The real reason why Army MEDEVAC helicopters fly unarmed


Since the Vietnam War era, there has been a tension between the MEDEVAC force and the Army’s combat arms force. At the time MEDEVAC operated with functional autonomy on the battlefield as a Army Corps level unit. During that war when a request for MEDEVAC was received a helicopter was dispatched from the MEDEVAC fleet – often at the discretion of a sergeant. Many casualties were also picked up by the armed troop carrying UH-1 Huey helicopters. The rule of the day was if a call for a Dustoff was sent somebody went in to get the wounded.

The commanders of the newly formed helicopter airborne units openly sought control of the MEDEVAC helicopters. This was staunchly resisted by the MEDEVAC units.

In When I Have Your Wounded, (Army Magazine, June 1989) a first person account of those days, Medal Of Honor winner Major General Patrick Brady recalls:

“I was joining the 57th Medical Detachment (Helicopter Ambulance), which had arrived in Vietnam in April of 1962. Since then, they had struggled for operational definition, recognition and permanence. There were those who coveted their brand-new helicopters and many who felt that the medevac (medical evacuation) mission should be a part-time mission. Their primary mission was American casualties, and since there were few of them at this time, these folks believed that the medevac birds should be fitted with convertible red crosses and used for other missions when there were no casualties to carry. The unit was holding its own and had become known as Dust Off. This radio call sign had no particular significance. It had been picked from a list of call signs and kept to avoid confusion. When someone called for Dust Off, everyone knew it was for a casualty. Maj. Charles L. Kelly was the commander.”

“Kelly’s great adversary, and boss, was Brig. Gen. Joe (Joseph W.) Stilwell. He was Vinegar Joe’s (Gen. Joseph W. Stilwell of World War II China-Burma fame) boy, and we called him Cider Joe. This guy was a genuine character. He was not an aviator, but he flew; and when he wasn’t flying, he rode as door gunner. The man was combat hungry and tough as hell. I was told he once survived a jump after his parachute malfunctioned. The last I heard about him was that his plane ditched at sea, and he was never found. Some folks waited a long time for him to walk up off the ocean floor.

His meetings with Kelly were always colorful, occasionally comical and even violent. Kelly was not intimidated by anything, let alone rank. Stilwell resurrected the issue of convertible red crosses and the cannibalization of Dust Off. He told Kelly that it was only a matter of time until he gained control of Dust Off and noted that the surgeon general was a personal friend of his. Kelly allowed that the surgeon general might be his friend, but he wasn’t a damn fool.

Kelly called us together after his first meeting with Stilwell and warned that those “folks in headquarters” did not wish us well. If Dust Off is to survive, he said, we had better prove that no one else could do what we did as well as we did. Performance was the key to our survival, and although he never set any rules for us, he certainly set the example.

The key was patients-saving lives no matter the circumstances; get them out during the battle, at night, in weather, whatever. Get those patients, the more the better; and don’t let anyone else carry our patients.”

[snip]

“I never again heard another word about convertible Dust Offs. In fact, they began to bring in more Dust Off units. There is no telling how many lives were saved because of Kelly, probably because of his death, and the preservation of the dedicated Dust Off as opposed to some part-time, ad hoc system.”

The Army Medical Department (AMEDD) and MEDEVAC leadership felt passionately that keeping MEDEVAC separate from the combat units granted it the ability to focus solely on its mission: retrieving the wounded from the battlefield and administering medical aid to them. Anything that diminished its ability to maintain a fleet of dedicated evacuation helicopters was to be fought.

In the early 2000’s the Army began restructuring itself into modular, self-standing units. The process included significant changes in how individual units were commanded and where they fit in the new modular Army structure. In a move that evoked loud protests and resistance from the Army Medical Department, the “Aviation Transformation Initiative” permanently embedded MEDEVAC units in the  Combat Aviation Brigades within the Army’s aviation arm. AMEDD would retain responsibility for training the pilots and flight medics, but  the crews and helicopters became the Charlie Company of the General Support Aviation Battalions within the various Combat Aviation Brigades and subject to the command and control of CAB commanders.

During the many meetings that worked out how the new structure would be implemented, some of the officers supporting the new structure voiced their opinions of the MEDEVAC mission and its pilots:

“My position on it was that it needed to be up under the aviation brigade… Arguments can be given for both sides of it. My personal view of it is that we hold that aviation brigade commander responsible for everything that flies. Therefore, if that’s the case, and they are looked at and he is responsible for that, what does the MEDEVAC do that is so special that that aviation brigade commander cannot oversee? And really, it is nothing. If you look at what a MEDEVAC pilot does, and what a lift pilot does, there is no difference. They transport items from point A to point B. What makes the MEDEVAC different is that mission equipment package that is in the back of the aircraft. And it is that medic and the equipment that is on board that aircraft that makes it special.

Otherwise, the pilots up there are no different. We put warrant officers in the front of the aircraft and go off single ship and perform that mission and they have no additional training other than their flight training. That’s no different than a lift unit can do.”

You can sense the frustration of the Colonel representing AMEDD in the planning sessions:

“I think it has been a theme. If you go back in time with Tom Scofield, all the way back to when they wanted us to be in aviation branch, there has always been a certain intent by the aviation community that MEDEVAC needs to belong to aviation. Some people will say they agree with it and some will say “No, don’t.” But I will say the current leadership that we had during the current transformation process versus the leadership that we had during the ’80s had a different opinion and the current leadership felt strongly that MEDEVAC should be part of aviation, and that aviation branch guys can command a MEDEVAC company. MEDEVAC should just be one of the many missions associated with aviation. Just like picking up bullets and supplies and milk and water. And that they can manage it; they can operate it; they can send it out where they need to; they can command and control it. …In some people’s minds, they think that this would be more efficient—to have MEDEVAC under aviation. …It looks great on Power Point slides.”

