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Lieutenant General Taylor: It's good to be here today. Hopefully you've got your tray tables folded and your seat backs in the fully upright and locked position because we'll spend a good amount of time talking about what's happened with Hurricane Katrina. I think it's important for the medics in the Air Force because what we began in Afghanistan—changing medical doctrine, the way we handled patients—we’ve now continued in handling over 2,500 patients that were air-evac'ed over about three days in New Orleans.

We all know it's a dangerous world out there that we're involved with. The Air Force that we grew up in after the initial drawdown looked like this, and we know from an expeditionary standpoint that we operates bases at many locations, most of them expeditionary and not a single one is out there that doesn't have some sort of medical presence, whether it's an Independent Duty Medical Technician (IDMT) or full-up Expeditionary Medical Support (EMEDS) capability or a flight surgeon team involved.

Before 9/11, the way we protected the homeland looked very different. We had to create a system using primarily the Federal Aviation Administration (FAA) and our Guard brothers and sisters. We had thought we could just protect the borders and that's not true. We have to protect from the inside as well.

Then there are natural disasters ... Katrina walked across the Gulf Coast, getting larger and larger, and headed for New Orleans and the Mississippi Gulf Coast.

I wanted to talk about just one Airman and then spend most of the rest of my time talking about the expeditionary capabilities and some of the technologies we bring to that. Then we’ll conclude with some thoughts about Katrina and Base Realignment and Closure (BRAC), if that engenders any questions.

For any medics out there, if you have anything you think makes this presentation better, send them to me—Peach.Taylor@pentagon.af.mil. If you have ways to make this presentation better, particularly when I talk outside the Air Force family, I'd appreciate it.

If you think about World War II, it was not unusual to field a thousand-airplane raid, each with ten men aboard—back then it was men. There were 10,000 men airborne to strike one target.

Today, the normal mission with a B-2 … A two-person team in the cockpit, dropping 16 bombs, and we're headed towards 84 250-pounders, each individually targetable so you could hit over 80 targets with one B-2. In fact, for those of you that don't know, we've actually flown the B-2 unmanned earlier this year, with an all-women crew. [Laughter]

Remember, 50 percent of the enlisted force—the medics—are women.

Just think of when you go from 10,000 men airborne to a two-person team. Now granted, you have to have bomb loaders, you have to have air refueling, you have to have launch and recovery folks, crew chief folks, but it's a very small number of people to deliver that kind of combat capability. If you look at our future with a smaller number of fighters and a smaller Air Force, each Airman becomes increasingly important.

Consider a mission in Baghdad. After the strike, you wouldn't see much. If you walk down the street immediately afterwards, you'd see some windows blown out and you'd see some holes in the roofs and you'd say, “not much happened,” but then, of course, when you look inside, it’s all gone. With each one of these weapons, it’s incredibly important that we drop it properly.

It's not only that, but we also spent a lot of time helping in the tsunami effort. Think of all the airlift and all the work we did to try and help those hundreds of thousands of people who were in harm's way.

If you look at the Berlin Airlift from ‘48 to '49, they had 225 C-54s at its peak and it required 18,000 sorties. If it was flown today, you could actually fly this mission from Dover with 185 C-17s and it requires far less sorties. And you could fly the mission from Dover with today's capability in terms of C-17s. So it's a miraculous amount of work, but imagine how many people were involved in this particular mission and how many fewer people could do the same mission today.

Whether it's the guy guarding the perimeter, whether it's the medic doing outreach, the guy who's loading up the weapons or refueling the vehicles, every Airman is important and that's why we try to create a fit force and a healthy force for the commanders.

If you think of wartime capabilities from the medical perspective, we think in terms of operational health care. What do we need to field in terms of medical operations to take care of the fielded warriors? We also know that we have a peacetime benefit in home station health care that's important to our family members. It also provides, frankly, the platform to make sure that the people that can work there have enough skills to do that on a moment's notice. It takes a strong peacetime health care system with a large beneficiary population to allow our doctors, nurses, technicians, to remain at the peak of their effectiveness.

