AE
OVERVIEW
Integrity - Service - Excellence
The Center for Sustainment of Trauma
and Readiness Skills
Cincinnati
Division of Trauma and Critical Care
Department of Surgery
The University Hospital of Cincinnati
Cincinnati, Ohio
Overview
Traditional AE aircraft
Non-traditional AE aircraft
 Capabilities
 Safety features and in-flight emergency
information
Ground operations
Crew Coordination
Integrity - Service - Excellence
C-130
• Oxygen
•
No onboard therapeutic
oxygen for pt use
• Portable Therapeutic
Liquid Oxygen (PTLOX)
• Communication system
• Electrical Systems
•
Seven 28VDC
• Three 115 VAC@ 400Hz
• Required use of
Frequency Converter and
ECAS System
•
Loud aircraft
• Communicate through
MCD/loadmaster
Integrity - Service - Excellence
C-130
• How do you load the patient?
• Cargo ramp (feet first)
• How many patients can I put onboard?
• 70-74 litter patients
• 92 ambulatory patients in evans seats
• Maximum of 15 floor loaded patients
Integrity - Service - Excellence
C-130
Emergency Exits
Primary Ground Exits
• Crew Entrance Door
• Paratroop Doors
Primary Ditching Exits
• Fwrd Overhead Escape Hatch
• Cntr Overhead Escape Hatch
Aft Overhead Escape Hatch
Secondary Exits
• Pilot/Copilot Clear view
Chopping Locations
Windows
• Side Escape Hatch – Avoid • Have no hydraulics, electrical,
or oxygen lines in these areas
Fish, Fan, Flame
• Chop in and inverted U
• Ramp - only if open and
unobstructed
Integrity - Service - Excellence
=Secondary Exits
=Ground Evacuation
=Secondary for
Ground and Ditching
=Ditching Evacuation
= Only if opened and
unobstructedI n t e g r i t y
- Service - Excellence
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7
C-17
• Stand-alone capabilities = 9 Litters (in 3 stanchions)
• Patient Support Pallet (PSP) expands litter capabilities
• Floor Load
•
•
48 Litters in cargo compartment
Additional 12 litters can be floor loaded on ramp
• 102 Seats for Ambulatory and AECMs
• Loading/unloading
•
•
Ambulatory: crew entrance door
Litters: cargo ramp (feet first)
Integrity - Service - Excellence
C-17
AIRCRAFT SYSTEMS
Oxygen
Electrical
•
Two 75-liter LOX Converters on
board
• Minimum 100 L before leaving
home station
o Therapeutic Oxygen

o
5 outlets all located on the
right side
Emergency Oxygen





Dixie-cup diluter mask
pull lanyard to start flow
available at each potential
litter space on stanchions
60 masks on sidewall
additional 48 for
centerline seats if/when
installed
• frequency converter is NOT
required
•
twelve 115VAC 60hz outlets on 6
panels
–
•
3 located on each side (forward, midcabin, aft)
twelve 28V DC plugs
–
No PMI application
Integrity - Service - Excellence
C-17
AIRCRAFT SYSTEMS
• Lighting
• Controlled by loadmaster
(LM)
• On/Off/Dim
• Communication
• Controlled by LM
• All briefings done by
LM
• Comfort Items
• Crew Lavatory
o
•
Galley
o
o
o
•
Forward Left side of AC
Forward Section
Convection Oven
Refrigerator / Freezer
May have Comfort Pallet
• Environmental
• Heating/cooling
controlled by LM
Integrity - Service - Excellence
C-17
EMERGENCY INFORMATION
• Emergency Exits (12)
•
Flight Deck:
o Pilot/co-pilot sliding windows
o Maintenance/ditching hatch
•
Cargo Compartment:
o
o
o
o
o
o
Crew entrance door
Forward emergency escape
door
Four overhead ditching hatches
 Flotation Equipment
Deployment System
(FEDS)
2 troop doors (rt/lt aft aircraft)
Cargo door
Chopping locations (4)
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Integrity - Service - Excellence
12
C-17
Integrity - Service - Excellence
CCATT In-flight
Evaluate all patients when at altitude
Maintain situational awareness at all times
Utilize critical thinking skills
Utilize closed loop communication
Utilize crew resource management (CRM)
TEAMWORK-TEAMWORK-TEAMWORK!
