Please take a moment today to think of SPC Clark. Chazray Clark left behind a wife and son. He also is survived by his mother, father, sister and three brothers.

http://fastsurgeon.blogspot.com/2012/05/picture-of-day28-may-2012-remembrance.html

The LTC with the message on her back honoring SFC Brian Woods has been a combat surgeon for 20 years. She is currently part of a FST (Forward Surgical Team) in Afghanistan. One can only imagine how many wounded soldiers and civilians she has treated in her years as a combat surgeon and how each left an impression on her that she carries with her every day.

Our MEDEVAC and medical personnel are the best in the world and offer the best care possible for our wounded.  They have jobs that subject them daily to physical and emotional stress beyond what most of us could imagine. Say a prayer of thanks and protection for them.

After over a decade of urgent calls for upgraded training of Army flight medics, it has begun. This article provides some details of what is involved. As noted, Army statistics have long shown that wounded troops rescued by National Guard MEDEVAC crews have a 66% higher chance of survival than if they were rescued by Regular Army MEDEVAC crews. This difference is directly attributable to the level of training attained by the crews and prior trauma experience. Most National Guard flight medics are paramedics in their civilian life, so they have more extensive training as well as daily contact with trauma victims. Even civilian paramedics, however, need additional training to handle military war casualties.

The other area of good news is that flight medics also will be trained for en route critical care of stabilized patients. What most people don’t realize is that a huge percentage of MEDEVAC flights entail the transfer of wounded troops from one level medical treatment facility (MTF) to another. These patients often are hooked up to various types of medical/life sustaining equipment which the typical flight medic is not trained on or certified to use. As a result there is a substantial risk to many patients during the transfer flight that their condition may seriously deteriorate. The Army attempted to address this with the assignment of en route critical care nurses, but as was reported by Col. Robert Mabry in his after action report in 2011 – those nurses had not been properly trained (indeed, many were unaware that they would be assigned to helicopter rather than ground transfer duties) and suffered from weak leadership in the field.

These much delayed positive changes should be acknowledged and applauded. However, I was informed by someone close to the MEDEVAC program that no special program was in place to assure that Regular Army MEDEVAC flight medics scheduled to deploy to Afghanistan in the next year would be enrolled in the enhanced training program before deployment. It is interesting that the early enrollees appear to be among the National Guard crews already providing the higher level of care and achieving the higher survival rates for their patients. Wouldn’t have made sense initially to maximize the number of Regular Army flights medics getting this training – especially those going to the combat zone? [If someone can provide updated information about enrollment policies and timelines, I would appreciate it.]

Note the comment from Army Master Sgt. Kym Ricketts, chief medical non-commissioned officer with the Army National Guard, “It’s advanced, pre-hospital medical care.” The term pre-hospital care is relatively unknown but includes all the medical care provided to the wounded from the time of injury to the time the patient is in the hands of medical staff at a medical treatment facility. MEDEVAC is but one portion of the spectrum of pre-hospital care for the wounded. As discussed in How the Army is slow to meet MEDEVAC Challenges in the 21st Century this also covers Tactical Combat Casualty Care training and doctrine, as well as pre-hospital care trauma registries that track the wounded and their care discussed in US Army Report: 2011 After action report blasts MEDEVAC shortcomings.

The article follows:

Army National Guard medics among first to attend revamped flight medic program

http://www.dvidshub.net/news/88451/army-national-guard-medics-among-first-attend-revamped-flight-medic-program#.T7PsTVIZckZ

By Army National Guard Sgt. 1st Class Jon Soucy
National Guard Bureau

ARLINGTON, Va. – Medics from the Army National Guard are among those taking part in a pilot program designed to revamp the training that flight medics throughout the Army will receive.

Taught at Fort Sam Houston, Texas, the program will provide flight medics with additional paramedic and critical care training and certifications.

“A paramedic provides a higher level of care,” said Army Master Sgt. Kym Ricketts, chief medical non-commissioned officer with the Army National Guard. “It’s advanced, pre-hospital medical care.”