There are four main effects that the Air Force Medical Service brings. We help assure a fit and healthy force. We prevent casualties. We restore health or treat those that are injured. And we do everything we can to enhance the human in the weapon system, to make sure we're making optimal use of that person. These are the reasons why you have medics in blue suits. If we didn't have to do these things, then we could all be civilianized, but because of these things, you'll find blue suiters with blue suiters.

If you look at the Air Force structure, as we build the structure for the Future Total Force and the AEF construct, the medics play right into that. You'll see this as we go through the talk today.

We span most of the entire spectrum of care, from the injured troops in the war fight all the way back to the theater hospitals either in Germany or all the way back in the States. We've redone self-aid and buddy care. If you haven't seen it, there's a new self-aid and buddy care system in place that provides advanced training in the one-arm tourniquet and with quick clot, which is a hemorrhage control. We have worked hard to be smaller forward and to pull air-evac as far forward as we possibly can. We’ll talk a little bit about what that means in a minute.

The pieces that we do in deployable health care … It's not only the health care capability, but the skills that we bring to organization, the ability to plan and train. What the Air Force brings that the other services can't quite bring is the speed. Air Force speed is different than other speeds. The Army brings incredible depth, the Marine Corps brings incredible depth as they project over the sea, but only the Air Force has this kind of modularity. The other services are moving to a much more modular force in terms of the medics, but we did this about ten years ago and it's proven itself very well in the war fight.

Examples of our rapid deployable capabilities ... We've responded to floods in Houston about five years ago; we’re in Operation Iraqi Freedom (OIF), working in East Timor; and Joint Task Force Katrina.

This expeditionary medical capability that's on the ground is very mobile and is actually quite small. Our 25-bed facility, the basic set, is only 87 people. Now this is just for the medics. The Army cache travels with a much larger population, but they bring everything—billeting, transportation, fuel, services, etc. Our smallest version is a two-tent version, 25 personnel and it fits on the back of a C-130. We also have a grow-up from the smallest version that is deployable and can operate. It can do ten major traumas or take care of 29 operatives in 24 hours. And it builds up from there, up to a 25-bed. We also have them over-pressurized. At the beginning of the war, we had five over-pressurized, 25 beds, all within strike distance of Iraq, the places that we were worried about.

Your basic operating room … We bring dentists with us, and if you're not actually in the warfight, these guys are about the busiest guys on the station, as well as ancillary services. In our larger places we even field Computed Tomography (CT) scans in the field. We have CT scans at Balad, for example. And, of course, the emergency departments.

If you think of the things that we're working on, we're working on tele-health capability to take pictures and send them back. Most of our EMEDS forward are all digital. The films can be sent around digitally. We're working on trying to transmit other things through the net. Our problem is bandwidth forward, because normally when an EMEDS arrives on a base, there is one phone and it's the commander's phone in the commander's tent.

One of my friends, Mike Cussman, who was in the Army, a brigadier general retired, he's the primary deputy in the Department of Veterans Affairs (VA) for health. He said the best tele-health is a telephone because there's not much that doctors talking on the phone can't figure out, or nurses talking on the phone. It's nice to have a picture, but it's not necessary. The most important thing is to have a telephone.

We're also working on the digital radiography that you'll see in the field, and we've got these portable ultrasounds that you see on TV all the time where the guy puts it in his backpack and takes it to Somalia. We use sort of the same thing and we make sure that our providers are ready to work with that kind of equipment.

We're working on the ability to try and reconstitute intravenous solutions. We carry a huge amount of intravenous solutions in the field so we're trying to work real hard to see if there's a way to take water, make it potable water, and then make that potable water into intravenous solution. It's a pretty difficult business but we're working real hard on it.

There's a fair amount of blood substitutes actually being fielded in the U.S. for tests now and we're very hopeful because they appear to have great resuscitation capability. They're using it in Alexandria right now, for example, under experimental protocols. But it has great stability and a great ability we think to help us in combat.