Integrity - Service - Excellence
14
Non-Traditional AE
Aircraft
Integrity - Service - Excellence
C-21
• Oxygen Capabilities
•
•
Portable D-cylinder oxygen tanks
Spectrum Unit has self-contained oxygen 3,500L
• Electrical Capabilities
•
•
Equipment battery
Power required:
o
•
28V DC AC power
Electrical Output:
o
o
#2 115VAC/60hz
total 15 Amps
Integrity - Service - Excellence
C-21
• Communication Capabilities
•
Easy (real small aircraft!)
• Loading/unloading
•
•
Crew entrance door (only option)
If Spectrum unit is in place, use patient loader
o Aluminum folding ramp that allows you to “slide”
patient in
Integrity - Service - Excellence
EMERGENCY EXITS
• Crew entrance door
• 2 over wing exits
Integrity - Service - Excellence
KC-10
• Oxygen Capabilities
•
Bring PT LOX
• Electrical Capabilities
•
Use pigtail of electrical cable assembly system (ECAS)
o
•
Frequency converter can be used for 60 Hz equipment
o
o
o
o
Power source: 115vac/400hz
Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary
panel/ galley outlet
Total of 15 amps ( 1 amp to drive the unit, 14 amps remaining)
Equipment On Battery
PSP adds Litter Capabilities
Integrity - Service - Excellence
KC-10
• Communication capability
• Relatively easy to
communicate with one another
• Use boom operator as a
runner/communication
between aeromedical crew and
flight crew
• Loading/unloading
• K-loader
• Lift truck
• Patient loading system (PLS)
Integrity - Service - Excellence
Integrity - Service - Excellence
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KC-135
• Oxygen capabilities
•
Bring PT LOX
• PSP adds Litter Capabilities
• Electrical capabilities
•
Use pigtail of electrical cable assembly system (ECAS)
o
•
Power source: 115vac/400hz
Frequency converter can be used for 60 Hz equipment
o
o
Modified Avionics Freq converter to receptacle #3 on the P22 auxiliary
panel/ galley outlet
Total of 15 amps (1 amp to drive the unit, 14 amps remaining)
Integrity - Service - Excellence
KC-135
• Communication
capabilities
•
Not that great, loud aircraft
• Communication between
aeromedical crew and flight
crew done through boom
operator
• Loading/unloading
•
K-loader
• Lift truck
Integrity - Service - Excellence
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C-5
• Oxygen capabilities
•
Bring PT LOX
o
o
•
•
Requires extra 300 feet of oxygen hosing
Load may require PT LOX be in cargo compartment and oxygen lines be
strung up to troop compartment
Therapeutic oxygen manifold system (TOMS) may be used from
recharger hose
Portable oxygen cylinders
• Electrical capabilities
•
•
•
Modified Avionic frequency converter for 60 Hz equipment
Secured in the cargo compartment with ECAS to troop or courier
compartment
Arrange with the loadmaster
Integrity - Service - Excellence
C-5
• Communication Capabilities
•
•
Relatively easy to communicate with one another
Communication between flight crew and aeromedical crew
done through loadmaster
• Loading/unloading
•
•
•
•
K-loader
Lift Truck
Catering Truck
Cargo Ramp (If patient is placed in cargo compartment –
ABSOLUTE LAST RESORT!)