Having lost the argument about functional independence, AMEDD drew the line at allowing its helicopters to be available for alternate tasks like utility flights or, if armed, participating in assault operations.

The sole remaining limit on the use of the helicopters for non-MEDEVAC purposes was the prominent Red Cross symbols on every flat surface and the fact that the AMEDD could point to the Geneva Convention as an absolute barrier to arming the aircraft. Under the terms of that treaty the MEDEVAC fleet would remain dedicated to the MEDEVAC mission as long as it displayed the Red Crosses and flew unarmed.

AMEDD is pursuing a public relations campaign to stop the movement to arm the MEDEVAC helicopters as reported by this email to Michael Yon site in early February 2012:

The Army MEDEVAC Scandal: Report of Conspiracy

02 February 2012

An Army officer writes:

The Army is not resisting Dustoff policy change because our leadership honestly believes the current policy is superior, but rather because of AMEDD’s (Army Medical Department) protectionist attitude toward “their” Dustoff MEDEVAC helicopters. I’m an active duty infantry officer, and I’ve been following the Dustoff issue since you first brought attention to it.  More importantly, I have a lot of contacts within the Medical Service branch.  While we have discussed this issue “around the watercooler” at work, Medical Service officers have been receiving briefings from senior members of their branch about a selectively edited account of SPC Clark’s MEDEVAC mission, and what their message should be if anyone asks about it.

My contacts have highlighted that AMEDD’s number one priority is protecting their “ownership” of the helicopters in question. They are concerned that removing the Red Cross from AMEDD’s birds will result in those helicopters being assigned general purpose tasks, outside of the Medical Service Corp’s control. In other words, their top priority is NOT providing the best possible care for our Soldiers and partners, but rather protecting their own fiefdoms. AMEDD is choosing to put Soldiers’ lives in danger rather than chance losing “their” birds. Never mind that our sister services, special operations forces and allies are all able to field armed, dedicated CASEVAC/MEDEVAC helicopters! Somehow, despite all the evidence to the contrary, this is still the irrational argument AMEDD is sticking to, and directing its officers to spread. I’m concerned that in the dust-up over policy recommendations, comparisons with Pedro, and rebutting the JCS letter that we may be losing sight of the real obstacle in our path to reform. Sincere thanks for all you do, and keep up the fire!

So it all comes down to a turf battle over control of the helicopters. AMEDD says only it can perform the MEDEVAC duties with professionalism, while the aviation team says that the complexities of the modern battlefield and airspace requires an integrated approach to handling all the aviation needs.

The MEDEVAC leadership refuses to remove the red crosses and arm their helicopters even though doing so would allow faster responses to some requests for evacuation of wounded troops. The Aviation branch has imposed on the MEDEVAC fleet mission approval procedures that can take the sign-off of a general and locating armed escorts before a MEDEVAC helicopter can launch to rush to save a life. Neither side appears willing to budge off their policies. Meanwhile missions are being delayed and men are dying unnecessarily.

Major General Brady summed up his thoughts in a 2005 response to an article in the January 2005 Army Aviation magazine defending the integration of the MEDEVAC units:

“The most serious ‘rash action’ that can occur during patient evacuation is when anything or anyone interferes with the  patient’s needs and the swiftness of evacuation. In his entire dissertation of bureaucratic changes, Col. Forrester does not mention patient needs once. And that is the question that should be at the foundation of any changes to the method of Dustoff…

Col. Forrester opines that the aviation battalion is the answer to Dustoff missions, mission understanding, maintenance, and operational awareness. I never met a non-Dustoff aviator who understood my mission better than I did. But more importantly, what does assigning Dustoff to the aviation battalion do for patient’s needs? I would bet that it will not add to the swiftness of launch, essential in life saving…Is Dustoff not performing? Have patient needs changed?

If Col. Forrester represents current attitude, I sense the beginning of the end of Dustoff and I fear the patient will be the worse for it.”

How prophetic were these words “and I fear the patient will be the worse for it.”

The Army Medical Department and the Aviation branch have not been focused together on doing the right thing for the patient. Both branches bear the responsibility for the dysfunctional policies and procedures that result in the unnecessary deaths of wounded American soldiers.

THIS MUST STOP

Comments
16 Responses to “The real reason why Army MEDEVAC helicopters fly unarmed”
  1. robrome says:

    After all this time and discussion on this issue I still have not heard one mention as to why, if the Dustoffs can’t launch “Immediately”, the call goes to the “Pedros or British Medivacs” who are always ready anytime anyplace! No waiting for gunships. Also, is it true that sometimes Dustoffs and Pedros are based at the same airfields? Should be no turf wars here, when casualties are concerned someone needs to launch and it shouldn’t matter who!

    • Administrator says:

      There is always a primary – “up” crew set to handle the next request for MEDEVAC, and a stand-by crew. The rotation is supposed to include the “CASEVAC” aircraft flown by the USAF and UK forces where they are available – there are far fewer Pedro and MERT aircraft than MEDEVAC in Afghanistan. Depending on the actual (as reported by the ground commander) or defined (as set by the remote Combat Aviation Brigade commander or staff) hostile environment category of the LZ for the mission, the order of which crew and aircraft to send can be adjusted.

