March Reservists finish Iraq combat tour caring for those unable to care for themselves

Contingency aeromedical staging facility team members prepare a critical-care patient Feb. 14 for transport on C-17 Globemaster III to Landstuhl, Germany, where he will receive further care for his wounds at Balad Air Base, Iraq. (U.S. Air Force photo/Tech. Sgt. Cecilio M. Ricardo Jr.)

Contingency aeromedical staging facility team members prepare a critical-care patient Feb. 14 for transport on C-17 Globemaster III to Landstuhl, Germany, where he will receive further care for his wounds at Balad Air Base, Iraq. (U.S. Air Force photo/Tech. Sgt. Cecilio M. Ricardo Jr.)

Contingency aeromedical staging facility team members prepare a critical-care patient Feb. 14 for transport on C-17 Globemaster III to Landstuhl, Germany, where he will receive further care for his wounds at Balad Air Base, Iraq. (U.S. Air Force photo/Tech. Sgt. Cecilio M. Ricardo Jr.)

Contingency aeromedical staging facility team members prepare a critical-care patient Feb. 14 for transport on C-17 Globemaster III to Landstuhl, Germany, where he will receive further care for his wounds at Balad Air Base, Iraq. (U.S. Air Force photo/Tech. Sgt. Cecilio M. Ricardo Jr.)

BALAD AIR BASE, Iraq -- This place does not smell like a hospital.

That's by design. The Contingency Aeromedical Staging Facility is located only a short distance from the Air Force Theater Hospital, but it might as well be miles away. Inside this hardened structure, patients from the hospital await transportation - away from Iraq, toward medical treatment in Germany or stateside, and finally, home.

Flights generally arrive late at night or early morning, and activity at the CASF rattles and hums loudest in the hours before takeoff. Patients wait, some restless and some resolute. Some try to sleep amid the noise and activity as the medical technicians fuss around them, adding extra blankets or stocking caps against the outside cold, cinching straps to secure the patients to the litters for transport, checking medication and medical records.

Some are attached to intravenous drips, some to oxygen. Some remain unconscious of the activity going on around them and others are ambulatory and watchful.

The patients wear the uniform of the Army, the Air Force, the Marine Corps, civilian clothes. Their duffel bags wait under the litters, tagged with the Red Cross card to indicate "patient."

The buzzing increases in intensity and urgency as the minutes tick by. This particularly morning - early, around 6:45 a.m. - there will be more than 40 patients to get ready for the flight to Germany aboard a C-17. The buses outside the CASF are fired up, the heaters cranked to "full" to melt the frost from the windows, to warm the interior against the 30-degree outside temperature.

It's time. The C-17 awaits its precious cargo on the flightline.

Four med techs pick up each litter and transport it to the bus for loading. There are quick hugs, big smiles, words of encouragement, scribbled addresses on scraps of paper traded with promises to keep in touch.

The stretchers are heavy, and the loading process is hard work. The techs take turns carrying and lifting, and one by one, the buses are loaded and on their way to the flightline in fog of early dawn.

This is the last flight for Aerospace Expeditionary Force 3/4 and the first for AEF 5/6. The old hands - four months into their tour of duty and ready to depart - run through their paces with the experience brought of repetition and good training. The new arrivals work with care, and slowly, with the encouragement and ready assistance of the outgoing team if necessary.

The night shift is ending. The last of last night's coffee - by now, an oily and evil brew - helps keep them alert, but it's hardly necessary. The adrenalin pumps; this is what they do, proudly, every day, facilitating the flow of patients from hospital to home.

AEF 3/4's CASF team is entirely made up of U.S. Air Force Reservists, about 50 of its approximately 60-member staff - including the commander - from the 452nd Aeromedical Staging Squadron (part of the 452nd Airlift Wing), March Air Reserve Base, Calif. The rest come from various Reserve units in Michigan, Washington, Florida, and Ohio.

Here, the CASF falls under the 332nd Expeditionary Medical Squadron, itself part of the 332nd Expeditionary Medical Group and the 332nd Air Expeditionary Wing, the largest Air Force unit in Southwest Asia - purveyors of combat air power in support of national objectives.

One sturdy spoke of the combat airpower wheel is medical care, and the CASF is the only one of its kind in Iraq. Though interdependent with the Air Force Theater Hospital here, the CASF provides a unique service: the transition between the combat zone and home.

The mission is 24 hours a day times seven, two 12-hour shifts every day, and it involves every stage of passenger movement from the hospital to the aircraft for evacuation.

"We're responsible for the care and movement of all patients. We get them to the flightline, get then onto the plane. If they're going out by fixed-wing air, we're responsible," according to Lt. Col. Keith Miller, CASF commander, deployed from the 452nd.

The CASF maintains approximately 50 beds at any time and can surge to more than 80 if necessary. Flights come in several times a week or as often as medical necessity dictates.

The goal is that no patient will be on the ground here for more than 72 hours, and in many cases, that time is considerably less. During those hours, "we make sure the patients' needs are met,"- medically and otherwise, the colonel says. "Human interaction is really therapeutic."

Success? In the period between September 2006 and January 2007, the CASF moved over 2,500 patients on more than 225 individual missions.

"We bring a lot of experience to the fight," Colonel Miller says. "We work and train to do precisely what we're doing here."

Lt. Col. Janet Lawrence, chief nurse with the 452nd ASTS, agrees enthusiastically. Back home, "we train and train and train," she says, but while a field exercise might have three or four simulated patients, "out here, they're real - and there are 30 or 40. To be able to see how our people work so hard to get these young men and women out of here is exciting."

She applauds the positive attitude and passion of the CASF staff. "They never complain," she says. The interaction with Air Force Theater Hospital personnel comes together "the way it's supposed to."

The work has its own rewards according to Senior Amn. Mishay Castro, also deployed from the 452nd ASTS. "They become your family," she says of the patients that pass through the CASF's doors. "You hear everybody's story. Their deployment is completely different from yours."

The work also has its own challenges, says Master Sgt Michael Depew, also with the 452nd. "It's hard to see the injured service members come through here," he says. "You have 18- and 19-year-olds with life-changing injuries. That's the toughest thing to see."

But he, like everyone on the staff, is here to do a job: "to insure the injured get home safely." On his second deployment, the reservist says, "I'm not here for myself. I'm here for the troops coming here. For the people I work with."

Moving patients from hospital to home: this is part of combat airpower for America. This is the way they fight, and every time an aeromedical evacuation flight lifts off the tarmac, "it's unbelievable," Colonel Lawrence says. "You did everything you possibly could" for the patients - hospital and CASF alike - and "they survived. Unbelievable."