Evacuation is the timely, efficient movement of the wounded, injured, or ill persons from the battlefield and other locations. Knowledge of evacuation platforms will enable the medic to make quicker decisions that could result in saving life, limb, and/or eyesight.
(1) Ground ambulances are vehicles designed for or converted to carrying patients
(a) They are dedicated assets to be used solely for the medical mission
(b) They may be organic to the combat battalion in which the driver and aidman are assigned
(c) These vehicles are equipped with a Medical Equipment Set designed for use in these ambulances, it consists of
(i) The Aidmans Aid Bag or CMVS
(ii) Long and short back boards, KEDs, and Cervical stabilization equipment
(iii) Supplemental Oxygen and suction equipment
(iv) Litters, patient securing straps and a blanket set
(d) They are staffed with a driver/medical aidman and an additional medical aidman who are both qualified in basic EMT procedures
(e) Track ambulances are staffed with three medical personnel (ambulance driver, track commander, and medical aidman)
(1) They are colocated with maneuverr elements and readily available when needed
(2) Operation is not limited by inclement weather
(1) Ambulance drivers are MOS qualified medics, their duties and responsibilities include but are not limited to the following:
(a) Responsible for the ambulance at all times
(b) Driver maintenance of the vehicle and reporting of major deficiencies to their section chief or supervisor
(c) Providing emergency medical care as necessary
(d) Providing maximum safety and welfare to the patients entrusted to their care
(e) Ensuring the operational readiness and responsiveness of their vehicle and equipment
(iv) Medical expendables
(v) Oxygen canisters
(vii) Auxiliary fuel
(viii) Decontamination equipment
(ix) Special medical materials and equipment
(f) Ensuring they have the required information, tools, and equipment to navigate to the pick-up location. This includes:
(ii) Map coordinates
(iii) Map overlays
(iv) Compass and position locator equipment such as GPS
(g) Preparing the ambulance for loading and unloading
(h) Assisting litter bearers in the loading and unloading of patients
(i) Performing property exchange when patients are loaded or unloaded
(j) Providing emergency transport of medical personnel, medical supplies, and blood and blood products
(k) Acting as a messenger in medical channels
(2) The medical aidman's duties and responsibilities include:
(a) Assistant driver
(b) Familiarity with the condition of each patient being transported and reviewing the information on the Field Medical Card (FMC)
(c) Coordination with the individual in charge for any special instructions in the care and treatment of patients en route
(d) Providing Emergency Medical Treatment as required
(e) Making periodic checks of patients while en route
(f) Supervising and assisting in loading and unloading of the ambulance
(f) Assisting the driver with land navigation and guiding the driver when backing or moving off roads, or when under blackout conditions
(1) Vehicles designed or modified as ambulances include field (wheel) ambulances, and the M13 (track) armored personnel carrier
(a) Military field ambulances are designed for use by field units, they can operate on:
(i) Paved and secondary roads, trails, and cross country terrain
(ii) They must possess mobility and survivability comparable to the units being supported
(b) Current field ambulance variations include (These ambulances are normally used to evacuate patients from front line units to Battalion Aid Stations)
(i) Truck Ambulances, 4x4 utility HMMWV (M996 and M997) casualty carrying capacity
* M996: 2 litter or 6 ambulatory or 1 litter and 3 ambulatory
* M997: 4 litter or 8 ambulatory or 2 litter and 4 ambulatory
(ii) Carrier personnel, Full tracked, Armored, M113, T113E2 (when configured with a litter kit, an NBC kit, and an MES, is classified as a standard evacuation vehicle) carrying capacity
* 4 litter or 10 ambulatory or a combination of the two
(1) In loading and unloading ambulances litter casualties are moved carefully so as not to cause additional discomfort and or injury. Procedures may vary depending on the number of litter bearers, the presence or absence of a medical aidman, and the type of vehicle used
(a) General Procedures
(i) Casualties are normally loaded head first for the following reasons
* They are less likely to experience motion sickness or nausea
* They experience less noise from doors opening and closing
* Less danger of further injury in the event of a rear collision
(ii) When a casualty requires en route care
* For an injury to one side of the body it may be necessary to load the casualty feet first to make the injury readily accessible
* For casualties that require I.V. therapy a lower berth may be indicated in order to obtain a gravity flow
* Casualties with bulky splints may also require a lower berth (if possible)
(b) Instructional procedures: For loading and unloading ambulances
(i) Litter bearers are numbered
(ii) Formal commands are given so that each individual can learn his particular job and work as a team
(c) Loading procedures
(i) Loading Sequence for four litter casualties
* Upper right
* Lower right
* Upper left
* Lower left
(ii) The most seriously injured are loaded last so that they will be the first to be off-loaded
(iii) A three man squad is required to load and unload the ambulance
(1) Aeromedical evacuation is accomplished by both helicopter and fixed wing aircraft
(2) Dedicated Aeromedical evacuation assets permit en route casualty care. This care minimizes further injury to the casualty and decreases mortality.