      Even Pedro and MERT aircraft must be accompanied by a SWT (Scout Weapons Team – e.g. Kiowa Warrior) or AWT (Attack Weapons Team – e.g. Apache) if the hazard is classified above a certain level. But for levels below that level, a Pedro or MERT could launch without incurring a delay waiting for an armed escort aircraft such as an armed Blackhawk,Warrior or Apache.

      Yes, MEDEVAC and CASEVAC can be assigned to the same airfields. The placement of the aircraft has evolved as the war intensified and more geographic areas became involved. Originally, there was a bias toward flying missions on an out and back basis from a airfield next to the Role/Level 3 medical treatment facility (MTF). When the acceptable mission timeline was a loose “2 hour +/-” it was easier to locate aircraft in that way. But as troops went farther and farther from the location of the MTF and the timeline was shortened to 1 hour, the old placement scheme was no longer viable.

      As a frame of reference understand that the 9-line request is sent to the ground command’s local HQ for relay to the Patient Evacuation Coordinating Cell (PECC) which evaluates the urgency of the request to approve the mission or to delay it based on medical need. Simultaneously, the combat aviation team evaluates the request based on the number of wounded, their seriousness (litter borne or ambulatory), the type of medical care needed in flight, and hazard conditions for the mission (this includes hostile fire, visibility levels, angle of the sun to the horizon, darkness) in order to assess what aircraft should be assigned and launched. If the risk is high the request can be bounced to higher authorities within the region, or Afghanistan or even as far as the general staff in Qatar.

      Those initial steps can be handled quickly, or they can be quite lengthy if specific circumstances warrant more review, or if the medical and combat aviation staff members have just started working together and haven’t established trust and a working rhythm. Next, the appropriate aircraft must be located and assigned. Once assigned the crew must be alerted and get to the aircraft. Even with general pre-flight work done already there are additional steps that must be taken in order to take off. Depending on the type of aircraft that typically can take 6 minutes for a Blackhawk and significantly longer for a Kiowa or Apache aircraft.

      For purposes of discussion, if the approval processes take 10 minutes and the pre-launch steps take another 10 minutes then 1/3 of your Golden Hour is already gone before you lift off for the mission. If you assume 5 minutes to land, recover the wounded and lift off again, then your available roundtrip flight time is just 35 minutes. If you don’t account for any further delays that can occur, each MEDEVAC helicopter is restricted to a circle of 17-1/2 minutes flying time around its base location.

      At this point MEDVAC aircraft and Role/Level 2 medical treatment capabilities were pushed further into the battlespace into select Forward Operating Bases (FOBs). That way a MEDEVAC helicopter was closer to the actual battlefield and could in essence pick-up the nearby patient and fly one-way to the closest Role/Level 3 MTF. This dramatically cut the delivery time of a patient from Point of Injury (POI) to MTF, or conversely nearly doubled the maximum allowable distance to a Role/Level 3 MTF.

      On the other hand, if the FOB was too far forward there were now circumstances that could result in the patient be taken first to a more limited capability Role/Level 2 MFT in order to stop the clock before the Golden Hour elapsed. If your mission exceeds one hour it is consider to be out standard, then your mission profile will land on the Secretary of Defense’s desk with his daily briefing the following morning and questions will be asked through the chain of command.

      Depending on what armed aircraft were also deployed to the FOB and their availability to fly cover for a MEDEVAC mission, an unarmed MEDEVAC light would depend on a more distant airfield’s assets or hope that an airborne armed helicopter can be diverted to help. This is why SPC Chazray Clark waited so long for his evacuation. A MEDEVAC a mere 3 minutes away had to wait for a escort from Kandahar Air Field (KAF) 25 miles away. That night two armed PEDRO CASEVAC helicopters were ready to fly immediately from KAF, but the command authority decided to keep them grounded and search for an Apache gunship instead. That caused a dual delay in launching the mission.

  2. John House says:

    I remember reading in “We Were Soldiers Once, And Young” that during the battle of the Ia Drang Valley, ‘independent’ MEDEVAC pilots were refusing to fly in to pick up wounded. One pilot in particular, who was recognized later for his bravery, rallied them to go fly in and take supplies to them while pulling the wounded out. And I can’t remember if it was ultimately done by the air cav pilots or Dust Off. But Dust Off stopped flying as soon as it became dangerous. Clear back at the beginning it was a struggle to do the right thing.

    • Administrator says:

      John,

      MEDVAC (Dustoff) pilots never signed up to fly suicide missions (although non-Dustoff pilots referred to them as such). Like every other aviator they made decisions about the survivability of any given mission. There is no doubt that armed, non-MEDEVAC helicopters played the CASEVAC role in many battles in Vietnam when unarmed MEDEVAC flights would have been doomed.

      Having acknowledged that fact, we should recognize that thousands of unarmed MEDEVAC flights were flown into the teeth of incredible volumes of enemy fire in order to rescue wounded troops. More than one Dustoff pilot and crew had a helicopter downed by enemy fire only to be rescued and get airborne again the same day. Early in the war a decision was made that some MEDEVAC birds were not only going to be flown unarmed – they were painted completely white in order to be visible at longer ranges and stand out more boldly against the jungle green. Thankfully that experiment was short lived.