One of the other things we used to drag around when I was growing up in the old days were these big monster H cylinders, the big green cylinders. You'd have plane-load after plane-load of those H cylinders coming through. We went to liquid oxygen. That was sort of developed in the old Cold War days when we had forward deployable liquid oxygen plants because we had to have them to put oxygen on the airplanes. The airplanes went to molecular sieve technology, so we've gotten to oxygen concentrators now. We're trying to field these. They are not simple to operate because they have some power problems and we're trying to field them. Some are huge, big monsters. Then we're trying to develop a little over-pressurized cylinder called a MOST to try and get oxygen in the field that's renewable.

We're working hard in the battle labs with some nano-technology to try and filter water, to make it better. At the same time, we’re trying to destroy the micro-organisms in the water. So again, the first step in providing IV fluid…we can just stick this in the ground, pump the water through it and you have drinkable water at the other end. It's exactly what they're fielding in the wilderness. You see folks bringing their wilderness packs and they have this kind of technology fielded already, so we’re just taking advantage of it.

An interesting thing that particularly Special Ops has been looking at is using ultrasound inside rubble to see movement. So you're able to detect respirations and heart rate through rubble. When you're trying to do earthquake relief or finding somebody on the other side of the wall, this could be sort of important if you're a special operator of if you're a medic or a rescue worker, so we're trying to work this out now. Special Ops has been working very hard to try and develop this capability in a hardened kind of form.

The folks that work aeromedical evacuation have been not only the basic back-enders for us, but also the critical care transport teams have been doing heroes’ work over the last four years in support of the warfighter. They're some of the early heroes in OIF, remain heroes in Operation Enduring Freedom (OEF), and like I told you, it was a remarkable set of work that we did over the weekend before last when everybody saw the terrifying scenes out of the Convention Center and the Superdome as they moved those people through the airport in New Orleans.

The Air Force is the executive agent for fixed wing aeromedical evacuation. We have worked a pretty tight system now, and I'll show you a little bit of how it works. What we've been trying to do is the Army, the Navy and the Air Force first responders bring them to the first level of surgery, then we do aeromedical evaluation pick-ups to get them to a theater hospital and then back to the States.

What's happened is we have Airmen in the field with the caches and with the Marine support units, the Navy field hospitals, very far forward to make sure this flow is as quick as possible. One of the big innovations in the last five years brought on by one of my predecessors, Lieutenant General Paul K. Carlton, Jr., was the ability to rapidly move very sick patients.

I grew up in the era that you only move stable patients which was normally about seven days post-op. Now it's not unusual in this warfight to move patients 30 minutes after surgery. The aerovac mission actually becomes a stabilizing mission for the patient where we try to tune them up for their damage control surgery at the next location.

Nothing's easy in medicine, but it's fairly easy to set up an Intensive Care Unit (ICU) in the back of a C-130, C-141 or a C-17—or a C-135 if you need to—to try and move patients in the air. There are huge challenges with dark and with noise and with other things that we're trying to hash through, but we have proven remarkably successful at moving a large number of critical care patients through the air very long distances. Some of the things we've been able to do is bring the new life packs aboard—the new pro packs that help with stabilizing a patient, detecting abnormalities of a patient—and then administrating drugs in the right sort of way for them.

Working on ventilators—it is not unusual for us to move ventilated patients in flight. It needs to be lightweight. You can't use compressed air because, remember, when you're flying in the airplane it makes it more difficult. And you see the IV pumps that we use as well.

Air Mobility Command developed a pallet upon which you can click in either seats or litters or both that allows slide-on capability to the airplane. We also use the spectrum patient care modules to actually move patients on the C-141. Then as Civil Reserve Air Fleet (CRAF) kicks in we have to have a high deck loading capability and they've been developing that for the US airplane that they allowed us to use the year before last.

Let’s talk a little bit about the warfight itself. The largest contribution that we make to the joint warfight is fielding the theater hospitals in Balad right now. The Air Force mission would probably put an EMEDS basic or EMEDS-plus-ten-bed facility there. Now we have a much larger capability. We took over the shelters from the Army. They're slowly being replaced. Eventually they're going to move into a hardened facility, but the core of this hospital is Air Force. Army critical care nurses are there. The Australians have been there in the past. It's a huge place. You'll hear about people who are deployed getting hurt, and then flying either to Baghdad or to Balad. They tend to come to Balad because the strategic air goes back to Rammstein Air Base from there.

