Medical Air Evacuation in World War II—Part 1

I am so so pleased to host amazing author and fellow research hound, Sarah Sundin, back to Redwood’s this week. Sarah is a fabulous historical author whose novels highlight the WWII era. This week she is discussing her research into medical air evacuation and flight nursing.

Sarah has also graciously agreed to give away one copy of her newest release, With Every Letter, to once commentor on any of this weeks posts. Simply leave a comment with your e-mail address. Must live in the USA. Drawing will be midnight, Saturday September 29th. Winner anounced here at Redwood’s Sunday, September 30th.

Welcome back, Sarah!

“Do you have room for one more litter case?” the doctor asked. “Private Jenkins fell headlong on a landmine. The nearest hospital’s in Cefalù, a long ambulance ride over rough roads. By air he’ll be in Mateur in two hours. He needs a thoracic surgeon.”

Mellie stared at the unconscious patient. He lay on a litter, his torso swaddled in white gauze.
Bloody streaks painted his face, arms, and khaki pants. “We’re his only hope.”

In my novel With Every Letter, the heroine serves as a flight nurse. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you might need to understand medical air evacuation.


Today I’ll discuss general principles of air evacuation and share resources, on September 26th we’ll follow one patient’s flight experience, and on September 28th we’ll meet the flight nurse.


History of Air Evacuation

As soon as the Wright brothers took to the air, clever minds thought of ways to use the new contraption. In 1910 two Army officers constructed the first ambulance plane, and during World War I the Army experimented with transporting patients by air.

The advent of large multi-engine cargo planes in the interwar years made these dreams realistic. In November 1941, the US Army Air Force authorized the Medical Air Ambulance Squadron. Air evacuation was first performed informally early in 1942 during the construction of the Alcan Highway and in Burma and New Guinea. The first official air evacuation with flight nurses was flown on March 12, 1943 in Algeria.


Advantages of Air Evacuation

Speed is the primary benefit of air evacuation. Planes can also traverse inhospitable terrain or dangerous seas. The military came to see that air evacuation required less equipment than ambulance transport, aided recovery, and increased morale on the front.

However, planes were unable to fly in bad weather, and planes were not reserved for ambulance use. Since top priorities for transport planes were airborne missions and carrying supplies, medical air evacuation depended on availability. Also, dangers existed from crashes and enemy planes. Since transports carried cargo and troops, they were not allowed to be marked with the Red Cross and were legitimate military targets. Fighter coverage was provided in some combat theaters.


Use of Air Evacuation in World War II


Thirty Medical Air Evacuation Transport Squadrons served in World War II in every combat theater. In all, 1,172,000 patients were transported by air. About half were ambulatory patients (the “walking wounded”) and half were litter patients. Only 46 patients died in flight, although several hundred died in crashes. By 1944, 18 percent of all Army casualties were evacuated by air.


Planes


The C-47 was the workhorse of air evacuation. This dependable two-engine plane was used for shorter flights within a combat theater and could fly into forward landing strips close to the battlefield. A C-47 carried 18-24 patients, depending on how many were on litters.

For transoceanic flights, the four-engine C-54 Skymaster was used. The preferred load for a C-54 was 18 litter patients and 24 ambulatory. These flights carried patients from the combat theater stateside when the patient required 90-180 days of recovery or was eligible for medical discharge.

The C-46 Commando was used less frequently. Although it could carry 33 patients, the cargo door made loading difficult, and the plane had an unsavory habit of exploding when the cabin heater was used.


Medical air evacuation revolutionized the care of the wounded. Gen. Dwight Eisenhower credited air evacuation, sulfa drugs, penicillin, and the use of plasma and whole blood as key factors in the significant drop in the mortality rate among the wounded from World War I to World War II.


Resources:


Sarnecky, Mary T. A History of the U.S. Army Nurse Corps. University of Pennsylvania Press, Philadelphia. 1999.


Links, Mae Mills & Coleman, Hubert A. Medical Support of the Army Air Forces in World War II. Office of the Surgeon General, USAF. Washington, DC. 1955.


“Winged Angels: USAAF Flight Nurses in World War II.” On National Museum of the US Air Force website.
http://www.nationalmuseum.af.mil/factsheets/factsheet.asp?id=15457

The World War II Flight Nurses Association. The Story of Air Evacuation: 1942-1989. Taylor Publishing Co., Dallas TX, 1989. [Source of most of the photos used in this article]


Website of the World War II Flight Nurse Association.
http://www.legendsofflightnurses.org/ Contains photos, news clippings, and PDF of The Story of Air Evacuation.

