MEDEVAC= medical evacuation.
The US has three systems in theater, sometimes more depending on how you count.
Most of the time, if you are Army, MEDEVAC means helicopter = Dust-off. The Huey of Viet Nam fame has given way to the Blackhawk UH-60. Two pilots in the front, crew chief and a flight medic in the back. Rapid transport from point of injury (POI) to the next echelon of care or between echelons of care. Because the altitude, the carousels are removed (saves weight) and litters are on the floor. The idea is to get the wounded to a surgeon as rapidly as possible.
If you are a Marine – you call PEDRO (which has been known to use opportunity aircraft but otherwise mostly operates on rotary wing).
If you are Air Force – well, you usually live on a larger base (fixed wing aircraft need some kind of runway) and your mind turns to air movement within the theater – usually from Role 2 to Role 3 by C-130 (on board is either an Air Evac Team or a CCAT Team – Critical Care Air Transport Team).
If you are British – there is the MERT (transports on a Chinook) which brings critical care to point of injury, then back to the Role 3. If you are German, a similar system exists.
And, if you are Special Forces, you are special – Fever is the name of the game.
What is common to all of these systems is the use of air frames. Which air frame varies by area, country and distance to be traveled.
What is not common is the level of provider on that air craft. Gone (about time in my opinion) is the system of depending on a junior medic to do “scoop and run.” Except, of course the US Army which is persisting in outmoded doctrine. Our Allies are all putting highly qualified emergency personnel on the aircraft so that a lot of resuscitation can be accomplished during the flight.
We are getting there – SF has paramedics. Army has started using en route critical care nurses for helicopter transports between “fixed” facilities – especially where the distance facility does not have a runway capable of handling a C-130. By doing so, we are starting to bring the standard of care up to level across the theater. Especially when you consider that the patient getting moved might just be 22 and just parted with both of his legs, part of his arm and now has both IVs and Blood running and is unconscious on a respirator for stabilization and pain control during the flight.
Me? If I am going to be injured – this is the one spot in the world where I don’t worry about whether or not someone is going to get me out of there, back to the best trauma surgeons that exist and move by the most expeditious method possible.
I think if you look at the US civilian trauma literature you will find that treatment is always best delivered at the highest level of care possible. The Europeans have been killing people at the scene of trauma for decades. Princess Diana is a prime example. She bled out under the care of a French ER Doc in the back of an ambulance at the scene.
I have practice medicine at every level in the US system, from the back of a moving armored vehicle, to a tent in a blizzard to Walter Reed. The 9 line MEDEVAC request is burned into my memory. I can speak to this issue with a little first hand experience. I have attempted to deliver care in a moving UH-60 I can tell you it is not easy or clear. The only sense that works is vision. Noise and vibration render all other evaluations useless. To push a trained nurse or doc to the scene or into battle risks a very valuable asset with little gain. I like the USAF PJ concept of sending a medically trained highly skilled operator/warrior to pick up downed pilots. They can both defend their patient and resusitate/stabilize in transport. SF mission would call for high level care at the scene due to difficulty in evacuation for location and tactical reasons. JSOC’s surgeons have been pushed into the fight for years with good effect.
My vote is keep the medical talent back out of the fight with facilities and equipment they can rely upon. Concentrate resources and talent and move the casualty out of the fight. I think our collective outstanding survival rates support our current policy and practices. We may actually be victims of our success. When I left active duty we were saving 98% of those who reached a facility (FST or higher) with a pulse. I doubt trauma survival has ever been higher in the history of human conflict.
We are saving too many head wounds… take a walk through a stateside VA and you will see extreme neurologic deficits in very young veterans with head injuries. The VA was almost useless prior to 9/11. Now it will have a neurologic injury treatment mission for the rest of our lives.
A lot has changed in the last five years – mostly due to combat here in Afghanistan.
there is no question that you are right about dicking around on the site and stabilising for a couple of hours. What I will tell you is that the on the scene morbidity and mortality are better here from the Germans and the Brits. Their crews work out of a Chinook – what you get is an ER doc and anaesthesia type people. Those patients are coming in with good tourniquets, several I/O devices, intubated and without a base deficient. I have seen the comparable trauma base information.
The injuries here are more devastating than anything we ever saw in Balkans or Iraq. Conditions here are much different, it is not just the cold, but it is the altitude and the multiple injuries. One medic simply can not keep 3 patients going at once, especially if they need lines and vents.
We claim we are doing better because we only count those who get alive to the Surgeons. The other countries count everyone who was alive at the time of the first medic response, even if they don’t make it onto the chopper.
What makes even more sense is the addition of the nurses to the back of the choppers for post surgery movement. In the civilian world you would never move a patient in the first couple of hours after surgery with lines, vent and drains with an EMT for an attendant.
The PJs are the right idea – putting paramedics on the back of choppers would drastically improve things. The Army doesn’t want to invest the training time.
This is not Viet Nam, the distances are vast and the gun ships along with the MEDEVAC often get to play.
The medical dept recruiters have the same unrealistic expectations of combat care. They do not understand stabilize and ship….
To expand on PEDRO; the USAF CSAR rotary wing combat rescue component; these folks have picked up Dust Off missions when the Army needed a higher tech, night capable helo both in Iraq and in Afghanistan. Dust Off has been and will continue to be the preeminent battlefield rescue resource as it has been since Nam. It is interesting to note 2% of the deployed helicopter assets (USAF CSAR) have been doing approximately 74% of the high risk missions. Also, when a high ranking Brit as in country to tour the British units, he requested that a USAF CSAR asset take him around due to the PJs being on board and overall competence of the entire CSAR team, Maintenance and Aircrew. I thought this was cool and reflected how far our CSAR reputation has spread. We have always used the Jolly call sign until Afghanistan and I don’t know why that changed though and find that interesting.
Thanks for doing a great job.