 | Lt. Col. (Dr.) Dan Dirnberger, 59th Maternal/Child Care Squadron Neonatal Intensive Care director, and Maj. (Dr.) Melissa Tyree, Extracorporeal Membrane Oxygenation transport team director, provide care to a critically ill infant during the flight from Kadena Air Base, Japan, to San Antonio, Texas, May 26. The infant required more immediate and long-term cardiac care than was available at the U.S. Naval Hospital in Okinawa. (U.S. Air Force photo)
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 | Two critically ill infants are loaded onto a C-17 Globemaster III for transport to San Antonio, Texas, from Kadena Air Base, Japan, May 26. The combined efforts of the 59th Medical Wing's Extracorporeal Membrane Oxygenation team, ground and aircrews from Kadena, Elmendorf and Eielson Air Force Bases, and Reserve support from Lackland Air Force Base's 433rd Airlift Wing helped to ensure a successful mission bringing the ill infants to the advanced care that was unavailable at the U.S. Naval Hospital in Okinawa. (U.S. Air Force photo)
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Wilford Hall team transports critically ill infants across the Pacific
by Linda Frost
59th Medical Wing Public Affairs
5/29/2009 - LACKLAND AIR FORCE BASE,Texas -- A team from Wilford Hall Medical Center rushed to Okinawa, Japan, May 24 to save the lives of two critically ill babies.
The infants - one nine months old and the other twenty days old - were moved from Kadena Air Base, Japan, to San Antonio, Texas, May 26 aboard a C-17 Globemaster III. Both are military dependents needing specialized care at medical facilities in United States. They are currently in stable condition.
The first child, a 9-month-old, was suffering from congestive heart and severe lung failure at the U.S. Naval Hospital in Okinawa. Despite the efforts of the medical team there, the infant required transfer to the U.S. for immediate and long term cardiac care.
Doctors felt the child needed to be placed on extracorporeal membrane oxygenation, or ECMO, to survive.
WHMC is the only medical center in the world with an ECMO team capable of transporting ECMO patients, whether Department of Defense, civilians or in support of humanitarian missions.
ECMO is a machine that provides cardiac and respiratory support to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function.
The second child, a 20-day old pre-mature infant with respiratory distress, was also moved on the same aircraft and cared for by an Air Force neonatal intensive care team. The baby did not require ECMO. The infant is currently under the care of a NICU team at WHMC.
According to Lt. Col. (Dr) Daniel Dirnberger, director of 59th Medical Wing's Neonatal Intensive Care Unit, the 9-month old was not making any progress with conventional medical and ventilator therapy and needed immediate evacuation to the U.S. for life-sustaining open heart surgery. However, the baby was too unstable to be transported without a heart-lung bypass.
"This was a massive undertaking requiring complex coordination across multiple agencies throughout the Air Force, including personnel at Scott and Hickam Air Force Bases, Kadena Air Base, U.S. Naval Hospital in Okinawa, Tripler Army Medical Center and Wilford Hall Medical Center," said Dr. Dirnberger.
The WHMC ECMO team traveled to Okinawa May 24, placed the first baby on ECMO and transported him 26 hours later to Christus Santa Rosa Hospital in San Antonio with no complications. The second infant with respiratory distress had some instability during transport, but physicians say this is not uncommon for a baby his age.
The ECMO team included two neonatologists, two neonatology fellows, a pediatric intensivist, pediatric cardiologist, a team of neonatal and pediatric intensive care nurses, medical technicians and respiratory technicians.
Because the WHMC pediatric surgeon is currently returning from deployment, an Army pediatric surgeon was flown urgently from Tripler Army Medical Center in Honolulu to meet the ECMO team in Okinawa to perform the surgery necessary to place the infant on ECMO.
"I'm extremely proud of our entire team. From technician through physician, every member gave 200% of themselves to this mission," said Dr. Dirnberger.
Meantime, there were challenges.
The C-17 had last minute mechanical problems, while the lives of two critically ill infants on life support were waiting on the flight line.
The clock was ticking fast while a new aircraft was quickly reallocated to assume the medical mission. As ground and aircrews worked feverishly, the ECMO and neonatal transport teams were running out of medical air and electrical power. The infants were taken to the Kadena Air Base Clinic, where they were able to utilize oxygen, medical air, and electricity while they awaited departure.
Once the aircraft was loaded, the doctors, nurses and technicians rotated three shifts to ensure that fresh eyes and alert minds were on the patients at all times.
An in-air refueling mission significantly reduced the trans-oceanic transport time to 14 hours, which saved approximately four to five hours, with the aide of the 168th Air Refueling Wing, Eielson Air Force Base, Alaska.
"Our ability to support our military dependents overseas with such phenomenal medical and surgical capability reflects a dedication to our families that is unparalleled in the world," said Dr. Dirnberger. "The coordination across multiple military agencies, and the logistical and medical complexities accomplished to bring these babies safely home is a testament to quality and character of our military healthcare system and the people in it," he said.
The nine-month old is doing well and has been able to successfully come off ECMO at Christa Santa Rosa Hospital. He is scheduled for corrective open heart surgery next week, and it is believed the baby will have an excellent outcome.
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