      Incredibly, until just a handful of years ago flight medics flying on MEDEVAC helicopters were ineligible to receive recognition of their work under fire. The first Combat Medic Badges ever awarded to flight medics were presented on July 29, 2008 to seven U.S. Army flight medics assigned to Company C, 2nd General Support Aviation Battalion, 1st Aviation Regiment for their service in Iraq.

      Major General JohnPatrick Brady served as a MEDEVAC pilot from 1959-1993 and received the following medals and awards for his service and valor:

      Medal of Honor
      Distinguished Service Cross
      Army Distinguished Service Medal
      Defense Superior Service Medal
      Legion of Merit
      Distinguished Flying Cross (6)
      Bronze Star (2 with V)
      Purple Heart
      Meritorious Service Medal (3)
      Air Medal (52 with V)
      Army Commendation Medal (6)

      Medal of Honor citation

      Rank and organization: Major, U.S. Army, Medical Service Corps, 54th Medical Detachment, 67th Medical Group, 44th Medical Brigade.

      Place and date: Near Chu Lai, Republic of Vietnam, January 6, 1968.

      Entered service at: Seattle, Wash.

      Born: October 1, 1936, Philip, S. Dak.

      Citation:

      For conspicuous gallantry and intrepidity in action at the risk of his life above and beyond the call of duty, Maj. Brady distinguished himself while serving in the Republic of Vietnam commanding a UH-1H ambulance helicopter, volunteered to rescue wounded men from a site in enemy held territory which was reported to be heavily defended and to be blanketed by fog. To reach the site he descended through heavy fog and smoke and hovered slowly along a valley trail, turning his ship sideward to blow away the fog with the backwash from his rotor blades. Despite the unchallenged, close-range enemy fire, he found the dangerously small site, where he successfully landed and evacuated 2 badly wounded South Vietnamese soldiers.

      He was then called to another area completely covered by dense fog where American casualties lay only 50 meters from the enemy. Two aircraft had previously been shot down and others had made unsuccessful attempts to reach this site earlier in the day. With unmatched skill and extraordinary courage, Maj. Brady made 4 flights to this embattled landing zone and successfully rescued all the wounded.

      On his third mission of the day Maj. Brady once again landed at a site surrounded by the enemy. The friendly ground force, pinned down by enemy fire, had been unable to reach and secure the landing zone. Although his aircraft had been badly damaged and his controls partially shot away during his initial entry into this area, he returned minutes later and rescued the remaining injured.

      Shortly thereafter, obtaining a replacement aircraft, Maj. Brady was requested to land in an enemy minefield where a platoon of American soldiers was trapped. A mine detonated near his helicopter, wounding 2 crewmembers and damaging his ship. In spite of this, he managed to fly 6 severely injured patients to medical aid.

      Throughout that day Maj. Brady utilized 3 helicopters to evacuate a total of 51 seriously wounded men, many of whom would have perished without prompt medical treatment. Maj. Brady’s bravery was in the highest traditions of the military service and reflects great credit upon himself and the U.S. Army.

      • Andy says:

        That would be MG Patrick H. Brady, not John Brady, and it is he whom you quote in your post.

        In 2008, MG(R) Brady responded to a post printed in the Army Aviation Magazine in which then Col. Bill Forrester, the Chief of Staff of the U.S. Army Aviation Center, stated a brash (and uneducated) opinion. He states that; “The days of receiving a call for help and blindly launching in haste to save lives are truly over.” Col. Forrester would later be promoted to Brigadier General and charged to lead the U.S. Army Combat Readiness/Safety Center as its Commanding General. This single sentence by a senior leader within the Army Aviation Branch sums up the very problem we have today. Army MEDEVAC is currently under the control of aviation leadership with no background or understanding of medical lines of effort. These are combat experienced aviators, but with a completely different view of aviation operations where their missions are planned and executed with a time on target focus, not an event oriented crisis reaction where seconds count. It is the aviation command leadership whom personally directs when MEDEVAC assets launch, limit where they are allowed to go, and under what circumstances they are allowed to accomplish their mission.

        Before the 2004 Aviation Transformation Initiative, where MEDEVAC assets were placed under the control of aviation organizations, the decision to launch, as well as whether or not it was safe to ingress into a landing zone was left to the MEDEVAC Pilot in Command who was on the scene and had full visibility of what was around him. To equate this for folks who may not have a military background, imagine if your local police force were set up with the same constraints. When a call came in via 911, the squad car would not be allowed to depart the station to respond to an emergency unless the Police Chief was contacted, briefed on the risk and nature of the emergency call, and then give his approval for the responding officers to depart. The initiative would be lost as soon as the officers hit the seats, waiting for approval to depart. Whatever emergency they are responding to would be long past any point of influence had they left immediately.

        To quote MG(R) Brady’s response to Col. Forrester; “The most serious ‘rash action’ that can occur during patient evacuation is when anything or anyone interferes with the patient’s needs and the swiftness of evacuation.” To further quote the man who was awarded the Medal of Honor for performing MEDEVAC mission in combat, “I never met a non-Dustoff aviator who understood my mission better than I did. But more importantly, what does assigning Dustoff to the aviation battalion do for patient’s needs? I would bet that it will not add to the swiftness of launch, essential in life saving…”

        Is this not what has happened with Aviation Transformation? The Army leadership has placed a complex command and control chain, to include risk assessments, launch criteria, decision matrix central processes, and a demand to attain full understanding of each and every mission before the crews are allowed to launch to retrieve a patient. The C2 and timliness in the decision to launch is the crux of the issue at hand, not the armament of aircraft or display of Red Crosses.

