evacuation platforms

Evacuation Platforms: Casualty Movement

1

2

Terminal Learning Objective

Evacuate a casualty manually or by a litter to a ground and/or air evacuation platform

2

3

Enabling Learning Objective

Given a casualty requiring evacuation with no litter available, manually evacuate a casualty IAW cited references.

3

4

Enabling Learning Objective

Given a casualty who requires extrication, perform a litter evacuation of a casualty IAW FM 8-10-6, Medical Evacuation in a Theater of Operations: Tactics, Techniques, and Procedures.

44

5

Enabling Learning Objective

Given a casualty or casualties that require evacuation by air or ground, evacuate a casualty IAW FM 8-10-6, Medical Evacuation in a Theater of Operations: Tactics, Techniques, and Procedures.

55

6

Casualty MovementEvacuation should be deliberate and Evacuation should be deliberate and methodicalmethodical

Improper handling may cause further injuryImproper handling may cause further injury

Moving casualties should be performed by Moving casualties should be performed by the quickest and most efficient means the quickest and most efficient means possiblepossible

6

7

Manual Evacuation

Process of transporting casualties by Process of transporting casualties by manual carries and drags.manual carries and drags.

Accomplished without the aid of a litter or Accomplished without the aid of a litter or vehiclesvehicles

Intended to end at the point where a more Intended to end at the point where a more sophisticated means of evacuation sophisticated means of evacuation becomes availablebecomes available

8

Know your physical capabilities and Know your physical capabilities and limitationslimitations

Use the leg muscles when carrying or Use the leg muscles when carrying or standing with a casualtystanding with a casualty

Maintain solid footing when lifting and Maintain solid footing when lifting and transportingtransporting

Rules to Follow

8

9

Use the leg muscles when carrying or Use the leg muscles when carrying or standing with a casualtystanding with a casualty

Keep the back straight; use arms and Keep the back straight; use arms and shoulders when pulling a casualtyshoulders when pulling a casualty

Work in unison with other bearers Work in unison with other bearers

Rest frequently, or whenever possibleRest frequently, or whenever possible

Rules to Follow

9

10

Gain fire superiorityGain fire superiority

Stop life-threatening hemorrhage from Stop life-threatening hemorrhage from extremities before moving the wounded extremities before moving the wounded

Perform movements that would prevent Perform movements that would prevent further injury, if possiblefurther injury, if possible

Move casualty as quickly as possible to Move casualty as quickly as possible to safetysafety

Manual Evacuation(Care Under Fire)

10

11

Manual Evacuation

Manual movement is physically Manual movement is physically demanding for bearers demanding for bearers

Involve risk of increasing the severity of Involve risk of increasing the severity of injuriesinjuries

In some instances, essential to save lifeIn some instances, essential to save life

11

12

When a litter is not available, terrain or When a litter is not available, terrain or the tactical situation make other forms of the tactical situation make other forms of casualty transportation impracticalcasualty transportation impractical

May be the only means to transport a May be the only means to transport a casualtycasualty

Manual Evacuation

12

13

Casualty Positioning

Position the casualty to be liftedPosition the casualty to be lifted

If conscious, tell casualty how he will be If conscious, tell casualty how he will be positioned and transportedpositioned and transported

This reduces casualty's fear of movement This reduces casualty's fear of movement and gains cooperationand gains cooperation

It may be necessary to roll the casualty It may be necessary to roll the casualty onto their abdomen, or backonto their abdomen, or back

13

14

Extricating Casualty in Urban Warfare

Instances where casualties need Instances where casualties need evacuation from enemy line of siteevacuation from enemy line of site

Exposed to enemy fire, casualties are at Exposed to enemy fire, casualties are at great riskgreat risk

Medics are a high value target in theatreMedics are a high value target in theatre

14

15

While under fire and without a weapon, Gunnery Sgt. Ryan P. Shane runs to Sgt. Lonnie Wells, a downed Marine to pull him to safety during combat operations as part of Operation Al Fajr in Fallujah on Nov. 9. 1

5

16

Gunnery Sgt. Ryan P. Shane pulls a fatally wounded Marine to safety while under fire.

16

17

Gunnery Sgt. Ryan P. Shane (center) and another member of the 1st Battalion, 8th Marine Regiment, pull a fatally wounded Marine to safety.

17

18

Gunnery Sgt. Ryan P. Shane, foreground at left, and another member of the 1st Battalion, 8th Marine Regiment, pull a fatally wounded Marine to safety. Seconds later Shane was also wounded by enemy fire.

18

19

Gunnery Sgt. Ryan P. Shane, left, is hit by enemy fire as he and another member of the 1st Battalion, 8th Marine Regiment try to pull fatally wounded Marine to safety.

