"MATS: The Story of the Military Air Transportation Service"

by Stanley M Ulannoff


Wings of Mercy
Aeromedical Evacuation


I will summon every resource to prevent the triumph of death over life.

I will stand guard over the medicines and equipment entrusted to my care and insure their proper use.

I will be untiring in the performance of my duties and I will remember that, upon my disposition and spirit, will in large measure depend the morale of my patients.

I will be faithful to my training and to the wisdom handed down to me by those who have gone before me.

I have taken a nurse's oath, reverent in man's mind because of the spirit and work of its creator, Florence Nightingale. She, I remember, was called "The Lady with the Lamp."

It is now my privilege to lift this lamp of hope and faith and courage in my profession to heights not known by her in her time. Together with the help of Flight Surgeons and Medical Technicians, I can set the very skies ablaze with life and promise for the sick, injured, and wounded who are my sacred charges.

This I will do. I will not falter in war or in peace.

There was a certain stillness in the air as the aidmen carried the stretchers toward the waiting silver and white aircraft. In its cavernous doorway stood a Flight Nurse, neat and trim in her blue Air Force uniform. On her blouse she wore the silver wings of her profession, and on each shoulder the single silver bar of a first lieutenant.

It was quite unnecessary to caution the medical technicians to exercise care. Well trained, they handled with gentleness their sick and injured charges, who lay helpless on the litters the aidmen were carrying. Still, the Flight Nurse could not help saying: "Easy does it, boys!"

This was the start of a story that is repeated well over three thousand times each year in the continental United States alone. Many more aeromedical evacuation missions take place in our overseas bases all over the world, some finally linking up with the MATS aeromedical evacuation system in the United States.

This is not the story of the Flight Nurse alone, although she is part of it, together with pilot, copilot, engineers, and medical technicians. The "Flight Nurse's Creed," however, holds true for all of them.

Did we say this was the start of the story? Well, not quite. Actually, it had its beginning at any of the numerous locations around the globe where our military or other government personnel are stationed in peacetime - or, in this case, on the battlefield during the Korean War.

The wounded soldiers were given first aid either by their buddies or medics and then moved back to the battalion aid station for further treatment and classification. Those needing additional care were airlifted by helicopter to the Field Hospital. (In some cases they were even taken by helicopter directly from the battlefield.) From the Field Hospital, if their wounds were serious enough, they were evacuated by air to Japan or to the states.

This speedy system of aeromedical evacuation was one of the principal reasons for the reduction of the Korean War death rate among the wounded to 50 per cent that of World War II.

The MATS Aeromedical Evacuation system also airlifted Turkish wounded from Korea to Ankara.

And it succeeded in demonstrating that twenty-one times fewer medical personnel were needed than if the evacuation had been carried out by ship.

During peacetime in overseas areas, accidents and serious illness cases among the military, their dependents, other U.S. government employees, and our Allies are moved by air in theater evacuation aircraft. They are taken to the Casualty Staging Units at the principal aerial ports of embarkation, such as Rhein/Main Airport in Germany. From here the regular MATS cargo planes which have just brought in supplies or passengers from the U.S.A. are converted for Aeromedical Evacuation for the return trip - home.

Today the giant four-jet engine C-135 - the military version of the commercial airliner Boeing 707 - makes this "airevac" run from Rhein/Main in Frankfurt, Germany, to McGuire Air Force Base near Trenton, New Jersey, in only eight hours. This journey used to take as long as twenty-four hours - a full day - in the C-121 Super Connies and in the Douglas DC 6B (known by the USAF as the C-118 Liftmaster).

Once back in the continental United States they are in the capable hands of the MATS 1405th Aeromedical Transport Wing, formerly the 1st Aeromedical Transport Group. MATS, which itself has an enviable safety record, had to take a backseat to the 1st AMTG because it claimed to have "the carefullest pilots in MATS" - with no accidents at all.

The Wing flies the Convair C-131 Samaritan, an aircraft specifically designed for the tough and exacting job of aeromedical evacuation. It is also the Air Force's first fully pressurized twin-engine transport. To all intents and purposes, it is a "flying hospital ward," completely all-weather air-conditioned and equipped with oxygen for the patients. It is also geared to carry such bulky medical equipment as iron lungs and chest respirators.