Currently, to be a flight medic, a soldier must be a qualified combat medic and be in a flight medic slot, but since flight medics operate under different conditions those requirements are changing to reflect that.

“The medics need additional training as flight medics as they do a higher standard of care and in a different environment than a line medic on the ground,” Ricketts said.

The program is designed to emphasize that fact and focus on training soldiers on those additional skills needed as a flight medic.

As part of the pilot program and proposed changes, soldiers go through three phases of training specific to flight medic duty.

“The first one is the flight medic phase,” Ricketts said, adding that it can be waivered in lieu of on-the-job training. “Phase two is the nationally registered paramedic [course], which is the longest phase, and phase three is the critical care transport piece.”

The push for making changes to flight medic requirements came from a number of elements, including a study done on a California Army National Guard medical evacuation unit that deployed to Afghanistan with full-fledged paramedics in flight medic positions.

“[The study found that with] having flight paramedics in the back of an aircraft there was a 66 percent higher survivability rate than with a straight [combat medic] that wasn’t paramedic trained,” Ricketts said.

Additionally, proposed changes to the flight medic requirements also mean that graduates of the program walk away with national certifications as paramedics. That provides additional benefits including a greater flexibility with integrating with local, state and other agencies in a disaster situation, she said.

“A citizen-soldier can do their wartime mission as well as their peacetime mission of taking care of their community,” Ricketts said, adding that those certifications are the same received by civilian paramedics.

But the important part, she said, is simply providing the best care possible.

“The benefit is the best battlefield medicine and care that a soldier can get,” she said.

“With the forward surgical teams that are out there casualties are actually having surgical intervention on the ground at the point of injury,” Ricketts said. “Combined with these medics that are able to have this training … the [casualty] will be getting the best standard of care.”

The pilot program wraps up later in the year and will then go through a review process.

“It’s still a pilot program and once the pilot program is through we’ll do an analysis to see what works best,” she said.

Ricketts remains positive about the results of the program.

“These medics are going to affect so many people,” she said. “Not just American forces, but coalition forces as well, and that’s amazing.”

“Further, arming MEDEVACs would not reduce the need for armed escort. Again, our aircraft travel in pairs. The decision to use escort is the tactical commander’s, and the Army does not dictate how or when it is necessary to use these assets.

Finally, it’s important to remember that the Army would change its policy if battlefield commanders wanted a change. We take our obligation to perform the MEDEVAC mission very seriously. We’re a learning organization and periodically we review our policies to make sure they remain relevant. We looked at the MEDEVAC policy in 2008, but after a review, we determined no change was necessary.

Additionally, neither the International Security Assistance Force or U.S. Forces – Afghanistan has requested a change in policy; because our MEDEVAC crews and aircraft provide the best chance at survival ever seen in warfare, and because — as commanders in Afghanistan have told us — not arming our MEDEVACs and identifying them with the red cross has had no impact on the medical evacuation mission.”

Yep. In 2008 they “looked at MEDEVAC policy” and determined “no change was necessary”. You know, the fact that the number of KIA and WIA increased more than 6 fold in 2009 and 2010 didn’t prompt any new “review” – why would it? This only reflected a sea change in the level of intensity of fighting and the weapons used. Did the number of MEDEVAC helicopters sustaining hits from ground fire increase after 2008?

If fires in your town increased 6 fold year over year, would you expect the fire department to re-examine its operations to make sure it had stations in the right places and procedures that got the fire trucks to the scene of a fire ASAP? If the last time your ambulance service reviewed procedures it defended getting a trauma victim to a medical facility within 2 hours (and accomplished that only 75% of the time) as being OK – would you be sanguine about how they operated? How about if they then published an article informing you that the benefits of the Golden Hour was all a myth?

Between 2008 and 2012 did the Army review some of its policies and procedures? Sure. Was a comprehensive review done? Not that I have found mentioned or documented anywhere. Even in 2012 the Army leadership still points to a 4 year old study done on activities that were conducted at a pace that is a fraction of the current one.

Did the Army heed any after action reports that stated that current launch authority procedures slow the initiation of MEDEVAC missions? No.