(1) The speed with which the casualty can be evacuated by air to a Medical Treatment Facility (MTF) ensures timeliness of treatment and contributes to:
(a) Saving lives
(b) Reducing permanent disability
(c) Increases the number of casualties returned to duty
(2) The range and speed of aircraft make it possible to evacuate casualties over long distances in short periods of time
(3) Helicopters can move casualties over terrain where evacuation by other means would be difficult if not impossible
(4) Because of speed, range, flexibility, and versatility of Aeromedical evacuation, casualties can be moved to MTFs best equipped to deal with their condition
(5) The selectivity of use of MTFs made possible by Aeromedical evacuation procedures permits
(a) Economy in the use of these facilities
(b) Fewer specialty treatment teams are required because Aeromedical evacuation assets allow the casualty to be evacuated directly to where they are located
(c) Hospitals are required to move less often thereby reducing their periods of noneffectiveness during movement and reestablishment
(1) It is the responsibility of the commander who initiated the evacuation request to have the casualty delivered to the landing site for loading aboard the aircraft
(2) The actual loading is supervised by Aeromedical evacuation personnel
(3) The soldier medic on the ground will direct litter teams to move casualties in concept with the air ambulance crew member directing approach to and loading of the aircraft
(1) Helicopters are rotary-wing aircraft that are capable of:
(a) Horizontal flight
(b) Vertical flight
(c) Lateral flight
(d) Hovering flight
(2) Their ability to circumvent terrain and obstacles, and the minimum requirements for takeoff and landing enable them to operate from areas inaccessible to fixed-wing aircraft or surface vehicles
(3) The helicopter's capability of flight at relatively slow speeds permits operations during periods of reduced ceiling and visibility
(4) Helicopters are organic to the air ambulance units and aviation units of the division and corps
(5) Military helicopters are designated by a combination of letters and numbers which are used to identify the basic mission and type:
(a) Observation helicopter (OH)
(b) Utility helicopter (UH)
(c) Cargo/transport helicopter (CH)
(6) The last two classes of helicopters can be used for the air evacuation of litter patients
(7) Army Medical air ambulances
(a) The UH-60A Blackhawk: This helicopter is used as the primary dedicated air ambulance
(i) Normal evacuation configuration
* Four litter patients and one ambulatory patient
(ii) Maximum evacuation configuration
* Six litter patients and one ambulatory patient
* Or seven ambulatory patients
(b) The UH-1H/V Iroquois: This aircraft also is used as a dedicated air ambulance
(i) Normal evacuation configuration
* Three litter and four ambulatory patients
(ii) Maximum evacuation configuration
* Six litter patients or nine ambulatory patients
(1) The unit requesting Aeromedical evacuation support is responsible for selecting and properly marking the helicopter LZ
(2) Criteria for Landing Sites
(a) The helicopter LZ and the approach zones to the area should be free of obstructions
(b) Sufficient space must be provided for the hovering and maneuvering of the helicopter during landing and takeoff
(c) The approach zones should permit the helicopter to land and take off into the prevailing wind whenever possible
(d) Landing sites should afford helicopter pilots the opportunity to make shallow approaches
(3) Definite measurements for LZs cannot be prescribed since they vary with
(e) Loading conditions
(f) Individual helicopter characteristics
NOTE: The minimum requirement for light helicopters is a cleared area of 30 meters in diameter with an approach and departure zone clear of obstructions
(4) Removing or Marking Obstructions
(a) Any object (paper, cartons, ponchos, blankets, tentage, or parachutes) likely to be blown about by the wind from the rotor should be removed from the landing area
(b) Obstacles, such as cables, wires, or antennas at or near LZs, which cannot be removed and may not be readily seen by a pilot, must be clearly marked
(c) Red lights are normally used at night to mark all obstacles that cannot be easily eliminated within a LZ
(5) In most combat situations, it is impractical for security reasons to mark the tops of obstacles at the approach and departure ends of a LZ
(6) If obstacles or other hazards cannot be marked, pilots should be advised of existing conditions by radio. In a training situation or at a rear area LZ, red lights should be used whenever possible to mark obstructions.
