BAGRAM AIRFIELD, Afghanistan--Editor's Note: This is the second in a four-part series about the 455th Air Expeditionary Wing’s medical response capabilities and the various teams within the wing who play a role in the care and transportation of combat wounded troops throughout Afghanistan.

More than 70 years ago, the first flight nurse graduated from the flight nurse course on Bowman Field, Ky. They trained to provide a higher level of care to patients while they traveled by aircraft to other medical facilities.

Today, the flight nurses and technicians of the 455th Expeditionary Aeromedical Evacuation Squadron keep that level of care going in the skies above Afghanistan.

The 455th EAES provides medical and nursing care in flight to ill or injured servicemembers or Department of Defense civilians. They perform their mission on fixed wing aircraft, including the C-17 Globemaster III, C-130 Hercules and KC-135 Stratotanker, and can provide extensive critical care capability equal to the level of care that patients receive at the Craig Joint Theater Hospital here.

“Our job is to move the sick and injured through the area of responsibility of Afghanistan,” said Col. Edward Farley, 455th EAES commander.  “We obviously don’t want to be very busy because that means that something bad has happened, and we have to move our servicemembers or our coalition partners to a higher level of care.”

Farley, deployed from Scott Air Force Base, Ill., leads 48 medical personnel with teams of four basic crews consisting of two flight nurses and three emergency medical technicians. All flight crew members received specialized altitude training to become universally qualified to move patients by aircraft.

Tech. Sgt. Alejandro Rojas is a 455th EAES medical technician and says the hardest part about his job is the uncertainty of the missions but his team trains for the unexpected.

“Each of our teams preps and configures all of our equipment the same way,” he said.  “That way no matter what aircraft or patients we get, we are ready.”

He also likes to point out that even though his unit doesn’t always stay extremely busy, primarily during the winter seasons, the necessity to have them is unquestionable.
“We are like life insurance,” he said.  “We are expensive and we are not always busy, which is good, but you are really happy to have us when something goes wrong.”

Working as a cohesive unit the members of the 455th EAES are a mix of Air Force active-duty, guard and reserve members from bases all over the globe. Rojas’ home station is Kadena Air Base, Japan, while other team members are from stateside bases like Joint Base McGuire-Dix-Lakehurst, N.J.

Farley believes his team works well together because of the awesome responsibility of their mission and just how worthwhile it can be.

“The team encounters these young and brave men and women that have gotten injured while serving their country,” he said.  “We get to take them by the hand and look them in the eyes to tell them just how proud of them we are.”

BAGRAM AIRFIELD, Afghanistan – Editor's Note: This is the first in a four-part series about the 455th Air Expeditionary Wing’s medical response capabilities and the various teams within the wing who play a role in the care and transportation of combat-wounded troops throughout Afghanistan.

"The Golden Hour" refers to the hour immediately following a serious injury and is the most critical period in the patient’s survival.

The call comes in: there is a coalition forces member in need of immediate and serious medical care in the eastern mountains of Afghanistan.  Within minutes, a small tactical recovery team, known as Guardian Angel, is on a helicopter heading towards their objective.

For the members of Bagram's 83rd Expeditionary Rescue Squadron Guardian Angel, this is exactly what they train for and are ready to execute. Their mission is to rescue, recover and return American or allied forces in times of danger or extreme duress. 

“We have less than an hour to get that patient under ‘bright lights and cold steel’ if they are going to live,” said Staff Sgt. George Reed, 83rd ERQS pararescueman, referring to that “golden hour” when a patient has no other option than immediate surgery.

“Any environment, anytime, anywhere we will execute a rescue mission or patient recovery,” said Reed.

Maj. Joe Lopez described Guardian Angel as a U.S. Air Force weapons system comprised of three career fields: the CRO (combat rescue officer), the PJ (pararescuemen) and SERE (survival, evasion, resistance, escape). 

This combined weapons system can execute the five phases of personnel recovery from Report, Locate, Support, Recovery and Reintegrate. 

Recovering patients in Afghanistan requires not just combat medical training but increased situational awareness in case of enemy activity.

“Our team is highly trained on ground tactics,” said Lopez, 83rd ERQS combat rescue officer.  “In many cases we have to provide our own security in a hostile location while we prepare the patient for transport.”

One of the distinct capabilities of the GA team is technical rescue where they utilize extrication equipment to remove war fighters or civilians trapped in wreckage or collapsed structures in almost any terrain or environment.

The situation can vary from a high altitude crash to a mass casualty incident to a packaged patient ready for evacuation.

“The idea is to get in and out as fast as possible without exposing the patient to additional threats,” said Lopez.  “The longer we are on the ground, the longer we are vulnerable to attack and can decrease the patient’s chance of survival.”

While in flight, the parascuemen perform trauma medicine to stabilize the patient in order to bring them safely to a higher level of care.

The actions of these Battlefield Airmen of the Bagram 83rd ERQS Guardian Angel prove their dedication and commitment to saving lives and staying true to their motto, “These Things We Do...That Others May Live...To Return With Honor.”

PARWAN PROVINCE, Afghanistan  -- With the sun rising over the mountains, Reaper Team 5 pointed their vehicles towards the north and shifted gears mentally as they moved on to their next mission.

The team left Bagram Airfield in the dark of night, and won’t return until midday.

“At night our objective is primarily [to counter improvised explosive devices and indirect fire attacks], but during the day, we focus on presence patrols and engaging with locals to gauge the atmosphere in the area,” said Master Sgt. Eddie Ray, 755th Expeditionary Security Forces Squadron Reaper 5 team leader.

Engaging with the locals requires the Airmen of Reaper 5 to leave their armored vehicles to trek through the small villages and across fields in the hills near Bagram on dismounted patrols.

