332nd Air Expeditionary Wing Fact Sheet
Balad Air Base, Iraq
332nd Expeditionary Medical Group
Mission: Combat Medical Care for America – Right Here, Right Now.
The 332nd EMDG is composed of approximately 380 staff members, primarily US Air Force and Army. The Air Force runs the Air Force Theater Hospital (AFTH), a mission it took over from the Army in September 2004. The AFTH is the equivalent of a Level I trauma center and provides medical care to all units on or around Balad Air Base, LSA Anaconda, and throughout the theater. It also serves as the inter- and intratheater aeromedical evacuation support hub. The AFTH provides medical services to US and Coalition military and civilians, contractors, Iraqi Army and police, Iraqi civilians and insurgents. The hospital has 18 intensive care unit (ICU) beds, 40 intermediate care ward beds and 6 operating room tables.
332nd Expeditionary Medical Group Team
– 308 Support Staff (AF)
– 37 Providers (AF)
• Includes NPs and PAs
– 5 Providers (A)
• Head/Neck Team
– 24 Army Support Staff
• OR staff/Nursing/LNOs
– 3 Marines Support Staff
– 1 Navy Support Staff
TOTAL: 378 STAFF
• Critical Care Emergency Medicine
• Flight Medicine
• General Surgery
• Infectious Diseases
• Life Skills (Clinical Psychology / Social Work)
• Nutritional Medicine
• Occupational Medicine
• Oral Maxillofacial
• Physical Therapy
• Plastic Surgery
• Preventive Medicine
• Primary Care
• Trauma/Critical Care
• Women’s Health
Mission Support Capabilities
Radiology/CT Pharmacy Nutritional Medicine
Lab/Biological Assessment Medical Logistics Patient Administration
On average, the hospital sees more than 650 ER patients and performs more than 450 surgeries per month. Roughly 2/3 of the patients treated at the hospital are American while 1/3 are Iraqis.
Contingency Aeromedical Staging Facility (CASF)
All patients leaving Iraq for more definitive care are routed through the Contingency Aeromedical Staging Facility (CASF) at Balad. The CASF is often described as a way-station for strategic patient movement; an air passenger terminal for patients. The CASF medically and administratively prepares patients for the rigors of inter and intra theatre Aeromedical Evacuation (AE) by fixed wing aircraft. The staff uses a full range of medical knowledge and nursing care skills, specializing in in-flight physiology, long duration transport and aircraft capabilities. Their work ensures that patients transported and cared for in the AE System are as stable and comfortable as possible during high altitude, long duration flight. There is a flight doctor on duty 24/7. The CASF is capable of providing basic nursing care for up to 72 hours; however patients typically stay for no more than 48 hours as flights are scheduled out of Balad to Ramstein Air Base, Germany each day of the week except for Tuesdays and Saturdays. The facility has 50 beds, expandable to almost 90. The CASF has moved as many as 47 patients in a single Aeromedical Evacuation mission. In addition, the CASF manages and staffs the In-Flight Emergency medical response for Balad AB
The CASF averages more than 500 patient aeromedical evacuations per month with an average of about 35 critical care patients per month.
Air Force Clinic
The Air Force Clinic provides primary care treatment for the soldiers and airman located in the AOR. The Clinic has the primary care capability to care for a population at risk of 3,000 Airmen. In addition, the Women’s Health Clinic and Life Skills Clinics provide extensive support to both Army and Air Force members. Bioenvironmental Engineering, Flight Medicine, and, Public Health assets provide a full spectrum of preventive medicine and environmental health for the 332nd AEW.
332nd Expeditionary Medical Operations Squadron
- 24-hour operations
- Primary air evacuation hospital for Northern and Western Iraq
- Military Level III Trauma Center equivalent to a CONUS Level I Trauma Center
- American, Iraqi and other patients
o 700 Patients per month
ß 120 US patients/week
ß 30 Iraqi soldiers and civilians/week
ß 25 Coalition and TCN/week
o 56% Trauma and 44% medical
ß 370 trauma patients/month
ß WHMC has ~ 120 trauma patients/month
o 4 ED Residency trained physicians
o 1 Family practice physicians with Advanced training in Trauma,
o 2 ED Trained Physicians Assistant
o 6 ED or ICU trained nurses
o 14 ED Technicians
- 400+ surgeries a month
o 750 OR procedures/month
o WHMC averages 2,500 procedures a month
o 15 Surgeons - General Surgery, Orthopedics, Plastics, Ophthamology, Neurology, Ear, Nose and Throat, Trauma, Thoracic, Urology, Vascular
o 10 nurses assigned in the OR ( 8 USAF & 2 USA).
o 9 Anesthesia providers (Army and AF)
o 1 Surgical Physicians Assistant
o 27 OR Technicians (Army and AF)
INTENSIVE CARE UNIT
- 18 critical care beds
- Care is equivalent to any major medical center ICU in the US
- 600 admissions a month ( % US % Iraqi)
- US and IRAQI Patients -
o Average 14-16 beds full every day
o US patients
ß LOS < 24 hours
ß Air Evacuation to Landstuhl Army Medical Center, Germany
o Iraqi patients
ß LOS 5-6 days
ß Helicopter transport to Medical City, Baghdad or other areas in AOR
o 6 ICU internal medicine physicians (AF and Navy)
o 20 ICU nurses (Army and AF)
o 17 medical technicians
o 5 respiratory therapy technicians
INTERMEDIATE CARE WARD
- 40 beds
- Short term care (< 7 days) for US and Iraqi patients who will return to duty
- Short and intermediate care for Iraqi soldiers and civilians pending transfer to Iraqi hospitals
- 100-150 admissions/month
- US and Iraqi patients
o US patients – LOS 2-7 days (Ave 3 days)
o Iraqi patients – LOS 3-20 days (Ave 9 days)
o 13 nurses (Army and AF)
o 12 medical technicians
332nd Expeditionary Medical Support Squadron
PATIENT ADMINISTRATION (PAD)
1. First responders, honor of transporting our Heroes from the Helos to the ED for care and that is when our tracking begins.