Futrell, Robert F. Development of Aeromedical Evacuation in the USAF: 1909-1960. USAF Historical Division, Research Studies Institute, Air University, 1960. Available free online at
http://www.ibiblio.org/hyperwar/AAF/AAFHS/AAFHS-23.pdf

***********************************************************************

Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

The Secrets Nurses Keep: 2/2

In the November, 2011 issue of Reader’s Digest— there was an article entitled 50 Secrets Nurses Won’t Tell You. I mean, of course, I am going to read this. As a nurse, as an author, and as a blog editor– I’m going to see what it has to say. Please, take some time to check out the full article.

I thought I’d give my thoughts here on whether or not I agree with the trueness of these statements. I’m not sure that’s truly a word– so don’t use it in Scrabble or anything. The items are taken directly from the article– so credit is given to Reader’s Digest for these.

You can read about my first post here.

Item Four: “When a patient is terminally ill, sometimes the doctor won’t order enough pain medication. If the patient is suffering, we’ll sometimes give more than what the doctor said and ask him later to change the order. People will probably howl now that I’ve said it out loud, but you have to take care of your patient.” A longtime nurse in Texas.

Hmmm…. this one is painful– no pun intended. First, let me say that I understand where this nurse is coming from. I’ve been in situations where the patient has needed more pain medication than the physician is willing to order and it is really frustrating because you’re the one whom the patient is staring at, begging for relief.

However, the nurse is right about the howling part. Put simply, this is illegal. A nurse who chooses to do this is operating outside her scope of practice. She would be giving a narcotic without an order. An uber-big no-no. She is at risk for losing her license.

Personally, I would not choose to do this. I’ve never done it nor has it even crossed my mind. What I have done is called the doctor relentlessly and summoned the physician to do a bedside exam so they can SEE exactly what I’m talking about.

Item Five: “Every nurse has had a doctor blame her in front of a patient for something that is not her fault. They’re basically telling the patient, ‘You can’t trust your nurse.'” Theresa Brown, RN.

Sadly true. I’ve had this happen. I spoke a little bit about this in the last post. A nurse would get in a lot of trouble for doing the same of a physician so there is a double standard. All corrective conversation should never be done in front of a patient, at the nurse’s station, etc— only a private room with reasonable discussion.

Item Six: “Never talk to a nurse while she’s getting your medications ready. The more conversation there is, the more potential there is for error.” Linda Bell, RN

True…true…true. In fact, this is becoming part of training videos for fellow staff– to not talk to your co-workers when they are calculating and drawing up meds. It is fine to ask medication questions– in fact, you should. But wait until you have your nurse’s undivided attention.

What do you think of these items?

 

Author Interview: Candace Calvert 2/2

We’re continuing today with my interview with medical thriller writer Candace Calvert. Be sure to pick up her latest and greatest novel, Trauma Plan.

Welcome back, Candace!

Jordyn: Tell us about your current release.
Candace: Trauma Plan is the first book in my (Texas set) Grace Medical series. Here’s the back cover blurb:

Sidelined by injuries from a vicious assault, nurse chaplain Riley Hale is determined to return to ER duties. But how can she show she’s competent when the hospital won’t let her attempt even simple tasks? To prove herself, Riley volunteers at a controversial urban free clinic despite her fears about the maverick doctor in charge.

Dr. Jack Travis defends his clinic like he’s commander of the Alamo. He’ll fight the community’s efforts to shut its doors, even if he must use Riley Hale’s influential family name to make it happen.
As Riley strives to regain her skills, Jack finds that she shares his compassion—and stirs his lonely heart. Riley senses that beneath Jack’s rough exterior is a man she can believe in. But when clinic protests escalate and questions surface about his past, Jack goes into battle mode, and Riley wonders if it’s dangerous to trust him with her heart.