        • Administrator says:

          Andy,

          Thank you for the correction – you are absolutely right it was MG Patrick Brady. [I made the correction in the original comment.]

          On the larger issue you are exactly on point. The conflict between the MEDEVAC units under the control of the Army Medical Department and the combat aviation units has been unrelenting. It was “solved” in the Transformation Initiative when MEDEVAC units became the C Companies of the GSAB under Combat Aviation Brigades. The Colonel in charge of the Directorate of Medical Evacuation Proponency is still [guardedly] complaining about the cultural challenges that seven years later are still interfering with executing MEDEVAC missions effectively and efficiently. LTC Mabry has also pointedly commented about the delays in mission launches – many of which come from the restrictions that result from flying unarmed aircraft that require armed escorts. In August 2011, the Defense Health Board issued strong recommendations that use of armed Air Force Pedro assets be part of the regular contingency planning done by CAB commanders to eliminate delays in MEDEVAC missions.

          I think that unless and until the DoD creates a standalone MEDEVAC force with its own armed escort aircraft, we are left with the squabbling between MEDEVAC and CAB leadership – all at the expense of providing the most timely care for the wounded troops. Until a structural change is implemented Army leadership must focus on getting the two branches to work together in addressing the MEDEVAC tasks.

          Without insulting anyone, the current arrangement it is like having a trucking company in charge of a fire department. As UPS says, it is all about logistics and planning and optimizing loads and following proven procedures to the letter. Fire departments are reactive to the alarm sounding right now. Your destination is not predetermined, you don’t have the luxury of time to plan the mission in excruciating detail because immediate response is of the essence. The mindsets are completely different. I’ll reflect more on this issue in future posts.

          There also are some interesting insights in journal articles published after the first Gulf War and Somalia about growing risk aversion within the American officer corps. Certainly nobody is calling for suicide missions or unnecessarily adding risk to missions, but MEDEVAC pilots and crews accept that their jobs have inherent risks associated with evacuating wounded troops from battlefield locations. Let them do their jobs as the professionals there are.

        • Administrator says:

          Reply Part 2:

          Finally, your using a civilian analogy is good. My take on this in a separate post describes the process a bit differently:

          – a 911 call for an ambulance is received by the >>Fire Department<>Police Department<< dispatcher to gain authorization for the ambulance to leave the fire station. This dispatcher has a matrix on a chart that lists hazards on one axis and required equipment on the other axis. Hazards include:
          + did the caller hear any gunshots before making the call
          + have there been gunshots heard in the area in the past
          + is the caller's home located within an area of the map that is marked as being
          hazardous regardless of whether or not gunshots have been heard
          + is the sun below 30 degrees above the horizon
          + is visibility limited in any way due to dust, haze, fog, low clouds, etc.
          + is it dark out already

          Up to a certain point on the chart the dispatcher merely has to ask the Police Department duty officer for permission to proceed. Above that level of risk, the police chief must give his approval. Above another level of risk, the mayor is involved, then the governor must give his authorization. If things are looking pretty scary, then you must get the approval of the Governor of a province in a neighboring country. (In Afghanistan, medical services including MEDEVAC fall under the auspices of NATO. There is a chain of command in place for launch approval that goes up from the CAB operations command center to CAB leadership to a member of the general staff and ultimately (as was reported in a comment on-line) a four star general based in Qatar who was tapped to give launch approval on a particularly hazardous MEDEVAC mission.)

          Phew! After all that, the caller is told that their request for an ambulance has been approved. Yea! But because it is dark outside and you live on the other side of the tracks, and even though there is no gunfire now and hasn't been in your neighborhood for a while your request has been deemed to be very dangerous.

          The ambulance is sitting in the driveway of the fire house 1-1/2 miles from your home. It's lights are flashing and the crew is aboard, but it can't leave until a police escort arrives. Because the dispatcher's matrix says how hazardous your situation is, a police car isn't enough protection – a SWAT team in an armored vehicle must accompany the ambulance.

          Unfortunately, all the SWAT vehicles are busy with drug raids this evening. The dispatcher will call each and see if any are able to divert from their raid to come escort the ambulance. When none is found already out and about that can help, the dispatcher calls a nearby police department and asks for them to send one of its SWAT vehicles. It is 25 miles away and it will take 15 minutes to warm up the truck and get ready to leave.

          It finally arrives at your local fire station and the ambulance and SWAT vehicle leave. But they take a route that takes 13 minutes to get to your house. Your loved one is loaded onto the ambulance and is taken away to the hospital. Your loved one dies shortly after he arrives in the emergency room.

          This in essence was the tale of the MEDEVAC call in September 2011 for SPC Chazray Clark. It took 66 minutes for him to be delivered to a medical treatment facility despite a MEDEVAC helicopter sitting on the ground 1-1/2 miles away from his POI. He died from what have been serious but survivable wounds for other American soldiers.

    • Andy says:

      The MEDEVAC who refused support at Ia Drang was an internal, 1st Cav MEDEVAC platoon, under the command and control of the 1st Cav leadership. They were not DUSTOFF, which had been (from 1962 to 2004) under the command and control of Medical Service Corps leaders with total autonomy in organizing and responding to coverage across an assigned area. In Ia Drang, the Cav “fenced off” their Area of Operations and refused to allow outside support elements to assist when they got over their heads. This is an element that wasn’t explained well in the book, yet constantly used to point out a moment where MEDEVAC failed. The failure was in the vanity of those who wanted to “take care of their own” without fully understanding the medical mission at hand, and thus failing to properly plan for the worst.