Integrity - Service - Excellence
CIVIL RESERVE AIR FLEET
(CRAF) Boeing -767
US DoD maintains several civilian/commercial
airlines with B-767’s that are capable of rapid
transformation into AE aircraft
Crew Complement:
• Flight attendants have primary responsibility for:
•
Egress
• Patient briefings
• Serve meals
Integrity - Service - Excellence
CREW COMPLEMENT
• AECMs have responsibility for:
•
•
Patient care
Assist with egress/ other emergencies
• 2 AE crews
•
•
•
•
2 FN’s/3 AET’s each crew
One forward crew
One aft crew
CCATT
•
Augment critical care capabilities as mission
dictates
Integrity - Service - Excellence
EXITS
• 6 Exits
•
•
•
2 doors in front of
aircraft
2 overwing exits
2 doors in back of
aircraft
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CRAF Capabilites
• Small-body B-767
– Configured to transport 87 litters and 37
seats (includes 2 MCD seats)
• Large–body B-767
– Configured to transport 111 liters and
37 seats
• Top litter is about mid-chest
•
•
18 inches between each litter
Aisles are 25 inches wide
Integrity - Service - Excellence
MEDICAL OXYGEN SUBSYSTEM
• Consists of six 75- liter
LOX in forward cargo
compartment
(total of 450 liters)
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MEDICAL OXYGEN SUBSYSTEM
• Therapeutic oxygen
outlets located at each
potential litter space
Oxygen
outlets
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AIRCRAFT PASSENGER
EMERGENCY OXYGEN SYSTEM
• Diluter-type masks
from overhead
consoles
Integrity - Service - Excellence
ELECTRICAL POWER
DISTRIBUTION SUBSYSTEM
• Subsystem consists of 6
electrical converters
•
Converts to 115 VAC 60 hz
• Supplied to electrical outlets at
each stanchion
• Outlets labeled #1, #2, and #3
• Power strips not to exceed 20
amps
Integrity - Service - Excellence
ELECTRICAL POWER
DISTRIBUTION SUBSYSTEM
CAUTION
When switching from ground to aircraft
power, power may be interrupted
momentarily in any aircraft
Closely monitor all critical equipment
Integrity - Service - Excellence
LOADING/UNLOADING
High Deck Loading Platform
System (HDLPS)
•
•
•
Holds 24 Patients
Patients placed 4-high
Raised/lowered to aircraft
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High Deck Loading Platform
System
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37
High Deck Loading Platform
System
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LOADING/UNLOADING
Patient Loading System (PLS)
•
•
•
•
•
50-foot length ramp
Can be assembled and rolled to
aircraft
Patients enplaned head
first/deplaned feet first
May have 2 units (one forward on
each side of aircraft)
Ground personnel enplane up ramp
and exit out aft stairs
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Integrity - Service - Excellence
40
CCATT Onload
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CCATT On-load
Ensure emergency litter is located under most critical
patient
Set up airway/Advanced Cardiac Life Support bags
Ensure all medications/blood products are enplaned
Are patients adequately sedated-give boluses prior to
take-off
Quickly re-evaluate all patients prior to take-off
Integrity - Service - Excellence
42
CCATT On-load
Ensure emergency litter is located under most critical
patient
Set up airway/Advanced Cardiac Life Support bags
Ensure all medications/blood products are enplaned
Are patients adequately sedated-give boluses prior to
take-off
Quickly re-evaluate all patients prior to take-off
Integrity - Service - Excellence
43
Is all equipment secured?
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Hang Supplies for Easy
Access
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Integrity - Service - Excellence
Stresses of Flight
G: G-Forces
H: Decreased Humidity
O: Decreased Partial Pressure of Oxygen
S: “Shakes”/Vibration
T: Thermal Changes
B: Barometric Pressure Changes
A: And
N: Noise
• All of the stresses of flight result in fatigue
for both you and your patient
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50
CCATT Preflight/Packaging
Preflight: CCAT team reviews Patient Movement
Request, discusses pt needs and anticipates needs for
flight-GAME PLAN!
Pre-Hospital: Have someone designated to do specific
jobs
Determine patient load plan
Oxygen calculations/electrical requirement
Extra equipment/supplies needed
Vacuum Spine Board
Extra IV Pumps
Extra ventilator circuits and batteries
Sign out narcotics
Integrity - Service - Excellence
51
CCATT In-flight
Evaluate all patients when at altitude
Maintain situational awareness at all times
Utilize critical thinking skills
Utilize closed loop communication
Utilize crew resource management (CRM)
TEAMWORK-TEAMWORK-TEAMWORK!
Integrity - Service - Excellence
52
CCATT Post-Flight
Patient off-load is a critical phase of the mission
CCATT crews are tired and have high risk factors for making a
mistake
Transportation from aircraft to the hospital is on a bus without
electrical capability
Perform team huddle to discuss off-load game plan
Provide a thorough hand-off to accepting team
Perform a debrief with your team: strengths, weaknesses
of mission and areas of improvement
Integrity - Service - Excellence
53
SAFETY CONCERNS
• Secure loose bags/gear before take off
• No gloves when handling oxygen
• Avoid patient care activity during take off/landing
• Alert AE if you need to stand during these times
• If pt is unstable, you can be secured to the pt litter while standing
• When 3 patients are transported per litter tower, each
litter position is rated to hold 320 lbs
•
•
Considerations with OSL (Over-Size Litter)
OSL can be tier loaded but consider floor loading
Integrity - Service - Excellence
SAFETY CONCERNS
• Airframe
•
Do not open crew entrance door on C-17 unless gauge
on door is in the “green”
• Patient
•
Do we have to remove all the rollers in the cargo
compartment?
• Crew/CCATT
•
What is our role during an aircraft emergency?
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Questions?
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