What else happened in that time frame? Oh, yeah. The question of removing Red Crosses from the MEDEVAC helicopters and mounting guns was posed to the Army Judge Advocate General by the Army Surgeon General. Much to the horror of AMEDD command, on October 8, 2008 the official 4 page legal opinion from the Office of the Judge Advocate General – International and Operational Law Division said there was no violation of international law or the Geneva Convention if the Red Crosses were removed and the helicopters armed.

“2. Purpose
Reference f. requests legal review of the proposal by C Company (Air Ambulance), 2-227 GSAB, to “paint over” the red crosses on three MEDEVAC Aircraft, in order to employ them as chase aircraft during their upcoming deployment. The unit is intending to keep the MEDEVAC carousels, medical equipment sets, and flight medics on board during all missions and install M240, 7.62 Medium Machine Guns in the door-gunner’s windows. the unit is exploring the possibility of training for aerial gunnery. The unit proposal is to use the aircraft in an escort/support role and use an “extra” set of cargo doors with red crosses for actual MEDEVAC mission, if required, after the M240′s have been removed. This legal review is provided at the request of the Office of the Surgeon General of the Army, to provide a legal opinion as to the implications of the proposed action under the Geneva Convention.

3. Summary Finding
As more fully described below, the arming of the MEDEVAC helicopters and employment in an escort/support role is not legally objectionable, even though it may result in the loss of GWS protection for the aircraft and its crew. However, the Surgeon General should coordinate with the receiving operational commander, to determine the best course of action for this unit, in this mission.

4. Discussion
[snip]
c. Analysis: Removing the distinctive insignia and mounting the M240 Medium Machine Gun (a crew served weapon according to Army doctrine), in order to conduct escort/support missions would be an act “harmful to the enemy,” which would deprive the aircraft, any patients it carried, and its crew of the protections of the GWS. Replacing the red cross insignia and removing the M240 would enable the aircraft to regain the protections of the GWS for the duration of the MEDEVAC mission. The aircraft could be accused of “perfidy,” a law of war violation that involves feigning protected status to gain an advantage on the enemy, should the aircraft be armed with crew-served weapons and marked as a MEDEVAC aircraft, however.

d. Legal/Policy Considerations: Ref. g, the DoD Law of War program, provides that Secretaries of the Military Departments shall develop policies and procedures consistent with the law of war, while Commanders of Combatant Commands must implement the law of war within their respective theater of operations. Longstanding Army policy and doctrine, outlined in ref. c. and para. A-12 of FM 4-02.02, prohibits the mounting of crew served weapons on MEDEVAC aircraft, lest the platform lose its protected status under the GWS. Although the Secretary of the Army has responsibility under ref i. to train, equip and mobilize forces, the Combatant Commanders are responsible under ref. h. to organize them for combat. Accordingly, while the Surgeon General, delegated the responsibility to establish law of war doctrine for medical personnel from the Secretary of the Army, can dictate policy and doctrine in preparing the unit for deployment, it is the receiving theater headquarters which must decide how they are to be organized for combat, as long as it is done in a manner consistent with the Geneva Conventions.

6. Conclusion.
While the GSAB proposal to arm MEDEVAC helicopters and employ them temporarily as escort/support aircraft is not a violation of the law of war, as long as the aircraft does not engage in “perfidy”, this action would deprive the aircraft and crew of any protections available from the GWS. Recommend coordination with the theater operational commander, through ARCENT, to determine the parameters of employment of the unit.”

So armed helicopters can fly MEDEVAC or non-MEDEVAC missions without limitation and no change in the medical equipment on board would be required as long as the Red Cross insignia is not displayed. It was a decision that the JAG opinion said rested with the operational commander. This opinion was signed by Richard B. Jackson, Special Assistant for Law of War Matters.

The only caution is that by removing the Red Cross insignia, it exposes the aircraft and crew to hostile fire from the enemy. Let’s recall the January 20, 2012 statement by the Chief Public Affairs Officer:

“First, there is no evidence, implied or proven, that the enemy deliberately targets MEDEVAC helicopters, but we know from hard experience that the enemy does try to shoot down any and all U.S. and coalition aircraft.“

(Clearly, even the Army says the presence of the Red Cross insignia does not provide the promised protection from the Geneva Convention. What would be lost then by removing them and arming the MEDEVAC helicopters?)

