In Operation Enduring Freedom being fought in Afghanistan against Taliban and al Qaeda forces, American and coalition forces in the ISAF depend upon helicopters for evacuation of wounded soldiers from the battlefield. The long distances involved between combat areas and medical facilities, and the fact that most roads are strewn with improvised explosive devices makes the use of helicopters vital.

Helicopter Assets

The helicopters used for medical evacuations are under the centralized control of a joint NATO command that counts among its assets:

  • U.S. Army helicopters (MEDEVAC – unarmed and marked with large Red Crosses on a white background on all visible surfaces; known as “Dustoff”)
  • U.S. Air Force helicopters (CSAR/CASEVAC – armed, unmarked; known as “Pedro”)
  • U.S. Marine Corps helicopters (CASEVAC – armed, unmarked) 
  • British armed forces helicopters (CASEVAC – armed, unmarked; known as “MERT”)

Policies and Issues

Policies and Issues Affecting MEDEVAC Missions

Each of these topics will be covered in turn in detail on separate pages of this web site. The policies, procedures and issues are intertwined and no solution can be effected without changing multiple policies and procedures currently in place.

For example, the policy in effect in Afghanistan that all helicopters must fly in pairs – and in many cases that requires an armed escort –  is linked directly to the number of helicopters deployed to Afghanistan – in particular the number of armed attack helicopters (Apache, Kiowa Warrior, etc.). Because there is a shortage of helicopters, it is inevitable that some MEDEVAC missions will be delayed because all armed escort helicopters are either already on escort or combat support missions or are down for maintenance.

Another example is the policy that MEDEVAC units are now part of Combat Aviation Brigades links with the policy of no armed escorts are dedicated to MEDEVAC units. Those helicopters have a priority in the eyes of combat commanders to support ground combat unit missions. The result again can be delayed MEDEVAC missions.

The Army policy that it will only fly unarmed MEDEVAC helicopters prominently marked with large Red Cross symbols announces to the enemy that they are defenseless, which in turn reinforces the policy that they often must be escorted by attack helicopters to protect them.

In the 1960’s the civilian trauma care world shifted to a benchmark of the “Golden Hour”, meaning trauma victim survival improves when they are in the care of doctors within 60 minutes of their injury. Until Secretary of Defense Gates insisted in 2009 that the Army MEDEVAC use this performance benchmark, the MEDEVAC missions were graded on meeting a 2 hour timeline to recover wounded soldiers and delivery them to a medical treatment facility. The effect of this direct order was that more helicopters were finally deployed to Afghanistan in 2009-2010.

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