In addition to the regular flying crew of three, the Samaritan has a medical staff consisting of the Flight Nurse and two Medical Technicians. It is their job to care for as many as 40 ambulatory patients, or 27 litter patients, or combinations of both, in this io-by-40-foot "airborne ward." Needless to say, this is a bigger operation and a greater responsibility than the customary land-based hospital ward because "airevac" patients can run the gamut from accident cases requiring plasma to a little boy with polio, in an iron lung, or to patients with dozens of other maladies including communicable diseases, injuries, psychoses, and other complications - and all in the same ward.

The Samaritan operates at altitudes of over 20,000 feet, travels at more than 230 mph, and has a range of over 1,000 miles. It has a large 6-by-8-foot litter loading hatch to accommodate the stretcher cases. Ambulatory patients and the crew use a built-in folding passenger stairway on the opposite side.

The Aeromedical Transport Wing boasts that, "no sick or wounded man is more than twenty-four hours away from the best medical care in the world."

And they live up to it!

Here is how they do it:

The Wing operates what they call "trunk lines" across the United States. These main line or express routes connect the two ports of aerial debarkation - McGuire Air Force Base in New Jersey and Travis Air Force Base in California, with Scott Air Force Base in Illinois and Kelly Air Force Base in Texas. Operating from each of these express stops are "feeder routes" which cover all of the local stops in between, and link up the entire continental network.

Day in and day out, each day of the year (there are no holidays in aeromedical evacuation), every few minutes around the clock, one of the i405th's gleaming silver and white Samaritans with a big bright red cross on its rudder, either lands or takes off with a patient load. This aerial-medical shuttle system picks up patients as well as delivers diem. They service more than 600 Army, Navy, Air Force, Veterans Administration, Public Health Service, and other government hospitals, using over 400 military and commercial airfields.

Once a patient arrives in the continental U.S.A., there are two considerations determining where he will be sent. The primary concern is his diagnosis - where can he best be treated for the particular ailment he has? The next consideration is locating him in a hospital nearest to his home.

Let's see what would happen to those patients that have just arrived at McGuire from Germany in the C-135 jet. Those whose destinations were in the northeast would be shifted to one of the Samaritans operating on that local feeder route. For example, a patient going to the Walter Reed General Hospital in Washington, D.C., would be "off-loaded" at Andrews Air Force Base. Here he would be met by an ambulance or, in emergency cases, by a helicopter.

The rest of the patients would be placed aboard one of the Samaritans operating on the trunk line. Patients for midwestern stops would be debarked at Scott, and transferred to the proper "feeder" plane. Others would be evacuated to Kelly for southern destinations, while still others would be delivered to Travis for far western stops.

The entire continental "airevac" operation was masterminded from the 1st AMTG Headquarters at Brooks Air Force Base, near San Antonio, Texas, from 1948 to 1964. Now the 1405th Aeromedical Transport Wing, it keeps tabs on the five Aeromedical Evacuation squadrons and dieir 17 C-131 Samaritans. From their new headquarters at Scott Air Force Base, Illinois, these operate from southern California to the northern tip of Maine, and numerous points in between, to cover the entire country. They know where each plane is at all times, and they know the location and destination of each one of over 40,000 patients a year while they are in their care. For an emergency pickup they can divert an aircraft, and are completely flexible in their operations - always keeping in mind that "24-hour" deadline.

In addition to their regular military duties, the 1405th carries civilians in emergencies. They have an arrangement with the National Foundation to fly polio patients on a "cost" reimbursable basis. They even fly special teams overseas to bring back polio patients.

In military parlance, every patient is a VIP and gets the "red carpet" treatment. In short, everything is done "to prevent the triumph of death over life."

Aeromedical evacuation actually had its embryonic beginning in February, 1918, during World War I, when a converted Curtis JN-4 Jenny carried the first litter patient in aviation history. But that was a far cry from today's custom-built C-131 Samaritan with its completely equipped and staffed "flying hospital ward," or the sleek C-135 Stratolifter jet.

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