# Presentation: 942220

## Air Operations

***AE Mission***
***AE Capabilities***
***AE Configurations***
***AE Crew Compliment***
***PRT/AE Interface***

**Overview**

**Air Operations**

**Notes:**
The next couple of slides will outline the topics we will be discussing:  I’ll give a brief over view of the AE mission, aircraft and crew capabilities.  We’ll look at configurations for the aircraft we use in the AE system to move patients—particularly the C-17 and the C-130.  I’ll introduce you to the different AE crew positions and how you will interface with the crew once the aircraft lands.  We will look at what you can expect when it comes to deplaning the patients—who is in charge and how we work together. Next slide

## Air Operations

***Forms/Documentation***
***Airport/Airfield Familiarity***
***Aircraft Support***
***Operating Around Military Aircraft***
***Safety Considerations***

**Overview (cont’d)**

**Air Operations**

**Notes:**
Once you do receive the patients there are forms which are unique to the AE systems—I’ll show you examples of the main forms on which you will see patient care documented.  The next section will concentrate on the airfields, equipment, vehicles and safety.  Keep in mind during this block of instruction—this is not intended to make you experts by any means regarding the AE and airfield environment, but to help you operate safely. Next slide

## Air Operations

**Capabilities**

***The Movement of Patients by Fixed-Wing    Aircraft, under the Supervision of Aeromedical Evacuation Crews, to and between Medical Treatment Facilities***
***Air Force is Executive Agent for AE***
***AMC is Lead Command for AE***
***AE is an AMC Core Competency***

**Air Operations**

**Notes:**
At HQ AMC where I work, we have oversight for 32 active duty, reserve and guard AE units.  The majority of the manpower in AE falls with the guard and reserve—approx 88% in fact.  AE is truly a Total Force.  Case in point, the aircraft and crew might originate in Mississippi, but the AE crew might be comprised of a mixture of personnel from two different reserve units and maybe even a active duty CCATT team could be transporting patients all on the same mission.  AE crews are comprised of nurses who are officers and enlisted medical technicians, these folks are deployed around the world.  These crews ensure our patients can be moved to the appropriate level of care in an expedient manner according to the classification of their illness.  There are ground and flying UTCs or codes by which individual crew members are tasked.  They may perform ground functions as in Command and Control (C2) or a MASF (Mobile Aeromedical Staging Facility) or as flight crews primarily tasked to transport patients. Next slide

## Capabilities

***Utilize Retrograde Airlift***
***Maintain Forward Capability***

**Capabilities**

**Secure Airfield**
**MASF**

**BATTLEFIELD**

**Mobility Hub**

**Expeditionary**
**      ****AE**

**CASEVAC**

**Expeditionary**
**      ****AE**

**Air Operations**

**Notes:**
What used to take days to move casualties, now can take a matter of hours to get patients to definitive care.  We put AE crews forward to minimize delays in transport and utilize available aircraft.  Our AE crew are “Universally Qualified” which means that we can fly on a wide variety of airframes.  Our equipment and care of the patient remains the same, we just have to adapt to the different electrical and oxygen systems of each aircraft, as well as how we configure the aircraft for transport .  Each aircraft presents a different set of challenges for enplaning and deplaning which we will discuss a little later. Next slide

## Air Operations

_**LEGEND**_

**Site of Injury**
**Level 2 (Army Forward Surge ****	****Team)**
**Level 3 Facility**
**Secure Airfield**
**Air Mobility Base**
**Strategic Airlift Hub**
**Route of Evacuation (AE)**

**MASF/CCATTs**
**AE Crews**

- ASF

**AES/CC, Crews, CCATTs,  MASF Support Personnel**

**Level 4-5 move**

**Level 3-4 move**

**Level 2-3 move**

**Capabilities**

**Air Operations**

**Notes:**
Patients are moved according to severity—routine, urgent or priority.   This is a busy picture—but in the next two slides you’ll see a general depiction of how a patient is moved in the system from point of injury out of the theater.  A casualty is picked up at the site of injury and moved to aid station or forward surgical team.  Once the injured member is taken to a hospital in the AOR such as in Balad, they receive more advanced medical care. Patients are stabilized and those who require movement from the AOR are prepared for flight.  Patients no longer have to be “stable” to move.  They can be prepared for flight and held temporarily in a MASF or CASF  which are near the flight line. Patients are picked up at one of these airfields and moved to one of our hubs where they will be transported on to Landstuhl in Germany.  Next slide 

