Wounded Soldiers Stuck in Middle of Aircraft Battle

This is the third in a series of stories by our special correspondent about military aviation issues linked to the war in Afghanistan. Read also the growing pains of the Afghan air force and the attempts of female pilots to find a place in it.

RAMSTEIN AIR BASE, Germany (Oct. 30) -- More than two dozen injured U.S. troops, including six critical-care patients, have been loaded onto the C-17 transport aircraft destined for Andrews Air Force Base, Md. Then everyone aboard gets the bad news:

There's a fuel leak, and the aircraft may not be able to fly today.

That means more waiting for the patients, a number of whom were wounded in operations in Afghanistan.

If the aircraft can't be fixed within a few hours, a new aircraft will have to be found, and that's easier said than done. Flights these like -- aeromedical evacuation -- have a high priority, but with military operations in Afghanistan surging, finding an aircraft can be a game of musical chairs.

This scenario plays itself out almost daily, not just here at Ramstein, but in Afghanistan and Iraq. Injured troops awaiting transport from Afghanistan, via Ramstein, back to the United States are caught in the middle of two battles in Washington. One is the long-delayed $35 billion plan to replace the Air Force's aging fleet of refueling tankers, which are also used for aeromedical evacuation. The second is over the further production of C-17s.

The Air Force uses four types aircraft for aeromedical evacuation, but the C-17s and KC-135s are the workhorses, carrying troops from Afghanistan to Ramstein, and then on to the U.S. For those working in aeromedical evacuation, the C-17, a modern transport aircraft produced by Boeing, is by far the preferred option.

"The KC-135 has tremendous limiting factors," said Lt. Col. Penny Harnisch, a flight commander for the 10th Aeromedical Evacuation Flight, who is currently deployed to Ramstein. "It's cramped and cold and has limited power."

The space issue isn't a matter of creature comforts.

The narrow body of the KC-135s, which are typically more than 40 years old, makes it challenging to load litter patients. Then, once they are loaded, a patient on a top litter might be almost up against the ceiling.

The amperage available on the aircraft is also a limiting factor when it comes to critical-care patients, who are hooked up to a number of monitoring devices and other medical equipment that require power. Another problem is that the temperature on board is hard to regulate -- it's cold on the bottom and hot on top, another source of patient discomfort.

Why the Air Force often moves patients with the KC-135, an Eisenhower-era aircraft, rather than the more modern and spacious C-17s comes down to simple numbers. "We don't have enough C-17s," Harnisch said.

The Air Force has ordered 213 C-17s to date, but further orders depend on a battle between Congress, which has pushed to extend the production line, and Defense Secretary Robert Gates, who wants to halt further purchases.

"The leadership of the Air Force is clear: They do not need and cannot afford more C-17s," Gates said during a speech earlier this year.

Like the other aircraft used for patients, C-17s are not dedicated to aeromedical evacuation. Rather, they are transport aircraft used for cargo and passengers, but can be reconfigured to carry patients. C-17s typically transport "beans and bullets" downrange to Iraq or Afghanistan, and then are used to carry the injured back, according to Air Force Capt. Erskine Cook, an 86^th Aeromedical Evacuation Squadron flight nurse.

"They may have just taken tanks off the plane 12 hours earlier," Cook said.

Like Harnisch, Cook says the C-17 is greatly preferred to the KC-135. Cook, who was previously a medical crew director, said the majority of his flights to Afghanistan were on KC-135s rather than C-17s.

"The C-17s is the Cadillac, the gold standard of patient transport," Cook said, adding that KC-135s were at the "bottom of the list" for aeromedical evacuation teams.

A replacement to the KC-135 would address many of the complaints, but for nearly 10 years, the Air Force's plans to replace its fleet of tankers, which may cost some $35 billion, have been mired in politics. An initial plan to lease 100 modified Boeing 737 aircraft was derailed in a scandal that eventually sent a former Air Force official and Boeing executive to prison. After a new, competitive acquisition was held, an Airbus-based tanker was selected, but that plan was also thwarted after Boeing successfully protested the award.

The Air Force is now conducting yet another competition and is expected to select a winning tanker later this year.

The problems with patient transport on the KC-135 play out in both little and big ways. Harnisch recalled one flight from Andrews Air Force Base, when an amputee being transported from theater was situated within a foot of passengers, in this case a mother with two young children.

"I had an issue with that," Harnisch said, adding that the patient who just lost a limb in a traumatic battlefield injury may not be ready to have children staring at him.

With the prospect of no more C-17s rolling off the production line after 2012, and the new tanker still in limbo, the options for aeromedical evacuation are limited. Cook, the aeromedical evacuation nurse, said the Air Force can make do with what it has. "Is the KC-135 the preferred air frame? No. But you do what you have to do," he said. "It does the job, but it's not the best for the jobs."

Cook, in a sentiment echoing the infamous statement Defense Secretary Donald Rumsfeld once made about the lack of armored Humvees, said: "You pick up the patients with the plane you have."

In the meantime, back in Germany, there's some good news for the patients at Ramstein awaiting transport back to Andrews: The leak on the plane can be fixed, and a new aircraft isn't needed. After a four-hour wait, they are reloaded onto the aircraft and ready to leave.