MEDEVAC Matters

2009 – MEDEVAC Force Expansion

“All 37 MEDEVAC companies grew from 12 to 15 aircraft and 85 to 109 personnel.  In addition, 9 MEDEVAC companies were added to the Reserve Component.  Six new LUH [Light Utility Helicopter] MEDEVAC Companies with 8 aircraft each were added to the Reserve Component in support of Homeland Security and available for deployment to permissive environments.

• The addition of 9 MEDEVAC Companies and 12 to 15 aircraft will result in a 60% increase in MEDEVAC aircraft in direct support of the Warfighter (an increase from 336 to 555 aircraft).

• The addition of 12 Flight Medics in each of the 37 MEDEVAC Companies is a 100% increase in strength.

• Additional MEDEVAC companies deployed to theater reduced evacuation times from 1 hour 40 minutes to 45 minutes, meeting the “golden hour” goal.  The golden hour is the 60 minute period after trauma, after which the chances of survival for wounded Soldiers drop significantly.”

Comment: In 2005 the number of MEDEVAC helicopters assigned to medical companies was dropped from 15 to 12. This innovation restored the cuts made 4 years earlier. The six new LUH MEDEVAC companies are outfitted with light MEDEVAC helicopters for non-combat area deployment only. The reduced evacuation times resulted directly from a mandate issued by Secretary of Defense Robert Gates to reduce the average time from nearly two hours to the “Golden Hour” standard used in the civilian trauma rescue world for the prior forty years. Interestingly, the AMEDD Journal published an article labeling the “Golden Hour” a myth.

2007 – UH-72A Lakota MEDEVAC Helicopter

In April of 2005, Headquarters, Department of the Army approved acquisition of a Light Utility Helicopter, UH-72A Lakota, manufactured by EADS North America. The UH-72A Lakota is a militarized version of EADS North America’s commercial helicopter model EC-145. By purchasing a proven commercial airframe, the Army streamlined the acquisition process, obtained advanced aviation technology, and minimized research and development cost.

The UH-72A’s high set main and tail rotor make the MEDEVAC equipped version an extremely capable evacuation platform. Additionally, the UH-72A offers rear loading clamshell doors, externally mounted rescue hoist and space for two litters or four ambulatory patients.

The UH-72A MEDEVAC is also well equipped to support high quality en route medical care. The aircraft supports full use of medical equipment set components including a defibrillator, vital signs monitor, ventilator and suction.

In July 2007, the U.S. Army Air Ambulance Detachment at Ft. Irwin, CA, became the US Army’s first operationally fielded UH-72A unit. The Army will field the new UH72A MEDEVAC aircraft to both active component and US Army National Guard Units.

Comment: The UH-72A Lakota deployment is limited to the United States and other non-combat areas.

2003 – Stryker Medical Evacuation Vehicle

Adapted from an article by Karen Fleming-Michael
Fort Detrick, Md., Standard

	Interior of the Stryker Medical Evacuation Vehicle. The medical attendant seat (center) allows the attendant to view all patients and monitor all equipment simultaneously. (Photo by Project Managers Office, Brigade Combat Team)

As the Army transforms its vehicle inventory for the Stryker Brigade Combat Teams, team medics will receive their new evacuation vehicles early next year.

“The important thing is it [the medical variant of the Stryker] has the mobility and ability to keep up with the forces. It lets us actually be there when we’re needed,” said Steve Reichard, Army Medical Materiel Development Activity product manager. “In Desert Storm, we were routinely one to two hours behind the forces.”

The medical evacuation vehicle can evacuate four litter patients or six ambulatory patients while its crew of three medics provides basic medical care.

The first five medical variants of the Stryker rolled off the assembly line at Anniston, Ala., in late fall. They are being tested at Aberdeen Proving Ground, Md., and Yuma Proving Ground, Ariz., before delivery to the Stryker Brigade Combat Team at Fort Lewis, Wash., in March, said Maj. Steven Wall of the Project Manager-Brigade Combat Team in Warren, Mich., which is part of the Program Executive Office-Ground Combat and Support Systems.