## Air Operations

- ’

- TURKEY

- IRAN

- SYRIA

- II

- IRAQ

**Capabilities**** **

- MASF
- AE Crews
- CCATT

- KUWAIT

**Air Operations**

**Notes:**
This is an example of the patient flow I just described.  This is just for one theater—but basically the same flow would occur in other theaters around the world.  For this particular theater we use C-17s and KC-135s to transport.  Next slide.

## Air Operations

**Capabilities**

***  ******The AE System provides:          ***
***  ******Integrated control of casualty movement by air                                        ***
***  ******Command and control (C2) of theater AE      ***
***  ******Forces and AE operations ***
***  ******Specialized ******clinical ******aircrew and augmentees     ***
***  ******Operational Support Personnel                           ***
***  ******En-route staging facilities on or near air fields     ***
***         ******for care of in-transit patients***

**Air Operations**

**Notes:**
As you can see by the slide—AE isn’t just about transporting patients once they get on the aircraft. We provide:  (read the items on the next two slides). Next slide

## Air Operations

**Capabilities **

***  ******Medical in-flight equipment***
***  ******Support to the communication network ***
***    ******between airlift C2 agencies***

**Air Operations**

**Notes:**
Again, reinforces the idea that AE has a presence on the ground as well as in the air.  Next slide.

## Air Operations

**Configurations**

**        **
*** ******AE is NOT tied to specific airframes ***
*** ******Multi-platform capable AECMs enables AE     ***
***   ******crews to take advantage of transiting airlift***

**Air Operations**

**Notes:**
Now let’s talk a little bit about configurations.  AE is a mission, not a platform.  Because we carry on our own equipment, our jobs don’t change, the patients are the same, the equipment is the same, what changes is the interface between the equipment/patient and platform which requires specially trained individuals.  As I mentioned earlier, we have several different aircraft on which we transport patients.  Let’s look at a few.  Next slide

##                   C-17

**                  *****C-17***
***36-48 Litters with additional seats for  ambulatory/medical crew***

**Configurations**

**Air Operations**

**Notes:**
The C-17 is a aircraft used for troop movement, cargo and AE. It has a huge payload.  It can be configured in many different ways based on mission requirements. This aircraft has built in AE capabilities.  There is built in electrical and patient oxygen sources, as well as a complimentary set of litter stanchions (nine total litters).  This capability can be increased with the use of the Litter Stanchion Augmentation Set (LSAS) to a total of 48 litters.  Additional seats can also be installed for ambulatory patients.  The C-17 has a long range, but under certain circumstances can be refueled in flight.  The interior is spacious, well lit and the temperature can be fairly well controlled. Next slide

## Air Operations

**AE-2 Configuration**

**Air Operations**

**Notes:**
This is a diagram of a typical configuration used on the C-17.  The comfort pallet is a set of portable toilets/sinks on one side---on the other side a food storage and preparation area (point to those areas on slide).  We can even make hot meals—Healthy Choice dinners are the standard fare.  As you can see along the sides of the aircraft are seats for ambulatory and crew.  Seats can also be added down the center.  The boxes at the end of the aircraft are the LSAS storage boxes which must accompany the litter sets (point to LSAS location).  As you can see, they take up a big portion of the ramp and you have to maneuver around the sides of them as you enplane and deplane patients.  Next slide

##  C-130E/H/J

**Configurations**

** *****C-130E/H/J***
***  ******50 Litters ***
***  ******C-130J (stretch) 97 Litters***

**Air Operations**

**Notes:**
The C-130 has been in service for many years. It can also be used for troop movement, cargo and AE. This aircraft is very versatile, however, interior is more confined,  less lighting, loud and not always well temperature controlled.  There are several configurations you might see with this aircraft as well as floor loaded litters.  There are many unique challenges when transporting patients, but the C-130 and the crews who fly are definitely work horses. Next slide

