It all had to sync up perfectly.
As the heavy C-17 Globemaster III transport aircraft departed Bagram Air Base, Afghanistan, and raced to its first aerial refueling point off the coast of England, more than a dozen U.S. airmen watched the clock, knowing the life of a badly wounded U.S. soldier hung in the balance.
The circumstances were dire. The special operations soldier, unidentified for privacy reasons, had been hit when an improvised explosive device detonated, fracturing his pelvis and gravely injuring his abdomen, arms and legs. It took three aircraft, 24,000 gallons of fuel and about two dozen gallons of blood to sustain the soldier during the 8,000-mile non-stop journey back to the U.S., where he required specialized care.
Nearly a month after the mission, the troops who participated in it are still in awe they were able to get the soldier home alive.
Also amazed is Asia, the special operator's wife, who is eternally grateful at the way the military mobilized not for combat, but for her husband.
"I knew that they flew straight over, and I knew that they weren't gonna stop -- unless they absolutely had to," Asia said in an interview with Military.com on Wednesday. "They commit 110%."
A Bona Fide Bloodline
Early on a Friday morning, Asia was getting ready to take her son to school in Savannah, Georgia, when she got a phone call.
For a moment, time stood still, she said.
"At first, I just stood there, and then I started crying," said Asia, who asked to be identified by only her first name. "You're not prepared for this, if you understand what I'm saying. You're more prepared for a death."
She snapped back to reality, knowing she'd be waiting for any type of answers the military could provide for the next few days until her husband was back on U.S. soil.
Asia had been with her husband for nine years and married to him for seven. Eight of those years, he had been in the Army.
She knew he'd been hurt, and doctors in Afghanistan called or sent a text message any time they had an update.
Maj. Charlie Srivilasa, a trauma surgeon with the 455th Expeditionary Medical Group at Craig Joint Theater Hospital in Bagram, had already had a busy morning with multiple casualties coming in when the soldier arrived at the facility.
Grievously injured, the operator immediately became a priority.
"We probably had about five or six surgeons working on him at any given time," Srivilasa said. In the three days before the soldier was transported, Srivilasa and his team performed four operations, including amputations of his right arm and lower right leg.
The frequent surgeries meant the patient needed a steady supply of fresh blood.
Roughly 100 troops stood in line to donate blood outside the hospital quarters.
Over the course of treatment at Bagram, the soldier received more than 195 units of transfused blood, including whole blood and plasma -- some 16 times the volume of blood in the average person's body.
A side effect of the massive transfusions was the possibility that his lungs could fail, said Srivilasa. The soldier also could have succumbed to infection from his wounds, he said.
"He was by far the most critically ill patient [we've] seen here in theater [in my] four months," he said. Doctors knew the best thing was to put him on a plane to Brooke Army Medical Center in San Antonio, where specialized care would be waiting for him.
Up in the Air
Maj. Dan Kudlacz, a C-17 evaluator pilot with the 436th Airlift Wing out of Dover Air Force Base, Delaware, was at Ramstein Air Base, Germany, with a planned stop at Bagram that August weekend when he got word the mission would no longer mean picking up basic cargo. Kudlacz was the commander of REACH 797, the call sign for the mission, and one of four pilots and three loadmasters. One of the pilots in the group was also in training, meaning Kudlacz was working on certifying his fellow pilot in addition to keeping the aircraft steady.
At Ramstein, 18 medical professionals came on board, including personnel from Aeromedical Evacuation (AE) and Critical Care Air Transport Team (CCATT), as well as a team out of San Antonio's 59th Medical Wing. Members of the 59th specialize in extracorporeal membrane oxygenation, known as ECMO.
ECMO machines oxygenate the blood and simultaneously removed carbon dioxide, explained Air Force Lt. Col. Valerie Sams, a trauma surgeon and one of the specialists dispatched for the flight.
"The ECMO team here in San Antonio is the only DoD team," she said.
By the time the specialists arrived, fortunately, ECMO was no longer needed, she said. But kidney dialysis was.