There is tremendous work being done on our Coalition forces, our own Airmen, Soldiers, Sailors, Marines. It's remarkable work. You can see the surgery that goes on in one of the iso-shelters, sometimes two surgeries at a time. You can see what the wards look like. You can see we have some incredibly sick people here and we're working real hard on making sure this hospital has exactly what it needs in terms of advanced technologies.

It’s a huge learning experience we've had operating in the warfight. Doc Jenkins is here. He spent some time working the trauma registry there. He worked on new techniques for wound healing, blood products, imaging—looking at what kind of imaging capability we need in the field, and treatment capabilities. We are taking today's technologies and applying them to the battlefield.

We do have Battlefield Airmen, like I said. Our mobile air medical staging facilities are very far forward to make sure that patients that are injured in the field have a direct hook into the aerovac system.

We're moving large numbers of patients through the system. Every month, there are as many as 5,000 patients in the system. This is across the entire planet. Much of it is coming from US Central Command (CENTCOM) and US Central Command Air Forces (CENTAF). Those numbers are now in the thousands or two thousands per month. Some of them are critical care movements, but by and large the vast majority are normal aerovac movements. And they're not all battle injuries. In a minute, we will talk more about the number of people that we moved in Katrina.

This expeditionary capability, as former US Air Force Chief of Staff General John P. Jumper said, requires broad thinking. We have international health specialists stood up, sort of liked medical Foreign Area Officers (FAOs), that work to teach disaster management. We run disaster management courses across the planet. The most interesting one is we went into Indonesia to do a disaster management training course just after the tsunami came in. We teach air-evac courses, we work on casualty care and interoperability across the globe. You have Airmen—active, Guard and Reserve—all doing this kind of work.

It's teamwork that counts for us. I went to New Orleans last Saturday, and there are Reservists and Guardsmen and active duty personnel there, and there are traditional State Guardsmen in traditional State status there, and there were some folks that were Title 32 and there are probably some Title 10s in there that I didn't see. As the air-evac core comes out of the Reserves, it's not unusual for us to have doctors in the field working as well. The point is the teamwork has been huge for us.

We have been stars of the show. Great individual efforts. This EMEDS flexible capability, from very small to very big, has been a model to emulate. As the Army is making that transition to modularity, they have to make their caches and other systems more modular. They've got forward surgical teams and they're building the systems to be rapidly responsive as the brigades are going to require them to be.

We've fielded an air-evac system, like I said, and it’s 30 minutes from injury until you're in the back of the airplane. That has changed doctrine in terms of how we do business. How many beds do you need forward if you can actually move the patients out? Do you want your beds occupied in the battlefield with people that aren't going to return to the warfight? You really want them out of the theater of operations so you free the beds up for the next injured crowd. So this is very important new territory.

In terms of national response, you think of local responses, but when local responses are overwhelmed, State assets kick in and the Guard has moved very rapidly in Operation Katrina to create an EMEDS-like capability at the State level. In fact, there are three EMEDS-plus-25s that State assets are fielding today. Two are State and one is from the training set from Alpina.

Then the big Feds can come on and we have a Medical Rapid Reaction Force. After 9/11, we got a standard set of deployable assets that we kick out in times of emergency. This particular time, on call through August, was a team of Scott Air Force Base and Wright-Patterson Air Force Base for the surgical part and the primary care part, and then the aeromedical staging facility was out of Wilford Hall primarily, they were on call. And, in fact, on September 1st the call was supposed to switch to Keesler Air Force Base. It turns out Scott and Wright-Pat were the ones that responded to Katrina.

Let's talk a bit about Katrina. Clearly a devastating hurricane. If you take a look at the wind gusts through the system, there was a 140-plus-mile-an-hour band through the system, so you can understand why the Mississippi Gulf Coast and the parishes were devastated.

