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

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

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 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-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

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

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)

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

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

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)

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!

Non-Traditional AE Aircraft

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

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

EMERGENCY EXITS Crew entrance door 2 over wing exits

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

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)

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)

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

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

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

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

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

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

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

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

High Deck Loading Platform System

High Deck Loading Platform System

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

CCATT Onload

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

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

Is all equipment secured?

Hang Supplies for Easy Access

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

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

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!

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

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 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?

Questions?