      • Administrator says:

        Thanks for the details. As I understand there were several instances where specific Divisions in Vietnam employed their “own MEDEVAC” units for a period of time. I have seen comments elsewhere but haven’t been able to confirm them yet, that some of those units flew helicopters with Red Cross emblems while carrying machine guns for protection. I don’t know when and why these units ceased to exist since the Army Medical Department which ran the true MEDEVAC units for the most part lacked the internal political muscle to force such a change on the combat arms side of things.

        • Ed DeFreitas says:

          In Vietnam, 1968 to 1971 the 101st had an Air Ambulance Platoon in the 326 Medical Battalion. “”Eagle Dustoff”. The commander was a MSC Major and most of the pilots were MSC commisioned officers or warrant officers with extra training. Occasionally, the Division would assign an non-MSC officer pilot to the platoon. The aircraft were unarmed and painted with red crosses. Cobra gunships and or OH-6s would often participate in missions. I don’t recall having to wait for gunship support. I do recall having considerable autonomy. Decisions were usually made enroute and at the scene. They usually involved the small unit commander and the pilot. Don’t know what happened before we received the mission but always had the impression that the calls were handled quickly.

  3. Colibri 8 says:

    In the midst of all of this ballyhoo is the lack of the most important question; where was the CASEVAC plan?

    Here is the deal, Super Six Four was heavily armed and it was blown out of the sky over Mogadishu. The issue has nothing to do with arming MEDEVAC. You don’t land assault helicopters into unprepared LZs if they are contested because in spite of their 240Bs they will get shot to pieces if they don’t have support.

    Arming MEDEVAC presents real issues, not just what the poseurs who sit around water coolers tell you but real operational problems, like, the need to add another crew member, weapons and ammo and the loss of cube and addition of weight to an aircraft that is already limited in performance in some parts of Afghanistan. You could put 40mm cannons on a MEDEVAC Blackhawk and the enemy would just change his TTPs to wait until the aircraft went into a vulnerable posture before they attacked. This is exactly how Super Six Four was shot down.

    Now the question that nobody who really flies MEDEVAC but who wants to appear the savior for a problem that does not exist should be asking is why there was no CASEVAC plan for this patrol.

    I have flown LOTS of CASEVAC as well as MEDEVAC. I have flown with shooters into LZs, dropped them off and fully understood that I might find myself right back on that LZ treating GSWs in a matter of minutes should they get into contact. MEDEVAC was not part of the equation on the operations because they were decidedly kinetic and there is no place for an HH-60, which by the way, has no place to put guns since it has no gunners windows, on a kinetic LZ.

    The deal is this; MEDEVAC comes with skilled flight medics, soon to be more skilled paramedics (because of course every medical problem looks like a nail so we need a hammer to solve all of them, which is another entirely different story) and they know a lot of things, really important things like how to manage heart attacks between hospitals. They also know the very basic things that all medics know, like plug holes, put on tourniquets and keep airways open and run like hell for the nearest MTF.

    HH-60s are very expensive, flight medics and paramedics are very expensive to train and retain and for MOST combat injuries, entirely unnecessary for point of injury transport to the closest MTF, especially when those flight times are measured in minutes. I was fully capable of treating at least 8 limb amputations, multiple GSWs and two critical airways with just the stuff I carried in a backpack. I did not need MEDEVAC to do that, I needed a ride that would carry those wounded.

    But that only works when assault teams actually plan for CASEVAC.

    THE FASTEST WAY OFF THE BATTLEFIELD IS USUALLY THE WAY YOU GOT THERE IN THE FIRST PLACE.

    The story is that this kid was 1 mile from the FOB? Really? I am pretty old but I can still cover a mile in about 15 minutes in foot. I don’t know the terrain but I would like to ask, why didn’t the assault team carry him to the FOB? Maybe there is a good reason; river, canyon, but then I ask how did they get to their patrol area? Where was the lift that got them there?

    One other thing, PEDROS are not for MEDEVAC. They are for downed aircrew recovery. They get pulled for MEDEVAC Because they are an asset in an asset limited theater and they happen to have a paramedic on board, but I launched on multiple CASEVACS where I waved at PEDRO crews who sat on the ramp while we were off inserting and exifilling troops BECAUSE the PEDROS were there to come get us if we got shot down. That is really what they are for.

    Now there is a serious issue with non medical commanders having control over MEDEVAC assets. Assault and Gun pilots do not understand the unique mission of MEDEVAC, they have no concept of what happens in the back of the aircraft and they really don’t like crews out flying around by themselves. It freaks them out and the parochial nature of the assault and gun community looks at this as some sort of trickery when in fact it is the very essence of MEDEVAC flying.

    You take off the crosses and you run a real risk of some ignorant non medical aviator tasking that dedicated asset to something absurd like hauling working dogs around for their shots and then when you really need what it can provide, like skilled care to transport a critical post operative patient to another airfield or facility, it won’t be there.

    You want to save kid’s lives? Quit debating the irrelevant and ask why nobody bothered to either drive out to that patrol or send the lift in to get the kid that dropped him off? Ask why the patrol had no plan B. No CASEVAC plan. I mean what would have happened had that FOB been hit by a suicide bomber and all MEDEVAC assets were suddenly employed elsewhere hauling wounded. What was the plan B? What was the CASEVAC plan?