19

20

The unidentified Marine runs for cover after Gunnery Sgt. Ryan P. Shane, on ground at left, was hit by insurgent sniper fire. 2

0

21

Gunnery Sgt. Ryan P. Shane, left, lies wounded after being hit by enemy fire while trying to pull a fatally wounded Marine, right, to safety.

21

22

Rescuers…Targets

22

23

Is this efficient and defensive?

Movement Physics

The basic forces we must concentrate on– Imposing our force on matter at rest.– Decreasing the contact points (friction) of

the specific matter.

24

Why Drag and not Carry?

Less energy expenditure

Lower profile

Ability to return fire accurately

Exponentially faster

25

Dragon Handle

26

RAT Strap(Rescue Assault Tether)

27

Special Manual Evacuation

Approach from the opposite side of the Approach from the opposite side of the vehicle, using all available cover and vehicle, using all available cover and concealmentconcealment

Ambulance teams should park the vehicle Ambulance teams should park the vehicle behind protective terrain and dismount behind protective terrain and dismount with the necessary equipmentwith the necessary equipment

28

Observing the Vehicle for Fire

Use fire suppression equipment and any Use fire suppression equipment and any protective measures availableprotective measures available

Attempting to save the crew of a burning Attempting to save the crew of a burning vehicle may only result in the injury or vehicle may only result in the injury or death of the rescuerdeath of the rescuer

Rescuer's decision based on the specific Rescuer's decision based on the specific circumstancescircumstances

29

C168W018/1 AUG 07

Extracting a Casualty Includes

Gaining access to the casualtyGaining access to the casualty

Administering lifesaving measuresAdministering lifesaving measures

Freeing the casualty from the vehicle or Freeing the casualty from the vehicle or other limited-access positionsother limited-access positions

Preparing the casualty for removalPreparing the casualty for removal

Transporting the casualty from the siteTransporting the casualty from the site

30

Extricating Casualty from a Tank

Removing a wounded soldier from the Removing a wounded soldier from the interior of a tank is difficult and requires interior of a tank is difficult and requires speedspeed

Crew members should be used to extract Crew members should be used to extract casualties from tankscasualties from tanks

Removing casualties from a tank requires Removing casualties from a tank requires 3 crew members/soldiers3 crew members/soldiers

31

Steps Medical Personnel Should Take

If a head and or spine injury are If a head and or spine injury are suspected stabilize the neck as much as suspected stabilize the neck as much as possible prior to attempting to extract the possible prior to attempting to extract the casualtycasualty

Depending upon the tactical situation, Depending upon the tactical situation, these procedures may be abbreviated if these procedures may be abbreviated if the vehicle and its crew are in imminent the vehicle and its crew are in imminent dangerdanger

32

Kendrick Extraction Device (KED)

3333

34

Litter Evacuation

34

35

Collapsible Litter

35

36

Talon II Litter

36

Stingray Poleless Litter

37

Tactical Extraction Device

38

Stokes Litter

39

SKED Litter

40

Patient Securing Strap

Used after casualty is Used after casualty is placed on dressed placed on dressed litter and coveredlitter and covered

Used to hold casualty Used to hold casualty in positionin position

Number of straps Number of straps depends on type of depends on type of terrain over which terrain over which casualty is carriedcasualty is carried

41

Use of Patient Securing Straps

42

43

General Rules for Litter BearersLitter bearers must make deliberate and gentle Litter bearers must make deliberate and gentle movementsmovements

The command STEADY should be used to The command STEADY should be used to prevent undue hasteprevent undue haste

The rear bearers should watch the movements The rear bearers should watch the movements of the front bearers and time their movements of the front bearers and time their movements accordinglyaccordingly

The litter must be kept as level as possibleThe litter must be kept as level as possible

4343

44

General Rules for Litter Bearers

The casualty is carried feet first, except when The casualty is carried feet first, except when going uphill or upstairs; his head should then be going uphill or upstairs; his head should then be forwardforward

If casualty has a fracture of a lower extremity, If casualty has a fracture of a lower extremity, he should be carried uphill or upstairs feet first he should be carried uphill or upstairs feet first and downhill or downstairs head firstand downhill or downstairs head first

When casualty is loaded on litter, his individual When casualty is loaded on litter, his individual equipment is carried by two of the bearers or equipment is carried by two of the bearers or placed on litterplaced on litter

44

Wood Spine Boards (Short & Long)

45

46

Spine Board (polyethylene)

46

Application of Short Spine Board

47

Securing a Patient

48

Kendrick's Extraction Device (KED)

C168W033/1 4949

Evacuation Platforms

50

51

Introduction

Evacuation is the timely, efficient Evacuation is the timely, efficient movement of wounded, injured or ill movement of wounded, injured or ill persons from the battlefield and other persons from the battlefield and other locations.locations.

