Operational Medicine 2001
Field Medical Service School
Student Handbook

CASUALTY EVACUATION

FMST 0503

17 DEC 99

TERMINAL LEARNING OBJECTIVES:

1.      Given a combat environment (day and night), multiple combat casualties, perform casualty evacuation, per the references. (FMST.05.05)

 ENABLING LEARNING OBJECTIVES:

1.      Without the aid of reference materials and given a random list of the steps in the chain of evacuation, sequence the steps, per the student handbook. (FMST.05.05a)

2.      Without the aid of reference materials and given a list, match the casualty carrying capacity to the appropriate evacuation platform, per the student handbook. (FMST.05.05b)

3.      Without the aid of references, while in a simulated combat environment with simulated combat casualties, conduct a nine line CASEVAC brief to another radio station, per the student handbook. (FMST.02.10g)

OUTLINE:

A.     CASUALTY EVACUATION

1.      CHAIN OF EVACUATION FOR CASUALTIES FROM THE FIELD

a.       Health Service Support (HSS) within an area of operation is organized into 5 separate echelons of care (Table 1).  These echelons extend rearward from the area of operation to those located in the Continental United States (CONUS).

b.      Each echelon in the chain of evacuation must have the ability to:

1.      Meet the characteristics of the supported unit.

2.      Provide progressive and phased treatment, hospitalization, and evacuation of all casualties.

c.       The organization of the HSS is designed for flexibility and is influenced by specifics of the mission - i.e. enemy, terrain, and tactical situation.

d.      Each echelon’s ability to provide optimum treatment is limited by 5 interfacing factors:

1.      Urgency and extent of the patient’s needs

2.      Mobility requirements of medical personnel, equipment, or facilities

3.      Capabilities of medical personnel at each echelon

4.      Workload reaching the echelon at any given time relative to the capabilities.

5.      Echelons I and II have environmental considerations - i.e. jungle, desert, mountain, or military operations in urban terrain (MOUT).

e.       All casualties are evacuated through the echelons until a facility is reached that has both the ability to begin intervention and the time required to perform the necessary procedures.

Figure 1 – Echelons of Care

2.      FACTORS USED IN DETERMINING EVACUATION PRIORITIES:

a.       Evacuation policy is established by the Commander of the Task Force upon the recommendation of the Task Force Surgeon.

b.      The evacuation policy designates which patients are required to be evacuated within the maximum projected number of days of hospitalization permitted for a given area during a specific operation.

c.       The evacuation policy must not hamper the mobility of the front line units.  This is a major factor with considerations to the area of operation, i.e., jungle, desert, mountain, or MOUT.

d.      Keeping front line unit integrity dictates that the evacuation policy retain the casualty as close to their unit as the treatment capability will permit in efforts to expedite their return accordingly.

3.      METHODS OF EVACUATION ORGANIC TO THE MARINE CORPS:

a.       The medevac urgency and tactical situation dictate the methods of evacuation.

b.      The methods of evacuation include:

1.      Self aid or the “walking wounded.”

                        2.   Manual transportation – Lifts and Carries:

                              a)   FIREMAN'S CARRY:  Used for unconscious and conscious patients

1)      Kneel on one knee at the patient's head, facing the feet, then extend your hands under their armpits, down their sides, and across their back.

2)      Stand, lifting the patient to their knees, then secure a lower hold and raise them in a standing position with his knees locked.

3)     Secure your arms around the patient's waist with their body slightly tilted backward to prevent their knees from buckling.  Place your right foot between their feet and spread them six to eight inches apart.

4)     With your left hand, grasp their right wrist and raise it over your head.

5)     Bend at the waist and knees, pull the pateint’s arm over and down your left shoulder, bring their body across your shoulders.  Pass your right arm between their legs.

6)     Place the patient's right wrist in your right hand and your left hand on your left knee for support in rising.

7)      Rise with the patient correctly positioned with your left hand free.

b)  ONE-MAN SUPPORTING CARRY:  Conscious patients only

1)      Raise the patient from the ground as in the Fireman's carry.

                                    2)  With your left or right hand grasp the patients's left or right wrist and

draw it around your neck.  Place your left or right arm around their waist.

                                    3)  The patient is able to walk using you as a crutch.

c)   SADDLE BACK CARRY:  Conscious patient only

1)      Raise patient to upright position.

2)      Support patient by waist and move to front of patient.

3)      Have patient encircle arms around your neck.

4)      Stoop, raise patient to your back and clasp hands beneath his thighs.

d)      PACK STRAP CARRY:  Good for unconscious patients, however, do not use if patient has fractures.

1)      Raise patient from ground as in Fireman's carry.

2)      Support by waist and move to front of patient.

3)      Grasp patient's wrist and hoist onto your back until their armpits are over your shoulders.