"His kidneys did not recover immediately, so in order to stabilize him ... we had to have dialysis continuously," Sams said. The teams borrowed one of Craig Joint Theater Hospital's dialysis machines for the return home.
Finishing up their necessary crew rest in Afghanistan, the personnel geared up for the 19-hour flight. Another patient also came on board; that service member was ambulatory, able to move about for the duration of the flight, Sams said.
Kudlacz said the aircrew consistently monitored speed and altitude, knowing there were sensitive medical machines on board keeping the soldier alive. The pilots kept a cruise altitude of 28,000 feet, a few thousand feet lower than expected. "Over a 19-hour flight, [that] can make a considerable change in your total fuel," he said.
He added that, had the critical soldier taken a turn for the worse, the plan was to divert back to Germany.
Asia, the soldier's wife, was praying that wouldn't happen.
"I was told that, if they would have had to stop in Germany, it was because something medically was going wrong," she said. Air Mobility Command's 618th Air Operations Center, also known as the Tanker Airlift Control Center (TACC), stood by to provide backup assistance.
During the first refuel near England, there was a close call.
Connecting the C-17 to the KC-135 Stratotanker refueling boom almost sent the two aircraft bobbing and weaving. The KC-135, flying on autopilot -- which controls the trajectory of the aircraft -- started to change the plane's pitch, which moves the nose up or down.
Kudlacz and his co-pilot disconnected, backed off and tried again.
"To make the situation even more challenging, it was at night, so you don't have all the visual cues of a horizon. And then we just happened to be right at the top of a cloud layer," he said.
In the back of the aircraft, the medical teams were monitoring the soldier's oxygen level, ventilation, blood pressure and kidney function.
"Regular AE and CCATT [teams] cannot do renal replacement therapy; maybe there are some that have just isolated familiarity with the renal replacement machine," said Lt. Col. Scott King, CCATT physician with the 10th Expeditionary Aeromedical Evacuation Flight at Ramstein.
With the help of the ECMO team, "I think it was a coordinated and collaborative effort among all of the members that brought in different pieces together to allow this mission to be accomplished," King said.
The C-17 had eight hours until its next refuel near Bangor, Maine. Meanwhile, maintenance crew chiefs with the second KC-135 hurried to get the aircraft, which had a gauge problem on one of the engines, ready to fly, said Maj. Jeffery Osgood, chief of 6th Operations Group training and the aerial refueling mission commander from MacDill Air Force Base, Florida.
"Adapting to the mission is probably the biggest takeaway. It's just making sure you have everything ready to go with all the people that you need and all the support from leadership," Osgood said. A backup tanker was on standby just in case, AMC officials said.
The second tanker caught the C-17 around 2 a.m. Monday morning. Together, the two tankers offloaded 24,000 gallons of fuel.
"I've been doing this for 23 years, and this [is] not something I've ever experienced," said Master Sgt. Joseph Smith, an AE member with the 10th Expeditionary Aeromedical Evacuation Flight. The duration and double refuel was not an easy task for the parties involved, he said.
With the amount of equipment and coordination needed, "rarely does it ever work out so perfectly," he said.
The Next Journey
Sams, the trauma surgeon, said she's hopeful the soldier -- who has required orthopedic treatment as well as treatment in the burn unit -- will be out of intensive care soon. He has months of physical therapy ahead, she said.
Asia is relocating her family to Texas to be closer to her husband as he goes through treatment.
This "is a new normal," she said. "It's about four to five months inside the hospital, and then, after that, I would say it's another six months. So I would say it's [going to be] a year total."
Their son will stay with family and friends in Illinois for the next few weeks until Asia and her husband feel he's ready.
"It's just a process," she said. "[But] I feel as though his determination to live and to fight, to come back home, to see me and to see his son has been the number one thing that has kept him alive; and then the good Lord and all the doctors and the medical team."
She'll never forget their persistence to save his life.
"They literally put their whole heart in it, their body and soul, and they do what they need to do to get loved ones back [home]," Asia said.