by Kevin M. Hymel
Air Force Surgeon General Public Affairs
1/14/2016 - FALLS CHURCH, Va. -- January
2016 marks the 25th anniversary of Desert Storm, it also marks a
turning point in Air Force Medical Service's Critical Care Transport
Teams (CCATT). "We were not serving the Army as well as we could have in
the Air Force," explained Lt. Gen. (Dr.) Paul K. Carlton, a former Air
Force Surgeon General who had been working on the concept of CCATT since
As the U.S. military and its allies assembled in the Middle East in the
summer and fall of 1990--Operation Desert Shield--in response to Iraq
President Saddam Hussein's invasion of Kuwait, then-Col. Carlton set up
the 1,200-bed Air Force 1702nd Contingency Hospital in combination with
an Army Combat Support Hospital outside of Muscat, Oman. Yet, as Desert
Shield turned to Desert Storm on January 19, 1991, the hospital only
took in 42 patients, and those were only from surrounding bases. "We did
not get any war wounded," said Carlton, who offered beds to the CENTCOM
surgeon in an effort to better utilize the facility.
To make the case for his hospital, Carlton traveled to the battlefield
to offer assistance. "I picked up a couple of Air-EVAC missions just to
let more people know we existed," he said. "I told Army commanders to
send anyone to us." But it soon became apparent the Air Force could not
meet the Army's needs. "We could not take people with catheters or
tubes, much less needing a ventilator."
Instead of relying on the Air Force, the Army built large hospitals
closer to the front. "The Army built up just like they did in Vietnam,"
said Carlton. "They had a very big footprint." AFMS leadership wanted
smaller hospitals connecting back to the United States, but to do that,
they needed a modern transportation system. Although Carlton and other
colleagues had been working on improvements to patient transportation
since 1983, air evacuations were still very restrictive. The equipment
needed to keep a patient alive was new and untested. "Modern ventilators
blew out lungs all the time," explained Carlton. "We needed to work the
kinks out and we needed the opportunity to work in the modern
battlefield. We needed critical care in the air."
When the war ended in late February, Carlton and other AFMS officers
returned home and brought their CCATT ideas to the Air Training Command.
"The war was not an aberration," Carlton said, "we had to modernize our
theater plans to be able to transport patients." Carlton and his
colleagues trained three-person crews to work with new and improved
ventilation equipment aboard airplanes. "That was the long pole in the
tent," he explained. "When you take a critical care patient you say 'we
can ventilate that patient,' and you better be able to." With the new
program up and running, the AFMS made CCATT available to the other
CCATT gained momentum when, in 1993, Carlton and his colleagues traveled
to Mogadishu, Somalia, for an after action brief on the U.S. Army's
"Blackhawk Down" engagement, and explained CCATT to the Joint Special
Operations Command (JSOC) surgeon. He, in turn, handed Carlton a check
and said "I want that as soon as you can make it."
The turning point came in 1995 during the Bosnian War, when an American
Soldier riding a train to Bosnia was electrocuted by an overhead wire
and fell off the train. He was immediately transported to Landstuhl
Regional Medical Center, Germany, where doctors wanted him transferred
to the burn unit at Brooke Army Medical Center in San Antonio, Texas.
When Maj. (Dr.) Bill Beninati picked up the patient for the flight to
the United States, he was still very unstable. Somewhere over Greenland,
the patient went into septic shock and Beniniati and his team
resuscitated him. When they touched down in San Antonio, some twelve
hours later, the patient was in better shape than when he left. "That's
when the Army took notice," said Carlton. "We had convinced them that we
could do what we said."
Soon, the Air Force Surgeon General at the time, Lt. Gen. Alexander
Sloan, approved the CCATT concept. Later, with the strong endorsement of
Air Force Surgeon General Lt. Gen. Charles Roadman II, CCATT became a
CCATT proved invaluable in the next conflict, Operation Iraqi Freedom,
where casualty evacuation became a vital necessity, as well as in
Afghanistan. Carlton is proud of CCATT. "We have developed a modern
transportation system to go along with the modern battlefield for the
Army, Navy, and the Marines." Today, CCATT is considered a vital
component of AFMS, but it took a war to liberate Kuwait some 25 years
ago for the military to realize how badly it was needed.