We are insignificant beings.
With all of the technology, capability and resources at the disposal of the military, our entire program of shuttling patients from theater to the US changed overnight with the middle earth exhalation from an Icelandic mountaintop. The ash which turns to glass when heated within a turbine jet engine has grounded not only passenger flights across Europe, but all of the military flights. There is word today of an F-18 test mission today over Northern Germany which left turbines encased in ash-glass, so apparently, it is still a problem, though the flying ban is supposed to lift imminently.
We have significant trauma surgery capability here at this theater hospital, but there are limits to what we can do when these surgery patients get infected or become chronic medical patients. We have very little capability to care for medical intensive care patients, and no capability to care for cancer, to my chagrin. Thus, anyone who we don't see going back to work within 2 weeks, we send up the road for a higher level of care. Most of the similar flights from Afghanistan go directly to Germany, north of Iran over Russian airspace. The flights from Iraq mostly come from here, over Turkey and southeastern Europe to the same destination. Patients can get everything they need in Germany, but we send them home to DC or San Antonio from there, when they are stable and/or they are requiring chronic medical care (e.g. a new leukemia patient requiring months of chemotherapy, or an amputee requiring rehabilitation).
With VolcanoGate 2010, all of the flights must now go directly to the United States. This has put an enormous strain on the air-evacuation system, and made our base the center of the AOR evac universe. All of the flights out of Afghanistan cannot fly north of Iran any longer, so they fly south of Iran to us. We cumulatively send our Iraqi evacuees and Afghan evacuues on flights that go directly to the United States. Recall that distances from Old World to New World are significantly longer as you move closer to the equator; that is, the flights which steer south of the Icelandic dust over Europe to go the US are 21-27 hours long. This usually means that 2 separate crews are needed for each flight. So, taxpayer, I am not sure on the math, but there is some serious costs incurred enacting "plan B" during a volcano eruption.
Seriously ill patients are tended to via CCATT - critical care air transport teams. These include a physician, usually an anesthesiologist or pulmonologist, a nurse, and a respiratory technician. Though each of these flights back to the US is filled with AE (air evacuation) patients, most of them are either ambulatory (e.g. digit amputation) or low resource (e.g. stable patient with foot ulcer) not requiring CCATT. My ICU patients do, however, and even the evacuation of 3 ICU patients at a time via CCATT is not a small thing. There are many wires, and IV lines, and tubes with which to contend. The most complicated issue is switching of ventilators, as all of the CCATT patients travel with the Uni-vent Eagle 754 compact portable ventilator, not the plug-in 5ft models at the bedside.
Tonight, I have 3 of them coming from Afghanistan, and 4 of them going out 2 hours later to the US. They are due to arrive within ten minutes, so adios, for now.