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.”
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