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Saturday, September 1, 2007

The Military Spin: Joint Service Medevac Capabilities

Steve Colby

EMERGENCY MEDICAL SERVICE is a primary mission for some and secondary one for most military helicopter units. As an aid to civil disaster planning officials, I offer here the different U.S. services’ doctrinal medic, corpsman, and swimmer capabilities.

Air Force pararescuemen (PJs) attend grueling training starting with a 10-week indoctrination course. Graduates go on to dive, survival, and military freefall schools and basic airborne, underwater egress, and National Registry of Emergency Medical Technicians’ (NREMT) paramedic training.

Next, PJs attend the pararescue course at Kirtland AFB, N.M., where they learn career-field skills such as combat-trauma medicine, advanced land navigation, advanced survival, small-unit tactics, combat marksmanship, adverse-terrain rescue, precision static-line jumping, and working with the Rigging, Alternate Method, Zodiac boat. Field exercises integrate these skills. Lastly, they train in-unit in assigned aircraft.

Air Force HH-60G combat search and rescue (CSAR) missions traditionally fly with 2-3 PJs per aircraft. They carry: fast and rappel rope, medical ruck, extrication kit, medical oxygen, collapsible litter, medical accessory bag, Stokes litter, spine board, Propaq vital-signs monitor, and military anti-shock trousers (MAST). Payloads and patient requirements dictate the number of PJs and equipment carried on civil SAR missions.

Navy SAR training has a different primary focus. Navy SAR-capable helicopters primarily handle carrier battle-group rescue, CSAR, special ops, battle-group defense against ships, subs, and mines, and vertical replenishment. Back-enders are predominantly aviation warfare systems operators. They include hoist operators and rescue swimmers. In a four-week school, rescue swimmers learn water-rescue techniques, first aid, and CPR. This training continues at the swimmers’ platform-specific training squadron. Occasionally, squadrons send one or two swimmers to EMT school to "train the trainer." Up to four crewmen a year are sent to the Coast Guard’s advanced rescue swimmer school.

Mission-qualification training is tailored to Navy H-60 variants. The SH-60B carries a hoist operator and a rescue swimmer and up to eight survivors on SAR flights. Its radio complement makes it an ideal SAR command-and-control platform. The -60F carries two crewmen and up to 10 survivors on SAR flights and employs the fast rope for team insertion. (It and the HH-60H are the Navy’s major CSAR players. They can fly with corpsmen to treat trauma.) The MH-60S carries two crewmen on SAR flights and provides CSAR coverage. It has the largest clear cabin in the Navy H-60 fleet. All Navy H-60s can carry a medevac litter, level "A" medical bag, backboard, head blocks, blankets, oxygen, drugs, a Lifepak automatic defibrillator and monitor, SKED, suction, and splints. The Coast Guard SAR basket is a new capability for the Navy. All crewman employ the TRI-SAR direct-deployment swimmer harness used well in many Hurricane Katrina rescues.

The Marine Corps has a formidable helicopter force whose missions vary but are focused on Marine air group support, CSAR, and air assault. They provide rescue capabilities on an as-capable basis. If pressed during disaster or combat, the Marines can provide assistance with their onboard crewmen. They deploy with EMT-qualified corpsmen or hospitalmen during combat and SAR missions, but they are not customarily trained in rescue swimmer techniques.

Coast Guard crewmembers attend a grueling, 18-week program at the Aviation Technical Training Center in Elizabeth City, N.C. It includes eight weeks of intensive physical and pool training to prepare rescue swimmers for the challenges of operating in heavy seas for 30 min. An eight- week academic block follows. The last two weeks prepare trainees with basic aircraft systems classes. New aviation survival technicians finish with on-the-job upgrades at their first assignment at one of 25 air stations. Some air station commanders unilaterally direct that a corpsmen join their medevac flights. The proximity of medical facilities, cabin space, payload, patient condition (if known) drive that and equipment decisions. A diverted patrol flight would likely not have a corpsmen aboard; the rescue swimmer would be solely responsible for the survivor/patient. The Coast Guard equipment list is very similar to the Navy’s but highly dependent on space and payload, which varies widely between the HH-65 and HH-60J.

The HH-60 is the dedicated U.S. Army medevac force. Medevac crews always consist of two pilots, a crew chief and a flight medic. They carry litters, burn kit, MAST, splints, oxygen, suction, backboard, head blocks, ambu bag, fluids, blankets, ice, Kendrick extrication device, Lifepak, drug box, and aide bag. Flight medics are enlisted health-care specialists trained to perform independently in combat to the NREMT basic level. They receive four extra weeks of training in aeromedicine, advanced trauma and cardiac life support, pediatric pre-hospital care, and tactical combat-casualty care.

Special thanks to Army Master Sgt. Carl Martin, Coast Guard Senior Chief Petty Officer Lewis Hart, Marine Maj. Dolph Sampson, Navy Chief Petty Officer Matt McOmber, and Air Force 1st Lt. Jason Egger for their input.

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