Wall said fully equipping an entire Brigade Combat Team would require 17 of the vehicles.

In addition to the medical variant, the Army’s nine other Stryker variants include an infantry carrier, mobile gun system, anti-tank missile guided vehicle, reconnaissance vehicle, fire support vehicle, engineer vehicle, mortar carrier, commander’s vehicle, and nuclear, biological and chemical reconnaissance vehicle. Each Stryker variant can sustain speeds of 60 miles per hour, has robust armor protection and a central tire-inflation system and shares the same chassis and repair parts. The medical variant boasts distinct differences.

When compared to its brothers, it has a higher roof.

“The headroom isn’t so much to let the medics stand up in it, but to get space above the litter patients. If something happens and the medic needs to get to the patient to do CPR, apply a pressure bandage or start an IV, there’s room to do that,” Reichard said.

An automatic litter-lifting capability will improve on the current M-113 ambulance, which will continue to accompany heavy fighting forces. In the M-113, “the medic is hunched over, trying to carry and lift a litter from an awkward posture,” Reichard said. “[With the Stryker], all the medics have to do is carry the litter to the back of the vehicle, load it on a tray, push it in and the vehicle will slide the litter over to the side then raise it up.”

The Stryker’s interior also accommodates more medical supplies and equipment than the M-113, as well as some crew gear.

“That’s not to say everything can fit inside it, because it can’t, but critically needed items will be more accessible,” Reichard said.

An additional improvement is the communications equipment on the medical variant. The vehicle is equipped with the same communications package as the rest of the force, which will give medics the situational awareness to know where everyone else on the battlefield is so they can get to casualties faster, Reichard said.

The medical evacuation vehicle is light, a requirement for deploying it on an Air Force C-130 Hercules transport aircraft.

“When you think about it, it doesn’t have the gun, it doesn’t have the ammunition. It’s a pretty empty vehicle until you get people in it,” Reichard said.

“There’s a set list of what has to go inside the vehicle, and it all has to fit somehow,” Reichard said. “We’re doing the best we can to make sure everything fits in the most ergonomically sound way that we can.”

Although abundant in features, the medical Stryker’s developers are planning additional upgrades, Reichard said. For example, planners wanted the vehicle to have air conditioning but funding didn’t permit it.

“We had to pre-plan product improvements because of funding availability,” Reichard said. “So we had to figure out what we needed to trade off and what we needed to fight for. Our goal was to try to get the vehicle as good as we could get it within the budget we were given.”

From the December 2002 Mercury, an Army Medical Department publication.

2002 – High Tech Bandages

Uncontrolled bleeding is a major cause of death in combat. About 50 percent of those who die on the battlefield bleed to death in minutes, before they can be evacuated to an aid station. New blood-clotting bandages will save lives on the battlefield.

Fibrin bandage

• Contains fibrinogen and thrombin, clotting proteins in blood.
• Can reduce blood loss by 50 to 85 percent.
• Approved by the Food and Drug Administration for investigational use by special operations soldiers, with informed consent by the patient.
• Developed by the U.S. Army Medical Research and Materiel Command and the American Red Cross. Produced by CSL, Ltd.

Chitosan bandage

• Made of chitosan, a biodegradable carbohydrate found in the shells of shrimp, lobsters and other animals.
• Chitosan bonds with blood cells, forming a clot.
• In test, effectively stanched a wound bleeding at a rate of 300 milliliters per 30 seconds.
• Approved by Food and Drug Administration in November 2002.
• No hazard to people allergic to shrimp.
• Developed by Oregon Medical Laser Center on a grant from the U.S. Army Medical Research and Materiel Command. Produced by HemCon, Inc.