(1) When the tactical situation permits, a landing site should be marked with the letter "H" or an invened "Y, " using identification panels or other appropriate marking material (See LP# C191W021, Evacuation Request Procedures)
NOTE: Special care must be taken to secure panels to the ground to prevent them from being blown about by the rotor wash. Firmly driven stakes will secure the panels tautly; rocks piled on the corners are not adequate.
(2) If the tactical situation permits, the wind direction may be indicated by a Small wind sock or rag tied to the end of a stick in the vicinity of the LZ. The man standing at the upwind edge of the site with his back to the wind and his arm extended forward.
(3) Smoke grenades that emit colored smoke as soon as the helicopter is sighted. Smoke color should be identified by the aircrew and confirmed by ground personnel.
(4) In night operations. the following factors should be considered:
(a) One of the preferred methods to mark a landing site for aircrews using NVGs is to place a light such as an infrared chemical light at each of the four corners of the usable LZ
(i) These lights should be colored to distinguish them from other lights which may appear in the vicinity. A particular color can also serve as one element in identifying the LZ.
(ii) Flare pots or other types of open lights should only be used as a last resort. They usually are blown out by the rotor downwash. Further, they often create a hazardous glare or reflection on the aircraft's windshield.
(iii) The site can be further identified using a coded signal flash to the pilot from a ground operator. This signal can be given with the directed beam of a signal lamp, flashlight, vehicle lights, or other means.
(iv) When using open flames, ground personnel should advise the pilot before he lands. Burning material must be secured in such a way that it will not blow over and Start a fire in the LZ.
NOTE: Precautions should be taken to ensure that open flames are not placed in a position where the pilot must hover over or be within 3 meters of them.
(v) All lights are displayed for only a minimum time before arrival of the helicopter. The lights are turned off immediately after the aircraft lands. Blue and green light sources should only be used as a last resort; the filter on the NVGs may make them difficult to detect.
(vi) When standard lighting methods are not possible. pocket-sized white (for day) or amber (for night) strobe lights are excellent means to aid the pilot in identifying the LZ.
(vii) During takeoff, only those lights requested by the pilot are displayed; they are turned off immediately after the aircraft's departure.
(viii) When the helicopter approaches the LZ the ground contact team can ask the pilot to turn on his rotating beacon briefly. This enables the ground personnel to identify the aircraft and confirm its position in relation to the LZ.
(1) Responsibility for Loading and Securing.
(a) The pilot is responsible for ensuring that the litter squad follows the prescribed methods for loading and securing litters and related equipment.
(b) The final decision regarding how many patients may be safely loaded rests with the pilot.
(2) Guides for Loading Patients.
(a) Litter patients should be positioned in the helicopter according to the nature of their injuries or condition. Personnel aboard the aircraft supervise the loading and positioning of the patients. Normally, the helicopter has a crew of four. The crew consists of a pilot in command (PC), copilot (PI), crew chief, and flight medic.