Power outages. For medicine, if you take away electricity, what do you do now? For nurses and doctors, you do a lot of this, don't you? The people at Charity had to make some very tough decisions about how long they hand-bagged ventilator patients. There were some pretty horrific stories.

There is flooding in the Keesler Air Force Base hospital and the basement's pretty much trashed. Brigadier General (Dr.) Jim J. Dougherty, the Commander of the 81st Medical Group at Keesler, was called down to the basement, and can you imagine hearing the cars banging against the side of the house with the flood, and then looking and seeing the glass doors outside half-full of water and nothing but water all the way out.

But our people did great work there. They're already beginning to do outreach programs there, to go to shelters. They humped 150,000 records from the basement upstairs. For those of you who are really impressed, they also saved the CHCS2 servers. [Laughter] That's the bad news, I know. [Laughter] And there are some great individual stories out of Keesler. A baby was born in the middle of the hurricane under lamps.

New Orleans we all know was horrific and we watched what happened at the Convention Center. We watched the evacuation, and there are some really remarkable stories that are going to come out. We published today a series of them in a special issue of the Surgeon General newsletter that you can see on our website at www.airforcemedicine.afms.mil/. It's very important for us to tell this story because it's not well understood what happened. I'll try to give you a little example of this.

When the hurricane came through on Monday night, the levees started breaking and by the morning, the levees were indeed broken and the place started flooding. We had had the Medical Rapid Reaction Force on call and it was a matter of when they were going to get tasked and where they were going to go. On Wednesday morning, General Jumper had us all in a staff meeting and said, “go and go now. No asking. There shouldn't be a helicopter that's not moving. There shouldn't be any capability that we're not flowing into the coast.”

The biggest problem for us is where to go. Where do you go? What's not flooded? Is the airport going to be flooded or not? Well yes it is, no it isn't, yes it is, no it's not. But the crews over the next couple of days started rescuing people. Pararescue Jumpers (PJs) operated at night, and the Air Force has the only night-capable PJs.

The next question was when you rescue them, where do you take them? Remember, all the hospitals were down. I think there are 14 hospitals in the greater New Orleans area. They're all out of power. Where do you take them when you rescue them? Where do you take all these people?

It became obvious pretty quick that the right place to take them was the airport and that's what folks did. They took them to the New Orleans International Airport.

Now when our folks arrived on Thursday morning, the Feds had been there the day before. Their Disaster Medical Assistance Teams (DMATs) came out very early and they were set up in the New Orleans airport. When our folks charged off the airplane and up the ramp in the D Concourse, the first thing that came out were the 12 dead bodies in the middle of the terminal floor. And then past that was nothing but people on stretchers as far as they could see. The smell of urine and feces and blood and everything else was pretty horrible, pretty atrocious. But pretty soon, working with the DMAT teams, the Guardsmen that were there worked very hard in terms of setting up a flow of patients.

Don't think that there weren't Airmen in the Convention Center and in the Superdome, because there sure were. There were Guard teams in both the Convention Center and the Superdome that rode out the hurricane and the next night, and then had to be extracted because of the increasing violence. They saw over 6,700 patients in that two-day period of time along with the DMAT teams. But the guys in the Convention Center, the Guardsmen, tell stories of getting shot at there. They'd take patients, dump them over the rail, and when you went out to get them they'd shoot at you. So there are going to be some very interesting stories and some tough times for the Guardsmen as they come out of there.

The word was passed, because there wasn't much of a command and control system, that when you rescued somebody the best place to bring them was to the airport. So they set up a flow in the airport where the helicopters were all landing, which you probably saw on CNN. The helicopters would land, they'd take the people—sometimes they were patients, sometimes they were normal people that were just wet—and they’d run them under the building, run them upstairs, and do a quick triage. Patients went to the patient side, the non-patients went to the other side to wait for normal lift-out. So they had sort of two tracks.

Understand, we knew there were going to be thousands of people coming through, so 25 EMEDs is not going to be particularly useful. It was more of an attempt to triage, stabilize and evac them out of there. So they built the system up so that there was a sharing with the DMATs and our Airmen—active, Guard and Reserves were all there. They had EMEDs and a Contingency Aeromedical Staging Facility (CASF) came the next day to provide through-put. We had the AE cells hooked up, and we had destinations hooked up in the system, so we began doing the patient stabilization and flow.