Knowledge of evacuation platforms will Knowledge of evacuation platforms will enable the soldier medic to make quicker enable the soldier medic to make quicker decisions that could result in saving life, decisions that could result in saving life, limb and eyesight.limb and eyesight.

52

Ground Ambulances

Designed for or converted to carrying Designed for or converted to carrying casualties.casualties.

Dedicated assets to be used solely for the Dedicated assets to be used solely for the medical mission.medical mission.

May be organic to the combat battalion in May be organic to the combat battalion in which the driver and soldier medic are which the driver and soldier medic are assigned.assigned.

Equipped with a Medical Equipment Set Equipped with a Medical Equipment Set

53

Ground Ambulances

The soldier medic’s medical aid bag or The soldier medic’s medical aid bag or CMVS.CMVS.

Long and short boards, KEDs and cervical Long and short boards, KEDs and cervical spine stabilization equipment.spine stabilization equipment.

Supplemental O² and suction equipment.Supplemental O² and suction equipment.

Litters, casualty securing straps and a Litters, casualty securing straps and a blanket set. blanket set.

54

Ground Ambulances

They are staffed with a driver/medical They are staffed with a driver/medical aidman and an additional soldier medic aidman and an additional soldier medic who are both qualified in basic EMT-B who are both qualified in basic EMT-B procedures.procedures.

Track ambulances are staffed with three Track ambulances are staffed with three medical personnel (ambulance driver, medical personnel (ambulance driver, track commander and soldier medic).track commander and soldier medic).

55

Ground AmbulancesAdvantages:Advantages:

Co-located with maneuver elements and Co-located with maneuver elements and readily available when neededreadily available when needed

Operation is not limited by inclement weatherOperation is not limited by inclement weather

Possess mobility and survivability Possess mobility and survivability comparable to the units being supportedcomparable to the units being supported

Normally used to evacuate casualties to BAS Normally used to evacuate casualties to BAS

56

Soldier Medic Responsibilities

Ambulance driver (MOSQ):Ambulance driver (MOSQ):Responsible for ambulanceResponsible for ambulance

Vehicle maintenanceVehicle maintenance

Emergency medical careEmergency medical care

Readiness & responsiveness of vehicle Readiness & responsiveness of vehicle and equipmentand equipment

57

Soldier Medic Responsibilities

Soldier medic:Soldier medic:Assistant ambulance driver/navigatorAssistant ambulance driver/navigator

Casualty careCasualty care

Supervises loading & unloading of Supervises loading & unloading of casualties casualties

58

M-996 HMMWV Mini-Ambulance (2 Litter)

M-997 HMMWV Maxi-Ambulance (4 Litter)

56

M-113 Armored Ambulance

57

Armored Medical Evacuation Vehicle (AMEV)

58

Stryker (Light Armored Vehicle) M1133

59

MRAP (Maxpro)

60

MRAP (HAGA)

61

TC3Bags

LitterSupportArmsStud Mounts

#3 MedResupply

chest

En-route care bag

Trauma Panel

SuctionVital Signs Monitor

Litter Support Arm

The patient compartment stores emergency medical care equipment i.e oxygen delivery system, vital signs monitor, a suction apparatus and thermometer.

IV BagHolders

MRAP

62

66

Ambulance Loading and Unloading

In loading and unloading ambulances, In loading and unloading ambulances, litter casualties are moved carefully so as litter casualties are moved carefully so as not to cause additional discomfort and or not to cause additional discomfort and or injury. Procedures may vary depending injury. Procedures may vary depending on the number of litter bearers, the on the number of litter bearers, the presence or absence of a soldier medic presence or absence of a soldier medic and the type of vehicle used.and the type of vehicle used.

67

Ambulance Loading and Unloading

Casualties are normally loaded head-first Casualties are normally loaded head-first for the following reasons:for the following reasons:

They are less likely to experience motion They are less likely to experience motion sickness or nauseasickness or nausea

They experience less noise from doors They experience less noise from doors opening and closingopening and closing

Less danger of further injury in the event Less danger of further injury in the event of a rear collisionof a rear collision

68

Ambulance Loading and Unloading

When a casualty requires en route care:When a casualty requires en route care: For an injury to one side of the body, it may be For an injury to one side of the body, it may be

necessary to load the casualty feet-first to make necessary to load the casualty feet-first to make the injury readily accessiblethe injury readily accessible

For casualties that require I.V. therapy, a lower For casualties that require I.V. therapy, a lower berth may be indicated in order to obtain a berth may be indicated in order to obtain a gravity flowgravity flow

Casualties with bulky splints may also require a Casualties with bulky splints may also require a lower berth (if possible)lower berth (if possible)

Ambulance Loading and Unloading

64

70

Review of Medical Air Ambulances

Aeromedical evacuation is accomplished Aeromedical evacuation is accomplished by both helicopter and fixed wing aircraft.by both helicopter and fixed wing aircraft.

