Shortly after the terrorist attacks on Sept. 11, 2001, Eric Johnson, a Spokane-based anesthesiologist, wanted to do something to help. At age 53, he joined the U.S. Air Force Reserves and became a member of an air transport team known as Critical Care Air Transport Team, or CCATT. For Johnson, now a lieutenant colonel, the job is everything he hoped it would be.

"I served a tour in Iraq, and it was fulfilling in every aspect," said Johnson, who has been an anesthesiologist for 28 years. "You really make a difference as a CCATT team member. It was as if everything I had done in my life led me here."

Formally named in the 1990s, CCATT units are medical teams that comprise a critical care physician (surgeon, anesthesiologist, emergency physician or pulmonologist), a critical care registered nurse and a cardiopulmonary technician who are responsible for transporting critically ill patients to major medical centers.  The CCATT teams can transport up to six unventilated or three ventilated patients for 10 to 12 hours by air and about 550 to 700 pounds of medical equipment (they have everything found in a ground-based hospital ICU with them) using the C-17 Globemaster III, C-130 Hercules, KC-135 Stratotanker and formerly the C-141 Starlifter.

The CCATT teams are charged with transporting critically wounded troops from Iraq and Afghanistan to Germany or the United States.

"Our job is to get critically injured soldiers out of the theater of war to Germany," Johnson said. "We pick them up and deliver them in the same or better medical condition that we found them in. They have to be stabilized, not stable."

On occasion, they get special requests that involve different scenarios of treatment.

One example was a request from the Polish commanding general to pick up and keep a soldier alive so his wife could tell him goodbye.

"Of course we did it," he said.

To be a member of the team, servicemembers must complete intense training that includes a basic course and a 12-day advanced training program that consists of 80 hours of clinical instruction for physicians and 56 hours of clinical for the registered nurse and respiratory therapists.

"The training for CCATT helps get the medical teams accustomed to caring for people under austere situations," Johnson said.

In addition to the training, you have to be flexible and prepared for most anything, he said.

Lt. Col. Dan Berg, a critical care nurse for the past 29 years, joined the Air Force in 1994 and was assigned to the 446th Aeromedical Evacuation Squadron.  He knew from the start that he wanted to take care of seriously ill or injured people.  He recognized that there was no critical care component in flight medicine.

"In the civilian world we were doing critical care transport," he said. "This had never been done in the Air Force world."

About seven years since the program was started at Joint Base Lewis-McChord, the program is making a dramatic difference in the number of soldiers who survive.

"Since the inception of the program, we have almost tripled the number of super sick people who live," said Berg, who also works as a paramedic.

He recalled a burn victim they flew to Germany who had third degree burns on 60 percent of his body.

"We had to give him about 15 units of blood, and he was arresting," Berg said. "In Seattle, if we take someone to a burn center in this type of condition it is rare that they would come back and live.  But today he is doing OK."

Besides the quality of care provided to the injured troops - only one person has died in flight since the program started at JBLM - there are several things that distinguish the CCATT teams.  First, is their ability to go across the world with patients.  "We can reach globally," Berg said. "It is amazing that we can go anywhere in the world and do whatever you need.  You can't do what we do anywhere else." 

Second, is the team's ability to deal with the stresses of critical care in the air, such as the decrease in barometric pressure and the partial pressure of oxygen, decreases in humidity, temperature fluctuations, vibration, noise and the small compact work area.