“Just driving around, you’re not engaging the locals and you can’t see much.  Plus there’s a lot that’s just not passable in a vehicle,” said Ray.  “This way we get to know the locals a bit more and we can tell when something’s going on.”

When the vehicles arrived at their destination, the Airmen dismounted and checked their gear.  Assured they had everything they needed, the Airmen set off through the village, stopping every so often to chat with locals and wave to the curious children watching them.  Though language barriers make their interactions brief, the Airmen know their presence makes a difference.

“I know if I was trying to do something [against Bagram], and I saw all these trucks and guns everywhere, I probably wouldn’t do it,” said Airman 1st Class Kameryn Futral, 755th ESFS fire team member.  “I think our presence also helps these kids know what Americans are like if their parents have told them they should hate us.”

As they patrolled, Airmen handed out pens and candy to local children.  Some of the local boys showed off their prowess with slingshots and let the Airmen try their hand at shooting some rocks.  The engagement was typical for the team, said Ray.

Reaper 5 is one of several teams from the 755th Expeditionary Security Forces Squadron responsible for the security of Bagram Airfield and its inhabitants.  Each Reaper team consists of approximately 20 Airmen who work 12 hour shifts patrolling the nearly 180 square mile security zone outside of Bagram Airfield.  The team leaders, like Ray, work with the squadron’s leadership to prepare their team’s missions for the week including routes, weapons and tactics to ensure the airfield is protected from all sides.

“The only way you’re going to defend [Bagram] is to reach out into the local community,” Ray said.  “You’re not going to stop it all, but the goal is to disrupt them and force them to use different routes and methods.”

BAGRAM AIRFIELD, Afghanistan – Every day, Airmen from the 455th Expeditionary Aircraft Maintenance Squadron are performing essential repairs to C-130 Hercules cargo aircraft.

C-130s generally spend a year here while crews rotate in and out.

Tech Sgt. Michael Raver, 455th AMXS dedicated crew chief, said that the crews currently deployed from Little Rock Air Force Base, Ark., may be from different squadrons at home, but they’re all a team out here.

“We all come together to do our thing,” Raver said. “We’re the system specialists, anything from changing tires to refueling to doing the everyday inspections.”

While perhaps not as glamorous as the F-15 Eagle fighters Raver once worked on before cross-training to cargo aircraft, Raver found a certain charm in them. He said many of the aircraft earn themselves nicknames.

For example, he pointed to one C-130 and said it was dubbed ‘Gizmo’ after a character in the movie Gremlins, “because we’re always chasing gremlins around it.”

Raver said that because the C-130s are aging aircraft, each day presents a new challenge. Senior Airman Zach Pectol, 455th EAMXS crew chief, added that in a deployed environment those challenges take on an added urgency.

“You know there’s a real mission to get done, it’s not just a training mission,” Pectol said, “so if something breaks you’re on point to get [it fixed].”

On the other hand, both Raver and Pectol marveled at the versatile, ‘go anywhere’ nature of the C-130.

“Very rarely will these things not fly because of weather,” Pectol said. “Just recently, we had a snowstorm and we wiped the snow off the plane, de-iced it, put heater cards on the prop[eller]s and [it] took off.”

When he cross-trained, Raver found that just learning the details between the two airframes was the biggest challenge.

“The workload is about the same, the pace is a little slower on the heavy side,” he said. However, he said when comparing the missions of dropping munitions to dropping cargo, “it can be just as satisfying.”

BAGRAM AIRFIELD, Afghanistan – Man cannot live on airpower alone, and at the Craig Joint Theater Hospital here, the 455th Expeditionary Medical Support Squadron Nutritional Medicine flight works tirelessly to keep their charges fed.

“We are the only nutritional medicine flight in Afghanistan,” said Capt. Lindzi Howder, flight officer in charge. “We feed a lot of people.”

The flight serves more than 8,000 meals a month, including regular meals for hospital staff in the cafeteria, MREs for use during contingencies and liquid diets for patients that cannot feed themselves.

Howder noted that allowances have to be made for local customs.

“A lot of the foods we serve are halal, because we have more local nationals. Americans come in and out very quickly in the inpatient ward, but our long-term patients are Afghan,” Howder said.

The liquid diets they serve can come in two forms: enteral, which is fed into the patient’s stomach, and parenteral, which is administered directly into the patient’s bloodstream. While Howder is responsible for recommending a patient receive parenteral nourishment, the actual supplies are maintained at the pharmacy.

“It’s very tightly regulated because being in the blood there’s a high infection [risk],” Howder said.

The parenteral nourishment is made up of simple dextrose and amino acids, while Howder likened the enteral to baby food.

“It is a medication, but we keep it in-house because it doesn’t need to be refrigerated,” Howder said.

Howder is one of just 45 dieticians in the Air Force, and the only one deployed to Afghanistan.

“I had to work very hard to get here, because this is the only deployment billet for the Air Force,” she said.

“I’m also the only dietician … for the Army Weight Control Program. Any time an Army member falls outside of those weight guidelines, they have to be seen by a registered dietician.”

In addition to her duties at the hospital for the joint force, Howder also goes on Freedom Radio twice a month to answer questions about nutrition.

“I’ll tailor the radio show to what people are asking. For example, a common misconception is there’s 3,000 calories in one MRE and there’s not, it’s 1,300.”

Howder noted that this job is much different from her normal duties at the Health & Wellness Center on Ramstein Air Base, Germany.

“A dietician is usually an inpatient dietician, an outpatient dietician or a food service dietician,” she said. “Here I have to do all three.”

Howder continued that at her homestation she mainly dealt with children or people playing sports.

“[At Ramstein] you’re dealing more with healthy people than here you’re dealing with chronically malnourished people who get blown up. It’s a different side of nutrition.”