"As the Guard migrated into the homeland defense mission, we got away from the CCATT mission," Air Force Col. Brett Wyrick, air surgeon for the Air National Guard, told participants in a "DOD Live" bloggers roundtable Jan. 11."However, recently what we've discovered is that there is a need for the Air National Guard in the CCATT mission," he said, "and also we've got quite a bit of expertise in the Guard and in the Reserve that allows us to meet the demands of the mission and take some of the strain off the active-duty sources, who have been stretched quite thin by the ongoing conflicts." The Air Force surgeon general introduced the concept about 10 years ago to meet a need for transporting the most critically injured patients in the aeromedical evacuation system. "This is a mission where we actually bring everything that you would find in an intensive care unit to the air frame," Wyrick said. "And it gives us the ability to move injured and wounded soldiers and airmen, Marines from the forward areas of the battlefield back to a tertiary care facility either in Europe, the Pacific or the United States." A critical care air transport team consists of an intensive care physician, a critical care nurse and a respiratory technician. The first Air Guard team is on alert at Ramstein Air Force Base, Germany. "If there's a need downrange, they can deploy forward from Ramstein into Iraq, Afghanistan or even into the African continent if there's a need for that," Wyrick said, "and then they [are transported with] the patients back to the United States or back to Europe, wherever the mission [dictates]." After this requirement was validated, it took less than six months for the Air Guard to field its first team with the help of the Air Force Expeditionary Medical Skills Institute's Center for Sustainment of Trauma and Readiness Skills at the University of Cincinnati. "We're going to have a constant and persistent line in the [aeromedical evacuation flight] now [and] for the next two years out of Ramstein," he said. Wyrick said the Air Guard plans to stand up 18 full teams from 17 states. Many of them have begun training, and they are expected to reach full operational capability within the next two years. The Air Guard also has volunteers from all 54 states and territories who would like to augment these teams when needed, he said. "There're a number of Guardsmen out there from various states who want to participate in the mission, who have the medical training and qualification to participate in the mission," Wyrick said. "And we're accepting them as volunteers." The current team consists of Col. (Dr.) Bruce Guerdan, who is the state air surgeon for the Florida Air Guard, Lt. Col. David Worley, a nurse from the Kentucky Air Guard, and Master Sgt. Jody Nitz, a respiratory therapist from the Michigan Air Guard. "So, we did combine people from all over the country to put these volunteer teams together," Wyrick said. The doctors will rotate about every 30 days, and the nurses and respiratory technicians will average about 60 days. At least one nurse has volunteered to serve for six months. All of these Air Guard medical personnel have one thing in common: experience. "If you look at your average Guard physician, he's got at least 15 to 20 years in medicine," Wyrick said. "Many of those are in primary care. And when you look at it most of us have an active-duty background, and then after they leave the military, then they go back out and they respecialize or they subspecialize. "So, we've got a lot of critical care physicians, a lot of surgeons, anesthesiologists -- guys who have literally written the book on modern medicine are residing in the Air Guard," he continued. "And by putting them in the CCATT mission, we bring years of experience and we bring years of knowledge that make us a good total force partner for the Air Force." Many of the volunteers, he said, have critical care air transport team experience, but "a lot of them, by virtue of the fact that there are already specialists in the civilian health care world, they bring that experience and they're readily trainable to the CCATT mission." In addition to its federal mission, a team also could be used for emergency response here at home. "For instance, if we had a situation on the Gulf Coast where a big hurricane rolls up on shore and you need to evacuate civilian patients from a civilian hospital in the hurricane's path, that would be another use for the CCATT teams," Wyrick said. "It gives you a way to transport critically injured patients from the strike zone to areas of safety. So it's not just battlefield and combat casualties; it could also be in humanitarian roles or in a disaster situation." Wyrick added that the states have access to Air Force equipment in the event of a disaster. "There just aren't the barriers that there used to be," he said. "After [Hurricane Katrina struck in 2005], there's been a lot of crosstalk, there's been a lot of planning, and we have access to the equipment and supplies that we need when we need them." Air Guard critical care air transport teams use life-support equipment that has been tested and verified as being safe and airworthy. "When you're talking about transporting patients through the air, what you have is what you bring with you," Wyrick said. "And the systems have to be super-reliable, there has to be redundancies in there, and they have to be safe for flight." The team's typical patient will come with a stretcher, a monitor, intravenous pumps and also a ventilator to maintain respiration throughout the mission, he said. In addition to the equipment, the teams often fly with a full aeromedical evacuation crew, which cares for the less-critical patients. However, the critical care air transport team may not have an aeromedical crew with them on every flight. "It depends on whether it's a routine scheduled mission or whether it's an emergency," Wyrick explained. "In a pinch, these guys can convert anything into [an] air evac platform." Wyrick said the Air Force has moved away from the concept that aeromedical evacuation is an air frame. Critical care air transport teams are the "back-end medical crew," he said. "As far as the aircraft goes, the CCATT teams can use an aircraft of opportunity, and while everybody prefers to have a C-17 because of the design in the room, we also fly missions from the theater far forward in Afghanistan back to the United States in KC-135s, or we can also do this in a C-5 or whatever aircraft is designated as the aeromedical evacuation platform." Only the most-critical patients will require a critical care air transport team, Wyrick said. "We're taking patients that otherwise wouldn't be candidates for the aeromedical evacuation system, because we really are talking about the most severely injured patients [at Landstuhl Army medical Center in Germany]," Wyrick said. Each team can handle up to four patients, who are flown directly from Landstuhl back to Walter Reed Army Medical Center in Washington or National Naval Medical Center in Bethesda, Md., or to the burn center at Brooke Army Medical Center in San Antonio. How quickly a patient is transported back to the United States depends on the patient's needs, Wyrick said. "A lot of times when the patients come back from the forward areas, there's more surgery to be done on them," he explained. "And after they've undergone the combat resuscitation and stabilization, then when they get to Landstuhl, there could be other procedures that are done where they take the patient back to the [operating room], and then it might be several days, or even weeks, before the patient is actually ready for transport back to the United States." He added that a patient who has suffered a burn could be shipped back almost immediately to San Antonio. The Air Guard critical care air transport team was scheduled for its first flight back to Joint Base Andrews Naval Air Facility Washington in Maryland on Jan. 11, no critical care patients needed movement from Landstuhl back to the United States. "So that's actually a good thing," Wyrick said. "Because the fewer injured patients there are for the United States military, the better things are going. So they're sitting alert right now, and they're ready." Jan. 13, 2011: By Air Force Lt. Col. Ellen Krenke- National Guard Bureau