MARIETTA, Ga. — In the back of a C-130 Hercules, a woman is giving birth. Like many other women, she is confused and nervous during the process, lashing out when a nurse touches her arm and anxiously calling out for her baby after delivering.

As lifelike as the scenario is, almost everything about the situation is fake, from the aircraft itself — actually a training system meant to replicate the fuselage of the C-130 — to the woman, a mannequin capable of blinking, speech and delivering a small mannequin baby. To the military nurses and medical technicians taking care of the clockwork woman and her newborn, this is as close to real as they can possibly get until they're face-to-face with a human patient.  

Air Force pilots typically practice their skills via ground-based fuselage trainers, as do many specialized crew positions like the C-17 loadmasters responsible for air dropping supplies. But until just recently, aeromedical personnel were forced to rely on either flight-based training or less immersive ground-based simulations where they would act out scenarios in a normal classroom, said Lt. Col. Chad Corliss, deputy commander of the 94th Aeromedical Evacuation Squadron.

"Our training has always been on live missions. When pilots start doing proficiency training and their proficiency flying, we get in on the back end and we fly. There's a cost associated with that," he said. "Every time the C-130 from this base takes off and flies, there's a cost for maintenance, operations of that aircraft, there's a cost of producing five members of the front-end crew, the maintenance members that support that aircraft off the ground, the guys in the air traffic control tower. There's a lot of personnel cost."

That paradigm is starting to change. Earlier this year, CAE delivered the C-130 Aeromedical Evacuation Training System to Dobbins Air Reserve Base in Marietta, Georgia. The system is the first fuselage trainer designed exclusively for aeromedical evacuation crews. It mimics the back of the C-130, with similar vibration, sound and even moving scenery displayed through the windows.

The CAE system reached initial operational capability on Oct. 1, and about 10 crews have cycled through the simulator since its January delivery. Once it hits full operational capability in March 2017, the plan is for crew members to use the simulator six days a week, with the seventh day reserved for maintenance, Corliss said in a briefing to reporters at Dobbins. Defense News accepted hotel accommodations from CAE.

"We’re still testing things out, making sure everything works exactly where we want it to, everything matches curriculum," Corliss said. "The 10 crews that have been here have loved the training. They’ve gotten to do things that we don’t get to do when we do things the old fashioned way."

The C-130 Aeromedical Evacuation Training System, made by CAE, and located at Dobbins Air Reserve Base, allows medical personnel to practice evacuating and treating patients in a realistic environment complete with the vibrations and sounds of the C-130.

Photo Credit: Valerie Insinna/Staff

While medical personnel care for simulated patients — a variety of mannequins including a child, a pregnant woman and a range of hyper-realistic injured adults that can bleed, sweat and cry out in pain — instructors can trigger other crises such as a fire or a power failure with a flick of a button. For instance, a mission last week tested the crew’s responsiveness to multiple emergencies.

"It took them about 10 minutes to troubleshoot the whole system, which was a little longer than we expected, but it worked out just like in the real world," Corlisss said. "They had a patient that had a chest tube that had suction going. When we killed the power, the suction unit shut down … so over about 10 minutes his breathing started getting worse."

After the crew reset the circuit breakers, instructors decided to simulate a fire, causing smoke to filter through the cabin. In a practice scenario held during a live flight or in the classroom, the experience would have been far less immersive.

"We’d have to go: ‘You don’t have power,’ but that’s it," Corliss said. "Here, without any indications from us, you push the button and power shuts down on them."

The Defense Department purchased the C-130 aeromedical evacuation training system for about $6 million with funds from the Air Force Reserve Command appropriated several fiscal years ago, and sustaining that level of funding might be a challenge in the current budget climate, Corliss said. He and others in the military medical community are trying to make the argument that the money spent on advanced, high-tech training and simulation equipment is worth the initial investment.

"Simulation training we know improves the acquisition and retention of knowledge. We know it decreases errors. We know it can correct problems," he said. "The medical world is just now coming into that. We’re a little behind, but we’re getting there. We know this can improve patient safety, and we know it improves our clinical performance."

Aeromedical evacuation technicians and nurses will still continue to conduct some training in flight, he noted, but regulating some of those scenarios to the ground-based system helps save money in the long term.

And beefing up the realism and fidelity of aeromedical evacuation training is critical if the military wants to sustain the gains it made over the wars in Afghanistan and Iraq, Corliss said. During the Gulf War, a service member injured in combat had a 24 percent chance of dying. Over the course of the war in Afghanistan, the US military drove that number down to only 2 percent.

"What we don’t want to have happen is, during our next conflict, new nurses and new med-techs coming in, not knowing what we’ve learned and having to learn it all over again," he said.

Using DLA funds, the Air Force plans to further improve the aeromedical evacuation training facilities at Dobbins. In November, the C-130 simulator will be transferred onto a motion system that will allow it to replicate the sensations of taking off, landing and turbulence, he said. It cost about $1 million to design and install the system.

Next year, CAE will deliver another two simulators that replicate the fuselage of the other fixed-wing aircraft commonly used for medical evacuation: the C-17 Globemaster III and KC-135 Stratotanker. The Air Force spent about $3 million for each of those, and is also considering the purchase of additional systems, Corliss said.

"The long-range plan is we’d like to have at least regional training sites, with Dobbins serving as the center of excellence," he said. "Since we do have three components that do air evacuation — the active duty, reserve and Guard — we would like to see there be three training sites," one for each component, with at least six more simulators divided among those locations.

An Air Force reservist practices applying a tourniquet during a demonstration Oct. 7 at Dobbins Air Reserve Base. The mannequin is so technologically sophisticated that it reacts to the pressure of the tourniquet, with blood continuing to emit from its leg if the tourniquet is improperly administered.

Photo Credit: Valerie Insinna/Staff

CAE views military medical simulation as an emerging market, said Chris Lilly, its program manager for the product. The company brought the C-130 medevac simulator to the Interservice/Industry Training, Simulation and Education Conference last year and received a lot of international interest. However, there are no requests for proposals on the books for such a system, he acknowledged.

One potential customer is the Canadian military, which has visited Dobbins and seen the C-130 training system. Although the Canadian military owns a C-130J training facility, it does not have enough capacity to use it for aeromedical evacuation, Lilly noted.

"They’re very interested. I think a lot of folks are in a wait-and-see kind of mode," he said. "They want to see it on motion. They want to see how this thing progresses."