The objective of the five-day mission was to bring home a service member who had been injured in an aircraft accident and had developed an invasive fungal infection on his face and leg, so that he could receive surgical treatment at the USAISR Burn Center collocated with Brooke Army Medical Center at Joint Base San Antonio-Fort Sam Houston, Texas.
Undertaking the complex mission involved a U.S Air Force C-17 cargo plane transporting a larger-than-usual team of critical care, respiratory and renal specialists and their equipment roughly one-quarter of the way around the world and back with stopovers in Hawaii each way for fuel and supplies – putting to the test the team's motto, Anytime, Anywhere.
Established in 1951, the Burn Flight Team comprises nurses, respiratory therapists and physicians who specialize in burn treatment. Everyone on the elite team has completed the U.S. Air Force School of Aerospace Medicine's Critical Care Air Transport Team course and works full-time in the Burn Center's intensive care unit.
Because the team is required to be able to deploy with just a few hours notice, it's not unheard of for a team member to climb aboard an airplane straight from a 12-hour shift.
The Burn Flight Team had been alerted to the condition of the injured service member in Australia within hours of the accident. However, after his arrival at The Alfred Hospital in Melbourne, he had remained in stable condition with the assistance of an artificial lung, called extracorporeal membrane oxygenation, and continuous renal replacement therapy.
For several weeks, there was little for the team to do beyond keeping regular tabs on him. But when the hospital reported that the patient had developed a rare fungal infection called Mucormycosis that was beginning to spread rapidly, the team swung into action to bring the service member home for surgical treatment.
Capt. Matthew Wood, a critical care registered nurse and the team's ECMO transport coordinator, said that because the patient was receiving ECMO and CRRT care, the Burn Center team consisted of 12 specialists – double the typical team size – plus all their primary and backup equipment. While team members typically travel outbound via a commercial flight and return with their patient via a U.S. Air Force cargo plane, in this case, the large number of personnel and extra equipment involved required a lift from the Air Force in both directions.
"We knew this would be a pretty significant transport for us," says Wood, who coordinated the logistics for the mission.
The team departed from Kelly Field at 10 p.m. on Oct. 2 and landed at Hickam Air Force Base in Hawaii 20 hours later. As the flight crew took their mandated rest, several members of the team drove to nearby Tripler Army Medical Center to pick up dialysis fluids, while Wood spent the time juggling the logistics for their arrival in Melbourne.
"Usually, we fly ECMO missions into or near another military base, which covers ground transport to and from the medical facility, but for this trip, we were flying into a civilian city, which required coordinating transport for our teams to and from our hotel, to and from the hospital and then back to the flight line," Wood said. "I was on the phone for most of my crew rest."
Once they were in the air again, strong headwinds over the Pacific required them to make an intermediate stop in Brisbane to refuel before continuing to Melbourne, where they arrived nearly 15 hours after leaving Hawaii. While the flight crew rested and tended to the aircraft, the medical team traveled to The Alfred Hospital to meet with the staff who had been caring for the injured Service Member.
Lt. Col. Alicia Williams, the Burn Flight Team's director and chief medical officer of the USAISR Burn Center, recalls how all the hospital staff who had treated the Service Member gathered to brief the team on his condition – including the doctor who had fast-roped from a nearby helicopter to the crash site immediately following the accident, likely saving his life.
"They were fantastic," Williams said. "They were very professional and very accommodating. There were many junctures at which it could have gone poorly for him, but the different teams all came together and worked together to save his life. The Alfred even handled the patient movement for us. They were a great asset to have."
Fully briefed on the patient's condition and with a night's rest after their grueling flight, the care team returned to the plane with the injured service member as well as his family, who had flown out to Australia to provide support during his treatment. The long flight back to Hawaii was uneventful – until just a few minutes before landing at Hickam.
"We were buckled up in our seats when, three minutes before landing, the ECMO machine clotted off," said Michael Mueller, RN, a staff nurse on the Burn Flight Team.
Normally, a clot in an ECMO machine can easily be corrected before it can injure a patient by conducting what medical professionals call a circuit change, which involves switching the patient to a second ECMO machine. The team had with them a backup machine for that very purpose. However, if no one can perform the circuit change – say, because they're required to be strapped in for landing – the situation can quickly get dicey.
Rather than abort the landing and conduct the circuit change in the air, the team assessed the situation and elected to proceed with the landing as it would allow them to get the patient to the hospital that much sooner.
As the plane descended, Williams and Mueller kept the patient's family informed about the ECMO machine changeout while Wood and another member of the team, U.S. Air Force Capt. Sarah Juhasz, an ECMO nurse and a 2023 recipient of the Henry M. Jackson Foundation for the Advancement of Military Medicine's Hero of Military Medicine San Antonio award, closely monitored the wayward ECMO machine. After the landing, as the airplane taxied to the ramp, Wood and Juhasz unbuckled themselves, stood up and successfully changed the circuit.
"Sarah was holding this ECMO machine in her hands, which was bananas," Williams said. "I mean, she could have accidentally smacked herself in the face with it!"
"Every flight, you try to come up with the worst possible scenario and have it pre-planned in your head, but I don't think we've ever thought about having to switch out an ECMO machine while landing," Mueller added. "The patient was very stable, which was awesome because when that kind of thing happens, you get an adrenaline rush, and you get a little nervous. It's somewhat of an emergency, because if the machine stays down, then the patient can decline very quickly. But I just kept looking at the vital signs and telling Capt. Wood, 'You've got time. You're good. Everything's fine, he's stable.' Just trying to alleviate any of the extra stressors on them. Capt. Wood and Capt. Juhasz did an awesome job."
"After the commotion was over, I went over to his dad – he had been able to see what was happening from where he was seated – and I just told him, 'Hey, I just want you to know that he's doing fine. I know it looks kind of hectic over there, but he's stable and everything's looking good.'"
"Replacing a pulmonary bypass machine in the back of a plane isn't an everyday thing," Wood said. "It's maybe the worst possible timing for that machine to need attention. It was a very tense moment, but everyone handled it and executed it very well."
Fortunately, the rest of the trip was drama-free and upon landing at JBSA the patient was admitted to the Burn Center, where Williams performed a series of intensive surgical treatments to remove the fungal infection.
The Australia mission wasn't the longest in the team's history; in 2013, a C-17 flew the Burn Flight Team 9,850 miles nonstop from JBSA to Singapore to transport a burn patient. However, it was the team's longest mission involving a combined team of burn and ECMO specialists. It was also the team's first in-flight ECMO circuit change. And for several of the team members, it was the longest mission of their careers – at least, so far.
"This is the epitome of military medicine," Wood said of the Burn Flight Team. "We will go to literally any lengths to get active duty service members home. This is why we serve in military medicine; this is what we train for and what we're ready for. And then, on top of that, to be a part of a team that went and did this dual record-breaking medical evacuation is just remarkable."