(b) The most seriously injured patients are loaded last on the bottom pans of the litter suppott unit. However, if it is anticipated that a patient's medical condition may require in-flight emergency medical care (such as cardiopulmonary resuscitation), he should be loaded onto either of the top pans to facilitate access to him.
(c) The structuring of the litter suppott unit allows patients to receive IV fluids and oxygen in flight. Patients receiving IV fluids can be placed on any of the litter pans, depending on their injuries or condition.
(d) Patients in traction splits should be loaded last and on a bottom pan
(e) The UH-60A has the capability to be loaded on both sides simultaneously.
(f) Patients should be loaded so that upon rotating the litter suppott, the patient's head will be forward in the cabin. To accomplish this:
(i) patients loaded on the left side of the aircraft should be loaded head first
(ii) patients loaded on the right side of the aircraft should be loaded feet first
(1) When loading and unloading a rotary-wing aircraft, certain precautionary measures must be observed
CAUTION: Failure to observe proper safety procedures could cause severe injury of death.
(2) Litter bearers must present as low a silhouette as possible and must keep clear of the rotors at all times
(3) The helicopter must not be approached until a crew member signals to do so
(4) The litter bearers should approach the aircraft at a 45-degree angle from the front of the helicopter
(5) If the helicopter is on a slope and conditions permit, loading personnel should approach the aircraft from the downhill side. Directions given by the crew must be followed, and litters must be carried parallel to the ground
(6) Smoking is not permitted within 50 feet of the aircraft
(1) In combat areas, ambulances are often not available, are to few in number, or are incapable of evacuating casualties over certain types of terrain
(2) Many vehicles available to most units can be used to transport casualties with little or no change in their configuration
(3) Some amphibious cargo and personnel vessels can be used for this purpose; however, their casualty carrying capacity varies
(4) When casualties have entered the CHS system, they are classified as patients. Patient evacuation includes providing en route medical care to the patient being evacuated.
(4) A casualty moved on a nonmedical vehicle without en route medical care, is considered to be transported not evacuated
(1) To provide timely and responsive evacuation or casualty transport, CHS planners develop proactive Operation Plans (A Detailed plan of how the operation is to be conducted) to meet the challenges of mass casualty situations
(a) Contingency plans should identify-
(i) Nonmedical transportation resources
(ii) Nonmedical personnel for litter teams
(iii) Evacuation routes
(iv) Ambulance exchange points
(v) Medical personnel resources to provide en route medical care on nonmedical vehicles
(vi) Capabilities and locations of MTFs
(vii) Communications frequencies and call signs for C2
(viii) Procedures for medical equipment exchanges
(ix) Ground nonmedical assets, all available ground vehicles to augment the medical evacuation assets in an emergency
(x) Staffing of nonmedical vehicles with medical personnel
(xi) Management of patient evacuation
(a) Bradley infantry fighting vehicle, M2/3
(b) Truck, cargo, medium tactical vehicle (MTV), long wheelbase (LWB), 5 ton, M1085
(c) Truck, cargo 2 1/2 ton, M35
(d) Truck, cargo, heavy expanded, mobile tactical truck (HEMTT), 8x8, cargo, M997
(e) Truck, cargo, MTV, light vehicle air drop/air delivery (LVAD/AD), 5 ton M1093
(f) Truck, cargo, light medium tactical vehicle (LMTV), air drop/delivery, 2 1/2 ton, M1081
(g) SemiTrailer, Cargo, 22 ½ Ton, M871
(h) Armored personnel carrier, M113
(i) Tractor, 5 ton, with stake and platform trailer
(j) High-mobility, multipurpose wheeled vehicle, M998
(1) Army Fixed-Wing Aircraft: The capability of Army fixed-wing aircraft to land on and take off from selected small, unprepared areas permits the evacuation of patients from Areas of Operations which would be inaccessible to larger aircraft
(2) These aircraft can fly slowly and maintain a high degree of maneuverability
(3) This capability further enhances their value in forward areas under combat conditions
(4) Army fixed-wing aircraft are limited in speed and range as compared with larger transport-type aircraft
(5) When adequate airfields are available, fixed-wing aircraft may be used in forward areas for patient evacuation
NOTE: This is a secondary mission for these aircraft which will be used only to augment dedicated air ambulance capabilities.
