The U.S. Army Burn Flight Team has transported patients twice from Singapore back to the U.S. Army Institute of Surgical Research at Joint Base San Antonio – Fort Sam Houston, Texas, and both flights resulted in record-breaking missions.
The Burn Flight Team is a five-person team that flies burned military personnel from anywhere in the world back to the USAISR Burn Center, which is the only burn center servicing the Department of Defense. A team consists of a burn surgeon, a critical care registered nurse, a licensed vocational nurse, a respiratory therapist and a forward operations noncommissioned officer. Four teams rotate call, so that two teams are always ready to deploy.
The team’s first mission to Singapore, on Feb. 22, 2013, was the longest nonstop flight in the team’s history. Because of the patient’s critical status, the Air Force critical care transport team operating the C-17 Globemaster III refueled inflight, allowing the Burn Flight Team to get the patient to the burn center as soon as possible.
“They have a hook up in the front, and then a little fueling plane flies ahead and lets out a little cable, and they have to connect them,” said Sgt. Matthew Anselmo, NCO in charge of the burn team. He is a respiratory therapist who worked as the rear operations NCO for that particular mission.
The team flew for 19 hours straight over 9,850 miles to bring the patient home. As the Burn Flight Team is not part of the plane’s crew, they are not afforded crew rest. But the team members said they didn’t mind the exhaustion. Getting their fellow service member back home safely was the only thought in their minds.
The second and only other time the flight team transported a patient from Singapore was Nov. 9, 2015. This flight also resulted in a record-breaking mission, but for a different reason. It was the first time the team used a kidney dialysis machine to provide continuous renal replacement therapy inflight.
The patient, a Marine who had suffered severe electrical and thermal burns, was experiencing kidney failure, and would not have survived the flight without the procedure, said Staff Sgt. Daniel Zimmerman, the NCOIC of the team at that time and the respiratory therapist on the flight.
Continuous renal replacement therapy, or CRRT, is similar to regular dialysis in that it removes blood, filters it and then replaces it back in the body. It is different, however, in that it is a slow, continuous process. Because CRRT pulls blood at a slower rate, it does not disrupt the patient’s hemodynamics.
“Without CRRT, that patient would have had to stay at that remote hospital, being treated in another country,” said Staff Sgt. David Shelley, a licensed vocational nurse and assistant NCOIC of the flight team. “So the medical director decided we needed to do what it takes, get this service member to the best place in the military to treat burns, and we made it happen.”
“We are always ready,” Zimmerman said. “I was the NCOIC at the time and the only respiratory therapist on the team, so I was basically on call for two years straight. When you get that call, it’s exciting.”
And this time, the team members knew the flight would require them to use equipment they had never before taken on a flight. The team now considers CRRT part of its capabilities and has dedicated transport equipment, but on that flight, the team used equipment from the intensive care unit.
“Everything went as planned in so much as we had never done the CRRT before,” Zimmerman said. “We weren’t sure what complications we were going to run into, but it was overall a pretty uneventful flight, and that is definitely a success.
“Every successful mission comes with a very rewarding feeling,” he said. “To go pick up a critically injured service member who really needs attention that they can only get in the ISR in our unit, to be able to get them back here safely and see them get better — it is a very rewarding feeling.”
Noncommissioned officers play a crucial role on the U.S. Army Burn Flight Team, which is prepared to fly any time, anywhere to transport burned military personnel to the U.S. Army Institute of Surgical Research Burn Center at Joint Base San Antonio – Fort Sam Houston, Texas.
During the height of the War on Terror, the flight team would routinely meet injured service members at Landstuhl Regional Medical Center in Germany. Since the drawdown of the war, however, flight team members will tell you that the frequency of calls has slowed significantly and that every mission is unique.
Since the 1950s, the team has successfully transported service members suffering from both combat- and noncombat-related burns back to the United States from far-off locations including Honduras, El Salvador, Argentina, Norway, Japan, Korea, Guam, Vietnam and Singapore.
“As soon as we get notice of the mission, the team pulls together,” said Staff Sgt. David Shelley, a licensed vocational nurse and assistant NCO in charge of the flight team. “We want to get there as fast as possible and make sure we have the ability to take care of that service member. There is just that drive to make sure everybody comes home safely and gets the best care possible.”
