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A Navy explosive ordnance disposal technician clung to life in a
Baghdad hospital in November 2017 a few days after an IED that he
was clearing left his body in tatters.
With extensive damage
to his airways and his lungs failing, this Sailor would need
specialized treatment if he had any hope of survival. That’s when a
team of doctors from the San Antonio Military Medical Center, led by
Air Force Reserve Citizen Airman Dr. (Maj.) Jeffrey DellaVolpe, was
called into action.
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November 2017 - Dr. Jeffrey DellaVolpe, an Air Force Major and Individual
Mobilization Augmentee, works to place a Navy explosive ordnance
disposal technician on extracorporeal membrane oxygenation therapy,
or ECMO for short. The procedure, which artificially oxygenates the
blood, stabilized the sailor's body, allowing him to be transported
directly from Baghdad to the San Antonio Military Medical Center,
Texas. (U.S. Air Force photo by Senior Airman Keifer Bowes)
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DellaVolpe is an Individual Mobilization Augmentee
assigned to a one-of-a-kind life-saving medical team at
SAMMC. He is one of less than a handful of military doctors
fully qualified to perform a treatment known as
extracorporeal membrane oxygenation, or ECMO for short.
According to Dr. (Col.) Phillip E. Mason, the SAMMC
Adult ECMO Program medical director, ECMO is a process in
which blood is oxygenated and circulated to the brain and
other critical organs. Highly-skilled doctors insert garden
hose-sized tubes, called cannulas, into blood vessels in the
neck or groin. These tubes are then connected to the ECMO
device, which uses a pump to remove the blood from the body,
pass it through an artificial lung, and then return it to
the body.
“It keeps the patients alive
while the lungs, and possibly heart, heal,” said Mason,
adding that a patients have successfully remained on ECMO
from anywhere from a few days to a few months.
According to Mason, who was deployed during the call for
ECMO help, DellaVolpe is one of the most experienced ECMO
physicians in the entire Department of Defense and also has
experience with long-range ECMO transports -- eight at the
time, with the November mission making his fifth
international transport and ninth overall.
“Getting
him activated for this mission was key to a successful
operation,” said Mason.
Due to the severity of the
bomb tech’s injuries, he would require the specialized care
of the SAMMC ECMO team in order to be transported to a fully
equipped medical facility. There’s a very small percentage
of patients sick enough to need an ECMO transport but those
who are, can’t be moved until they’re on the therapy.
“The biggest part,” said DellaVolpe, “is if they need
ECMO, they need it quick.”
DellaVolpe and his team of
two doctors and five nurses went into action as soon as the
call came in.
The Air Force Reservist, who works at
Methodist Hospital in San Antonio, coordinated the time off.
The ECMO team was placed on travel orders, gathered their
equipment -- nine Pelican cases of gear, plus enough backup
supplies to operate independently for 72 hours -- and hopped
on the next flight to Germany. At Ramstein Air Base they
were picked up by a waiting C-17 and flown to Baghdad.
“This was about as complex as a mission can get,” said
DellaVolpe, who credited the many people working behind the
scenes to ensure orders were cut and travel arrangements
made with getting the team in the air on time.
While
the medical staff in Baghdad waited, they kept their Sailor
alive on a ventilator. However, because his lungs were
severely failing, it was a race against the clock to get the
ECMO team in place.
“A ventilator supports your
breathing, but if your lungs are failing, it’s not going to
help,” said DellaVolpe.
During the flights, the ECMO
team prepared for what was ahead so they could show up ready
to go; the Sailor was on ECMO within one hour of arrival.
DellaVolpe said it took 30 hours from the time they got the
call in San Antonio until they were treating the patient on
the other side of the world in Baghdad.
After the
patient was on ECMO, doctors at the Baghdad hospital
performed several more critical surgeries. The Sailor was
then loaded onto a C-17 for a historic flight. Historic
because the medical evacuation marked the first time a U.S.
service member undergoing ECMO treatment would be flown to
the United States on ECMO. 72 hours after initial
notification, the medical evacuation flight delivered its
patient directly to SAMMC, where he is now recovering,
surrounded by family and friends.
“It is also the
first time we have responded from the continental U.S. to an
overseas location for a combat casualty,” said Mason, who
added that it was the longest ECMO transports ever conducted
by the military.
While the life-saving capability is
not uncommon, few doctors come out of training with any
experience in the niche therapy. Coupled with the frequency
at which military doctors have a permanent change of station
or leave the military, they rarely have time to become fully
qualified.
“Factor in 6-month deployments for some of
our people and you can see that we have a revolving door
that makes it very difficult to retain talent and sustain
the program,” said Mason.
The head ECMO doctor said
the first military team to use ECMO was an ad hoc group of
doctors and nurses from Landstuhl Regional Medical Center,
Germany, between 2005 and 2011. This team saved nine of the
10 patients they treated but, with no in-patient ECMO
facilities available, they had to rely on a local German
hospital to sustain the treatment once the service member
transported out of theatre. This early team highlighted the
need for the Department of Defense to maintain an ECMO team
and develop an in-patient capability said Mason.
The
ECMO team at SAMMC treated its first patient in 2012. The
first few years saw no more than six cases per year, said
Mason. But, beginning in July 2015, that number exploded,
growing to 17 in 2016 and on track for 35 patients in 2017.
Since 2013, the team has also conducted 42 total ECMO
transports, “including international missions from
Afghanistan, Iraq, Japan, Honduras, Germany and Columbia,”
said Mason.
In addition to combat casualties, ECMO
utilization is growing quickly for multiple patient
populations, including trauma, medical conditions and acute
illnesses, Mason added. These missions help keep military
medicine on par with leading civilian centers, while also
maintaining readiness for combat casualty care.
With
the growing demand and short supply of qualified doctors,
Mason turned to the Individual Reserve to retain and nurture
talent.
The Individual Reserve is managed by the
Headquarters Individual Reservist Readiness and Integration
Organization, Buckley Air Force Base, Colorado. The program
includes IMAs, reservists assigned to funded positions at
active-component organizations and government agencies where
they augment full-time counterparts. They have military
requirements similar to traditional reservists, serving
between 24 and 36 days per year, but also manage a civilian
career.
According to Col. David Lesko, the HQ RIO
Detachment 5 commander, responsible for all Individual
Reserve medical positions, the IMA program was a good fit
for Col. Mason’s need at SAMMC. An IMA can continue serving
in the Air Force, contributing directly to the active-duty
mission as-needed, while simultaneously working a full-time
civilian job. In this case, DellaVolpe gains full-time
specialty experience at Methodist Hospital, where he works
in the surgical and cardiac intensive care unit, and the Air
Force can retain him and his ever-growing ECMO capability
for critical missions like the one in November.
The
Det 5 commander said that during their annual review of
positions, Mason reached out to him to inquire about adding
several IMA billets to the SAMMC ECMO team. Lesko had
several billets he was able to redistribute to Mason’s team.
DellaVolpe went directly from active duty into one of the
new IMA positions in July.
“Working for Methodist
allows me to build experience in ECMO, since the Air Force
doesn’t do much in the way of heart transplants and
mechanical circulatory support devices,” noted DellaVolpe.
“This is a treatment usually for the critically ill but the
military still has a need for the war fighter.”
He
said he could not have asked for a better mission. For the
eight who went, the dedication of the whole team working
around the clock to safely bring their brother-in-arms home
was inspiring.
“Hopefully this demonstrated our
capability and we can continue to save lives,” said
DellaVolpe.
By U.S. Air Force Senior Master Sgt. Timothy Huffman
Provided
through DVIDS
Copyright 2018
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