2. Primary birds are the CH46, Marine Bird and the Black Hawk, Army Bird
a. During mass casualty events, we have the capacity for 4 birds to land
b. Our average monthly traffic is 283 Helo msns, 352 litters, 344 Ambulatory
3. Hub for Patient Administration, only PAD in AOR that retrieves their own patients
4. We utilize Joint Patient Tracking Application to track our patients. At any level of care in the AOR, the staff can utilize this application to access previous care received.
5. We secure patient valuables. Our goal is they always leave with their valuables.
6. Fortunate to have the support of our Army and Marine LNOS who assist us with tracking our Sister Services.
1. Transfuse 1000 units of blood product each month, double the amount of product that WHMC does with a tenth of the staff
2. Provide a full service laboratory complete with full chemistry, hematology and serology and microbiology with a total volume of ~8000 tests/month.
4. Provide a Whole Blood Donor center for emergency blood transfusion when called.
5. Make platelets in theater here at AFTH, Balad and 10th CASH Baghdad. This reduces the need for Whole Blood Donation.
7. Perform testing for all the ARMY FOBs in AOR and Air Force Clinics around the Base and all the Army Physical Annual physical Lab exams and emergency clinic exams.
1. We respond average 350 traumas in the ED a month and about 4 meds for each patient.
2. Aerovac Patients 280 per month and about 6 meds per patient
3. We make as many IV’s in a month as Wilford Hall
4. We dispense about 3200 inpatient meds a month
5. We have an OTC program that prevents a physician visit. Patients walk up and get what they need from about 20 meds.
6. All of areas are trending up.
1. We have two Phillips Mx-8000 CT scanners, one plain film radiograph machine, and one portable sonosite.
2. We perform approximately 1200-1400 CT scans per month. This is at least 2-3 times the amount of studies performed at Wright-Patterson Medical Center, and very comparable to Wilford Hall, which is our major trauma/teaching medical center
3. We perform 60-80 ultrasounds a month, which has progressively increased since took over the hospital in 2004.
4. We perform about 1500-2000 plain radiographs per month.
5. We have a total of 10 radiology personnel: 3 radiologists, and 7 technologists. Our techs all cross-train and can perform all plain films and CT procedures. The only exception is ultrasound cases. Only the radiologist and cross-trained tech can do the ultrasounds.
332nd Expeditionary Aerospace Medicine Squadron
Total CASF personnel: 66 members. 61 CASF members from Andrews 459th, Niagara 914th , Wisconsin 440th McCord 446th and Lackland 433rd and Maine 101st Med Groups. The majority of the CASF members 95% are Reserve Air Force Members. Total Clinic personnel: 22.
∑ Determine the need for AE to LRMC; Kuwait; Al Udeid
∑ Generate 3899 ‡ turn into FCC’s (PAD)
∑ FCC will screen 3899
∑ Pt will be entered into TRAC2ES database
∑ Must be validated by the theater validating FLT MD (JPMRC)
∑ Pt to be cleared by CASF FLT MD
∑ Pt will be transferred to CASF if applicable (see CASF capabilities)
∑ Pt will be transferred from AFTH/CASF to Aircraft for AE movement
AE PRECENDENCE CLASIFICATION
∑ From AFI 11-2AEV3 Dated 18May2005
∑ Urgent: Patients who must be moved immediately to save life, limb, or eyesight, or to prevent complication of a serious illness
∑ Priority: Patients requiring prompt medical care that must be moved within 24 hours
∑ Routine: Patients who should be picked up within 72 hours and moved on routine/scheduled flights
∑ From Joint Pub (Army/AF/Navy/MC) 4-02.2
∑ Urgent: Patients requiring emergency evacuation to save life, limb, eyesight or to prevent serious complications of injury or existing medical conditions. Psychiatric or terminal cases with a very short life expectancy are therefore not considered urgent (we deviate here with at times in order to get our severely brain injured guys up to Germany for their family to say good-bye—this has been acceptable with JPMRC).
∑ Priority: This category includes patients requiring prompt medical care not available locally. This precedence is used when the medical condition could deteriorate and the patient cannon wait for routine evacuation.
∑ Routine: This group of patients requires medical evacuation, but their condition is not expected to deteriorate significantly
IMPACT OF UPGRADING AE PRECEDENCE
∑ JPMRC will task AE assests to bring in Aircraft for multiple priority patients; CCATT; or Urgent patients at Balad.
∑ Could a priority patient wait until the next scheduled mission? Coordinate with FCC’s
∑ Standby Aircraft in Germany is available for urgent missions
∑ Financial impact - $630K per mission from LRMC to Balad to LRMC.
TYPICAL AE SCHEDULE
∑ To LRMC – about every 33 hours or 5 days a week.
∑ To Al Udeid/Kuwait – about every 36 hours or 4 days per week.
∑ Urgent missions as needed
FLT MD APPROVAL
∑ All AE patients must be cleared by the on-call FLT MD from the CASF
∑ FCC’s will coordinate with FLT MD for clearing AE patients
∑ If cleared for flight for helo missions – the patient must be cleared again for fixed wing AE
TOTAL CASF PATIENT FLOW
∑ AEF Rotation 7/8 9/10
∑ Total Missions 227 167
∑ Total CCATTs 226 200
∑ Total Patients 2846 2143