One-handed tourniquet

• Allows an isolated soldier to stop bleeding in an arm or leg without assistance.
• Issued to special operations soldiers.
• Consists of loops of nylon webbing that tighten when pulled to shut off blood flow.
• Exempt from Food and Drug Administration approval.
• Developed by U.S. Army Medical Research and Materiel Command. Produced by Canvas Specialties.

Comment: While not limited to MEDEVAC environments, these innovations have proven to be major factors in the enhanced survival rates in Afghanistan and Iraq.

2000 – New MOS – 91W Health Care Specialist

Modern battlefields feature highly mobile formations rapidly moving over a large area. Casualties are likely to be far from medical facilities and require sustaining care for an extended time before evacuation can be complete. The U.S. Army therefore is restructuring its military occupational specialty for enlisted combat medics, providing them more training to help them save lives on the battlefield and maintain care until the patient can be removed to a medical facility. These soldiers also provide more highly trained medics for service on hospital wards.

• All 91W (Health Care Specialist) soldiers will be qualified as nationally registered Emergency Medical Technicians.
• The course for training new combat medics has been extended from 10 weeks to 16 weeks.
• Training includes theories and practices of Basic Trauma Life Support or Pre-hospital Trauma Life Support, Trauma AIMS (advanced airway, intravenous therapy, medications and pharmacology, shock management), and CPR (cardiopulmonary resuscitation).
• Medics in the former military occupational specialties of 91B (Combat Medic) and 91C (Licensed Practical Nurse) are reclassified as 91W. All active-duty 91W will complete the additional training necessary by Oct. 2, 2007, while Reserve 91W will complete training by Oct. 1, 2009.
• Approximately 40,000 active-duty and Reserve 91Ws form the third-largest military occupational specialty in the Army.

1997 UH-60L Improved MEDEVAC Helicopter

The UH-60 Blackhawk’s use as a MEDEVAC helicopter predates Operation Desert Storm, although about 75 percent of the MEDEVAC helicopters used in Desert Storm were the Vietnam-era UH-1.

The significantly improved UH-60L provides many on-board medical capabilities, including an oxygen-generating system, integrated suction systems, medical storage, external rescue hoist and an improved interior treatment space. In addition to medical improvements, the helicopter’s avionics, navigation, communications and interior lighting systems have been improved.

A small number of UH-60Ls are in use in current operations. Also in use is the HH-60L, with enhanced capabilities in patient locating, extraction and en-route medical care.

1995 Forward Surgical Teams

If an injured person receives advanced medical care within the first hour after injury, the chances of survival and recovery go up exponentially. Historically, 10 to 15 percent of wounded in action require surgical intervention to control hemorrhage and provide stabilization for evacuation. Highly mobile surgical teams deployed far forward near the fighting allow this to happen.

The forward surgical team:

• Provides versatility, expandability and deployability.
• Deploys in the area of a maneuver brigade or armored cavalry regiment.
• Typically includes 20 staff members organized into four functional areas: triage-trauma management, surgery, recovery and administration/operations.
• Can provide initial surgery on two operating tables, and up to six hours of postoperative care for a maximum of eight patients at a time.
• Can treat major chest and abdominal wounds, continuing hemorrhage, severe shock, compromised airway or respiratory distress, amputations, major organ fractures, crush injuries, and acutely deteriorating consciousness with closed head wounds.
• May be attached to a combat support hospital to provide additional surgical capability.

Forward surgical teams maintain skills and learn teamwork by treating patients during rotations at the Army Trauma Training Center, working in association with the Ryder Trauma Center at Jackson Memorial Hospital in Miami, Fla.

Comment: This has proven to be a breakthrough in providing lifesaving care to wounded troops. Again it is interesting to note that despite the comment contained here, the Army Medical department has published articles decrying the “Golden Hour” as a myth and unimportant in affecting survival odds. Of course, those articles were published during the period before 2009 when it was using a two hour MEDEVAC mission timeline as a measure of success. In 2009, Secretary of Defense Gates mandated the Army to begin adhering to the “Golden Hour” metric for successful performance.

Source for these entries is the Army Medical Department website.