In the Second World War, American military doctors lost about 30% of all wounded soldiers who reached a medical facility, despite standing up an aeromedical evacuation capability during wartime.
As that capability matured in peacetime, the “died of wounds” rate dropped to about 24% from the Korean War until the early years of operations Enduring Freedom in Afghanistan and Iraqi Freedom, but that was not good enough. In the past decade, US military officials focused on improving medical care on the battlefield, and the survival rate for solders reaching medical facilities has soared to 98% today.
A range of improvements has led to the died of wounds rate stabilising at 2%: blast-resistant vehicles, more effective body armour, a regained appreciation for the tourniquet and, perhaps most importantly, forward-based surgical centres supported by aeromedical evacuation crews set up to retrieve combat wounded within 1h. Combat operations are continuing, but have slowed in recent years. So the US military’s aeromedical evacuation community has turned to new advances in air crew and medical simulators to at least maintain the current standard, even if peace prevails.
“We want to chase zero. We want 0% died-of-wounds,” says Lt Col Chad Corliss, deputy commander of the 94th Aeromedical Evacuation squadron at Dobbins AFB, Georgia. “I don’t think that’s going to happen, but what I don’t want is for us to go back to that 24% died-of-wounds rates. I want to keep us at that 2%.”
Fortunately, simulation technology has caught up with a way to realise Corliss’ ambitions. Earlier this year, UK-based EDM received a contract from China Southern Airlines to develop the first full-motion cabin trainer for an Airbus A330. The same technology that China Southern uses to train crews to evacuate the cabin during emergencies can now be used to train US military nurses how to keep patients alive while en route to a trauma centre.
CAE USA has selected EDM’s six-degrees-of-freedom platform to support a C-130H cabin mock-up configured for aeromedical evacuation. The USAF and international militaries have used stationary C-130 cabin mock-ups for loadmaster training, but this is the first time a motion-based platform has been developed for a military cabin simulator.
As EDM continued developing the motion platform, CAE delivered the cabin mock-up to Dobbins in January. The former is expected to be installed in the next few months, allowing aeromedical evacuation crews to begin training on the moving device in 2017. More motion-based platforms are on order for cabin mock-ups of the Boeing C-17 and KC-135.
Bureaucratic miscues almost scuttled the aeromedical evacuation motion simulator before the programme began. Congress approved acquisition funds of $6 million for the motion platform several years ago, but Corliss’ unit was not informed by air force budget officials. With less than a year remaining on the funding authorisation, air force officials finally contacted the 94thAeromedical Evacuation to inquire if they intended to use the funding. Once alerted, the squadron scrambled to launch the motion simulator programme, using the Defense Logistics Agency to select CAE and complete the contractual paperwork.
CAE seems a logical choice for the job. The company supplies simulators for both aircrew and medical professionals, the latter of which is a comparative newcomer to the value of simulators.
Like airlines, the USAF uses full motion cockpit simulators to maintain pilots’ proficiency levels and even to check out crews in new aircraft types. In the military airlift community, loadmasters are familiar with using stationary cabin mock-ups to train how to load cargo efficiently and safely on to an aircraft. Surprisingly, civilian and military medical professionals have been less familiar with simulation as a training tool, Corliss says.
“A lot of clinical training is what we call ‘experience by chance’. We train people when they go to a hospital and you get to see what’s at the hospital,” Corliss says. “We don’t want experience by chance. We want to guarantee that every crew member who comes to this facility will get a chance to put hands on and go through each one of those experiences.”
Between the active duty and reserve component, the USAF can call upon 7,000 nurses to serve as aircrew in aeromedical evacuation missions, which leads to an intensive training load. In aeromedical evacuation missions, nurses must be proficient as both medical staff and aircrew, Corliss says.
Aeromedical evacuation has gained significantly in priority and sophistication as a mission area for the US military airlift and rotary wing fleet, but its history predates powered flight. In the Franco-Prussian war in the 1870s, the French used hot-air balloons to evacuate wounded from the besieged city of Paris. By World War II, the US Army Air Corps had established dedicated crews for the first time. The addition of helicopters in Korea and Vietnam created a new standard for battlefield medical response. Now, all military aircraft, including the forthcoming Boeing KC-46 tanker, are provisioned to serve a role in aeromedical evacuation.
In one example, crews are trained to respond in the event of a door seal leak, which is signified on the C-130 by a red warning light that activates on the forward bulkhead. In classroom training, Corliss simulates a door seal leak by pointing at a spot on the wall with a picture of the red warning light. By contrast, the cabin mock-up allows him to active the light and then observe how long it takes for nurses to notice.
The motion simulator for aeromedical evacuation is expected to draw many visitors, including international militaries looking for realistic training. Canadian aircrews have already visited the cabin mock-up, and could be among the first in line to acquire their own full-motion training device.
“They’re very interested,” says Chris Lilly, CAE’s programme manager for C-130 and aeromedical evacuation training devices. “A lot of folks are in wait-and-see mode.”
Having the motion simulator running is also the first step in a larger strategy to make Dobbins a global centre of excellence for aeromedical evacuation training. Such an organisation already exists for the C-130’s mobility mission in St Joseph, Missouri, says Col Patrick Campbell, commander of the 94th Operations Group. As the C-130 centre of excellence, the USAF uses the St Joseph site to test new tactics and new technology for the mobility mission, then trains aircrews how to use them.
A similar role could develop for the aeromedical evacuation mission at Dobbins. The USAF is already in contact with the medical school at Emory University in nearby Atlanta. For example, a C-130 fuselage mock-up on a motion platform offers an ideal tool for adapting surgical procedures to make them safe to perform inside a flying aircraft. Emory’s doctors and researchers could help the USAF develop those procedures, Campbell says.
To create the centre of excellence, the C-130 mock-up is just the first step. Similar motion devices for the C-17 and KC-135 are already in development for installation at Dobbins. In the future, the USAF could also acquire aeromedical evacuation simulators for the KC-46. The army’s helicopters and the US Marine Corps’ Bell Boeing MV-22 Osprey are also in consideration.