## Air Operations

**AE-1 Configuration**

**Air Operations**

**Notes:**
This is a typical configuration you might see—point to litters and seats.  Patients are enplaned and deplaned via the ramp. Next slide

## Air Operations

**AE-2 Configuration**

**Air Operations**

**Notes:**
This diagram shows the max litter carrying configuration. Next slide

## Air Operations

**AE-4 Configuration**

**Air Operations**

**Notes:**
Just another variation...next slide

## PSP Configuration

**Air Operations**

**Notes:**
The next couple slides are of the Patient Support Pallets I mentioned earlier.  They can be configured in a number of ways with all litters or a combination of litters and seats.  They are used on board the C-17  and KC-135.  We hope to use them one day on the KC-10 as well. They slide onto the aircraft on rollers just like a cargo pallet.  They are raised and have some ramps—you actually have to step up onto them.  I mention this because sometimes there is space between them or the ramps don’t cover all areas where litter bearers or crew might be walking—thus creating a tripping hazard. Next slide.

## PSP Configuration

**Air Operations**

**Notes:**
Another variation of the PSP configuration.  Both the PSPs and LSAS are tracked very closely.  For Example—one LSAS is worth $450K.  Next slide

## Air Operations

**Configurations**

***KC-10***
***Opportune Aircraft-single litter patient movement***

**Air Operations**

**Notes:**
The KC-10 is a tanker that is rarely used—except for a single urgent patient.  Next slide

## Configurations

**Configurations**

***KC-135***
***36 including crew max***

**Air Operations**

**Notes:**
The KC-135 is another aircraft that sees a lot of AE action. Patients can be floor loaded, seated, or transported on PSPs.  AE crews must carry electrical converters and patient therapeutic oxygen (PTLOX).  Special care must be taken because this is a vapor environment—it’s a tanker.  Only a limited portion of the aircraft can be used for patients, crew and passengers. Lighting is limited, the temperature can be difficult to control. Next slide

## Air Operations

**AE-2 Configuration**

**Air Operations**

**Notes:**
This is a typical configuration you might see with the PSPs (point to the PSPs).  Patients are enplaned/deplaned via the cargo compartment by the Patient Loading System (PSP), High Deck Patient Loading Platform (HDPLP), or you might even see a K-loader or air stairs for ambulatory patients.  If the aircraft doesn’t have the engines running or an external heating or air conditioning unit up and running expect extremes in temperature.  It can get very hot during the summer months.  So that is a huge consideration when you have to plan on vehicle support during off-load.  
** Discuss with audience just how hot and cold it can get—give personal examples of flying on this aircraft.  Different temperature variations from top to bottom and forward to aft. 
The crew does what they can to maintain patient comfort.  But the temperature extremes can have a negative affect on patient condition as well as the crew and litter bearers. 
Next slide

## Air Operations

**Configurations**

**Air Operations**

**Notes:**
This slide shows the placement of two PSPs.  Any questions before we go on to the next section?  Next slide

## Air Operations

**AE Crew Compliment**

***Flight Nurses***
***Medical Technicians***
***Critical Care Aeromedical Transport Team***

**Air Operations**

**Notes:**
The normal crew compliment is 2-flight nurses and 3 aeromedical technicians.  There may be additional crew depending on the load/acuity or the length of the mission. A separate specialized team known as a Critical Care Aeromedical Transport Team  (CCATTs) may also accompany the AE crew. Next slide

## Air Operations

**AE Crew Compliment**

**Air Operations**

**Notes:**
The Medical Crew Director (MCD) is the flight nurse with overall responsibility for the patient care and crew. This person can be of any rank, Lt thru Col.  But regardless of their rank, they are the authority for the patients and AE crew on the mission.  Next slide

