Terms can be specific. Stratevac = strategic evacuation. That is – out of theater to definitive care). In just about everyone’s military, Air Forces are the ones with this responsibility. Unless, of course, you are too small to have such abilities or find it is cheaper to buy the services from another military or civilian source.

No, I am not kidding about the civilian course – S.O.S. is contracted by smaller militaries as a great way to move the occasional patient.

The following information is nothing that you can’t find by perusing various Stars & Stripes, Washington Post, New York Times or other articles that have been written over the last several years.

For the ATO (Afghan theater of operations) the hub is located here at Bagram. That means that all patients leaving theater, whether litter or ambulatory have to come through here. Critically ill patients have their care transferred from the hospital to the CCAT at the ICU (ITU for you Brits) who effect the transfer to the aircraft. Ambulatory patients are rounded up at the CASF (Contingency Air Staging Facility) and are either hiked or bused out to the plane depending on how close it is. In the case of Bagram, just about everything is by bus/ambulance bus since there is a definite dislike of stray individuals on the flight line.

From here to Ramstein is about about 7-8 hours, give or take. The length of the flight means that there are limited choices of aircraft in the current inventory. The Nightengales are gone. Taken out of the inventory just a couple of years before they became critical, part of the decision was the fact that they were dedicated aircraft and pilots, not interchangeable with other missions. The advantage of built-ins and specialty air craft was billed as over come by the limited number of air frames and high expense.

So, now we have opportunity air craft – C-17s and KC-135s. Yes, you read that right – tankers being used for patient movement. They have some challenges: smaller, fewer patients, large tanks which limits the places the Air Force is willing to land (can you spell rocket attack?). The C-17s are huge and you can pack a lot of patients on them, both liter and ambulatory.

Most of the time there is a regularly scheduled C-17 run once a week where they try to move most of the ambulatory patients and all “stable” litter patients along with all on hand critical patients and CCAT. The rest of the time it is KC-135s because it is a critical patient move.

There is a limit to what we can do for patients here in theater. Additionally, we have a limited number of ICU beds. In order to support on-going operations, those beds have to be open. When they are filled with casualties, the casualties need to be moved to the next echelon of care.

So it seems that just about everyone got here on a C-17, and there are a few who leave via another aircraft.

(CCAT= Critical Care Team)