Rescue the wounded

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United States Marines transport an unable-to-walk patient outside Fallujah Iraq 2006

Wound rescue is the military rescue and evacuation of wounded soldiers from the battlefield. The injured can be rescued by air transport or on the ground. The English term is Casualty Evacuation and the military callsign CasEvac [ ˈkæzɪvæk ]. Rescuing the wounded is part of Tactical Evacuation Care as part of Tactical Combat Casualty Care .

Demarcation

The primary difference between CasEvac and MedEvac lies in the equipment of the means of transport . While the MedEvac uses dedicated rescue helicopters like the NH90 FAM or ambulance vehicles like the Piranha ambulance tank, in which emergency life-saving measures can be carried out during the transport by paramedics trained in organ medicine (also using apparatus medicine ) , the immediately available, nearest means of transport are used for CasEvac.

history

Rescuing the wounded with a Blackhawk in Helmand Province in Afghanistan 2009

Like many other innovations in emergency medicine , the concept of air transport of the wounded originated in the military. The concept of using aircraft is almost as old as motorized aviation itself. The first written mention of the term "Air Ambulance" can be found in Jules Verne's novel Robur the Conqueror from 1866, which describes the rescue of shipwrecked people using a "flight platform" called Albatros describes. The first documented air rescue took place in 1870 during the siege of Paris (1870–1871) , when over 160 soldiers were evacuated from the besieged city by balloons.

The first air rescue was carried out during World War I when a Serbian officer was flown from the battlefield to a hospital by French air forces . French records from the time document that the death rate of wounded fell from 60% to 10% when air rescue was carried out within six hours. The first documented British rescue of the wounded took place in Turkey in 1917 when an Imperial Camel Corps soldier who was shot in the ankle was flown to hospital on a de Havilland DHH within 45 minutes.

In continental Europe, up to the end of the Second World War, mainly STOL short take-off aircraft such as the Fieseler Fi 156 and Piper J-3 were used to rescue the wounded.

The first MedEvac mission with a helicopter took place during World War II . On April 21, 1944, the shot Imperial Japanese Army during the Burma Campaign an aircraft of the United States Air Force from behind the Japanese lines in the jungle near Mawlu. Three British soldiers were wounded in the process. Lt. Carter Harman evacuated them with a Sikorsky YR-4B helicopter of the United States Army in four flights from April 25 to 26, 1944 from the combat area.

The first planned use of helicopters by US forces to rescue the wounded took place in the Korean War (1950-53). The helicopters not only evacuated the wounded from the battlefield, but also transferred more critical patients from field hospitals to more distant hospital ships after initial treatment . On August 4, 1950, just a month after the beginning of the Korean War, the first helicopter-based wound rescue was carried out with a Bell H-13 . The wounded were transported in grinding basket stretchers, which were attached outside the small cabin of the H-13 above the landing skids.

The next major development in air rescue was the use of the Bell UH-1 multi- role helicopter during the Vietnam War . The cabin of the helicopter known as the Huey was large enough to accommodate patients and to be able to provide them with initial treatment by medical staff while they were being transported to the field hospital or hospital. The adequate use of medical helicopters for rescuing the wounded reduced the average waiting time to an hour for care and sustainably reduced the mortality and morbidity of the wounded. Military paramedics were able to place the first emergency measures on board, such as a venous catheter with an infusion and a thoracic catheter.

Helicopters continue to play a crucial role in military wound rescue in the 21st century. Rescue helicopters of the type UH-60 Blackhawk were used extensively in the Iraq war (2003), the occupation of Iraq 2003-2011 and in the war in Afghanistan since 2001 . Both countries have a sparse, desert-like topology over a large area, which makes the use of helicopters imperative, also due to the widespread use of booby traps. However, as in Afghanistan in the Hindu Kush , there are limits to these in operational areas due to mountain ranges up to 7500 meters high.

Callsign

The ambulance forces of the United States Army use the callsign DUSTOFF [ ˈdʌst ˈɑ: f ], which is a backronym from Dedicated Unhesitating Service To Our Fighting Forces ( German for  immediate use for our fighting troops ). The DUSTOFF tactical callsign for a medical evacuation mission was first used in 1963 by Major Lloyd E. Spencer, Commander of the United States Army 57th Medical Detachment. The term established itself by the end of the Vietnam War.

procedure

CasEvac with an MV-22 Osprey

At the call sign CASEVAC or EMERGENCY AIR MEDEVAC REQUEST (9-Line) by a paramedic or rescue doctor on the ground, the nearest available (air) vehicle with free space, regardless of its medical facility, requests support for a medical rescue operation.

In the United States Marine Corps , this can be the MV-22 Osprey or the SH-60 Seahawk of the United States Navy . The British Army uses the AgustaWestland AW101 , Aérospatiale AS 332 and Boeing-Vertol CH-47 transport helicopters . The French Air Force has been using several Eurocopter EC 725 Caracals in Afghanistan since April 2008 .

After the crew mission briefing, the mission starts with the flight and landing in the landing zone, as close as possible to the wounded person. The recording of the wounded should take a maximum of five minutes, while the rotors remain at speed. After departure in coordination between the security and rescue helicopters, the mission ends after the return flight with the handover of the wounded person to an inpatient hospital and the debriefing .

The general principle behind CASEVAC is the transport of wounded, the extremely urgent need of evacuation from the battlefield and their injuries no longer allow a MedEvac- rescue helicopter with intensive medical equipment ( patient monitor , ventilator , Pumpspritzeninjektoren, ultrasound machine , blood gas analyzer , shock trousers to wait) . An unfavorable danger situation or a missing or hot landing zone can also make a CasEvac necessary. Typically, air rescue transports a wounded person classified as “urgent” from the site of the wound to an inpatient medical facility within an hour (“golden hour”).