Roles of the NCO team members
The flight team is composed of active duty Soldiers and DA civilians who work daily in the Burn Intensive Care Unit at the U.S. Army burn center, which is the only burn center servicing the Department of Defense.
A team consists of one burn surgeon and one critical care registered nurse, both officers, and one 68C licensed vocational nurse, one 68V respiratory therapist and a forward operations NCO. A rear operations NCO also assists the team from Fort Sam Houston. Four teams – about 20 personnel – rotate call, so that two teams are on call and deployable at all times.
Both the vocational nurse and respiratory therapist positions are filled by NCOs. The vocational nurse provides wound care to the patient during the flight and works closely with the surgeon and other nurses, while the respiratory therapist manages the ventilator and everything related to the patient’s airway and lungs.
“The nurses and doctors are all concentrated on wound care and the other aspects of the patient’s health, and we (the respiratory therapists) are pretty much on our own there,” said Sgt. Matthew Anselmo, a respiratory therapist and NCOIC of the flight team. “We manage our ventilators. If the pressure changes, we change the ventilators as we see we need to. We are the only ones who can manage the ventilators as we do. Nurses and doctors are trained on basic ventilator management, but [respiratory therapists] are really needed in this situation because of the specialized equipment and circumstances.”
The forward operations NCO, usually either a vocational nurse or a respiratory therapist, is responsible for getting the team from point A to point B and makes sure all of the equipment traveling with them gets there and back. The rear operations NCO stays behind in San Antonio to act as liaison between the flight team and the Institute of Surgical Research leadership during the mission. The rear operations NCO is also responsible for providing the team with logistical support during the flight and arranging transportation from the airport for the team and the patient once they return. The forward and rear operations NCOs work together to make sure the team has everything it needs and to ensure the logistics of the mission run as smoothly as possible.
“The forward operations NCO is really coordinating the entire movement, and they are responsible for accountability and really every aspect of the team’s movement from when we leave here in San Antonio to wherever we arrive, getting to and from the hospital and getting back,” said Staff Sgt. Daniel Zimmerman, a respiratory therapist. “The forward ops and rear ops are constantly dealing with all levels of command. Some of our missions are very high visibility; sometimes they go all the way to the Secretary of Defense for approval. Communication is key to our missions, and the operations folks have to handle all of that.”
The team’s NCOs are offered frequent opportunities to use their leadership skills in unique ways, Zimmerman said. The NCOIC in particular is responsible for training and teambuilding exercises for a team of mostly officers, and all of the NCOs are involved in setting up that training to make sure the team stays current on certifications and is familiar with the different types of equipment they may need to use.
“The NCOIC is responsible for the training and the readiness of this team that is mostly officers,” Zimmerman said. “It can definitely be challenging to have influence over people you really don’t have authority over. So it is definitely about tact and mutual respect, team building, gaining the confidence of everyone. Everyone on the team is very professional. It normally runs pretty smoothly, but it can be intimidating.”
Bringing them home
Team members have regular jobs providing daily care to patients at the hospital. But once they get that text message notifying them of a mission, they have two hours to be ready to fly. The forward and rear operations NCOs quickly get to work arranging transportation, because their goal is to have the team in the air within six to eight hours.
The five-member team travels to the patient’s location on a commercial flight, bringing with them eight large cases of specialized equipment, each weighing about 70 pounds. The forward and rear operations NCOs coordinate with the Air Force through the Theater Patient Movement Requirements Center to arrange the team’s travel back on the nearest C-17 Globemaster III, which is operated by an Air Force critical care air transport team.
“You fly there, you have all of this adrenaline, excitement, nervousness, going through the steps A, B, C of what you need to look out for on this particular patient,” Shelley said. “We get an outlook of what the patient’s picture is, so we always have that in the back of our minds. It’s important to try to calm yourself down and get the rest you can get, because there will be no sleep on that long flight back.”
As soon as the patient is ready, they begin the journey home.
