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MILITARY MILITARY
MEDICINE MEDICINE

When Pigs Fly put together and performed local and regional transports of single pa- mander of the largest col-

tients in conjunction with AE crews in C-21 Lear and C-9 Nightingale
on active duty. I
aircraft. The first test deployment of CCATT (including now Lieu- lection of CCATTs
By Col. James H. Henderson II, MD, USAF MC, Ret. tenant Colonel (Dr.) Steve Derdak) was to Operation Uphold Democ- continued to assist
racy to Haiti in 1994 after an earthquake disaster. Other mission in teaching
A s a young Air Force officer and Pulmonary/Critical Care at- in order to stabilize and fly severely wounded soldiers for several hours came back to haunt me soon thereafter when we tested multiple patient and participated
refinements were made after these experiences. My offhanded comment
CCATT courses
tending physician stationed at Wilford Hall Medical Center
at a time between facilities. I was quite accustomed to the idea of medi-
transport by flying six sedated and intubated pigs in a C9 over West
in Allied Force
in 1993, I had certain expectations and career aspirations. I
had just returned from a one-year Sleep Medicine fellowship at Mayo vac: short 20-to-60-minute helicopter transports of patients who Texas and Oklahoma. Yes, pigs really did fly! education courses
would die quickly if not moved. This plan was to move patients who
in several coun-

Clinic Rochester and planned on expanding and improving the Sleep had been stabilized and might get better but were at high risk to de- CCATTs consist of three personnel: tries. Subsequently, I
Lab there while starting a Sleep Medicine fellowship with my new part- compensate and were at a location already operating at the limit of its a critical care (trained) physician, a critical care nurse helped write the formal
ner, Major (Dr.) Larry Epstein. I hoped to do my part as faculty in an capability. Instead of adding medical capability for the patient, we and a respiratory therapist. Air Force tactical and doc-
excellent Pulmonary/Critical Care Medicine would find a way to transport the patients to more ca- trinal instructions and directed the
(PCCM) fellowship and provide state-of-the- pability. These teams are trained and provisioned to care for up to three ven- agency in charge of pre-deployment trauma and critical care training,
art medical care to the patients in the Air Over the prior 10 years, several emer- tilated or six non-ventilated critically ill patients for up to 72 hours be- to include CCATT and deployed hospitals.
Force’s best tertiary medical center. gency missions like this had been fore resupply. They may have CCATTs work alongside standard AE I retired from the USAF in 2011 after 26 years of service and remain
In retrospect, it’s interesting spun up on short notice in ex- crews who transport hospitalized stable patients. This development al- proud of those who have carried on and expanded the mission.
how, at that time, very little of traordinary circumstances. For lowed for downsizing of forward operating hospitals from 250-500 CCATTs support humanitarian missions such as hurricane and earth-
the primary mission of Mili- more than five years, beds to 30-60 beds while providing Level 1 trauma services as injured quake support and tsunami relief. They have supported foreign travel
tary Medical Service occu- Brigadier General (Dr.) and ill warriors could be transported away in 12-48 hours rather than of several presidents and other senior leaders. They have transported
pied my thought process. P.K. Carlton had wanted 5-7 days as in earlier conflicts. CCATT facilitated rapid repatriation patients on primary heart-lung bypass as well as VV-ECMO, and
During the Grenada op- to make this a core mis- of our injured to the continental U.S. when the injuries would require highly infectious patients in special isolation equipment. Most impor-
eration, I was a medical sion of the AF Medical multiple surgeries and prolonged recuperation. tantly, CCATTs continue to serve our warriors and their families across
resident in the ICU and Corps for fixed-wing CCATT was accepted as a core mission of the USAF Medical Serv- the globe, ensuring that the best of Critical Care is provided. They serve
helped care for seriously transport and obtained ice and became an integral component of all military medical doctrine with honor and are a unique force multiplier for the Air Force Medical
injured soldiers return- approval for a proof-of- for all services. Teams have combined with other small mobile medic Service. In the end, I’m incredibly happy that pigs do fly.
ing on Aeromedical concept project. Major teams, such as Mobile Field Surgical Teams in both forward deploy-
Evacuation (AE) flights. (Dr.) Steve Derdak had ments and served with Army and Navy units. Teams have subsequently Col. James H. Henderson II, MD, USAF MC, Ret. is a
The Panama invasion only been testing portable ven- deployed to Kosovo, Bosnia, Turkey, Saudi Arabia, Afghanistan, Iraq, Critical Care Intensivist and Family Medicine residency fac-
lasted one month entering tilators and other equip- Djibouti and other locations as needed to support warfighters. Tech- ulty member at CHRISTUS Santa Rosa Westover Hills Hos-
1990, and I was not involved. ment on C-130 training niques developed for this mission were combined with other core tac- pital while serving as President of Medical Staff at CHRISTUS Santa
Later, for “Gulf War 1,” I was a missions to begin the process of tics to strengthen every aspect of military medical transport on air, sea Rosa Hospitals, President of CSR Family Health Center and member of
PCCM fellow doing research and airworthiness certification. Lieu- and land. And for me, from that doubtful moment in 1993, CCATT its Board of Directors. He serves as Adjunct Assistant Professor for the
was not listed for deployment. It tenant Colonel (Dr.) Chris Farmer became the prime mission of my career. UTHSCSA Department of Family and Community Medicine and the
seemed my entire Air Force career was like and others had developed concepts and My life became immersed in this mission and military medicine and, UIW Department of Family Medicine. He is board-certified in Critical
any other civilian physician’s career, except for procedures to be employed and refined. Hon- over the next few years, every position I held was intimately aligned Care, Pulmonary Medicine, Internal Medicine and Sleep Medicine. Dr.
field exercises, wearing a uniform daily, doing physical estly, I thought it was all crazy. We would now develop with it and the incredible doctors, nurses and respiratory therapists Henderson is a member of the Bexar County Medical Society.
training, etc. At least it was until that day. a plan to routinely move patients who were presently deemed too un- who performed the mission. I became a support instructor at the Pri-
That unique day in 1993, we had a department meeting and dis- stable to leave the ICU for a CT scan. In short, I did not believe it was mary CCATT course. I served as a CCATT team leader flying numer-
cussed a new mission, a new concept: Critical Care Air Transport. Un- wise. I expressed my sentiment that this would work “when pigs fly.” ous stateside missions, rescue missions to El Salvador and Bolivia, and
beknownst to me, the crazy guys I was working for had been testing a Little did I know how wrong I was. eventually deployed shortly after 9-11 to Uzbekistan, supporting Spe-
concept for some time — the idea of setting up the equivalent of a The basic concepts that were discussed that day were refined over the cial Forces in Northern Afghanistan. Once back in the States, I became
working ICU in the back of a transport plane or at a forward location next several years. Critical Care Air Transport Teams (CCATT) were the CCATT tactical development team leader, then a Squadron Com-

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