So how did the Army Surgeon General react to getting the A-OK on October 8, 2008 from the JAG to arm the helicopters? On January 8, 2009 he sent a memo to the Deputy Chief of Staff. In the memo Lt. General Schoomaker informed the Deputy Chief of Staff of the Army:

“Key Points:
a. There are significant legal concerns regarding the execution of the concept [painting over the Red Crosses and installing M240 crew served weapons on MEDEVAC aircraft] and the likely problems that will arise from a practical standpoint.

b. Longstanding Army policy and doctrine prohibit the mounting of crew served weapons on MEDEVAC aircraft and provide detailed guidance on the utilization of the MEDEVAC aircraft, lest the platform lose its protected status under the Geneva Convention.

c. The Hague Convention, Regulations Respecting the Laws and Customs of War on Land specifically prohibits the misuse of the Red Cross symbol. A misuse would include marked with Red Crosses for offensive operations (M240 crew served weapon viewed as offensive) or in self-defense beyond that allowed by Geneva Convention. The arrangement proposed by the 1st CAB invites the possibility of a Law of War Violation.”

Did you notice the sleight of hand that happened? Aside from not informing the Deputy Chief of Staff of the JAG opinion 90 days earlier approving the Combat Aviation Brigade proposal, the Lt. General misrepresented the facts by saying “There are significant legal concerns” about painting over the Red Crosses and arming the MEDEVAC helicopters.

In points b and c, he has shifted to ignoring the part of the proposed action that painted over the Red Crosses and therefore removed any issue about violating the Geneva Convention and its non-existent protection of MEDEVAC helicopters in 21st century warfare with non-signatory forces.

Lt. General Schoomaker concludes by asking for the Deputy Chief of Staff for the issuance of “immediate guidance in reference to the utilization of MEDEVAC aircraft” that would prohibit the proposed action by the CAB.

I understand that the Army Surgeon General was concerned about losing control of MEDEVAC aircraft. This had been a point of contention since the 1960′s. I do have a problem that he did not rest his case solely on an argument based on assuring adequate equipment availability for MEDEVAC missions. His memo can at best be charitably described as being misleading through omission.

Aside from the core issue at hand in this case (removing Red Cross insignia and arming MEDEVAC helicopters), there is a lesson here about taking Army and DoD statements at face value. If a Lt. General felt comfortable wordsmithing his appeal to the Deputy Chief of Staff of the Army in a way to manipulate a response, why should we  (and interested Congressmen) think we are immune to similar tactics directed at those wishing to review AMEDD and Army handling of MEDEVAC issues? Caveat Emptor.

This photo from a 3 minute video filmed in April 2012 about Norwegian MEDEVAC missions shows that if the Norwegian helicopter has external markings all it is simply “ISAF” on its side doors. Some fly without even that marking.

This video filmed in May 2011 shows that the Norwegian MEDEVAC helicopters fly without the large Red Cross markings required by the U.S. Army on its MEDEVAC helicopters.

The Norwegian armored ambulance does have Red Crosses, but very inconspicuously displayed:

By contrast U.S. Army helicopters are marked like this:

Here is a U.S. Army Stryker with ambulance markings. (In Afghanistan the vehicle would be desert tan.)

Photo courtesy of Michael Yon

From Yon’s article:

An Afghan friend translates:

*Destroying the cross is an Islamic obligation*

1. Christians want to publish and spread their unholy and cursed religious logos and signs in different shapes and appearances in clean and holy Muslim society.

2. These Christianity signs (Crosses) have affected our Islamic society too

– even our mosques and our Menbers are not safe from those Christianity signs (Crosses).

(Further note from my Afghan friend explaining “menber”: When you enter a mosque, the menber is a chair in the most forward point. After the prayer is done, a mullah sits on that chair and enlightens people. Talking rubbish about how to be a good muslim or other nonsense. That chair is higher than the regular ones in terms of height. It’s higher in order to enable the mullah to see all the folks and the folks seeing mullah – even the ones sitting far away. Menber is the written name of it.)