4)     Do not cross the patient's wrists with palms down before applying pressures.

e)  PISTOL BELT CARRY:  Used on unconscious or conscious casualties

1)      Link together two pistol belts (or improvise) to form a continuous belt under the thighs and hips so that a loop extends on both sides of the patient.

2)      Lie between the patient's extended legs and put arms through both belt loops.

3)      Grasp patient's arms and roll toward the uninjured side to the prone position.  The patient will now be on your back.

4)      Raise to a kneeling position and slowly stand up.

f)        TWO-MAN SUPPORTING CARRY:  Patient is conscious and has no suspected fractures.

1) Same as for one-man carry but done with two individuals.

 g)      TWO-MAN CARRY:  Used for placing patient on a litter or moving short distances.  Similar to performing a patient log roll.

1)      Two corpsmen kneel at one side of patient.

2)      One bearer places a arm beneath the hips and the other beneath the knees.

3)      The second places a arm beneath the shoulder and one beneath their back.

4)      Lift patient to knees, then stand up and carry at chest level to lessen fatigue.

h)      FORE / AFT CARRY:  Used to carry  uconscious patient for short distances.

1)      With patient lying on their back, front bearer spreads legs of patient,  steps between legs back towards patient, grasp legs behind the knees.

2)      Rear bearer kneels at the head of the patient, place arms under armpits of the patient and clasp hands on their chest.

3)      Bearers rise together

i)   FOUR-HAND CARRY:  Patient must be conscious

1)      Each bearer grasps their left wrist with the right hand and then the each others right wrist with the left hand.

2)      Patient sits on the interlocked hands supporting himself by placing an arm around each of the bearer’s necks.

j)        TWO HAND SEAT CARRY:  Used for conscious patient with no fractures

1)      With patient on their back and bearers on each side of the patient's hips

2)      Arm placed under thighs and around back interlock wrists

3)      Bearers rise together lifting patient

 k)      CLOTHES DRAG CARRY:  Used during "under fire" conditions.

1)      Grasp the patient's shirt collar or gear and drag to safety.

                  2.  Litter transportation:

                        a)  Standard Army Litter

                        b)  Stokes Stretcher

                        c)  Neil Robertson Stretcher

                        d)  Nylon Poleless

                        e)  Improvised Litters:

                        f)   Litter bearers: Should be made up from available non-medical personnel.

3.      Ambulance Ground Vehicle Platforms:

a)   M996 Ambulance:

1)      HUMVEE frame with kevlar armor protection for crew and patients.

2)      Capable of transporting up to 2 litter and 3 ambulatory patients.

b)   M997 Ambulance:

1)      HUMVEE frame with armor protection for crew and patients.

2)      Capable of transporting up to 4 litter and 8 ambulatory patients.

c)   M1035 Ambulance:

1)      HUMVEE frame with removable soft-top.

2)      Capable of transporting 2 litter and 3 ambulatory patients.

Note:  Litters should be loaded from the top right to top left then the bottom right to bottom left.  Avoid overloading the vehicles.

                              d) M1010 Tactical 1 ¼ Ton Truck Ambulance:

1)      Can facilitate 4 litters or 8 ambulatory patients.

2)      Loading sequence is the same as for the M996 / M997 and M1035.

4.      Air Evacuation Helicopters Platforms: The methods of air evacuation vary depending on the situation in which it is to be utilized.  The Marine Corps does not provide any formal “dedicate” air medevac platforms from it’s own assets.  Rather, any of it’s aircraft can be utilized as a “medevac of opportunity.”  To meet operational commitment, the platforms’ primary duty may be to transport personnel, supplies, or equipment.  Once completed, this aircraft is then available to assist in the air medevac of casualties.  The use of the helicopter expedites transport of patients from the frontlines where evacuation by other means would be difficult and perhaps impossible to accomplish.  The Marine Corps primary platforms for air medevac include:

a)  CH-46E Sea Knight:

1)      Medium helicopter used to transport personnel and cargo.

2)      When configured with litter racks, able to carry 15 litters, or 20 ambulatory patients.

       b)  CH-53D/E Sea/Super Stallion:

1)      Medium/Heavy helicopter used to transport personnel and cargo.

2)   When configured with litter racks, able to carry 24 litters, or up to 37 ambulatory patients.

 c)   UH-1N Huey:

1)      Light transport helicopter used to transport personnel and cargo.

2)      When configured with litter racks, able to carry 6 litters, or up to 8 ambulatory patients.