## Air Operations

**PRT/AE Interface**

***AE Crew***
***Loadmaster (LM)***

**Air Operations**

**Notes:**
OK, let’s talk about PRT/AE interface.  Once the aircraft lands, the aircraft load master is the authority on the ground around the aircraft.  The Load Master will direct vehicle movement and marshal vehicles to the aircraft. No movement up to the aircraft will take place unless directed by the Load Master. We’ll discuss that a little later when we discuss vehicle movement/safety. Once the Load Master directs the PRT reps onto the aircraft, the AE crew will communicate and direct all matters pertaining to patient care and deplaning in and around the aircraft. So, the ultimate question is: who is responsible for the patient and when?  When the patient is in and around the aircraft—the patient belongs to the AE crew.  Once you load the patients up and drive off they belong to you.  Next slide

## Air Operations

**Forms / Documentation**

***AF IMT 3899a-k***
***AF IMT 3854 Receipt Movement for Patient Valuables***
***DD Form 602 Patient Evacuation Tag***

**Air Operations**

**Notes:**
Several forms will accompany the patients in the AE system.  The next series of slides are scans of those forms.  The 3899 series are the main forms you will see.  You might come across a DD Form 602, but it is not the standard any longer.  I believe you have hand-outs with these forms.  Next slide

## Air Operations

**AF IMT 3899**

**Air Operations**

**Notes:**
These are a little hard to see on the slides, but the 3899 is the most important form—it contains the physician orders, patient demographics, vital signs etc...  Next slide

## AF IMT 3899

**Air Operations**

**Notes:**
The reverse side is where notes are made.  Next slide

## AF IMT 3899A

**Air Operations**

**Notes:**
Now we get into the subsequent forms—this is the progress note.  Next slide

## AF IMT 3899B

**Air Operations**

**Notes:**
Physician orders    Next slide

## AF IMT 3899C

**Air Operations**

**Notes:**
Physical assessment   Next slide

## AF IMT 3899D

**Air Operations**

**Notes:**
Hemodynamic/respiratory flow sheet   Next slide

## AF IMT 3899E

**Air Operations**

**Notes:**
Intake and output   Next slide

## AF IMT 3899F

**Air Operations**

**Notes:**
Restraint order sheet   Next slide

## AF IMT 3899G

**Air Operations**

**Notes:**
Restraint observation flow sheet   Next slide

## AF IMT 3899H

**Air Operations**

**Notes:**
Neuro flow sheet     Next slide

## AF IMT 3899I

**Air Operations**

**Notes:**
Next slide

## AF IMT 3899J

**Air Operations**

**Notes:**
Hemodynamic / rhythm strip sheet   Next slide

## AF IMT 3899K

**Air Operations**

**Notes:**
Resuscitation / CODE sheet  Next slide

## AF IMT 3854

**Air Operations**

**Notes:**
This form – 3854 is the patient valuable form generally used for patients who are unable to care for themselves or their own valuables.  Next slide

## DD Form 602

**Air Operations**

**Notes:**
This is the old DD Form 602 Patient Evacuation tag – as I said you might still see one of two of these out there, but the 3899 is the form we use now.  Next slide

## ZULU Time Conversion Chart

**Air Operations**

**Notes:**
I know this is hard to see, but this is a time conversion chart we use since we traverse so many time zones.  In the AE system we only use Zulu time to document (which is Greenwich Mean Time) .  This makes it easier to determine things such as when did the patient have their last pain medication in relation to the local time so there isn’t no chance of over/under-dosing.  Any questions before we go on to the next section?  Next slide

## Air Operations

**Airport / Airfield Familiarity**

***Military versus Civilian Airfields***
***Command and Control (C2)***
***Flight Line***
***Taxiways***
***Entry Control Points***
***FOD***
***Vehicle Movement Guidelines***

**Air Operations**

**Notes:**
Here are the areas we ill discuss for airport/airfield familiarity.  ** Read list on slide.  Regardless of what airfield the aircraft lands on, GPMRC will contact the airfields and medical facilities with details regarding the in-bound aircraft.  Medical facilities will also be given details regarding the numbers and the disposition of the patients.   The facilities will be notified of transportation requirements and will be given contacts at the individual airfields in order to secure entry.  GPMRC will in turn contact the FBO (base ops) at both military and civilian airfields to arrange for entry and escorts for personnel, ambulances and ambuses. The airfield managers/Base Ops will direct access, parking and security on the flight line.  Be assured that the no one will be sent onto the flight line without directions or unaccompanied. Let’s take a look at things to be aware of once the PRT and transport vehicles are granted access to the airfield.  Next Slide