3. The respected Ulemas agree over the fact that destroying these crosses is an Islamic obligation and on whatever object or surface where there is a cross, praying is a sin.

4. —– had a gold cross in his neck and prophet Mohammad told him to remove that ‘idol’ from himself and is narrated from Aisha that prophet Mohammad never allowed anything in his house with a cross on it and used to destroy or throw it away.

6. For further explanations, refer to …. / …. / …. (Names of references given)

*Some of the names on the crosses:*

1. Cross of George

2. Cross of Andrew

3. Cross of Lauren

4. Cross of Jerusalem

5. Cross of Anthony

6. Cross in shape of the Nazi logo

7. Catholic Cross

===End of Translation===

Predictably, naysayers immediately pummeled Yon as spinning a fantasy. But was he?

The Red Cross symbol is the inverse of the Swiss flag in honor of the lengthy neutrality of Switzerland and the home of the International Committee of the Red Cross which administers the Geneva Convention. The basis of the Swiss flag is somewhat uncertain but there are three leading explanations:

War flag of the Holy Roman Empire (Reichssturmfahne) during the 13th century

Triangular field ensign used by Swiss confederate forces from ca. the 1420s

Field ensign used from ca. 1470 and during the early 16th century

(Image source: http://en.wikipedia.org/wiki/Flag_of_Switzerland)

In each case there was a history associated with the design that includes an element of the Christian religion.

In early 1863, the International Committee of the Red Cross (ICRC) adopted the red cross on a white background as the distinctive emblem to be used to mark medical vehicles, buildings and personnel granted protection under the provisions of the new Geneva Convention.

Only 13 years elapsed before the Red Cross symbol was embroiled in religiously based contention by a Muslim nation. During the war between Christian Russia and Islamic Turkey in 1876-1878, the Ottoman Empire used a white flag with a red crescent in lieu of the Red Cross symbol because it believed that the Red Cross was offensive to its Muslim troops.

In 1929 Egypt petitioned the ICRC to formally adopt the Red Crescent and a flag bearing a red lion and a red sun as alternatives to the Red Cross symbol. They were accepted.

In 1949 the Netherlands and Israel each petitioned for approval of new symbols, but were rejected, as was a request to revert to the Red Cross as the sole authorized symbol. Israel refused to sign the Geneva Convention based on the rejection of it proposal to use the Red Star of David (used within Israel) as an internationally authorized symbol.

In 1980 Iran waived its right to continue using the red lion and red sun in favor of adopting the Red Crescent symbol.

In 1999 the ICRC established a working group to address comprehensively the question of which symbol or symbols should be authorized officially for future use. The goal was to avoid any symbol with any national, political or religious connotation. Member nations rejected the abandonment of the existing Red Cross and Red Crescent symbols in favor of new symbol.

So, a new religiously neutral symbol was designed consisting of a red square rotated 45 degrees (to stand on a corner) on a white background.

In 2005 – 2007 the ICRC took the steps necessary to formally adopt the Red Cross, the Red Crescent and the new Red Crystal as official symbols to be used by signatory nations. Muslim signatory nations fought the approval because it would pave the way for Israel to join the ICRC. Upon the approval of two signatory nations the symbol was officially adopted and Israel joined the ICRC. Israel reserved the right to display the new Red Crystal with a Red Star of David within it for use within its national borders.

Is it reasonable to believe that Muslims in Afghanistan are more culturally tolerant than those in other Muslim nations? Would the Taliban avoid exploiting a historical distrust of any group that displays a symbol that includes a cross?

Background

In late October a concerned Iowan contacted Senator Harkin’s office by letter and fax expressing her concern about the risks endured by Army MEDEVAC pilots and crews because they fly unarmed while displaying large Red Cross emblems on white backgrounds. She also expressed concern about the resulting delays in launching some missions while an armed chase or escort helicopter is found or diverted from another mission to accompany the MEDEVAC helicopter. (See the full letter and a commentary here.)