“I think the biggest feeling we have once we leave ground is of being … alone,” Anselmo said. “You know, once you are in the air, it’s your team. That’s all you’ve got. There is no one else who can help, especially when you are over the ocean.”
Because of that, the team is prepared for anything and everything to go wrong. Elevation affects patients’ blood pressure levels and airway pressures, and any movement brings some sort of risk. The team monitors all of those things as well as the patient’s hydration and temperature, which are key to the healing process.
As soon as they land, they are met by the rear operations NCO and other team members who were not on the mission to help load the patient into the ambulance and then get the equipment back to the hospital, break it down, clean it, restock and make sure everything is ready to go again.
Getting into this line of work
Shelley initially came into the Army as a 68W combat medic. Anselmo began as a 19K M1 armor crewman. Both of them, like many of their fellow NCOs, changed their MOSs and were eventually assigned to the Institute of Surgical Research.
“As soon as I found out I was coming here, one of my main goals was to get on the flight team,” Anselmo said.
A year of experience in the Burn Intensive Care Unit is required for vocational nurses and respiratory therapists to be considered for the flight team. Both Shelley and Anselmo said it takes a lot of work to ensure you have the needed capabilities.
“For example, we use different ventilators up here that really no conventional ICU would use, so it takes a lot of training,” Anselmo said. “It just works with pressure – it doesn’t give you any numbers, so you really have to know what you are doing with it before you take it in the air.”
All of the extra work is worth it, Shelley said, because working closely with a small group like this is an opportunity unlike any other.
“To have such an impact around the world for fellow service members is amazing,” Shelley said. “That’s why I got into the medical field – to help other service members, and it’s been great to be there in their critical time of need and to provide such a high level of care at the top of my scope of practice.
“I hope other NCOs learn that the Army has this type of capability,” he said. “Respiratory therapists and vocational nurses – or even medics looking to become one of those MOSs, if this is the route that they want to go, they should work hard to hone their skills in a critical-care sense. It’s an amazing chance to grow as a leader and as a clinical expert. They will have to work hard, but the opportunity is here.”
From dreaming up the competition’s challenges to acquiring the resources and executing the event, NCOs are responsible for the Army’s Best Medic Competition from start to finish.
The jobs of medics and others with medical professions are so crucial to the Army that those NCOs are often not leaned on for their expertise in other areas, explained Master Sgt. Michael Eldred, the NCO in charge of the Command Sgt. Maj. Jack L. Clark Jr. Best Medic Competition, which took place Oct. 24-27 at Joint Base San Antonio – Fort Sam Houston and nearby Camp Bullis, Texas.
“We are often delegated to running the medical care of a section and we don’t get involved in the security, the planning process,” Eldred said. “But Command Sgt. Maj. Gerald Ecker, command sergeant major of U.S. Army Medical Command, said it is all about presence. He made it clear he wants us – Army Medical Department Center and School NCOs and Army Medical Command NCOs – to be present at everything that happens out there. That gets us into the middle of that planning.
“We need these NCOs to start thinking about how to plan and learn how to train other people,” he said. “So the command sergeant major wanted that to be the emphasis for the Army Best Medic Competition. We don’t just dictate the style and everything that goes into this. I take each one of these NCOs and teach them, watch them grow from that information that I give them.”
Eldred is proud of what his NCOs have accomplished, and said the success of the Best Medic Competition is proof of their ability to plan, adapt and execute at every level.
“I’ve got an NCO in charge of the tactical operations center, an NCO in charge of supply and resourcing. I’ve got an NCO in charge of every aspect: each lane, each phase,” Eldred said. “We make this competition work as the NCO Corps.”
The competition is designed in a modular fashion, which allows the planners to switch things up and keep it fresh. Each of the six lanes is run by a major command or brigade, which assigns the NCOIC. Eldred works with all of them to make sure they understand the requirements they must meet, as well as the intent of the command sergeant major.
“Some of them jump at the opportunity to be creative, sometimes to the point that they get protective about it,” Eldred said. “They get upset if I need to come in and change this or that. And I don’t mind that. I would much rather have to calm somebody down than amp somebody up. It is easier to get somebody to do the right thing if they are really motivated. I’m a medic, so I’m no stranger to emotions. We learn to treat people in a healthy emotional way. I am used to dealing with emotions on that level, and I [use that experience to help me guide these NCOs.] I want to encourage them through their emotions to get the job done.”
