SCOTT AIR FORCE BASE, Ill. – For a U.S. Army active-duty member, hospitalized on Kwajalein Atoll, Republic of the Marshall Islands, and requiring expeditious movement to a higher level of care this past April, his medical emergency had impeccable timing and the creative support of U.S. Transportation Command (USTRANSCOM) and U.S. Air Force teams.Within 24 hours after the attending physician on the Pacific isle contacted the U.S. Transportation Command Patient Movement Requirements Center-West (TPMRC-W), Joint Base Pearl Harbor-Hickam (JBPHH), Hawaii, requesting assistance in transporting the individual to a medical facility with an intensive care unit, the soldier arrived via military airlift in Honolulu, Hawaii, for treatment at Tripler Army Medical Center.The backstory behind the successful aeromedical evacuation (AE) across more than 2,400 miles and the International Date Line also spotlights the sacrifice, selflessness, and dedication to duty of the TPMRC-W team of dedicated professionals including Theater Validating Flight Surgeon, U.S. Air Force Lt. Col. and Dr. Jeremy Garlick, and the AE Mission Head Nurse, U.S. Air Force Maj. Tammie Canada, operations flight commander, 18th AE Squadron, Kadena Air Base, Okinawa, Japan.Serving as the Department of Defense’s single manager for global patient movement, USTRANSCOM executes this critical mission through the U.S. Air Force’s AE system. Each month, the combatant command executes between 500 to 600 aeromedical evacuations, transporting ill and injured active-duty service members, as well as other patients, to locales with appropriate medical treatment facilities.On April 17, 2020, while serving at the TPMRC-W, Garlick received, and subsequently validated, the requirement to transport this critically ill soldier. He then discussed with, and got consensus from, his coworkers – a nurse and controller – on employing Tripler Army Medical Center as the preferred treatment facility. But, finding a way to move the soldier from Kwajalein Atoll to TAMC proved to be more challenging.Initially, the Aeromedical Evacuation Control Team (AECT), the AE element within the 613rd Air Operations Center, also located at JBPHH, and manager of Pacific Air Forces’ assets, assigned a KC-135 Stratotanker for this AE mission, but the runway at Kwajalein Atoll could not accommodate this aircraft. Next, the AECT projected employing a C-130 Hercules airframe from Yokota AB, Japan, but because of the sense of urgency in moving the patient, and also that the aircraft would require multiple stops en route, this option too was ruled out. With choices and time running out, the AECT decided to use a C-17 Globemaster from the 535th Airlift Squadron at JBPHH for the trip to and from Kwajalein Atoll.Even with the designated aircraft selected, Garlick and his TPMRC colleagues still had to find a Critical Care Air Transport Team (CCATT) to support the patient during the more than five-hour flight, but to no avail.“There was an AE crew already in Hawaii, but no CCATT team. So I subsequently spoke with the AE crew head nurse, Maj. Tammie Canada, and she agreed to participate. I also volunteered to serve as the onboard physician,” said Garlick. “Both Maj. Canada and I had ICU experience, so we made a good team for this AE mission. Everything about this patient movement was unusual. Similarly, it was actually my first time participating in a patient movement.”Another uncommon angle to this AE flight originating in Hawaii is that 80 to 90 percent of patient movements in the Pacific region are executed from Japan.“This mission demonstrated the flexibility of aeromedical evacuation teams. We launched out of Kadena Air Base en route to Guam to pick up a pediatric patient and deliver them to a higher level of care at JBPHH, Hawaii. Upon arrival in Hawaii, we were retasked to pick up a very sick priority patient on Kwajalein Atoll and return him to Tripler Army Medical Center,” Canada stated. “By utilizing the additional resources available in Hawaii, including the flight physician (Garlick), we were able to optimize the transport with the designated aircraft and air crew from JBPHH and avoid having to alert additional AE personnel. Great teamwork and overall mission success.”USTRANSCOM exists as a warfighting combatant command to project and sustain military power at a time and place of the nation’s choosing. Powered by dedicated men and women, TRANSCOM underwrites the lethality of the Joint Force, advances American interests around the globe, and provides our nation's leaders with strategic flexibility to select from multiple options, while creating multiple dilemmas for our adversaries.