How the Senator Enlightened His Constituent

• “The reason for not allowing medical evacuation vehicles to be armed can be traced to World War I, when German military units disguised themselves with red crosses to conduct sneak attacks.”
  • False. The relevant articles within the Geneva Convention date to the mid-1800′s.

• “…combat search and rescue helicopters that are unmarked with a red cross, do not carry doctors…”
  • True. Combat Search and Rescue helicopters are unmarked with a red cross.
  • Deceptive. CSAR helicopters do not carry doctors. Neither do U.S. Army MEDEVAC helicopters. Only the UK’s unmarked, armed MERT-E medical evacuation helicopters carry doctors.

• “…medevac helicopters…maintain a full complement of medical equipment for military doctors to use.”
  • False. It depends on what you think is a “full complement of medical equipment“. There is a realistic limit on what can be done in the madly vibrating, noisy environment of a helicopter. Also, the Army’s decision for the past dozen years to ignore pleas from its own expert doctors and MEDEVAC officers to deliver more advanced medical training to its flight medics has limited what can be done by the on board medics – regardless of what equipment might be on board.
  • False. Military doctors do not fly on MEDEVAC missions in the U.S. Army.

Senator Harkin ends with this:

“However, the lessons of history clearly show that allowing medevacs to become military targets is simply a worse alternative.“

Chose all answers that you believe are true.

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.

Another argument put forth is about how the Red Cross symbol itself is a morale booster for troops. They argue that arming the helicopters would require the removal of the very symbols that lift spirits out in the field. It seems more likely that morale is boosted not by a paint scheme, but by the anticipated arrival of a medical evacuation aircraft. It is a matter of conditioning – troops would cheer Barney the dinosaur if it was painted on the nose of armed MEDEVAC helicopters.

It’s Not Easy Being Green

This got me thinking about the color of the Army’s unarmed MEDEVAC helicopters in Afghanistan. Afghanistan is mostly devoid of forests, and the terrain is more likely to be described as being beige or grey rather than green except along rivers. Yet, MEDEVAC helicopters – like other Army helicopters – sport “Aircraft Green” paint that was selected in the Cold War when the expected battlefield would be the Fulda Gap in Germany or the jungles of Southeast Asia. That dark green shade is out of place in Helmand Province and elsewhere in Afghanistan as much as it was also out of place in Iraq. However, the Army’s fixed wing aircraft have adopted the light blue-grey color long favored by the US Air Force, US Navy and US Marine Corps for its helicopters and fixed wing aircraft:

(All photos courtesy of the Department of Defense, US Air Force and US Army)

Sometime between 2006 and summer of 2010 the Army Aviation Applied Technology Directorate conducted research to determine the best colors to reduce detectability of helicopters across desert and vegetative terrain and against sky backgrounds. The tests assessed visibility at distances of 1km and 3km from a computer modeled ground observer. Color samples were obtained from desert terrain in AZ and CA, and vegetative background colors were gathered from Monterey and Carmel Valley in CA.

The results included three recommended monotone paint choices – optimized tan (FS30372) for desert environments, optimized green for vegetated environments and a mixed color (FS34201) paint for mixed desert and vegetated terrain.

This is the mixed color solution applied to a test CH-47F airframe:

The tests showed that increasing the camouflage color more to the blue-grey end of the scale did not reduce the ability of the program to identify the helicopter against the sky. The sky has so many different lighting conditions that the program was always able to discern the helicopter. The problem was the underside of the helicopter will almost always appear black from a distance in the sky regardless of the color it is painted because it is in the shadow of the aircraft. As a result, the Army elected to downplay the need to camouflage its helicopters against a sky background, and to emphasize camouflaging them against terrestrial backgrounds.

During the Cold War the Air Force trained its pilots in T-34 and T-38 trainers. In order to minimize the risk of mid-air collisions the Air Force painted its trainers white with red or orange tails and wing tips because that scheme that yielded high visibility for the aircraft. After additional research the Air Force determined that the color scheme that yielded the highest visibility was black accented with white:

Errr, Right.

• Dark background? Check.
• White contrasting sections? Check.
• Red markings for enhanced visibility? Check.