    Look, there are real problems with MEDEVAC but it has nothing to do with this. The real problems have to do with trying to do critical care medicine in a platform like a Blackhawk when what you need is a Chinook (BIG TARGET on a battlefield, ask the folks who launched Extortion 17 or Turbine 33, both heavily armed and both blown to bits by a smart enemy) or fixed wing that can fly STABILIZED patients to and from hospitals and airfields and can carry all the critical care crap that you need to do it. None of which you need on a scoop and run evac where time is critical and the most important tools you need are combat gauze, tourniquets and nasal airways and, and blood or a working substitute.

    We seem to be overlooking the countless soldiers that have benefitted from MEDEVAC and the fact that by and large the system works pretty well. It can work better but not in the manner that Yon thinks…

    • Mustang 13 says:

      Colibri –

      “Now there is a serious issue with non medical commanders having control over MEDEVAC assets. Assault and Gun pilots do not understand the unique mission of MEDEVAC, they have no concept of what happens in the back of the aircraft…”

      I know this post is practically decades old, but to hell with it; I’ll add my two cents for posterity. There’s a common theme running through your posting and the postings of others who feel non-med CAB commanders can’t appreciate the nuances of the MEDEVAC mission set and therefore cannot effectively conduct mission command for the C companies. To that I say boohoo.

      “Everyone” serves in a role that is poorly understood and infinitely under appreciated. I never felt so misused and abused as a hawk guy as when we were being led by a Scout CAB commander. He was either confused, or genuinely didn’t give two sh!ts, about the role and capabilities of the Army’s utility helicopter. I know the attack/scout guys felt the same way in a previous deployment when the commander was a 60 guy. The bottom line is it takes a dynamic, deeper-thinking CAB head-shed to effectively lead all four airframe’s mission sets. Yes, the MEDEVAC mission is “unique” but guess what, so are the AASLT, the TST, the VI, the Heavy Lift, the A2C2, the VIP, the Scout, the Attack, the Pink, Brown and Purple teams, the DART, the CASEVAC, etc – they are all unique. MEDEVAC should stop deluding themselves with this “our mission set is so unique.” No doubt there a legit frustrations in the decision-making but you don’t think all other mission sets experience this?? Come on, brother (or sister as maybe the case).

      This means AMEDD, due to some feedback loop in it’s non-aviation logic, would probably do no better than the CAB at managing the red crossed helicopters. If Med pilots and MSC officers feel their commander can’t effectively manage them due to lack of understanding, then it’s probably true but this doesn’t mean they need a commander with a medical background; it means their commander needs a lesson in FMs 3-0/5-0 and the mission command concept.

      BTW – as you lump “assault and guns” together, I have seen plenty of instances where either one of those entities did not speak the language of the other, and more importantly they didn’t bother to try. It’s not a “MED versus everyone else” issue.

  4. Administrator says:

    @Colibri8 – Thank you for your service, and your thoughtful comment. Let me address your topics as best I can – starting with your last:

    – “We seem to be overlooking the countless soldiers that have benefitted from MEDEVAC and the fact that by and large the system works pretty well.”

    I have tried hard to make clear in this blog that I have nothing but the highest regard for the courage and performance of the men and women involved in providing MEDEVAC services in Afghanistan. They are committed to do everything within their power to save as many wounded soldiers as they can. But there are policies and procedures beyond their control which inhibit their ability to provide more timely and better care. This blog is documenting many of the leadership issues that need to be addressed.

    – “Why there was no CASEVAC plan for this patrol?”

    Excellent question. The MEDEVAC Proponent, the Defense Department Health Affairs Board, LTC Mabry in AMEDD, our NATO partners and others have commented about this problem in general. There has been variability in the degree of Plan B preparations for ground assault missions that have resulted in inadequate assets being available for MEDEVAC/CASEVAC mission support. Last August, the Health Affairs Board explicitly recommended to the Army that its units actively plan for the use of armed CASEVAC helicopters for missions involving hot LZs:

    “TACEVAC planning should aim to optimize evacuation time for all likely tactical contingencies.
    i. Define hostile fire evacuation options in mission planning as a supplement to dedicated
    MEDEVAC platforms.
    ii. Consider the use of armed, armored CASEVAC aircraft to avoid evacuation delays due to
    ground fire.
    iii. Consider the use of modular medical packages for deployment on tactical aircraft designated
    to perform TACEVAC duties.”

    – Regarding SPC Chazray Clark: “…why didn’t the assault team carry him to the FOB? Maybe there is a good reason; river, canyon, but then I ask how did they get to their patrol area? Where was the lift that got them there?”

    As described in the article on the SPC Chazray Clark incident (see the menu above to read that article), the area had been actively patrolled by the 4/4 long enough to know that ground ex-filtration would be extremely hazardous due to IEDs in the roads, paths and fields. The 1-1/2 mile cross-country trek was deemed to be not an option. The patrol had been dropped off by a CH-47 earlier that night. Where it was at 4:45am, I don’t know. I do know that a MEDEVAC Blackhawk was sitting in the FOB waiting for an escort in order to launch. The disposition of the armed Blackhawk stationed at the same FOB that often accompanied it on missions is unknown. It may be that the hazard level declared by the CAB team overrode the 9-line description of the LZ profile and a Apache was the minimum level escort required by RC-South policy. The subsequent search for an airborne Apache that could be diverted and then running up one at Kandahar Air Field is the cause for the launch delay. During the delay the PECC kept informing the patrol that the Dustoff was “wheels up”, when in fact it was still on the ground. Meanwhile two Pedros at KAF were ready to execute the mission but never got the order.