There was all nature of humanity there, from well-off people to very poor people, from elderly people to clearly HIV-positive people. There were people carrying weapons, there were animals, there were birds, there were snakes, there was everything imaginable there that these folks had to contend with.

The CASF worked with the DMAT team to stabilize patients for movement. They pulled the C-130s up to the back of the terminal. Personnel from the Forestry Service were used to heave-hoing and working in the heat and that environment and they helped, along with us, to load the C-130s. They finally got the C-130s down to the point where they had a MOG of two. They were loading two C-130s at any one time and every 90 minutes two plane-loads of C-130 patients were going out. We evac'd them to safety.

The area was huge that we had to cover in terms of moving patients to a central system, and being able to move them out. This is the system you have to work to get Feds, so if anybody wants to know why it's so hard to get the Feds here it's because you've got to go through this chain before you can go. This is what's going to be handled throughout the system. This is something the medics have railed against a long time, because human life is perishable, it can't last very long, and therefore you can't have long delays in the system, but there are about—it seems like—50,000 Mother May I's in this loop. This is what we're going to spend the next year going over, this Mother May I loop.

The first priority has always been lifesaving efforts. This is the most difficult part because you only have a small amount of time to do this before human life perishes. The next priority is to make sure you get help to the folks at the other end. You have to have a system of plucking people from water, but you've got to take them some place. You've got to take care of them on the way and then take them some place.

We know that in any event like this there are going to be huge numbers of people that are in harm's way. Even after receiving warning we knew that. Everybody knew there were going to be lots of people in New Orleans and on the Gulf Coast that would not or could not move and were going to be the recipients of whatever Mother Nature brought.

Title 32 Air Guard operations … They’ve done a lot of transportation, brought a lot of people in. They were actually working firefighting, you've probably seen some of the pictures. The National Guard also employed helicopters. We moved most of the Soldiers and Airmen into Title 32 status so they weren’t making nine bucks a day or twenty bucks a day or whatever they were. A lot of sorties...

Two days after the canal broke we were on the scene. We’re trying now to get data for the traditional Guardsmen who were in the field early. When we do get it, you’ll have a much better feel of what the Airmen medics contributed very early in the warfight, in this particular warfight.

A huge number of patients treated. 2,000 or 3,000 a day were seen during the hurricane. The peak number of patients was 2,000 patients seen in a 24-hour period of time by 90 or 100 medics in the building. Two thousand patients... Peak number for the evac was 823 in a 24-hour period.

Remember I said the number of patients we moved in a whole month across the system was 5,000? Where did we move them? We moved them all over. Most of the patients went to Houston, San Antonio, Dallas and Atlanta, into federal receiving sites.

What does the footprint looks like today? The total number of patients we've seen is 13,508 since Katrina started. Aeromedical total is 2,500 patients, and the bulk of those were over that one really bad weekend. Amazing work. Only 35 of them, but 35 important people, were critical care air transport team folks.

The Air National Guard has an Air Force Special Operations Command (AFSOC) medical team up at Jackson, Mississippi. The New Orleans International Airport is where the EMEDS-plus-25 and the Contingency Aeromedical Staging Facility is. Keesler Air Force Base has an EMEDS-plus-ten up. Gulfport has an Air National Guard Clinic, Bay St. Louis, an EMEDS-plus-25. The New Orleans Naval Air Station has an EMEDS-plus-25 stood up. We've had Critical Care Transport Teams on alert at Kelly Air Force Base ready to move, and you can see that we have another two 25s, three 10s, three hospital expansions, and five air transportable clinics waiting to be tasked if needed, but I think we're through most of this.

The total number of medics that did this is only 566 medics. 315 active duty and 251 Guard medics doing this work. If you look again at the New Orleans airport you can see there are only 182 people between us doing all that work moving all those patients. An incredible story.

