BUCKLEY AIR FORCE BASE, Colo. —
A week before Thanksgiving, a Navy explosive ordnance disposal technician clung to life in a Baghdad hospital after an roadside bomb he was clearing left his body in tatters.
With extensive damage to his airways and his lungs failing, this Sailor would need specialized treatment if he had any hope of survival. That’s when a team of doctors from the San Antonio Military Medical Center at Joint Base San Antonio-Fort Sam Houston, led by Air Force Reserve Dr. (Maj.) Jeffrey DellaVolpe, was called into action.
DellaVolpe is an Individual Mobilization Augmentee assigned to a one-of-a-kind life-saving medical team at SAMMC. He is one of less than a handful of military doctors fully qualified to perform a treatment known as extracorporeal membrane oxygenation, or ECMO.
According to Dr. (Col.) Phillip E. Mason, the SAMMC Adult ECMO Program medical director, ECMO is a process in which blood is oxygenated and circulated to the brain and other critical organs. Highly-skilled doctors insert garden hose-sized tubes, called cannulas, into blood vessels in the neck or groin. These tubes are then connected to the ECMO device, which uses a pump to remove the blood from the body, pass it through an artificial lung, and then return it to the body.
“It keeps the patients alive while the lungs, and possibly heart, heal,” Mason said, adding that patients have successfully remained on ECMO from anywhere from a few days to a few months.
According to Mason, who was deployed during the call for ECMO help, DellaVolpe is one of the most experienced ECMO physicians in the entire Department of Defense and also has experience with long-range ECMO transports – eight at the time, with the November mission making his fifth international transport and ninth overall.
“Getting him activated for this mission was key to a successful operation,” Mason said.
Due to the severity of the bomb tech’s injuries, he would require the specialized care of the SAMMC ECMO team in order to be transported to a fully equipped medical facility. There’s a very small percentage of patients sick enough to need an ECMO transport but those who are, can’t be moved until they’re on the therapy.
“The biggest part,” DellaVolpe said, “is if they need ECMO, they need it quick.”
DellaVolpe and his team of two doctors and five nurses went into action as soon as the call came in.
The Air Force Reservist, who works at Methodist Hospital in San Antonio, coordinated the time off. The ECMO team was placed on travel orders, gathered their equipment – nine Pelican cases of gear, plus enough backup supplies to operate independently for 72 hours – and hopped on the next flight to Germany. At Ramstein Air Base, they were picked up by a waiting C-17 and flown to Baghdad.
“This was about as complex as a mission can get,” said DellaVolpe, who credited the many people working behind the scenes to ensure orders were cut and travel arrangements made with getting the team in the air on time.
While the medical staff in Baghdad waited, they kept their Sailor alive on a ventilator. However, because his lungs were severely failing, it was a race against the clock to get the ECMO team in place.
“A ventilator supports your breathing, but if your lungs are failing, it’s not going to help,” DellaVolpe said.
During the flights, the ECMO team prepared for what was ahead so they could show up ready to go; the Sailor was on ECMO within one hour of arrival. DellaVolpe said it took 30 hours from the time they got the call in San Antonio until they were treating the patient on the other side of the world in Baghdad.
After the patient was on ECMO, doctors at the Baghdad hospital performed several more critical surgeries. The Sailor was then loaded onto a C-17 for a historic flight. Historic because the medical evacuation marked the first time a U.S. service member undergoing ECMO treatment would be flown to the United States on ECMO. Seventy-two hours after initial notification, the medical evacuation flight delivered its patient directly to SAMMC, where he is recovering.
“It is also the first time we have responded from the continental U.S. to an overseas location for a combat casualty,” said Mason, who added that it was the longest ECMO transports ever conducted by the military.
While the life-saving capability is not uncommon, few doctors come out of training with any experience in the niche therapy. Coupled with the frequency at which military doctors have a permanent change of station or leave the military, they rarely have time to become fully qualified.
“Factor in 6-month deployments for some of our people and you can see that we have a revolving door that makes it very difficult to retain talent and sustain the program,” Mason said.
The head ECMO doctor said the first military team to use ECMO was an ad hoc group of doctors and nurses from Landstuhl Regional Medical Center, Germany, between 2005 and 2011. This team saved nine of the 10 patients they treated but, with no in-patient ECMO facilities available, they had to rely on a local German hospital to sustain the treatment once the service member transported out of theatre. This early team highlighted the need for the Department of Defense to maintain an ECMO team and develop an in-patient capability said Mason.
The ECMO team at SAMMC treated its first patient in 2012. The first few years saw no more than six cases per year, said Mason. But, beginning in July 2015, that number exploded, growing to 17 in 2016 and on track for 35 patients in 2017. Since 2013, the team has also conducted 42 total ECMO transports, “including international missions from Afghanistan, Iraq, Japan, Honduras, Germany and Columbia,” Mason said.
In addition to combat casualties, ECMO utilization is growing quickly for multiple patient populations, including trauma, medical conditions and acute illnesses, Mason added. These missions help keep military medicine on par with leading civilian centers, while also maintaining readiness for combat casualty care.
With the growing demand and short supply of qualified doctors, Mason turned to the Individual Reserve to retain and nurture talent.
The Individual Reserve is managed by the Headquarters Individual Reservist Readiness and Integration Organization, Buckley Air Force Base, Colo. The program includes IMAs, reservists assigned to funded positions at active-component organizations and government agencies where they augment full-time counterparts. They have military requirements similar to traditional reservists, serving between 24 and 36 days per year, but also manage a civilian career.
According to Col. David Lesko, the HQ RIO Detachment 5 commander, responsible for all Individual Reserve medical positions, the IMA program was a good fit for Col. Mason’s need at SAMMC. An IMA can continue serving in the Air Force, contributing directly to the active-duty mission as-needed, while simultaneously working a full-time civilian job.
In this case, DellaVolpe gains full-time specialty experience at Methodist Hospital, where he works in the surgical and cardiac intensive care unit, and the Air Force can retain him and his ever-growing ECMO capability for critical missions like the one in November.
The Det 5 commander said that during their annual review of positions, Mason reached out to him to inquire about adding several IMA billets to the SAMMC ECMO team. Lesko had several billets he was able to redistribute to Mason’s team. DellaVolpe went directly from active duty into one of the new IMA positions in July.
“Working for Methodist allows me to build experience in ECMO, since the Air Force doesn’t do much in the way of heart transplants and mechanical circulatory support devices,” DellaVolpe noted. “This is a treatment usually for the critically ill but the military still has a need for the war fighter.”
He said he could not have asked for a better mission. For the eight who went, the dedication of the whole team working around the clock to safely bring their brother-in-arms home was inspiring.
“Hopefully this demonstrated our capability and we can continue to save lives,” DellaVolpe said.