BALAD AIR BASE, Iraq - They flew at night and into the next day from Iraq nonstop to the United States. Fifteen hours and 10 time zones later, they handed over their precious cargo in Maryland: a Soldier who had been wounded in combat.
Then, to the hum of jet engines, they packed their gear and returned to fly similar missions again and again.
Members of the Air National Guard flew directly from Balad Air Base, Iraq, to Andrews Air Force Base, Md., Feb. 7 to transport a critically injured Soldier to stateside medical personnel in an effort to save his life.
The Soldier had sustained life threatening injuries from an improvised explosive device. His best chances for survival were in the hands of neurologists thousands of miles away.
An all-Guard critical care air transport team (CCATT) from the 332nd Expeditionary Operational Support Squadron and a C-17 Globemaster III aircrew from the Mississippi Air Guard's 172nd Airlift Wing changed their schedule to fly the Soldier to the U.S.
Col. Jerry Fenwick, the critical care team physician, said his team had never before flown a critical care mission nonstop from Iraq to Andrews. But after consulting with neurosurgeons in Balad and Maryland, they agreed the Soldier's condition warranted the nonstop flight.
Fenwick coordinated with the command post and the C-17 crew, which had just flown in from Germany with the 791st Expeditionary Aeromedical Squadron. Members of the 791st also joined the mission.
"When we got on the ground, they said they had a flight plan change for us," said 1st Lt. Wes Carter, a pilot from Mississippi. "So we went to the command post and found out we were going direct to Andrews."
The longer flight would require an aerial refueling “ something that is generally not done during normal medical flights. It was the first direct flight from Iraq to Andrews for the Mississippi Guard, which transports a large number of sick, wounded and critical care patients out of Balad to Germany and then flies to the U.S.
Carter said the crew quickly filed a new flight plan, took on more fuel and boarded the medical team and patient. They took off into the Iraqi night with aircraft commander Maj. Mark Crossman, pilots Capt. Lee Miller and Maj. Ed Evans and loadmasters Tech. Sgt. Dean McDill and Master Sgt. Allen Randle.
Fenwick's CCATT team included critical care nurse Maj. Dave Cox of the Indiana Air Guard and respiratory therapist Staff Sgt. Nicole Costigan from New Hampshire. Together they constantly monitored the wounded Soldier.
Their challenge was providing critical care for 15 hours in a cargo bay. That was equivalent to nearly a full day at civilian intensive care units that are on the ground and are not traveling at 500 mph, Fenwick said.
The Mississippi pilots said their biggest challenge was the aerial refueling. Their C-17 needed 100,000 pounds of fuel from a 100th Air Refueling Wing tanker out of England.
"Aerial refueling puts a whole new challenge into it," Carter said. "We had already flown five hours from Ramstein to Balad, and we flew six hours from Balad to meet the tanker."
Everything worked perfectly, however, and the C-17 got its fuel from the tanker. The pilots rested throughout the flight by alternating time at the controls.
Carter said it felt good to know the military spends so much time and effort to bring critical care patients to the best care possible. "The Soldier might not have made it if he had not arrived at Andrews as quickly as he did," he said.
The Soldier was handed over to stateside specialists and was downgraded from critical to serious condition. The CCATTs, air crew and aeromeds had given him a fighting chance.
Fenwick's all-Guard CCATT team returned to Iraq and continues to fly lifesaving missions to Germany and back. They fly into Ramstein every 36 to 48 hours. The Air force has seven other CCATT teams performing similar missions across Southwest Asia.
The medical teams care for up to three critical condition patients at a time. There are four teams assigned to Operation Iraqi Freedom and two teams assigned to Operation Enduring Freedom. Each team has a critical care doctor, a critical care nurse and a respiratory therapist.
As good as these special teams are, they cannot perform their missions without the support of aeromedical evacuation squadrons and aircrews who are conducting extensive operations overseas.
The squadrons also transport the walking wounded and patients that don't require critical care. They configure the aircraft with litter systems, hang power and oxygen lines and connect other medical equipment.
"The Guard and the Reserves are vital participants in the CCATT and aeromedical missions," Fenwick said. "They pull in experienced medical professionals and critical care specialists from the civilian sector."