## Airport / Airfield Familiarity

**Air Operations**

**Notes:**
Generally, all airfields are pretty much the same, they just differ in size and shape.  They all have active runways, taxiways, parking ramps, some have large terminals, others just have a small building.  They are all similarly marked, use same color coding and follow the same rules regarding vehicles and access.  This happens to be Scott AFB—you can go on Google Earth and see what just about any airfield looks like—that’s one way of familiarizing yourself with any particular layout.  Next slide

## Airport / Airfield Familiarity

**Airport / Airfield Familiarity**

_***Taxiway***_***: Yellow centerline, yellow signs with black letters***
_***Runway***_***: White edge and centerline, red signs with white numerals***
_***Lights***_***: Blue lights indicate taxiways, white or amber lights bound runway***
_***Parking Ramp***_***: Yellow lead in lines with yellow nose wheel spots***
_***Runway Hold Lines***_***: Two solid yellow lines followed by two broken yellow lines across all taxiways approximately 100 feet before entering the runway***

**Air Operations**

**Notes:**
This slide lets you know the colors for the different areas on an air field.  You know if you see white and red lights---you’re in the wrong spot—get out of there!!  Next slide.

## Airport / Airfield Familiarity

***Stay within marked traffic lanes***
***Do not cross “Red Lines” except at designated FOD    access points ***

**Air Operations**

**Notes:**
Flight lines are marked with red lines on the periphery.  Do not cross those lines. Entry areas are marked with a white line---so you will see red-white-red painted line and a FOD sign—we’ll talk about FOD in a minute.  The consequences for crossing at an unauthorized point can be finding yourself face down on the concrete with a machine gun pointed at you and guard dogs at bay.  That’s not a good day.  Next slide	

##  Airport / Airfield Familiarity

***Enter and exit through FOD access points***
***Give right of way to taxiing aircraft***
***Upon meeting a moving aircraft, pull well to the side, stop, and wait until the aircraft has passed before proceeding. Obey the commands of the aircraft, move team personnel while aircraft is passing***
***Use spotters to guide vehicle approach to an aircraft ***

**Air Operations**

**Notes:**
Here is some flight line etiquette.  ** Read slide.  Remember when driving on the flight line, taxiing aircraft have the right of way.	Next slide

##  Airport / Airfield Familiarity

***Operators will stop at the FOD entry point and check tires and exposed surfaces of vehicles, towed vehicles, bicycles, scooters, and other mobile equipment for foreign objects (rocks, nails, metal shavings, and any other debris***
***Upon completing the initial tire inspection the operator will move the vehicle forward so that the remainder of the tire can be inspected***

**Air Operations**

**Notes:**
Ask the audience--Does anyone know what we mean by FOD?  Foreign Object Debris.  Why is it so important to remove FOD from entering the flight line?  The engines are so powerful on some of these jets, a rock or piece of metal can be sucked up into an engine an cause damage.  Do you remember the Concord jet that crashed?  Didn’t they determine there was debris on the runway that cause the tire to blow out?  FOD.....FOD can be something as simple as loose paper.  Next slide	

## Airport / Airfield Familiarity

***Observe warning lights and signals***

**Air Operations**

**Notes:**
This slide is self explanatory.  Each airfield has their own version of traffic control lights.  So, if the sign says stop when light is flashing, you better stop!  Next slide	

##  Airport / Airfield Familiarity

***Use seatbelts in all vehicles that are equipped with them ***
***Pedestrians and aircraft ***_***always***_*** have the right-of-way***
***Obey all posted traffic signs and speed limits***

**Air Operations**

**Notes:**
Here are some general vehicle safety rules you should follow regardless of what type of vehicle you are driving.  Next slide	

## Airport / Airfield Familiarity 

***Standing on moving vehicles is prohibited***
***Park in designated areas only***
***Do not block aisles, stairways, intersections, emergency exits, or emergency equipment***
_***Never***_*** leave a vehicle unattended with the engine running***
***Do not exceed maximum load or seating capacity of the vehicle***

