At 3,500 feet, the patient starts shaking violently on the floor of the plane, a wounded soldier stricken by a seizure.
While she struggles, an Air Force medevac crew tries to get her breathing through an open airway, staving off cardiac arrest in the belly of a four-engine turboprop transport plane.
It’s dark inside and loud enough to need earplugs. The walkways are crowded with wounded on their litters. Equipment sits in stacks and cables wind along the floor.
And this is only a drill.
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If this crew were flying wounded soldiers out of Bagram Airbase in Afghanistan, they’d be wearing body armor, and the air would sizzle at 135 degrees.
“It’s the most rewarding and humbling job I’ve ever done,” said Capt. Mackenzie Johnson, 27, a reservist in Fayetteville. “You get to see their eyes when they hit American soil.”
This crew could soon vanish from North Carolina, its mission shuttled elsewhere.
An Air Force budget being debated in Congress would deactivate the 440th Airlift Wing at Pope Army Airfield, sending all 11 of its C-130s to other bases.
The 440th provides airlift, airdrop and medical support from Fort Bragg in Fayetteville, and all of the airmen training Monday had been deployed overseas at least once. Last year, the 440th moved more than 500,000 pounds of cargo, 3,400 passengers and 13,000 paratroopers, working with a combination of active-duty and reserve personnel.
The move comes as a broad shuffling of Air Force resources nationwide, including increasing the number of reserve wings equipped with F-16 fighters.
“These force structure changes are significant, but they ensure the Air Force Reserve remains an integrated, flexible and combat-ready force,” said Brig. Gen. William “Buck” Waldrop, director of plans, programs, requirements and assessments for Air Force Reserve Command.
Who would fill its role?
But at Pope, worries run high about lost jobs, lost expertise and lost capability. The 440th ran a four-hour training mission to the Outer Banks and back Monday, inviting media to watch them treat dummy patients as if in real combat.
“This puts my stomach in knots,” Col. Tom Hansen said. “It’ll be a shame if they can’t continue doing this job. Some people are probably going to quit this.”
Hansen works at Pope one week a month, commuting from his home outside Seattle, where he works as a nurse practitioner. First deployed in Desert Storm, he’s had five more overseas stints since 2003, including time in Afghanistan.
It takes two years to train as a medevac, he said. It means working 16-hour days, changing time zones constantly and treating patients on litters in the back of an airplane without the aid of a doctor. Over time, medevacs become experts in the ways altitude and vibrations affect the wounded.
“What do we see a lot?” he said. “We see gunshot wounds. We see head injuries. We see fresh amputations. For our patients with broken bones, if you put your hand against any part of this plane, you get vibrations. These are things you don’t experience on the ground.”
So if the 440th goes away, who would fill its role?
“Nobody around here,” Hansen said.
The planes the 440th flies are all C-130H, built by Lockheed mostly in the 1980s. You can tell their age from their tail number. The first digit represents the year of construction. In the case of the crew Monday, it’s 1988. The planes may be noisy and cramped, but pilots nurture a fondness for the lumbering workhorses.
Calming the chaos
You sit in a chair made of nylon mesh, hanging from a metal bar. When the plane takes off, passengers all lean into each other. Propellers make conversation impossible. The windows are too small and round to see much in the dim light, except on the flight deck.
“It’s not that bad,” said crew member Staff Sgt. Justin Wells. “I prefer riding in one of these to commercial any day of the week.”
It’s possible that new C-130Js will be sent to Pope, said 440th spokeswoman Maj. Lisa Ray. For now, the wing must prepare for both possibilities.
Back in the C-130, the crew finishes treatment of its mock seizure victim and prepares to land back at Pope, having circled half the state in the air.
If the wing gets deactivated, Mackenzie Johnson, a nurse, will still have a full-time job at Cape Fear Valley Medical Center. But she’ll lose a big part of her family – the one that calms down the chaos at 3,500 feet.