Risks to the wounded

The particular danger of the CasEvac lies in the fact that the wounded are transported in a way that does not guarantee adequate medical care, that they can be stored incorrectly or taken to the wrong medical facility. Rough or improper handling can lead to further injuries to the wounded, which is why the transport should be organized and carried out according to plan. Any lifting or carrying movement should be performed as carefully and gently as possible. The primary goal is to prevent loss of life, limbs, and eyesight .

Except in extremely urgent emergencies, the nature and severity of the wound should be diagnosed before moving the wounded person. The necessary first aid measures are the stopping of life-threatening bleeding ( hypovolemia ), if necessary also the administration of HES from the first aid level B, keeping the airways open , restoring breathing and the heartbeat, avoiding and controlling shock and protecting Wounds against further contamination. If a bone fracture is evident or suspected, the corresponding part of the body must be immobilized with an aluminum upholstery splint to prevent the broken end of the bone from piercing through muscles, blood vessels, nerves or skin. Therefore, every soldier in the first aid equipment group must be equipped with this and an elastic bandage .

Risks for the vehicle crew

Ground and aircraft vehicles for MedEvac missions are unarmed and clearly marked in accordance with the Geneva Conventions . The fight against "clearly identified" MedEvac vehicles is a violation of Article 2 of the Geneva Conventions and as such a war crime . Due to the lack of armament of MedEvac helicopters, they are only used in a gang with an armed escort machine. The rescue helicopter is referred to as "Forward Air MedEvac" (FAM) and the backup or escort helicopter as "Chase" [ tʃeɪs ] ( German  pursuer ).

Approaching a contested, “hot” landing zone to pick up the wounded is a dangerous undertaking. Peter Dorland and James Nanney wrote in their book Dust Off: Army Aeromedical Evacuation in Vietnam :

Hot landing zone in the La Drang Valley, Vietnam 1965

“… Slightly more a third of the aviators became casualties in their work, and the crew chiefs and medical corpsmen who accompanied them suffered similarly. The danger of their work was further borne out by the high rate of air ambulance loss to hostile fire: 3.3 times that of all other forms of helicopter missions in the Vietnam War. "

“... a little more than a third of the pilots were victims of their activities, and the flight crew and paramedics who accompanied them suffered comparable losses. The dangerousness of their work became clear in the high rate of loss of medical aircraft to enemy fire: 3.3 times more than all other forms of helicopter missions in the Vietnam War. "

The US armed forces are trying to ensure the continuous readiness of MedEvac transport vehicles with trained personnel. For this reason, too, the survival rate of wounded has increased from 80.9% in World War II to 90.6% today.

literature

Web links

Commons : Medical evacuation  - collection of pictures, videos and audio files

Individual evidence

  1. ↑ Stefan Pump: Air rescue and air transport with NH 90 - state of development. In: Wehrmedizin und Wehrpharmazie , issue 2/2008. February 1, 2008, accessed January 20, 2015 .
  2. ↑ John S. Haller: Battlefield Medicine: A History of the Military Ambulance from the Napoleonic Wars through World War I . Southern Illinois University Press, 1992, ISBN 978-0-8093-3040-9 , pp. 288 ( google.de ).
  3. ^ History of Air Medicine. (PDF) In: Pearson Higher Education. June 8, 2005, accessed December 8, 2015 .
  4. ^ A b History of Air Ambulance and MedEvac. (No longer available online.) In: Mercyflight. Archived from the original on December 10, 2015 ; accessed on December 8, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.mercyflight.org
  5. ↑ Stefan Pump: Helicopters in rescue and transport of the wounded . In: Military medicine and military pharmacy . No. 03 , 2011, ISSN  0043-2148 ( wehrmed.de ).
  6. ^ William G. Howard: History of aeromedical evacuation in the Korean War and the Vietnam War. (PDF) In: US Army Command and General Staff College, Fort Leavenworth . June 6, 2003, accessed December 8, 2015 .
  7. ^ DUSTOFF Association History. In: dustoff.org. Retrieved March 1, 2016 .
  8. ↑ Frédéric Lert: High-flying Samaritan . In: Flight Revue . No. 03 , 2009, ISSN  0015-4547 , p. 48-50 .
  9. ↑ Marc Royko: Forward Air MedEvac - rescue from the air . In: Military medicine and military pharmacy . No. 03 , 2011, ISSN  0043-2148 ( wehrmed.de ).
  10. ↑ Volker Schubert, Bernd Schwendel: Forward Air MedEvac - Nine lines to rescue from the air. In: German Army . July 14, 2014, accessed February 15, 2015 .
  11. ↑ Matthias Seeliger: Every second counts. (No longer available online.) In: Y - Das Magazin der Bundeswehr . December 4, 2013, archived from the original on February 13, 2015 ; accessed on January 21, 2015 .
  12. ↑ a b Volker Günter Schubert: Air rescue in combat. In: Aktuell - newspaper for the Bundeswehr . Retrieved February 15, 2015 .
  13. ^ Peter Dorland, James Nanney: Dust Off: Army Aeromedical Evacuation in Vietnam . Lulu.com , 2012, ISBN 978-1-105-63783-4 , pp. 146 .
  14. ↑ Frank Butler: Tactical Combat Casualty Care. (PDF; 3.84 kB) In: Defense Health Board. March 9, 2009, archived from the original on September 3, 2012 ; accessed on January 20, 2015 .