Members of the 59th Medical Wing Extracorporeal Membrane Oxygenation transport team connect a patient to an ECMO system for transport from Lafayette General Medical Center, Louisiana, to San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas. (Image courtesy of the U.S. Air Force/Staff Sgt. Kevin Iinuma)
The nature of military operations dictates the need for immediate, professional health care, available globally at a moment’s notice. Sometimes that needed care is more extreme, and the 59th Medical Wing’s Extracorporeal Membrane Oxygenation team is ready.
A mission exclusive to the 59th MDW headquartered at the Wilford Hall Ambulatory Surgical Center, the ECMO team is bedded down at the San Antonio Military Medical Center on nearby JBSA-Fort Sam Houston. Together, the integrated team of Air Force and Army medical professionals delivers unique life-saving procedures both on the ground and in the skies.
The ECMO process circulates blood through a machine that removes carbon dioxide and adds oxygen back – thus bypassing and reducing stress on a patient’s damaged lungs. This technique allows diseased or injured lungs to heal. It’s this capability that gives an ECMO team the ability to transport critically-ill patients around the world.
“We work to keep the patients alive, keep their other organs going,” said Air Force Lt. Col. Phillip Mason, ECMO team lead. “Typically, we can reduce a patient’s chance of dying from 80 to 90 percent down to 30 to 40 percent. When you’re talking about people this sick, the difference is actually a major victory.”
“Today’s ECMO program for the Department of Defense was born out of the 59th MDW, originally with neonatal care and expanding to adult care (in 2011),” said Bernadette Elliot, the 59th MDW Extracorporeal Life Support transport program manager.
Kathryn Naagard, ECLS program manager and senior team member, was a nurse for seven years at the 59th MDW’s neonatal intensive care unit. Initially, the adult ECMO program started as an extension of the neonatal program that was still operating at Wilford Hall, she explained.
In 2011, the 59th MDW took the adult ECMO program to SAMMC. Today, the team is capable of providing 24-hour care to two patients simultaneously, both at their facility and aboard military transport planes.
At a minimum, the 59th ECLS has 10 medics always on standby to respond when the call comes. Within 12 hours, the team can be airborne with all of the equipment necessary for aeromedical patient care.
History: From Landstuhl to the 59th Medical Wing
In 2005, a group of Air Force Critical Care Transport specialists operating out of Landstuhl Regional Medical Center in Landstuhl, Germany, first explored a technique to transfer patients in pulmonary failure using a Novalung membrane device.
The Novalung membrane ventilator was successful early on. Enhancements in medical technology led to using ECMO in 2010. With a decreased patient stream from Operation Enduring Freedom, there was no longer a significant need for this process. Eventually, the mission capability was phased out at Landstuhl. The Air Force’s 59th MDW revived the technique soon after.
Maj. James Lantry, Extracorporeal Membrane Oxygenation transport team vice director, watches for stabilization on the ECMO prior to transporting the patient. (Image courtesy of the U.S. Air Force/Staff Sgt. Kevin Iinuma)
“The 59th Medical Wing took over the remnants of that program,” said Air Force Col. Mark Ervin, 59th MDW chief of operational medicine. “Since then, we have been rebuilding and improving on those concepts so that we can project this enhanced capability.”
“The team’s diverse background is a force multiplier in getting the mission done, as the more experienced members act as mentors and provide guidance for a new generation of doctors,” said Air Force Maj. James Lantry, ECMO transport team vice director.
“We were able to attract a lot of the ex-members of the alert lung team out of Landstuhl in Germany,” said Lantry. “We don’t do the mission exactly the same way as they did back in the early to mid-2000s. But, we combined all of our knowledge, experience and vantage points into a solid mission that supports the entire DOD community.”
“The good news about ECMO is that there is no one way of doing it. Depending on the situation and patient needs, optional equipment and setups can be incorporated into the system,” Lantry said.
The ECMO program has expanded rapidly since the late 1990s when the 59th MDW only provided this air transport capability with the neonatal unit.
“We’re the only full-fledged medical team in the DoD that can go all over the world,” Naagard said. “There are a few other EMCO transport teams out there but they have limited capabilities. Some can only travel 60 miles from their home base, or can only transport patients by ground.”
The 59th MDW continues to secure its place as the DoD’s only ECMO hub by expanding training opportunities for those who chose to deliver military health care across the globe.
“We train 10 new specialists every year,” said Naagard. “The ECMO program will only continue to grow and save lives around the world.”
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