Electrical Output:
#2 115VAC/60hz
total 15 Amps

17. Communication Capabilities
Easy (real small aircraft!)
Loading/unloading
Crew entrance door (only option)
If Spectrum unit is in place, use patient loader
Aluminum folding ramp that allows you to “slide” patient in

18. EMERGENCY EXITS
Crew entrance door
2 over wing exits

19. KC-10 Oxygen Capabilities Electrical Capabilities
Bring PT LOX
Electrical Capabilities
Use pigtail of electrical cable assembly system (ECAS)
Power source: 115vac/400hz
Frequency converter can be used for 60 Hz equipment
Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary panel/ galley outlet
Total of 15 amps ( 1 amp to drive the unit, 14 amps remaining)
Equipment On Battery
PSP adds Litter Capabilities

20. KC-10 Communication capability Loading/unloading
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)

22. PSP adds Litter Capabilities Electrical capabilities
KC-135
Oxygen capabilities
Bring PT LOX
PSP adds Litter Capabilities
Electrical capabilities
Use pigtail of electrical cable assembly system (ECAS)
Power source: 115vac/400hz
Frequency converter can be used for 60 Hz equipment
Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary panel/ galley outlet
Total of 15 amps (1 amp to drive the unit, 14 amps remaining)

23. KC-135 Communication capabilities Loading/unloading
Not that great, loud aircraft
Communication between aeromedical crew and flight crew done through boom operator
Loading/unloading
K-loader
Lift truck

25. C-5 Oxygen capabilities Electrical capabilities Bring PT LOX
Requires extra 300 feet of oxygen hosing
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

26. 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!)

27. 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

28. AECMs have responsibility for:
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

29. EXITS 6 Exits 2 doors in front of aircraft 2 overwing exits
2 doors in back of aircraft

30. CRAF Capabilites Small-body B-767 Large–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

31. MEDICAL OXYGEN SUBSYSTEM
Consists of six 75- liter LOX in forward cargo compartment
(total of 450 liters)

32. MEDICAL OXYGEN SUBSYSTEM
Therapeutic oxygen outlets located at each potential litter space
Oxygen outlets

33. AIRCRAFT PASSENGER EMERGENCY OXYGEN SYSTEM
Diluter-type masks from overhead consoles

34. 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

35. 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

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

37. High Deck Loading Platform System

38. High Deck Loading Platform System

39. Patient Loading System (PLS)
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

41. CCATT Onload

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. 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

44. Is all equipment secured?

45. Hang Supplies for Easy Access

50. 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

51. 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 jobs
Determine patient load plan
Oxygen calculations/electrical requirement
Extra equipment/supplies needed
Vacuum Spine Board
Extra IV Pumps
Extra ventilator circuits and batteries
Sign out narcotics

52. 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!

53. CCATT Post-Flight Patient off-load is a critical phase of the mission
CCATT 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

54. 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

55. SAFETY CONCERNS Airframe Patient Crew/CCATT
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?

56. Questions?