Eldred encourages the NCOs planning the lanes to get creative. He tells them, “This is your moment to shine, so take it and run with it.”
That creativity can make things interesting for Sgt. 1st Class Steve Gaddy, the logistics and personnel operations NCOIC for the Best Medic Competition.
“They dream it, and I resource it, plan it and execute it. Sometimes I have to rein Master Sgt. Eldred in,” Gaddy said with a laugh. “As a long-term Ranger, he has some grand ideas. I tear them apart and figure out what we need to make them a reality.”
Last year, the NCOs planning the competition pulled off a full-blown paintball war in the force-on-force lane. The competitors had to fight their way through a mock village to get to a casualty. In a matter of about three weeks, Gaddy sourced paintballs, paintball guns, CO2, masks, eye protection and more.
This year, competitors faced a lane in which they were overrun by the enemy and had to escape and evade. Gaddy arranged for “hunter-killer teams” to lurk in the woods, looking for the competitors. If the competing team didn’t move covertly enough through the terrain and the hunter-killers got close enough to read the numbers displayed on their shoulders, that team lost points.
“The NCOs come up with great things, too. We give them an idea and let them run with it. We hold weekly meetings to make sure they stay on track. But as long as they hit the required tenets, they can make it how they want it,” Gaddy said. “They develop their plans and then tell me the resources and personnel they need. Nine times out of 10, I’ve already got it, but there have been some interesting ones that have come up – a jump car, one guy needed a tractor. I’ve had canoes requested, M1 Abrams tanks, Strykers. If I can get it for them, I will.”
Gaddy taps into the expertise and resources not only of U.S. Army Medical Command and the U.S. Army Medical Department Center and School, but also of every other entity on or near Joint Base San Antonio – Fort Sam Houston, including Army North, Army South, the Air Force, the National Guard, the Reserves, a special forces unit based at Camp Bullis, and even other posts such as Fort Bliss, Texas. He said building those relationships has enabled them to make the competition a success.
“What makes this competition so interesting is the fact that I’m getting the best and the brightest Army medical NCOs coming up with lanes that are both applicable to being a combat medic and still challenging in that they are most likely outside of the competitors’ daily scope of practice,” Gaddy said.
Creating the lanes
Sgt. 1st Class Delmar Lockett, a pharmacy instructor at the Medical Educational Training Campus at Fort Sam Houston, jumped at the chance to create the warrior tasks and battle drills lane for this year’s competition. He said he was looking to take on more responsibility and was honored to have been a part of such a prestigious event.
“My goal is to capture the essence of what the Army Best Medic Competition is all about,” Lockett said. “I want things to run smoothly and for Command Sgt. Maj. Ecker to be able to walk down and say, ‘You know, this is exactly what I needed.’”
As NCOIC of the lane, Lockett did everything in his power to make the lane feel as real as possible.
Often, when Soldiers are asked to do warrior tasks and battle drills, they do them in a round-robin fashion, Eldred explained. In the Best Medic Competition, however, competitors faced a challenge within a combat scenario.
“Lockett had to employ personnel resources that influence the competitors’ decisions,” Eldred said. “So a tank moves up, competitors have to do a call for fire. They have to adjust off a target reference point. They will do the task, but they will do it within a realistic scenario.
“The competitors won’t even realize they are being tested on some of this stuff,” Eldred said. “When the grader says, ‘Hey, you’ve got a guy in a tunnel. He just hit a chlorine gas mine, and he is unconscious. Here is his mask. Here is your mask. Do what you need to do.’ Immediately – if they don’t put their own mask on first, they are wrong. If they do put their own mask on first but then jump down into the tunnel without the other mask, they are wrong because they will need to immediately put it in place before dragging him out of there. And while they are putting their masks on, they are being timed.”
Lockett said he was grateful for the learning experience and for the opportunity to work with NCOs such as Eldred, who gave helpful suggestions along the way while inspiring him to develop his own ideas.