How’s this?

And this?

Wait! Isn’t that the standard paint on MEDEVAC helicopters in Afghanistan? Ah, yea as a matter of fact it is!

Well, seriously. How important is visibility in an age of shoulder fired missiles? Does it really matter that the Army paint scheme maximizes visual perceptibility for ground observers?

According to a just released Department of Defense study of U.S. aircraft damage in Afghanistan the following weapons were responsible:

(1) Includes all hand-carried rifles such as the AK-47.

(2) Includes all larger caliber, typically mounted, weapons such as the 12.7 mm DSHk and PKM. Also includes the 14.5 mm ZPU family of weapons.

(3) Man-Portable Air Defense System

In Afghanistan, as in insurgencies in general, the bad guys do not have an air force. This relieves the concern of a visual look-down, shoot-down scenario where a terrain matching paint scheme would provide some protection. Unless a major power is sponsoring the insurgents, they also tend not to have shoulder mounted anti-aircraft missiles or other systems that use heat seeking, laser or radar targeting systems. This has been the case in Iraq and Afghanistan. The types of hostile fire that downed American helicopters are visually sighted small arms (e.g. AK47s), heavy machine guns, and rocket propelled grenades. So choosing a paint color that minimizes the ability of an enemy to accurately find, track and target an airborne unarmed MEDEVAC helicopter sounds like a pretty good idea.

Aircraft High Lights

One thing that the Army paint tests did get right – the undersides of aircraft tend to be perceived as being black because of the angle of the sun relative to the aircraft. This is not a new problem. As a matter of fact it was addressed by the US Navy during WWII when it discovered that the success of its anti-submarine patrols against surfaced submarines was less than expected. In the days before widespread installation of radar German U-Boat look-outs were able to visually spot the black image of the approaching aircraft 12-15 miles away which gave the Captain plenty of time to dive the boat and make targeting it much harder.

In a surge of ingenuity the idea of counter-illumination was tested under Project Yehudi. Strong spotlights were placed on the leading edges of the wings and around the engine cowling of Navy Avenger dive bombers. By adjusting the brightness of the lights to match the ambient light level behind the aircraft the distance at which the aircraft could be discerned dropped from 12-15 miles to about 2 miles. This made it possible for the plane to get close enough to a submarine to launch a torpedo or drop a bomb before the submarine had time to dive.

Similar tests also were conducted successfully on Army Air Corps bombers with the lights arrayed beneath the wings and fuselage of the aircraft because of their higher altitude flights.

While the Project Yehudi tests were successful, the spread of radar to submarines and ground anti-aircraft batteries made the lighting solution less useful and the idea was dropped. It was resurrected under Project Compass Ghost during the Vietnam War when the massive F4 Phantom flown by the Air Force, Navy and Marines proved to be exceptionally easy to spot visually due to its size and smoke trail. The lights reduced the visual acquisition distance by 30% but proved inadequate to the task. An outcome that was adopted was the blue grey color now used extensively on aircraft across the US military…except the Army’s helicopter fleet.

Currently, research is being done with electroluminescent panels on drone aircraft that has demonstrated once again that visual target acquisition is significantly impaired when Yehudi/counter-illumination lights are deployed.

So What Now?

This seems to be a perfect scenario for the Army to adapt either:

• The color that the Army Aviation Applied Technology Directorate determined at least two years ago to be optimal for helicopters in Afghanistan to use, or
• The well-established helicopter color scheme used by the USAF, USN, and USMC for their helicopter forces.

At a minimum it seems that unarmed, unarmored aircraft such as MEDEVAC Blackhawks should benefit from anything that reduces their susceptibility to visually aimed ground fire. The cost would be minimal and would require no modifications to the airframe or change orders for helicopters in procurement other than a change in the paint color to be applied.

Would the new color scheme provide reduced visibility in all conditions? Certainly not, but either new color scheme does better than the solid OD green currently used.

The Army doesn’t send combat medics out with ground units dressed in fluorescent yellow uniforms…does it?

Artist’s conception

 (Note to self: check if combat medic uniforms actually are designed for highest possibility visibility.)