Medical group sharpens patient evacuation skills during exercise

by Air Force Staff Sgt. Robert Barnett
JBER Public Affairs

4/3/2014 - JOINT BASE ELMENDORF-RICHARDSON, Alaska -- In 1964, a 9.2-magnitude earthquake ravaged Southcentral Alaska. Streets and buildings were ripped apart, tsunamis devastated towns and the need for medical services was dire.
Fifty years later, the state of Alaska hosted exercise Alaska Shield 2014 from March 27 to April 3. Federal, state and local authorities worked together to test interagency response during the disaster scenario - the largest exercise of its kind in Alaska.

"The last Alaska Shield exercise in 2010 had more than 4,000 interagency participants," said Richard Everson, an exercise planner for Joint Task Force - Alaska.

This year's exercise has more than doubled in participation. In addition to the military involvement, approximately 10,000 Alaska-based Department of Defense assets participated in the exercise.

"I can't think of a time we've ever had this volume, size and scope for a 'bed down' exercise," said Air Force Lt. Col. Chad Hazen, acting 673d Mission Support Group deputy commander.

During the exercise scenario, a simulated 9.2-magnitude earthquake hit Joint Base Elmendorf-Richardson March 27. The simulated natural disaster was the start of Mission Assurance Exercise 14-3, and included multiple simulated casualties and more than two dozen simulated injured military and civilian personnel at Fire Station 2 on JBER.

Additional scenarios included road blocks and emergencies such as gas or fuel leaks in various locations across the installation throughout the remainder of the week.

Firefighters and medical services responded to the scenes, removed the simulated victims from any immediate dangers, and helped care for injuries in the simulated crisis.

More than 1,200 service members traveled to JBER to participate in the exercise, playing as responders or victims. Many residents of JBER also role-played so emergency services could practice their responses, Hazen said.

Buses and ambulances arrived with medical services and transported the injured to the hospital.

On March 31, the 673d Medical Group began evacuating role-playing patients due to simulated earthquake damage to their facilities, reducing their echelon capabilities and causing the hospital to seek air transport to get patients to medical treatment facilities capable of meeting their needs.

The Critical Care Air Transport Team's mission is to operate an intensive care unit in an aircraft cabin during flight, adding critical care capability to the U.S. Air Force Aeromedical Evacuation System. CCATT patients received initial stabilization, but still required evacuation to a more capable hospital.

A CCATT consists of a three members: a physician, a critical care nurse and a respiratory therapist.

Most of the victims had simulated crash or accident injuries. Many patients required procedures that could not be received on JBER, said Air Force Capt. Fernando Tovar, 673d Medical Group anesthesiologist.

With the degraded capability of medical centers caused by the earthquake, higher echelons of care could be damaged or destroyed, requiring medical personnel to transfer the patients to the continental United States, he said.

Practicing their response and transport of patients helps give them confidence in themselves and their equipment, he said.

"It's important for us to know that our equipment functions correctly," the anesthesiologist said. "We go through the motions of preparing a patient for transport, thinking about all that we need to set up our equipment, to go through the logistics of transporting from the hospital to the ambulance, from the ambulance to the airplane."

The patients were transported to Hangar 5, where they simulated travel to medical centers capable of providing a higher echelon of care than an earthquake-damaged hospital could provide.

"I'm learning the logistics of transporting patients," said Air Force Staff Sgt. Melissa Lepp, 673d Medical Group cardiopulmonary therapist who served as respiratory therapist in the CCATT. "It's interesting because this scenario is a natural disaster, so it's slightly different than being down range. This is a good chance to brush up on my skills that I use in a deployed setting."

Transporting patients out quickly is a capability that's unique to the Air Force, Tovar said.
"I think it's good," said Air Force Capt. Annie Nesbit, 673d Medical Group critical care nurse. "You need to actually get in there and physically have people being moved, orders being written and things being coordinated for the patients so that muscle memory would come. [Medical personnel] would say 'we know what we are doing now, so let's do it' and it wouldn't be such a surprise. If you don't practice this once in a while, things will never go smoothly, especially in something like a natural disaster."

They coordinated efforts with the Army, Tovar said, with the sister service providing many of the simulated patients.

The exercise also demonstrated how the military could provide emergency aid to the state.
"If there were a natural disaster, we'd be able to transport any patient, civilian or military - there would be no [dividing] line," Tovar said. "We'd provide not only care here in the hospital, but transport by air to any injured or ill patient."

Northern Command's Exercise Ardent Sentry, Joint Task Force - Alaska's Arctic Edge, the Alaska National Guard's Exercise Vigilant Guard, JBER's MAE 14-3 and several other large-scale exercises working together under Alaska Shield to respond to the simulated natural disaster.

"There are a lot of people coming together for a greater good," Nesbit said. "It's a really great practice and exercise with all the different in-state and out-of-state agencies, Army, Air Force, Guard - all the different types of people who can come together and work through a true crisis."