Impact of Reduced Transport Volume on Deployment Skillsets and Operational En Route Critical Care Skill Sustainment

Critical Care Air Transport (CCAT) operational experience has steadily declined during recent low-tempo operations, with deployment readiness suffering from the "peacetime effect." The objective of this study was to compare critical care interventions performed by CCAT teams during high-tempo versus low-tempo operations.

A retrospective analysis of the patient population and clinician-performed interventions during high-tempo (2007-2012) versus low-tempo (2015-2019) operations was conducted using abstraction from CCAT records in the Department of Defense Trauma Registry (DoDTR). The 59th Medical Wing Institutional Review Board approved this study. Patient demographics, mission characteristics, and the frequency of critical care interventions were compared between high-tempo and low-tempo cohorts using descriptive statistics and Bonferroni-adjusted comparative tests. Team-level clinical experience was evaluated using physician deployments as a proxy to aggregate and compare median intervention volumes per deployment and 30-day period across both operational cohorts.

The study included 147 teams from the high-tempo period and 124 teams from the low-tempo period, who completed a median of 11 patient movements (IQR 5-22) and 5.5 patient movements (IQR 3-10), respectively, during deployment. Blood gas measurement, mechanical ventilation, intravenous sedation and vasopressor administration, blood product transfusion, and management of chest tubes, wound vacs, and external fixators were all performed in a high proportion of patient movements in the high-tempo vs. low-tempo cohort (P < .0001). Additionally, within a 30-day period, a greater proportion of clinicians in the high-tempo cohort performed interventions significantly more often during deployment than providers in low-tempo operations (P < .0001).

The diminishing frequency and acuity of patient transports have created a significant experience gap for CCAT team personnel. To maintain operational readiness, it is imperative to leverage alternative opportunities such as military-civilian partnerships, clinical sustainment platforms, and robust training exercises. These initiatives are crucial for sustaining the diverse clinical and operational skills necessary for critical care air transport, effectively bridging the current gap in training and experience.