“This is definitely the biggest project I have had the opportunity to oversee in my career so far,” Lockett said. “It is a proud moment to see it all come together. If you think about it, only about six people are in charge of lanes this year. Who wouldn’t want to be a part of something like that in the Army?”
With only a week’s notice, Sgt. Derick Bosley found out that he would be competing in a 72-hour contest to name the Army’s top combat medics.
The 33-year-old Ranger paired up with Staff Sgt. Noah Mitchell, a fellow Ranger, to compete in the Army’s Best Medic Competition, held in the San Antonio area. Both Mitchell’s original partner and backup partner had suffered injuries before the competition began, making them unable to participate.
“I looked at him and said, ‘I guess we’re going into this and straight winging it,” Mitchell recalled.
As Rangers continually train at a high standard, Mitchell, 26, said he had no worries about the abilities of his newest teammate.
“I expect and know what he can do because he’s an NCO in Ranger regiment medicine,” he said. “There’s no dropping the ball because we know that’s just not what we do.”
And the quick change couldn’t have worked any better.
With basically a second alternate as a teammate, the duo grabbed first place Friday after representing the Army Special Operations Command in the annual contest, in which expert combat medics from across the service competed against each other in several physically and mentally demanding tasks.
This year, 42 two-person teams vied for the competition’s coveted statuette award, dedicated to Command Sgt. Maj. Jack L. Clark, the Army Medical Command’s former senior enlisted leader who focused on the vital role medics play in the Army.
After battling the stifling heat and rough terrain of the Texas countryside, Mitchell and Bosley were able the claim the award.
“There was never a doubt in my mind,” Bosley said. “It’s either we win this, or we’re coming back next year to win. It was one or the other.”
That doesn’t mean the contest, tailored after the Best Ranger Competition, was a walk in the park, they said.
“It was way harder than we expected,” Bosley said, adding that some parts of the competition really tested their skills. “There was a lot of stiff competition, with some creative medics out there.”
Sgt. Jarrod Sheets and Sgt. Matthew Evans from the 10th Mountain Division took second place in the competition, while Capt. Jeremiah Beck and Sgt. Seyoung Lee from the 2nd Infantry Division secured third.
Once those teams were honored, Command Sgt. Maj. Gerald Ecker, the Army Medical Command’s senior enlisted leader, addressed all of the medics during Friday’s awards ceremony.
“The only certainty in war is that we will take casualties. And that’s where you come in — the combat medic,” he said. “You are the front line.”
In the future, he said that expert medics will be needed even more as multi-domain concepts emerge and change the battlefield.
“We’re going to be fighting in the unknown,” he said. “Thank God we have expert and dedicated medics such as you. That’s why this is a very proud day for Army medicine.”
Two medics representing the U.S. Army Special Operations Command were named the Army’s best medics after a grueling 72-hour competition at Fort Sam Houston, Texas, and Camp Bullis, Texas.
Staff Sgt. Noah Mitchell and Sgt. Derick Bosley from the 75th Ranger Regiment, representing the U.S. Army Special Operations Command, were named the winners of the Command Sgt. Maj. Jack L. Clark Jr. Best Medic Competition during a ceremony Friday at the Army Medical Department Center and School at Fort Sam Houston. Both Mitchell and Bosley are stationed at Fort Benning, Georgia.
Second place went to Sgt. Matthew Evans and Sgt. Jarrod Sheets from the 10th Mountain Division, and third place went to Cpt. Jeremiah Beck and Sgt. Seyoung Lee from the 2nd Infantry Division. Awards were also presented for the top performing teams in different categories, including the best overall physical fitness score, medical skills score and marksmanship score.
The competition, hosted by Army Medical Command and conducted by AMEDDC&S, is designed to test Soldiers’ tactical medical proficiency, teamwork and leadership skills. The competing teams were graded in the areas of physical fitness – in addition to PT and combat water survival tests, they were required to walk up to 30 miles throughout the competition – tactical pistol and rifle marksmanship, land navigation and overall knowledge of medical, technical and tactical proficiencies.
Wesley P. Elliot of Army Medicine contributed to this report. Header image courtesy of AMEDDC&S.
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