(1) The U-21 Ute and C-12 Huron are used as utility (U-21) and passenger/cargo (C-12) aircraft. These aircraft are not normally employed as evacuation aircraft. In emergency situations, both of these aircraft can be configured to evacuate litter and ambulatory patients
(a) The U-21 Ute is a twin turbine, propeller-driven utility aircraft with a normal cruise speed of 210 knots and an endurance of over 5 hours flying time. It is capable of accommodating ten ambulatory patients, or three litter patients plus three ambulatory patients and a medic
(b) The C-12 Huron is the newest addition to the Army's fixed-wing aircraft inventory. Depending on the model, its normal cruise speed ranges from 240 to 260 knots with 5 to 6 hours endurance. It is capable of carrying eight ambulatory patients, or two litter and four ambulatory
(1) The personnel who transport patients to the landing strip load the patients aboard the aircraft
(2) They may be required to assist in configuring the aircraft for litters
(3) Litters are generally loaded from the top downward and from the front to the rear
(5) The four-man litter squad plus the crew chief normally load these aircraft
(1) The CH-47 (Chinook) helicopter, has a capacity of 24 litter patients, or 31 ambulatory patients, or a combination of litter and ambulatory patients
(2) The aircraft's overall size and rotor blade diameter make it unsuitable for use in smaller or more confined areas
NOTE: The CH-47 helicopter should not be brought into a LZ that is smaller than 40 meters in diameter.
(1) This helicopter's maximum capacity is 24 1itter patients or 31 ambulatory patients. The 31 ambulatory patients are seated in the ten 3-man seats and the 1-man seat as shown in Figure 10-42 of FM 8-10-6. The two 1-man seats are used by crew members.
(2) When carrying 24 litter patients, the seats are replaced with six tiers of litters, four litters high. The two 1-man seats in the rear section should remain in place for the crew members. The 1-man seat at the left front may also be left in place provided it is needed.
(3) The combinations of litter and ambulatory patients the CH-47 is capable of accomodating are provided in Table 10-5 of FM 8-10-6
(1) Litter Support Kits. These kits are available for use in adapting the helicopter's interior to evacuate litter patients.
(2) These kits contain 12 litter poles, stored in the front of the cargo compartment and 12 litter traps, stored in overhead recesses.
(3) The poles contain safety attachments for securing them along the side walls of the compartment. The pull-down straps on the aisle side are secured to floor studs.
(4) Permanently attached to each litter pole and each strap are four litter support brackets with locking devices for securing litter handles in place
(6) It is not necessary to remove the seats before adapting the compartment for litter patients. The seats can be folded against the wall and strapped in place.
(1) In a 2-man carry, the litter squad carries each litter patient through the lowered rear door and ramp to the litter rack where he is to be placed
(2) The squad then moves into a 4-man carry and places the litter patient into the appropriate tier
(3) The litter racks should be loaded from front to rear and from top to bottom
(4) Litter patients requiring in-flight medical care should be positioned to facilitate this care. If the helicopter is to be loaded with a combination of litter and ambulatory patients, the litter patients should be positioned to the rear of the ambulatory patients whenever possible.
(1) However, more likely USAF AE will be accomplished by dedicated (aircraft identified for AE only) or designated (mission scheduled specifically for AE) AE aircraft
(2) The flexibility and responsiveness provided to AE by designated or dedicated AE missions also improves cargo and passenger airlift throughput by not pulling scheduled cargo missions from their scheduled routes to support AB
(1) The C-130 Hercules Transport. This aircraft is a four-engine, turbo-propeller driven aircraft with a pressurized, air-conditioned cabin and a self-contained loading ramp.