There are actually are three hospitals that are up now in New Orleans—Oxner, East and West Jefferson hospitals. Together, they have 1,100 hospitals beds now operating in the New Orleans area. For those of you who are fondly linked to Charity Hospital, we hear Charity is toast, if you listen to the folks talk down there. Most of the lower two floors were flooded and it's in a tough part of town anyway, so who knows what's going to happen as they bring these up. But three hospitals are open for business. The problem is there's not much business left in town because most of the people have left.

The total number of patients moved is 2,500, but remember through this same airport they were moving 25,000 people through normal civilian airliners, moving them around the United States.

One thing I didn't mention is we weren't only getting patients in from the helicopter system, but all those folks in the ground-based ambulance service stayed in business. Gound ambulances were driving around like crazy. The front of the airport looked like a mad dash of ambulance services, so they had to have the ground-based evac coming in with the air-based evac at the same time.

4,500 lives have been saved, we believe; 30,000 people have been assisted. 125,000 law enforcement officers have been involved in distributing relief supplies.

We do have a lot of challenges, not only in servicing our nation, but in our ability to work jointly and with our allies. We all have the same focus across the three services as we work together. We have to be seamless. It has to be the highest quality. But we have to be able to operate from foxhole to home station.

It is not unusual to tell the story of the Marine who's shot in Fallujah, resuscitated by a Navy Corpsman, taken by Army medivac to Balad where they get damage surgery done by Air Force, and then flown by an Air Force team to Landstuhl after damage control surgery. They have another damage control procedure done in Landstuhl by Army, Air Force, and now Navy teams there, then they're flown to Bethesda. And it is not an unusual story for the guy to go down in Fallujah and in less than 48 hours wake up at Bethesda.

A few things from BRAC to finish off ... There are three major things that we did in BRAC and they're all joint. One thing is to create Centers of Excellence in biomedical research. We know that the 21st century is going to be a biomedical century. If you think of the Agricultural Revolution, the Industrial Revolution and the Communications Revolution, the next revolution is in the biomedical sciences. What we did is we corralled the Army, Navy and the Air Force and put them together at one location where the operators are. For example, the Joint Center for Battlefield Health and Trauma will be in San Antonio. If you think about aerospace medicine research, that will all be at Wright-Patterson Air Force Base. Biomedical research will be at Fort Dietrich where the nation's putting its biotech center. Having the chem folks at Aberdeen where most of the chem work is being done in the field makes perfect sense.

If you think of the capabilities we're trying to field today, we're going to create the new Walter Reed National Military Medical Center at Bethesda and a Community Hospital at Fort Belvoir and in the San Antonio Regional Medical Center with a world-class Ambulatory Surgery Center at Lackland Air Force Base. So if you think of what we're doing, we're taking smaller hospitals, creating one larger hospital in those metro areas and making it world-class. We're going to have to put, within those two, somewhere between $1 and $2 billion of new construction and it will be truly a world-class infrastructure for our world-class staff to work in.

We're putting together enlisted training and the basic officer courses at one location at Fort Sam Houston. All Army Medical Soldier training, Navy Medical Sailor training and Air Force Medical training for Sheppard Air Force Base will be co-located at one place at Fort Sam Houston. The core curriculum's the same, but still Airmen, Soldiers and Sailors are being developed. So, if you think about it, there will be an Air Force College, a Navy College and an Army College.

In the end, what we're trying to do is to create a dominant force—dominant medically—as the Air Force becomes a dominant future force.

We are one team. There are three stories I like to tell. There is the Katrina story, which I told already. There is the story of the USS Cole, where the Air Force responded very quickly. There was a Marine baby who went sour with breathing problems in Okinawa; 72 hours from the call the baby was in Wilford Hall on a heart bypass machine. The heart bypass machine was put in Okinawa and they flew back on the machine. There is the story of an Apache crash early in Afghanistan. Never fly below your lead. These guys flew below their lead and hit the top of the mountain. The two pilots had long bone fractures, facial fractures. PJs stabilized them, dragged them out, went through a series of resuscitations, got them back to Landstuhl. Sixteen and a half hours after this thing hit the mountain in Afghanistan, they were on the ground at Rammstein Air Base.

