Early in my career at Wilford Hall USAF Medical Center in San Antonio, I was part of a small group of physicians wrestling with a problem that had no clean solution. Critically injured service members were surviving injuries on the battlefield that would previously have been unsurvivable, because surgical care at forward operating locations had improved dramatically. But survival at the point of injury was only part of the challenge. Getting those patients back to definitive care at a major medical center, sometimes halfway around the world, required intensive care in transit. And at the time, the infrastructure to deliver that care in the air simply did not exist in any organized form.
What came out of that period was the Critical Care Aeromedical Transport Team program, known as CCATT. I was part of its original formulation at Wilford Hall. The concept was straightforward in theory and demanding in practice: build a small, highly trained team capable of bringing ICU-level care to a patient during flight on a standard military aircraft. Not a dedicated hospital plane. A workhorse transport aircraft configured on short notice to carry the most critically injured patients in the military system, with a physician, nurse, and respiratory therapist managing a level of care that belonged in a fixed facility.
What CCATT Required Us to Solve
The clinical challenges of critical care in flight are real and specific. Altitude changes affect physiology in ways that matter for critically injured patients. Equipment has to function reliably in a pressurized aircraft cabin without the power infrastructure of a hospital. Teams have to make complex decisions with limited resources and no ability to consult the full range of specialists available at a major medical center. Every protocol, every piece of equipment, and every training standard had to be built and validated from the ground up.
Over the three decades that followed, I stayed deeply involved in the evolution of CCATT through seven combat deployments as a military trauma surgeon, including multiple tours in Iraq and Afghanistan. Each deployment tested what we had built and revealed what needed to improve. The battlefield generates data about trauma care that no research institution can replicate. The injuries are severe, the conditions are austere, and the margin for error is small. Every lesson learned in that environment has the potential to save the next patient, both in the military system and in civilian trauma care.
Building Cincinnati CSTARS
When I joined the faculty at the University of Cincinnati, I brought that military experience with me and began building the infrastructure to sustain it. In 2001, I led the founding of the Cincinnati Center for the Sustainment of Trauma and Readiness Skills, known as Cincinnati CSTARS. It was one of the first formal military-civilian strategic partnerships of its kind in the country.
The core problem CSTARS was built to solve is a structural one. Military trauma surgeons and critical care providers rotate in and out of deployments over careers that span peacetime as well as conflict. During peacetime, the volume of severe trauma cases at military facilities is insufficient to maintain the high-level surgical and critical care skills that combat deployments demand. Civilian Level I trauma centers see that volume consistently. The partnership gives military providers access to a high-volume civilian training environment. It keeps their skills sharp between deployments and ensures that the USAF CCATT teams going downrange are prepared for what they will face.
Cincinnati CSTARS has served as the advanced course training center for all Air Force CCATT teams since it opened in 2001. Over those more than two decades, it has trained teams who have served across every theater of U.S. military operations. The program has touched thousands of service members directly through the providers it trained, and indirectly through every patient those providers treated.
The Bidirectional Flow of Knowledge
One of the things I want people to understand about the military-civilian partnership model is that the benefit runs in both directions. The military brings combat-forged urgency and hard-won protocol experience. The civilian trauma center brings volume, research infrastructure, and exposure to a broad range of injury mechanisms. When those two environments work together rather than separately, both get better.
Much of what defines modern civilian trauma care reflects knowledge that originated in military medicine. Damage control surgery. Massive transfusion protocols. Tourniquet use. Hemostatic dressings. Improvements in prehospital care and transport. These advances were tested and refined in combat environments and then translated to civilian emergency departments and trauma centers across the country. Cincinnati CSTARS exists in the space where that translation happens deliberately and continuously.
During my 25 years at the University of Cincinnati Medical Center and my subsequent role as Director of Trauma, Surgical Critical Care, and Acute Care Surgery at University Hospital, I worked to embed that military perspective into a major academic civilian trauma system. I also led the development of West Chester Hospital into a Level III Trauma Center designated by the American College of Surgeons, expanding the regional trauma network’s capacity to care for severely injured patients before they reach a Level I center.
From Cincinnati to Knight Aerospace
My current role as Chief Medical Officer of Knight Aerospace is a direct extension of everything that came before it. Knight builds advanced aeromedical transportation modules, the systems that allow military and government aircraft to be rapidly configured for medical transport missions. The clinical requirements those modules have to meet come directly from the experience of teams like CCATT operating in real austere environments over many decades.
Serving as CMO means bringing that operational history to bear on questions of design, capability, and performance. What does a critically injured patient actually require during an extended air transport? What can a team of three manage reliably in a cabin under pressure? What equipment has to work the first time, every time, with no backup and no service call? These are not abstract engineering questions. They are clinical realities I have lived through on seven combat deployments and 30 years of involvement in aeromedical transport.
I also continue to practice as a trauma surgeon at Brooke Army Medical Center in San Antonio, and I serve in an advisory capacity to the Uniformed Services University of the Health Sciences in Washington, D.C. The work at the bedside and the work at the policy and design level reinforce each other. You cannot do one well without the other.
What Stays Constant Across 40 Years
Trauma medicine changes continuously. Protocols improve. Technology advances. The understanding of hemorrhagic shock, coagulation, and organ failure deepens with every generation of research. What does not change is the fundamental commitment required to build systems that work when they are needed most under conditions that are as difficult as conditions get.
Whether the context is a battlefield in Iraq, a Level I trauma center in Cincinnati, or an aircraft at 30,000 feet over an active theater of operations, the question is always the same. What does this patient need right now, what resources do we have, and how do we use them most effectively? Four decades of answering that question in every setting imaginable is the foundation of everything I do in this field.
More about my background and current work is available on my full biography page. I write and share on Medium and you can find all my links at Linktree.