(a) In the normal patient configuration, this aircraft can accommodate 50 litter and 27 ambulatory patients
(b) This can be varied for as many as 70 litters with no ambulatory patients, or 85 ambulatory patients with no litters
(c) These figures represent maximum patient capacity and would not be used routinely
(d) The medical crew is normally provided by the USAF. It consist of:
(i) Two flight nurses
(ii) Three AE technicians
(e) The C-130 can land on and take off from short, austere runways
(f) It can also be used on landing strips such as those found in forward base operations. Its normal use is within a TO for tactical and assault airlift
(g) The ambulance bus maybe backed up to the ramp at the tail of the aircraft for easy enplaning of litter patients
(h) The C-130 can also be used for intertheater airlift missions
(2) The C-9A Nightingale. This aircraft is a T -tailed aeromedical airlift with two jet engines and a pressurized, air-conditioned cabin.
(a) The Nightingale is the military version of the DC-9 airliner with an interior specifically designed for in-flight patient care
(b) It is the only aircraft in the USAF inventory that is dedicated to the medical evacuation mission
(c) It has a self-contained patient enplaning ramp and can accommodate 40 litter patients, 40 ambulatory patients, or a combination of both
(d) The ambulance bus maybe backed up to the ramp at the tail of the aircraft for easy enplaning of litter patients
(e) This aircraft can operate from and between CZ, BAC, or CONUS from improved mile long runways
(f) The medical crew normally consists of:
(i) Two flight nurses
(ii) Three AB technicians
(3) The C-141 Starlifter. This aircraft is a four-engine, jet cargo transport aircraft. The cabin is pressurized, heated, or cooled, as required
(a) The ambulance bus may be backed to the ramp at the tail of the aircraft for easy planing of litter patients
(b) The C-141 can accommodate 103 litter patients, 147 ambulatory patients, or a combination of both
(c) Normally, the aircraft will be configured to accommodate 48 litters and 38 seats. Maximum capacity is not routinely used, as crowding detracts from patient care.
(d) The usual medical crew consists of
(i) Two flight nurses
(ii) Three AE technicians
(e) The C-141 is used for all missions of the AMC intertheater AB system. With the backhaul capacity, these intercontinental cargo aircraft provide AE from a TO to CONUS
(4) The C-5 Galaxy .The C-5 is the US's largest aircraft. The aircraft is normally a cargo mover, with a payload of over 200,000 pounds.
(a) If required, it could carry up to 70 ambulatory patients in its upper- aft passenger compartment in addition to its cargo load
(b) This aircraft is considered an aircraft of opportunity and is only used if absolutely necessary
(5) The C-17A. This aircraft is a four-engine, jet driven aircraft with a pressurized, air-conditioned cabin and a self-contained loading ramp.
(a) In the normal patient configuration, this aircraft can accommodate 36 litter and 54 ambulatory patients. These figures represent maximum patient capacity.
(b) The medical crew is provided by the USAF. It consists of:
(i) two flight nurses
(ii) three AE technicians
(c) The C-17 A can land and take off from short, austere runways. It can also be used on landing strips such as those found in forward base operations.
(d) When available, the ambulance bus may be backed to the ramp at the tail of the aircraft for easy enplaning of litter patients
(e) The C-17 A can also be used for both intratheater and intertheater airlift missions
(6) The KC-135 and KC-I0. These aircraft are four-engine, jet driven aircraft with a pressurized, air-conditioned cabin.
(a) In the normal patient configuration, this aircraft can accommodate 8 litters and 24 ambulatory patients
(b) The litter patients would be loaded and secured to the floor of the aircraft for transport
(c) Because these aircraft do not have loading ramps, either a ramp or cargo loader must be used to load and unload patients
(d) The medical crews are provided by the USAF
Evacuation is essential, especially in a battlefield when life is at stake. In this lesson, we have evaluated evacuation platforms available for use. Given this knowledge, the medic is prepared to move the casualty by ground or air.