Jordyn: What’s one thing readers might be surprised to learn about you?
Candace: Like the nurse heroine in Trauma Plan, I’m also a certified lay chaplain.
Jordyn: Most embarrassing moment while nursing? Most triumphant nursing moment?
Candace: Embarrassing: I once walked into an ER treatment room, glanced at the partially clad young man on the gurney and asked, “Can you expose your upper thigh without taking off those bicycle shorts?”  He stared at me for a moment, then struggled to do that: healthy skin exposed. Confused, I asked him where his “infected boil” was. It turns out that the clerks had put the wrong ID sticker on this man’s chart. He was there for a sore throat. I can’t tell you how many times nurse friends STILL snicker and ask me, “Can you expose your thigh . . .”?
Most triumphant: Once there was a woman brought in as a possible overdose, she was unconscious, pale, rapidly deteriorating. We were about to intubate, give reversal agents and lavage. In talking with the husband, I learned that she’d also taken Benadryl because of a “sudden rash and itching.” She was in anaphylactic shock, but too far gone to show the hives. We turned her around in moments with the appropriate interventions. It was a small “triumph,” but I always think about the “what ifs” had we proceeded along that OD path instead.
Jordyn: Most embarrassing writing moment? Most triumphant writing moment?
Candace: Most embarrassing: Probably my first submitted manuscript years ago. After I mailed it off (snail mail era), I was looking through the Word file and realized that I’d accidentally pasted a huge chunk of Internet research smack in the middle of a scene. To this day I always check my manuscripts compulsively, then still hesitate and take a deep breath before pushing the “Send” button. Submission PTSD.
Triumphant: The most obvious would be getting that first call from my agent Natasha Kern saying she was interested in signing me. But, in truth, the moments continue. Not so much the starry reviews or awards, but rather the connections I make with readers; the incredible notes that say my stories have touched their lives, made a difference, offered hope in tough times. For me, this is exactly like “the best part” of nursing.
Jordyn: What are you writing now?
Candace: I’m currently writing (working title) First Responder, the third book in the Grace Medical series.
Jorydn: Any final thoughts?
Candace: I’d like to say how very happy I am that medical drama has found its place in today’s Christian fiction market. I love teaming with talented writers like Dr. Harry Kraus, Hannah Alexander, Dr. Richard Mabry and Jordyn Redwood (!) to invite readers into our exciting world. And help “Grey’s Anatomy find its soul.”
Thank you for hosting me here, Jordyn. It’s a pleasure to connect with your readers. I invite them to stop by my website: candacecalvert.com or visit me on Twitter and Facebook. Happy reading!
***********************************************************************



Candace Calvert is a former ER nurse who believes love, laughter and faith are the best medicines. Her Mercy Hospital and Grace Medical series offer readers a chance to “scrub in” on the exciting world of emergency medicine—along with a soul-soothing prescription for hope. Wife, mother, and very proud grandmother, she makes her home in northern California.

Author Interview: Candace Calvert 1/2

I can’t tell you how excited I am to be interviewing Candace Calvert today and Wednesday! She’s a fellow medical thriller writer, a great mentor and true friend. Her novel, Trauma Plan, just released so be sure to pick up your copy.

Welcome, Candace!

Jordyn: Tell us a little about your nursing/writing path. Were you always an ER nurse? Have you always written stories? Or, did writing come after nursing?
Candace: I was an ER nurse for more than 3 decades. Yes, (laughing) I was drafted into this calling as a mere child. Writing has always been an outlet for me, and in school I was one of those rare (and possibly odd) students who welcomed essay assignments as a treat. Though I tinkered with creative writing off and on during my adult years, it was a near-death experience that actually launched my publishing career.
In 1997, I was thrown from a horse and eventually landed “on the other side of the stethoscope” in my own trauma room. I’d suffered thoracic and multiple rib fractures, a bleeding lung, cervical fractures and a spinal cord injury. The inspirational account of that event—“By Accident”—appears in Chicken Soup for the Nurses Soul and was my first published work.
Jordyn: What was your favorite part about nursing? Least favorite part?
Candace: Favorite part: That heart-warming and goose bumpy moment when you know that “being there” for a particular patient has made a big difference in that person’s life. Least Favorite: Inflicting physical pain during necessary treatment, especially with children.
Jordyn: What do you think are some common misconceptions about nurses– or ER nurses specifically?
Candace: People think that nurses get “tough” and immune to the pain and tragedy they experience in their careers, that there is some protective psychological flak jacket we pull on to distance ourselves. It’s so not true. As a peer counselor for Critical Incident Stress (“burn out”), I saw the profound effects that painful scenarios have on staff. One of the main reasons I write medical fiction is to reveal (and honor) the compassionate hearts behind the stethoscopes.
Jordyn: What made you decide to pursue publication?
Candace: In truth, my husband. I’d been dabbling, dreaming. One day he signed me up for an online writing class, saying, “Stop talking about writing a book and just do it.” Pushy and wonderful man.
Jordyn: What are some common medical inaccuracies you see when you read novels or watch television?
Candace: One of things that irks me most, is when a young, healthy person is the victim of trauma (gunshot, MVA, etc.), drops to the street of a huge city (meaning LOTS of hospitals!) and someone does a quick pulse check and then says with wisdom and melodrama, “He’s gone.” Excuse me? I’m sure it’s plot effective to get rid of that victim, but no CPR, no 911 call, no transport to a nearby trauma center? Where’s that “Golden Hour”?  A witnessed collapse and no one does anything. Makes me crazy.
We’ll continue with Candace on Wednesday. Looking forward to seeing everyone for Part II!
**********************************************************************

Candace Calvert is a former ER nurse who believes love, laughter and faith are the best medicines. Her Mercy Hospital and Grace Medical series offer readers a chance to “scrub in” on the exciting world of emergency medicine—along with a soul-soothing prescription for hope. Wife, mother, and very proud grandmother, she makes her home in northern California.