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Thursday, November 1, 2012

Uplifting News for Combat Casualties

By Andrew Drwiega

One of the amazingly positive results to have come from the war in Afghanistan is the increase in survival rate of battlefield casualties airlifted to in-theater hospitals by helicopter. From the days of extracting casualties from the frontlines by Bell 47/H-13 during the Korean War around 60 years ago, the methods and techniques have moved on to the point where a Medical Emergency Recovery Team (MERT) of two paramedics, one nurse and one consultant now travel into the danger zone in the back of a medically equipped Boeing CH-47. Currently, this is use of a Chinook is solely a British activity but its achievements have been widely praised and there is a strong desire to replicate it within areas of the U.S. military.

With a medical consultant onboard in addition to the other specially trained team members, the “Golden Hour” clock is slowed significantly, if not stopped, when treatment of the casualty begins in the back of the helicopter as it lifts off from an emergency landing zone cleared by Troops in Contact (TICs) in the boonies.

“What we are essentially doing is taking an A&E [accident and emergency] department in the back of a CH-47,” said Wing Commander Andy Evens, SO1 Med Ops, Royal Air Force Tactical Medical Wing, who has been one of the MERT team members in Afghanistan.

“We deliver as much treatment as we can. Intravenous (IV) lines are set up for standard casualties but in cases of multiple amputee trauma victims where huge blood loss occurs resulting in the inability to get fluids into veins that have collapsed, we use intraosseous access where we drill into humeral head, end of humerus or sternum and inject fluids through those particular bones.”

“We get two lines into the patient from minute one into the helicopter and we immediately start giving blood products,” he continued. “The delivery of blood products pre-hospital has saved many lives in the back of the Chinook to the point where the civilian UK air ambulance structure are now considering taking blood on board their helicopters as they see the value of bringing it to the actual scene of the accident.”

The type of blood given is universal blood at this stage without waiting to cross match it. Evans said that “while on the negative side the universal blood can distort the picture when they are trying to perform an identification of blood type, the hospital always conducts its own lab test to fully determine the exact type.”

The absorption of blood and/or plasma into the bone, although it has to be warmed and injected with some degree of force, is very quick, continued Evans. “A patient will come onboard with no radial pulse and normally by given less than 500mls of blood. After that you will get a radial pulse back—it is that quick.”

“We are providing the top end of the capability in our Area of Operation (AO) from Camp Bastion,” he said. He added that the reason the U.S. did not currently do the same was that there were misgivings about sending consultants forward into dangerous areas, but that the concept was currently being debated. In addition, the supply of consultants for U.S. forces would need to be large. “The number of consultants required for all of their operations around the world would be considerable, but there are discussions between U.S. military and the UK Tactical Medical Wing on this subject.”

But Evans restated that the RAF is also now well practiced and committed to using the MERT based on a dedicated Immediate Response Team CH-47, complete with RAF Regiment security force of four soldiers: “We always have a dedicated aircraft ready to go.”

Following the announcement that the U.S. Air Force has relaunched its Combat Recovery Helicopter (CRH) procurement program, this option must surely be one that again deserves close consideration. Last time around the CSAR-X competition that was due to select a replacement for the USAF’s HH-60G Pave Hawk (Pedro) combat search-and-rescue helicopters. Aircraft put forward included two offerings from Boeing—the PRV-22 Osprey and the HH-47 Chinook, Sikorsky’s H-92 Superhawk and Lockheed Martin’s bid of the US101 (from AgustaWestland).

The Chinook HH-47 won the CSAR-X competition in November 2006 before its competitors objected and the whole thing was “deep-sixed” in 2009. Although budget and numbers will be a key issue in this new competition the opinion that the CH-47 was too big and noisy to operate as a combat recovery helicopter now seems irrelevant following the extensive use by the RAF in Afghanistan.

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