    That time of morning is a near low point for MEDEVAC calls, yet there were no gunships available to support that mission. That day only three troops were killed in Afghanistan – 2 in the south, and one in the north. It was a relatively quiet night.

    – Regarding arming MEDEVAC helicopters, you made several points.

    From comments on-line from Dustoff pilots and conversations I have had one to one with some active duty Dustoff pilots in Afghanistan it is clear that there are a variety of opinions about the wisdom and usefulness of arming the helicopters. AMEDD itself asked the question of the Judge Advocate General and was told that it was the theater commander’s prerogative to take off the Red Crosses and arm the aircraft. It would not violate the Geneva Convention or other laws or treaties.

    The weight issue has been covered elsewhere. The main way of handling the weight of the guns, ammunition and gunners is to remove the 660 lb. litter carousel that is not used. There would be little if any incremental weight for the aircraft. In January, 2012 the MEDEVAC Proponent reported on his trip to Afghanistan. Among the topics covered was the fact that the brand new HH-60M helicopters were 2000 lbs. heavier than the helicopters they replaced, plus an additional 200 lbs. was related to ECCNs they were supposed to start flying on some missions. So, the Army itself designed the HH-60M to be over a ton heavier than the legacy UH-60A/L models. It turned out that the helicopters couldn’t fly nearly high enough and the first thing to get pulled off the bird was the carousel. The unit flight medics unanimously voted that it wasn’t needed and strapping litters to the floor allowed them to provide better care to the patients. By the end of the exercise, the ENTIRE medical package on the HH-60Ms was stripped off every bird, leaving them less equipped for MEDEVAC than the helicopters they replaced.

    Nobody is advocating for MEDEVAC suicide missions, but as you note time is of the essence and Pedro flights have been sent when MEDEVACs are grounded due to gunfire at or near the LZ. You correctly state that the primary mission of the Pedros is Combat Search and Rescue. But there hasn’t been a lot of need for that in Afghanistan, which is why Secretary Gates in 2009 ordered Pedros to be included in the rotation for MEDEVAC missions. Even earlier than that, the Army’s launch rules explicitly stated that Pedros were to be sent for nighttime missions because at the time only Pedro HH-60’s had navigation and night vision capabilities to fly in the dark. As MEDEVAC birds have been upgraded and replaced that situation has been changing.

    – Regarding flight medic training and capabilities

    As LTC Mabry so strongly noted, there have been over 40 after action reports since 2002 by senior AMEDD officers returning from Afghanistan that have stated and documented that the EMT-B level training of the average Regular Army flight medic has resulted in unnecessary deaths of wounded troops. AMEDD controls the training curriculum but has not reacted for a decade to the urgent calls for ungraded training. Ditto for En-route Critical Care Nurses. Most people don’t know that the majority of MEDEVAC flights are not to the battlefield but between medical facilities. In the case of many of those flights, the flight medic training and certification prevents them from providing necessary life-sustaining care en-route.This isn’t to knock the professionalism of the flight medics – they just haven’t received the needed training. When the Army did send ECCNs to Afghanistan they were not properly trained nor lead.

    When the Army leadership said in January 2012 that MEDEVAC was reviewed in 2008 and it was determined that no changes were needed, the acceptable MEDEVAC mission timeline was 2 hours +/-, and the volume of WIA/KIA was less than 1/6th what it was two years later – or now. One official Army report said that an extensive study of the Died of Wounds cases between 2001 and 2009 a full 51.4% died of potentially survivable wounds. Another Army report in 2009 said that had the Army improved its training regimen earlier in the decade, over 1,000 of the troops who died by that time in Afghanistan and Iraq would have been still alive. These reports focus primarily on pre-hospital care of the wounded.

    The senior staff of the Army Surgeon General/Commanding General of the AMEDD includes a veterinarian, family medicine, sociologist, immunologist, etc., but nobody representing MEDEVAC or field medical operations. In January 2012 the new Surgeon General of the Army touted the fact that she was running the world’s 5th largest HMO and said her top goal was to make sure every soldier was outfitted with a pedometer so they could lose weight. I have listened to three of her speeches and she never mentioned MEDEVAC.

  5. bart cutler says:

    this is my first visit to this website,but I served as a crew chief for Eagle Dustoff in I corp 1968,69,70 and can tell you we had the best pilots in vietnam.We always flew unarmed except 38 0r 45 pistols and more often than not flew without armed escorts.In the Ashau valley we flew bocu night missions,and with the tripple canopy jungles utilized the hoist frequently.In fact one our birds was shot down on Hamburger hill with the loss of three crew members,and several wounded.Origionally it required a medic to serve 6 months in the bush ,before we would accept them for dustoff.I think I lost almost 20 friends from crashes.one month affter hamburger hill we lost two more crews.Origionally we ahd 6 choppers to support the entire 101st airborne,arvans,ROK, civilians,marines,andanyone else.Later we were increased to 12 choppers,allowing us to station them at fsb sIn May of 1969 shortly after Hamburger hill we sent one Battalion and 6 choppers to rescue the Americal division.But in all tht time I never saw a chopper not go in because of lack of cover.The worst scenario I remember was a headwound in the mountain,dispite a monsoon our major and my bird made an attempt,but were forced to wait 24 hrs for weatherThe soldier was delivered alive

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