MEDEVAC Matters

A constituent of U.S. Senator Tom Harkin finally received a reply five months after her initial letter and fax to Senator Harkin about MEDEVAC operations in Afghanistan. Despite the date on the Senator’s letter, she just received it today.

The letter is another example of how the Army’s spin doctors have misled members of Congress and the American people about the truth about MEDEVAC operations.

Here We Go Again – The Geneva Convention Prevents Us from Doing the Right Things

In paragraph 2 we are informed that the rule regarding not arming medical evacuation vehicles is traced to German perfidy in World War I. Not true. The relevant provisions in the Geneva Convention come from the Convention for the Amelioration of the Condition of the Wounded in Armies in the Field signed in Geneva on August 22, 1864:

Article 1. “Ambulances and military hospitals shall be recognized as neutral, and as such, protected and respected by the belligerents as long as they accommodate wounded and sick.”

“Neutrality shall end if the said ambulances or hospitals should be held by a military force.” [emphasis added]

Source: http://www.icrc.org/ihl.nsf/WebART/120-40001?OpenDocument

Article 7.” A distinctive and uniform flag shall be adopted for hospitals, ambulances and evacuation parties. It should in all circumstances be accompanied by the national flag.”

“An armlet may also be worn by personnel enjoying neutrality but its issue shall be left to the military authorities. Both flag and armlet shall bear a red cross on a white ground.”

Source: http://www.icrc.org/ihl.nsf/WebART/120-40007?OpenDocument

More importantly, the Senator argues that “clearly marked medical evacuation vehicles may not be targeted for attack and must not be armed.” As radio icon Paul Harvey used to say, “and now for the rest of the story.”

The Geneva Convention is a legal agreement signed by nation states. It includes rules about how medical evacuations shall be conducted in wars involving nations that signed the agreement.

• The treaty does not require medical evacuations to be conducted only by vehicles dedicated exclusively to that purpose.
• It does not require medical evacuations to be done only by unarmed vehicles
• It does not require medical evacuations to be done only while showing Red Cross emblems on the vehicles.
• It does state that if vehicles bear Red Cross emblems then
  • they shall be used for medical purposes only (evacuating the wounded, transporting medical supplies, etc.) and
  • they shall be unarmed

This is a point that confuses many people arguing that the Red Crosses cannot be removed from MEDEVAC helicopters. They have the argument backward, saying that because the helicopters are used for MEDEVAC purposes then they must bear the Red Cross emblems and thus must be unarmed. Armies are free to transport wounded in any vehicle they wish – armed or unarmed. It is only if they bear the Red Cross emblem that they are restricted to being unarmed in exchange for not being attacked by enemy forces of signatory countries.

The Geneva Convention clarified for signatory nations that in the event of a war with a non-signatory nation or other non-signatory armed forces, then another set of rules applies. The signatory nation (the U.S. in Afghanistan) is obliged to abide by Geneva Convention rules for a reasonable period of time upon commencement of hostilities. During this period the enemy nation or force must declare whether it will abide by all the provisions of the Geneva Convention. If it fails to make that declaration and/or fails to act fully in conformance of the terms of the Convention, then the signatory nation is relieved of its obligation to adhere to the terms of the Geneva Convention. Given the lack of a declaration of adherence from al Qaeda or the Taliban and their repeated violation of the terms of the Geneva Convention, the U.S. is free to choose which if any provisions of the Geneva Convention it wishes to follow.

Assuming the U.S. decided to abide by the Geneva Convention, it still is entitled to remove the Red Cross emblems from the MEDEVAC helicopters and arm the aircraft. In October, 2008 the U.S. Army Judge Advocate General – International and Operational Law Division gave an opinion to the Army Surgeon General that arming MEDEVAC helicopters with M240, 7.62 Medium Machine Guns (defined by the Army as crew served) may be done at the discretion of the Theater Commander in Afghanistan without violating the Geneva Convention or other international law – as long as the aircraft are not bearing Red Cross emblems. In the case of this specific request for an opinion, the helicopters would “keep the MEDEVAC carousels, medical equipment sets, and flight medics on board during all Missions.” The helicopters could then be employed for an escort/chase or general support role – and by extension medical evacuation (as long as the Red Cross emblems are not replaced). The sole consequence of doing so is the helicopter and crew will “lose its protected status under the [Geneva Convention].”

If We Armed Them Then We Would Reduce Care for the Wounded

In paragraph 3 of Senator Harkin’s letter we find several assertions needing rebuttal.