**Air Operations**

**Notes:**
I can’t emphasize line #4 enough.  Never leave a vehicle running unattended.  The other lines are common sense.  Next slide	

##  Airport / Airfield Familiarity

***All vehicles must follow posted speed limits and traffic signs***
***All vehicles must stay within the white lines ***
***Keep vehicles off grass***
***No attempt should be made to pass any moving or stationary aircraft in the taxiway, if engines are running. If a towed aircraft has stopped, passing is permitted provided there is a minimum 50-foot clearance between the vehicle and aircraft***

**Air Operations**

**Notes:**
** Read each item.  Pay special attention to line #4.  You also need to maintain at least a 50 ft clearance from refueling trucks.  This all  seems pretty common sense—but why am I even mentioning these things?  Because people don’t pay attention and do stupid stuff.  I guess I could have said that in a more politically correct way, but when you see vehicles crashed into aircraft---believe me, I could have shown you pictures of people who did not pay attention and well, did stupid stuff.  Next slide	

## Airport / Airfield Familiarity

***Never park a vehicle pointing directly toward an aircraft***
***When parking the vehicle: ***
***Always turn the engine off***
***Set the parking brake***
***Verify the doors are unlocked ***
***Leave the keys in the ignition***

**Air Operations**

**Notes:**
There are strict guidelines as well for parking near an aircraft.  (Read each line)  Next slide 

## Airport / Airfield Familiarity

***Only those operators with proper clearances can drive across taxiways or runways***
***At night, vehicles moving toward aircraft will turn off headlights and use parking lights only***
***Personnel operating vehicles on the Flightline must comply with all additional training and certification requirements***

**Air Operations**

**Notes:**
Ask audience--Are civilian ambulance drivers taught to drive on a flight line as part of their training?  If any drivers are ever in doubt—request a Follow-Me truck.  Never any shame in that verses driving where they aren’t supposed to go, or being detained by security for unauthorized access—or worse yet—getting in the path of an aircraft!  Next slide

## Airport / Airfield Familiarity

***Approach aircraft with the driver’s side toward the aircraft***
***Do not park in front of run station/hangar doors***
***With the exception of authorized emergency vehicles, vehicles shall not be parked or driven within 25 ft to the front of, or 200 ft to the rear of any aircraft, except when the aircraft is being serviced, loaded, or off-loaded, and spotters are used to guide the vehicle's approach to the aircraft. Vehicles shall not be driven under any part of the aircraft***

**Air Operations**

**Notes:**
When driving around an aircraft—do you want to move in a clockwise or counter clockwise direction? Remember no one will approach the within the 25 / 200 ft directions without a go ahead from the Load Master.  Under no circumstances will any medical vehicles be driven under the wings of the aircraft.  Next slide	

## Airport / Airfield Familiarity 

***Do not use a vehicle for towing unless properly equipped***
***Set brakes when parked***
***Use wheel blocks/chocks when loading/unloading trucks or trailers***

**Air Operations**

**Notes:**
When parking near an aircraft, chocks MUST be used and you MUST have a spotter!!  Unfortunately the spotters (unless it’s a Load Master) don’t pay close attention (tell story about service truck delivering meals at Travis). Any questions?  Have I made my point about vehicle safety?  Next slide	

## Air Operations

**Aircraft Support**

***Patient Loading System (PLS)***
***K-Loader***
***HDPLP (High Deck Loading Patient Platform)***
***Fleet Service***
***Fire Protection***
***Follow-me Truck***
***Power Carts***
***Fire Extinguisher***
***Lighting***

**Air Operations**

**Notes:**
A lot of different vehicles and equipment are necessary to support aircraft.  Depending on the type of aircraft and whether the aircraft arrives during the day or night-time, how long the aircraft will be on the ground will depend on what level of support is needed.  Next slide 

## Aircraft Support

***Hazards***
***Noise ***
***Tripping (Cable)***

**Air Operations**

**Notes:**
The generators provide power to the aircraft without having to stat up the engines for things like air, lights, electricity.  They can be loud, have cables that attach to the aircraft that can be tripping hazards and should not be touched except by trained personnel.  They are black or dark green—can be difficult to see in the dark.  Next slide

