Aeromedical evacuation (United States)

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Aeromedical Evacuation (AE) usually refers to specialized medical transportation units in the US Air Force. Within the US Air Force, AE is coordinated by Air Mobility Command located at Scott Air Force Base, Illinois. There are four active-duty AE squadrons in the USAF, but the 375th Aeromedical Evacuation Squadron, Scott AFB, and the 43d Aeromedical Evacuation Squadron, Pope AFB, North Carolina, are the only two located within the continental United States. All AE units are primarily manned by personnel from the Air Force Medical Service, but are usually aligned under an Operations Group instead of a Medical Group. Aeromedical evacuation usually involves medical transportation of active-duty military members, but in the past, AE also included a significant amount of transportation of military dependants requiring specialized care. Until recently, the Air Force had a number of specialized C-9 Nightingale aircraft dedicated to aeromedical evacuation. These aircraft have now been retired from service.

Currently, aeromedical evacuation is used to transport injured from Operation Iraqi Freedom, and Operation Enduring Freedom, as well as to respond to humanitarian missions such as Hurricane Katrina. Units such as the 43d Aeromedical Evacuation Squadron, located at Pope AFB, North Carolina provide tactical aeromedical evacuation for U.S. troops and regional Unified Commands using C-130 Hercules, C-17 Globemaster III, and other opportune aircraft.

History

The story begins in 1947, the year of the birth of the Air Force. World War II was still fresh in the minds of the American people. There was fierce pressure from the voters to cut government spending and recover the peace dividend after winning World War II.

At about 0100 on a cold February morning, Maj. George Donley left Oklahoma City traveling to Hill Field, Utah on business. The C-54 he was traveling on was cold and unheated. Here is the narrative of the events in Maj. Donley's own words:

“It was strictly the air flow from the air vents coming in from force feed, not pressurized. It was dimly lit. It was a cargo freighter with a big engine box tied down in the middle ... I was cold, tired and I happened to look over and see three ambulatory patients...

“I was a little tired at 2 o’clock in the morning and I wouldn’t have been there but for the importance of the job. I would have taken another airplane. But I guess it was the good Lord’s graces that I did, because I happened to look over and there was the three of these injured fellows huddled in a blanket wrapped around them and once in a while the blanket would fall away. I saw that this one boy had a leg in a cast.

I got up and I walked over and I said, “You three fellows warm enough?” I was going to look around to see if I could pick up anything, even a tarp to throw over them. It was cold.

They said, “No, we’re alright. We’re doing alright.” They stayed huddled together. That was what you called togetherness!

I said, “You got a cast on your leg.”

They said, “Yeah, we’re three ambulatory patients on our way to California.”

I said, “Didn’t the operations officer tell you this was an unheated airplane?”

They said, “No, they just told us to board.”

And I thought to myself, “This is inhuman.” I thought about all the VIP aircraft I was responsible for, all dolled up, and here the three ambulatory patients traveling like cattle in an open car. I thought, this is something, but this is out of my line. I’m in engineering and development. But then I guess at that hour in the morning the humanitarian point came out to me. I thought something had to be done about this and that when I get back, I’m going to start doing some homework and see if we can’t initiate a program to have air evacuation aircraft like we have VIP ships.”

He returned home and forgot his plans until the image of those patients came into his mind again. He began making some sketches but became frustrated by his lack of medical knowledge. He went to visit General Wilford Hall to request help. Gen. Hall listened to Maj. Donley’s plan and assigned a surgeon named Col. Maurice (Johnny) Johnson to assist.

Maj. Donley continues, “I did all this on my own, besides my regular job, which was still taking my time. I worked around the clock sometimes between flights and everything. But I was all for it, and I loved it. I went back to Wright Patt and got out the draft board and started drawing sketches. Johnny and I swapped a lot of ideas. I worked with crews in the hangars on the fabrication of tie-down equipment, different types of frames for litters, and quick installation in case of belly landing. All these little minute things went into it. We tried to figure all the things that could happen in an emergency.”