First, helicopters prior to the early 1960’s lacked the power to carry crew served weapons, but that did not prevent Marines during the Korean War from firing personal weapons from helicopter as they recovered the wounded. During the Vietnam War the Combat Search and Rescue (CSAR) helicopters were tasked with recovering downed airmen – not as supplements to the MEDEVAC forces. However, there were reports of several cases where U.S. Army divisions converted armed air assault helicopters into “division MEDEVAC” assets complete with Red Crosses that were unaffiliated with actual MEDEVAC units under the Army’s Medical Department control.

Next, in an attempt to dismiss the ability of a CSAR/CASEVAC helicopter crew to provide medical aid to the wounded, the Senator says CSAR/CASEVAC helicopters do not carry doctors. Left out is the truth that U.S. Army MEDEVAC helicopters do not carry doctors either. MEDEVAC crews include a single Army flight medic trained as an Emergency Medical Technician – Basic. (National Guard MEDEVAC crews typically have an experienced paramedic as the flight medic.) On the other hand, the regularly denigrated unmarked, armed CASEVAC aircraft are staffed like so:

• USAF CSAR/CASEVAC Pedro – a minimum of 2 of the more highly trained Emergency Medical Technician – Paramedic as crew members; some flights carry 3 paramedics
• UK Medical Emergency Response Team (MERT) – carries a trauma/emergency medicine doctor, trauma/emergency nurses and paramedics who have extensive training and experience in all aspects of trauma management. MERT functions as a portable trauma room.

Harkin’s letter then says that MEDEVAC helicopters “maintain a full complement of emergency medical equipment for military doctors to use” and that “arming MEDEVACs may only displace necessary medical equipment in favor of weaponry.”

It is true that UH-60A/L MEDEVAC helicopters typically are outfitted with more medical equipment than a USAF Pedro helicopter, but that is changing, too. In 2011 the Army began phasing in the new HH-60M helicopters as replacements for legacy UH-60A/L models. In August, 2011 C Company, 3/82^nd MEDEVAC Company became the first active duty MEDEVAC unit to deploy to Afghanistan with them. Immediately upon arrival in RC-East it was clear that the extra 2000 lbs weighed by the HH-60M over the older UH-60A/L prevented them from reaching locations previously serviced by the UH-60’s.

In an attempt to lighten the birds enough to fly to the necessary altitudes, orders were given to strip out the electric litter pans (much to the joy of the unit’s medics), the Aircraft Medical Oxygen Generation System and the Environmental Control System. When that proved inadequate, the command ordered the removal of the entire medical package.

In less mountainous regions, the UH-60A/L unused 600+ lb. litter carousel (which medics decry because it limits their ability to care for patients in flight) could be removed. Adding two machine guns, ammunition and gunners would be a virtual swap in weight. So, the change could be accomplished without interfering with patient care or “displac[ing] necessary medical equipment” while adding protection for the aircraft and crew.

Let’s Not Make Our MEDEVAC Helicopters Targets

In a final statement which displays complete ignorance of the reality of every conflict the U.S. has been in since World War II, the Senator informs us that ”allowing medevacs to become military targets is simply a worse alternative.”

We do not “allow medevacs to be military targets”, our enemies make that decision. Consistently. In every conflict. Thousands of times in the past decade MEDEVAC helicopters with Red Cross emblems on all surfaces flying in Iraq and Afghanistan have been attacked with small arms fire, rocket propelled grenades, heavy machine guns, anti-aircraft guns and shoulder launched missiles (Iraq only).

The Real Issue Is Delayed Launches

The real issue is delayed launches of some MEDEVAC flights under current policies in Afghanistan. Eliminating the delays can be achieved in a variety of ways:

• Arm the MEDEVAC helicopters and let them fly under the same conditions as USAF Pedro aircraft
• Dedicate an adequate number and type of armed helicopters to fly chase/escort for MEDEVAC missions so time isn’t wasted waiting for an escort to be found
• Change the rules determining launch requirements

Army leadership and Senators who can influence Army policies refuse to take any of these steps. They refuse to arm the MEDEVAC helicopters, insist that they be painted in highly visible colors, maintain the same launch rules, and refuse to dedicate enough armed escort helicopters to provide MEDEVAC helicopters airborne protection without delay.

We know that it is not international law that prevents the problem from being solved. What else explains the failure to fix the problem? Money? Political power struggles within the Army? Weight? Tell the Gold Star families whose loved ones died due to delays in getting them to medical care that it was because of money or petty politics or weight.

So our wounded troops and MEDEVAC crews continue to be imperiled because no one in authority will take the simple steps necessary to provide adequate protection to the MEDEVAC helicopters.

When will members of Congress realize that Army leaders managers are not telling them the whole truth about MEDEVAC and pre-hospital care in Afghanistan?

There are none so blind as those who will not see.