##  Aircraft Support

*** ******Hazards***
*** ******Loud Noise***
*** ******Hot exhaust***
*** ******Plane of Rotation***

**Air Operations**

**Notes:**
These auxiliary carts look similar to the generators, but serve a different purpose.  They have some of the same hazards with the addition of hot exhaust.  Next slide  

##  Aircraft Support

*** ******Hazard***
*** ******Noise***

**Air Operations**

**Notes:**
The light carts provide a flood light capability, but they too can be loud.  Next slide

## Air Operations

*** *****Aircraft Support**

**Air Operations**

**Notes:**
This is the light cart opened up.  They can put out a lot of light—almost blinding.   Next slide

## Aircraft Support

*** ******Hazards***
*** ******Noise***
*** ******Tripping (Ducts)***
*** ******Heat***
*** ******Carbon monoxide****** ***

**Air Operations**

**Notes:**
During times of inclement weather the aircraft must be cooled or heated for patient comfort.  This is an example of a heater (cooler works the same way).  They are loud and the air ducts can be tripping hazards.  Next slide

## Air Operations

**Aircraft Support**

**Air Operations**

**Notes:**
These large fire extinguishers are placed in front of the aircraft.  Be careful when driving around the aircraft.   These are Halon extinguishers—they can be used for all types of fires.  Next slide 

## Air Operations

**Operating Around Military Aircraft**

***Situational Awareness***
***Circles of Safety***
***Prop Wash***
***Who is in charge in and around aircraft***
***Security / Military Police / Canines***

**Air Operations**

**Notes:**
I can’t emphasize enough, and you will hear me say it over and over again...operating around an aircraft can be dangerous business.  But if you follow the rules and maintain situational awareness, you and those around you will be safe....and most of all the precious cargo—the patients will be safe.  We talk about situational awareness constantly in our AE training, we even grade our crews on their habits of situational awareness—that’s how important it is.  The flight line is a busy place and everyone has their own job to do—often seems chaotic—but everyone moves in concert....but that one person not paying attention, or that one person not speaking up about seeing something out of the ordinary or taking immediate measure to prevent an accident can be deadly.  You’ve heard the old saying you have to watch out for the other guy—that especially holds true on the flight line.  Now let’s look at some hazardous areas around the aircraft. ** Read items on slide.  Next slide

## Air Operations

**Operating Around Military Aircraft**

**Air Operations**

**Notes:**
When loading or unloading personnel, baggage, or equipment through the crew entry door, with engines operating, stay clear of engine inlets.  Engines, at any power setting, are capable of developing enough inlet duct suction to cause fatal injuries to a person too close to the inlet—I don’t think I need to get graphic with that—do I?  Secure all loose personal items before passing in front of operating engines.  You will not be deplaning patients with engines running, but these hazard area are import to know so you don’t approach too early.  For the most part, activity will take place in the rear of the aircraft—but there may be an occasion to enter the crew entrance door—which is actually located in the same area on most aircraft.  ** Point to crew entrance.  Next slide

## Air Operations

**Operating Around Military Aircraft**

**Air Operations**

**Notes:**
To prevent possible injury to personnel and/or damage to equipment, ensure all potential danger areas are clear.  Special attention will be conveyed to wake velocity speeds caused by the prop blast at high power settings.
Personnel will not be in the vicinity of or go through the static propeller arc (bleed air on or off) unless absolutely necessary in the performance of duties.  Most likely you will not be deplaning patients with engines running on this aircraft—but in the odd event that you do---it is important to secure all items, the prop blast is very powerful.  Eye protection is a must.  We call deplaning/off-loading with engines running and “ERO”  Next slide