Figure 19 – Additional Medevac Platform Data Description

      5.  MEDEVAC REQUEST (9 Line Brief):

a.       Medical evacuation request transmisions should be by the most direct communication means available to the medical unit controlling evacuation assets.  The means and frequencies used will depend on the organization, availablity, and location in the area of operations, as well as the distance between units.  The primary and secondary frequency for medevac requests will be specified by the unit evacuation plan.

b.      The information must be clear, concise, and easily transmitted.  The is done by use of the authorized brevity code.  The authorized brevity code is a series of phoenetic letters, numbers, and basic descriptive terminology used to transmit medevac information.

c.       Under wartime conditions and for training purposes this includes radio frequency encryption and the use of authorized brevity codes.  These codes indicate the standard information required for a medevac commonly known as the “9 Line Brief”.

d.      This brief is verbally transmitted in numerical “line” sequence utilizing the authorized brevity codes as follows:

1.      Line “One”:

a)      Location of pickup site in descripitive terms –  encrypted grid coordinates.

b)      Coordinating unit will provide planned route if casualties are located in more than one location.

2.      Line “Two”:

a)      Radio frequency, call sign, and suffix – Encrypted frequency of requesting unit and suffix of person to be contacted as needed.

3.      Line “Three”:

a)      Number of patients by precedence – Reported only as medevac categories applicable with encrypted brevity codes:

1)      “A”+ # - Urgent.

2)      “B”+ # - Urgent Surgical.

3)      “C”+ # - Priorty.

4)      “D”+ # - Routine.

5)      “E”+ # - Convenience.

b)      If two or more categories are reported in the same request, the word “BREAK” is to be verbalized between each category.

4.      Line “Four”:

a)      Special Equipment Required:

1)      “A”- None.

2)      “B”- Hoist.

3)      “C”- Extraction equipment.

4)      “D”- Ventilator.

5.      Line “Five”:

a)      Number of patients by types- Litter or ambulatory:

1)      “L” + number of patients.

2)      “A” + number of patients.

b)      Report applicable info only and if requesting for both types, use “BREAK” between entries.

6.      Line “Six”:

a)      Wartime- Security of pick up site:

1)      “N”- No enemy troops present.

2)      “P”-  Possible enemy in area, approach with caution.

3)      “E”- Enemy troops in area, appraoch with caution. 

4)      “X”- Enemy troops in area, armed escort required.

b)      Peacetime- Number and descriptive type of wound, injury or illness.

7.      Line “Seven”:

a)      Method of pick up site marking- Ensure encrypted especially during wartime:

1)      “A”- Panels.

2)      “B”- Pyrotechnic signal.

3)      “C”- Smoke signal.

4)      “D”- None.

5)      “E”- Other, specify.

8.      Line “Eight”:

a)      Patient nationalty and status - The number of patients in each of the below does not need to be transmitted:

1)      “A”- US Military.

2)      “B”- US Civilian.

3)      “C”- Non-US Military.

4)      “D”- Non-US Civilian.

5)      “E”- Enemy prisoner of war (EPW).

9.      Line “Nine”:

a)      Terrain description - Descriptive details of terrain features and there relationship in and around proposed landing site (lakes, mountains wires, etc.).

b)      Wartime - Include as applicapable, NBC contanimation:

1)      “N”- Nuclear.

2)      “B”- Biological.

3)      “C”- Chemical.            

10.  MEDEVAC 9 Line Request Voice Template Example:

a)      "CharlieMed, this is Echo-2-Niner, over".

b)      "Echo-2-Niner, this is Charlie-Med, send over".

c)      "This is Echo-2-Niner, request medevac, over".

d)      "Echo-2-Niner this is Charlie-Med, authenticate Yankee, over".

e)      "Charlie-Med, this is Echo-2-Niner, I authenticate Champion, over".

f)        "Roger Echo-2-Niner, send request over".

g)      “Roger, nine line as follows, break,”

h)      “ONE, Tango-alpha 6577, break”

i)        “TWO, 39.39,E-7-Romeo, break”

j)        “THREE, 1-Charlie, 2-Delta, break”

k)      “FOUR, Alpha, break”

l)        “FIVE, Lima-1, Alpha-2, break”

m)    “SIX”, November, break”

n)      “SEVEN, Green smoke, break”

o)      “EIGHT, US military, break”

p)      “NINE, Large raising hills to the north, and south with wires to the north running east to west, over.”

REFERENCE (S):

1.  Tacticale Emergency Care

2.  Emergency War Surgery

3.  Cold Weather Medicine Handbook

4.  Wilderness Medicince Handbook

5.  First Aid for Soldiers

6.  Medical Evacuation In A Theatre of Operations 9FM 8-10-6 Oct 91)

7.  Health Services Support Operaitons (MCWP 4-11.1)

8.  Operational Health Services Support (MCWP4-20)

9.  Academy of Health Sciences, US Army (Sept 1988)

Field Medical Service School
Camp Pendleton, California

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Operational Medicine 2001
Health Care in Military Settings

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