Operation Katrina shows we have new American heroes, whether they were taking care of folks or rescuing people. If you do get to see people when they come back home, they're going to really need to talk about it. So if you're back home and you have people coming back, they really need to discuss this and write about it and talk about it because not too many people went through the hell on earth which was…as bad as we talk about the Convention Center, from a medical perspective that's what the airport looked like on Thursday, Friday, Saturday and Sunday for all our Airmen that were working there.

It's all about expeditionary medicine. You've seen doctrine, the ability to rapidly move a small number of patients which we did in Afghanistan, to a larger number of patients which we did through Iraq, to the ability to move a monstrous number of patients in very short order with very small numbers of people if you have the system in place, which is what we did weekend before last.

So I'm incredibly proud of the medics that have this capability, that have the discipline to run a system, to partner with their transporter teams, helicopter folks, the ambulance ground-based folks, being able to work with the communications that it takes to run that kind of high speed system. It’s been an incredible bit of work and I think we can all be very proud of the medics. I certainly am, and I get a chance to thank them every day.

It’s about living up to the slogan "Expeditionary Medics"—and it doesn't matter whether you're going to Kandahar or you're going to New Orleans, we bring great professionalism, great discipline and great talent to chaos. So thank you very much.

Q: I was wondering if you had heard about any of the civilian walking wounded coming up to the airport in New Orleans. I know on previous operations things were pretty smooth in terms of getting patients in regular transport, but we were overwhelmed by walking wounded just showing up…

Lieutenant General Taylor: Colonel Riddles and the chief nurse on the staff there don't talk much about walking wounded because I think they had most people corralled in certain parts of town and they only allowed them to move by ambulance or bus or by the helicopters. So there was less of that I think just because transportation was down through most of town and these folks, if they'd had transportation they'd have used it earlier. There were 120,000 or 150,000 cars that are history now in New Orleans.

It was very dangerous. They were very worried on Thursday and Friday that if the crowd had decided to turn ugly, bad things would happen. It was a pretty rough community and they were lucky enough…I think everybody's fairly clear that they didn't have enough security and were lucky the folks outside didn't decide to charge the unit or they'd have been in trouble.

So there are a lot of things we have to learn. One of the reasons we couldn't get the EMEDS there faster is because we couldn't figure out exactly where to go and we couldn't figure out the security and civil engineering slice that went with them, so we'll have to think that out as well.

They charged off the airplane without their equipment and they really didn't need that much EMEDS equipment to do this. We weren't doing that many surgeries there, although they had some work to do in terms of resuscitating people and they had people that had chronic conditions; diabetic or renal disorders that were issues for them. We have this really bad tendency to get the people there out of sequence with the equipment. It wasn’t unusual, when we went to OIF, for 100 people to hit the desert and their stuff gets there two weeks later. We're going to have to figure out something about what you take, so if you're a nurse, there's a personal kit that you take with you to be able to carry out your basic nursing functions. The surgeons know how to take a backpack with them, but we probably need to think through every team member in terms of what gear they bring, whether it's two IV bags or your basic monitoring pieces. That's the stuff we need to think through. Because they charged off of the back of the airplane and they were in the middle of it. And as their packs came they just pulled some pieces of it off, but by and large they operated off of the Federal Emergency Management Agency (FEMA) equipment sets that were there.

There is some bad news. They had 11 people die on them in that two-day period, but they also had three babies born in the airport—two inside and one outside on the ramp waiting. So they do have three new babies that are now hurricane babies, flood babies.

Thank you very much for being here today. Next time you see a medic, if you're not a medic yourself, give them a hug from me. If you do get a chance, if you know people that are involved, please ask them to write this up because we need to understand how to do this better next time. We learned a lot from scrambling up to 9/11, but then didn't engage that much. This is one we engaged and we have to give the team that charges off the back of that C-130 or C-141 or C-17 when they arrive at the airport the tools and the doctrine to know how to tackle this kind of situation because this is the kind of thing we're going to see in the future.

So thank you very much. I appreciate it.

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