He was given a plane to modify, a C-47. He began the modifications with his crew and things were going well until he was called in by Colonel Boyd, the colonel in charge of maintenance. He knew what was going to come.

“Colonel Boyd said, “I’ve got some bad news on your project, George. I have got to cut down the budget. Your air evac is a low priority.” When he said that, boy, I thought right away about that cold February morning in that plane.

“I told him about that flight I was on to Ogden (UT), and I explained the whole thing. I said it was cold, and just imagine the humanitarian side of the thing. We’ve got all these VIP aircraft but nothing for injured patients.

I said that we are three quarters of the way through this and to dump it now would be a waste. He said, “I am complimenting you for your attitude and the whole humanitarian goal, but it’s the greenbacks.” I knew what he meant, so I walked to the door and left.

“On my way back to my office, I said, “I’m not going to let this thing fall through. I’m going to stick my neck out.” I realized that he didn’t say I shouldn’t do it in a direct order. He only said, “I’m canceling your project because of a lack of funds and it’s low priority.” So he didn’t tell me not to do it.

“I went back over to the hangars and talked to the three foremen who had been working on the air evac plane. I told them what had happened. They said, Boy, what a shame, this beautiful white interior all going to waste.” They didn’t want to quit either.

We were also doing aircraft modification on fighter landing gear at that time. We decided to “crib” some time from other programs to get man-hours to finish the air evac plane. Borrowing time like this was totally outside the accepted procedure. That’s when my scrounging started in earnest for man-hours and materials, because none were available through regular channels.”

He was warned by Gen. Wilford Hall that what he was doing was risky but Maj. Donley proceeded anyway. They finished the plane and Maj. Donley called Gen. Hall to tell him that a prototype was complete. Gen. Hall instructed him to fly the modified C-47 air evac plane to the School of Aviation Medicine at Randolph AFB, Texas.

Maj. Donley goes on, “We flew it down there around the first week of November, 1949 and put three hundred nurses and doctors through the aircraft. I had two of my officers taking notes and answering questions as I briefed them on the aircraft. The initial aircraft had things like racks for litter patients, seats for ambulatory patients, a nurses station, a compartment for medical equipment, night lighting and a better heating system. I think the idea in modifying the C-47 for air evac was to let the generals and everybody else see what could be done.

“Gen. Hall decided the plane should be brought to Washington next. By that time I still wasn’t out of the woods. I still had the boys that controlled the purse strings at the Pentagon to convince. It was do or die after years of sweat, headaches and a big gamble on my part.

We flew the plane to Andrews AFB in November of 1949. We displayed it 28 December 1949 and we had several officers tour the plane including officials from the Secretary of the Air Force’s Office, the Secretary of Defense and even General Malcolm Grow.

Two weeks after this display, Gen. Hall called and told Maj. Donley that funds would be made available. Initial Air Force plans called for similar modifications of twenty-four C-47s and established a precursor of the current aeromedical evacuation system. The program grew and was taken over by the Pentagon. Eventually the Pentagon team developed the C-131 with input from Maj. Donley. Nearly seven years later the first Convair C-131A was delivered. It was the first aircraft designed exclusively for evacuation of patients..

Years later, Gen. Hall took Maj. Donley aside at a farewell gathering and put his arm around him and said, “I know, you didn’t get any monetary reimbursement. I know you didn’t look for it, but as an extracurricular event, you handled it well. To put this on some people would have been a full time project. You worked hard and nobody will ever know what you risked to finish this job. When you look at what was accomplished, it was a great project. “In the Korean War, your work put us five years ahead. A lot of boys would not be alive today had you not scrounged around to get this aircraft ready.” I wish we could give you a good monetary reward. Anyway, when you look up in the sky and see that Red Cross on the tail of an air evac plane going by, you can say ‘that is my emblem, my insignia.’

From a speech delivered by Capt. Scott M. Stallings (M.D.) at Malcolm Grow Medical Center Residency Graduation Ceremony, July, 1997. Retired Colonel George Donley (in his 84th year) was in attendance. He provided the above information in personal interviews during the spring of 1997.