## Air Operations

**Operating Around Military Aircraft**

**Air Operations**

**Notes:**
Rules for C-17 also apply to the KC-135. Next slide

## Air Operations

**Safety Considerations***** ***

***Tripping hazards***
***Noise***
***Smoking***
***Fuel / LOX***

**Air Operations**

**Notes:**
We have already hit upon the many hazards associated with flight line operations.  It is a busy, often chaotic place that requires every individual to possess a heightened sense of awareness related to their surroundings and activities.  The engines are loud and have danger areas, vehicles are moving all over the place, there are various pieces of support equipment to maneuver around.  I think you all have a pretty good idea.  There are a few more areas I want to point out that are safety related:  I want to emphasize tripping hazards I pointed some of them out in previous slides....there are power cords, communication wires, rollers, gaps, ramps that all present tripping hazards. Use spotters and additional personnel as needed—not only for vehicles but for your litter bearers as well—because you certainly don’t want to trip while carrying a patient or some expensive piece of equipment—nor do you want to injure yourself!  For those who smoke---There is NO smoking in and around the aircraft. There is also no smoking within 50 feet of fuel sources (i.e. fuel trucks). Smoke only in designated smoking areas.  Speaking of refueling....generally, aircraft refueling will take place after the patients  have already been deplaned.  Just the act of walking on and off the aircraft can cause static electricity which can cause a spark---and you know what happens when there is a spark around fuel and vapors!  Same holds true for cell phones.  Do not use cell phones within 50 feet of refueling.  When in doubt, it‘s best to just get as far away from fuel source as possible.  What is LOX?  Liquid oxygen. The aircraft are filled with LOX which is converted to breathable oxygen on the aircraft, also for use in emergency situations (example—the drop down masks—those masks receive O2 from the LOX system).  In the C-17, LOX is also converted in a separate system to patient therapeutic oxygen.  The LOX tanks on the aircraft must be refilled, but only by trained personnel.  During refilling the area around the port on the aircraft is considered a hazardous area and no one but the person actually filling the LOX should be in the area.  Next slide  

## Air Operations

**Safety Considerations**

***Required individual safety items***
***Gloves ***
***Goggles***
***Reflective belt / vest***
***Ear plugs***
***Remove jewelry, hair pins, hats***
***Low visibility in C-130 and KC-135***
***Limited space to maneuver***

**Air Operations**

**Notes:**
How do you keep yourself safe around the aircraft.  Here are a few rules aircrew and ground support personnel follow to minimize injury or accidents....wear gloves (I don’t mean latex exam gloves), I’m taking about canvas, leather, nomex type gloves that allow you to grip and hold a litter and will minimize the injury if your finger/hand got pinched in a litter stanchion or collapsible litter etc....ear plugs are a must on the flight line.  We already talked about all the noisy equipment as well as the aircraft.  Goggles should be worn if engines are running (may also consider if it is really windy).  Reflective belts and vest must be worn at night—doesn’t hurt to wear them during the day as well.  We also remove jewelry (especially rings) to prevent getting caught and yanked.  Hair pins should be removed as well as hats.  Anything that can come loose from your body and fall to the ground or be blown away becomes FOD.  As we discussed earlier, certain aircraft have limited lighting such as the C-130 and KC-135, so being mindful of those tripping hazards are even more crucial.  With such limited space to maneuver on these aircrafts, it can be very difficult to lift and carry these heavy litter patients.  Your clothing can get caught on litter stanchions, you can get tangled up in cords/wires, medical equipment can get hung up.  Don’t try to be superman—work together.  Next slide  

## Air Operations

***AE Mission***
***AE Capabilities***
***AE Configurations***
***AE Crew Compliment***
***PRT/AE Interface***

**Summary**

**Air Operations**

**Notes:**
So, now we’ve come to the end and it’s time to summarize... we talked about how AE transports patients, who the key players are. Next slide

## Air Operations

**Summary**

***Forms/Documentation***
***Airport/Airfield Familiarity***
***Aircraft Support***
***Operating Around Military Aircraft***
***Noise, Hazards, Vehicle Movement***
***Safety Considerations***

**Air Operations**

**Notes:**
We talked about the airfield environment and how to operate safely around a military aircraft.  As we say in our world, flexibility is the key to airpower.  Communication is key to successful operations and above all—safe operations.  Look out for each other, if it doesn’t look right, feel right, smell right---it probably isn’t right---then say something!  Safety is everyone’s responsibility when you walk or drive out onto that flight line. Thank you the for the time to allow me to share a part of my world with you. Any Questions??