Dedicated aeromedical evacuation assets Dedicated aeromedical evacuation assets permit en route casualty care.permit en route casualty care.

En route care minimizes further injury to En route care minimizes further injury to the casualty and decreases mortality.the casualty and decreases mortality.

71

Review of Medical Air Ambulances

Advantages of aeromedical evacuation:Advantages of aeromedical evacuation:– The speed with which the casualty can be The speed with which the casualty can be

evacuated by air to a Medical Treatment evacuated by air to a Medical Treatment Facility (MTF) ensures timeliness of Facility (MTF) ensures timeliness of treatmenttreatment

– The range and speed of aircraft make it The range and speed of aircraft make it possible to evacuate casualties over long possible to evacuate casualties over long distances in short periods of timedistances in short periods of time

72

Review of Medical Air Ambulances

Advantages of aeromedical evacuation:Advantages of aeromedical evacuation:– Helicopters can move casualties over Helicopters can move casualties over

terrain where evacuation by other means terrain where evacuation by other means would be difficult if not impossible would be difficult if not impossible

– Because of speed, range, flexibility, and Because of speed, range, flexibility, and versatility of Aeromedical evacuation, versatility of Aeromedical evacuation, casualties can be moved to MTFs best casualties can be moved to MTFs best equipped to deal with their conditionequipped to deal with their condition

73

Army Rotary Wing Air Ambulances

Helicopters are capable of horizontal, Helicopters are capable of horizontal, vertical, lateral, and hovering flight.vertical, lateral, and hovering flight.

They can circumvent terrain and They can circumvent terrain and obstacles.obstacles.

Their minimum takeoff and landing Their minimum takeoff and landing requirements enable them to operate from requirements enable them to operate from areas inaccessible to fixed-wing aircraft or areas inaccessible to fixed-wing aircraft or surface vehicles.surface vehicles.

74

Army Rotary Wing Air Ambulances

Their relatively slow speed permits use in Their relatively slow speed permits use in reduced ceiling and visibility. reduced ceiling and visibility.

Organic to air ambulance units and Organic to air ambulance units and aviation units at division and corps.aviation units at division and corps.

75

Army Rotary Wing Air Ambulances

Are designated by Are designated by a combination of a combination of letters and numbers letters and numbers to identify the basic to identify the basic mission and type:mission and type:– OH, UH, CH, AH, OH, UH, CH, AH,

and MHand MH

UH-60 Blackhawk

69

UH-1H Iroquois

70

78

Hoist OperationsStokes basketStokes basket

Jungle PenetratorJungle Penetrator

Sked litterSked litter

73

79

Loading Casualties

71

80

Safety Measures

Failure to observe proper safety procedures Failure to observe proper safety procedures could cause severe injury of death.could cause severe injury of death.

Litter bearers must present as low silhouette. Litter bearers must present as low silhouette.

Do notDo not approach until a crew member signals. approach until a crew member signals.

Approach the aircraft at a 45-degree angle Approach the aircraft at a 45-degree angle from the front.from the front.

81

Safety MeasuresIf on a slope and conditions permit, loading If on a slope and conditions permit, loading personnel approach from the downhill side.personnel approach from the downhill side.

Directions by the crew must be followed, Directions by the crew must be followed, and litters carried parallel to the ground.and litters carried parallel to the ground.

Smoking is not permitted within 50 feet of Smoking is not permitted within 50 feet of the aircraft.the aircraft.

82

Helicopter Landing Zones (LZ/s)

Unit requesting aeromedical evacuation Unit requesting aeromedical evacuation support is responsible for selecting and support is responsible for selecting and properly marking the LZ.properly marking the LZ.

Criteria for landing sites:Criteria for landing sites:– The LZ and the approach zones should be The LZ and the approach zones should be

free of obstructionsfree of obstructions– Sufficient space must be provided for the Sufficient space must be provided for the

hovering and maneuvering during landing hovering and maneuvering during landing and takeoffand takeoff

83

Helicopter LZs Criteria for LZ:Criteria for LZ:

– The approach zones should permit landing The approach zones should permit landing and take off into the prevailing wind whenever and take off into the prevailing wind whenever possiblepossible

– Landing sites should afford helicopter pilots Landing sites should afford helicopter pilots the opportunity to make shallow approachesthe opportunity to make shallow approaches

Definite measurements for LZs cannot be Definite measurements for LZs cannot be prescribed since they vary with prescribed since they vary with temperature, altitude, wind, terrain, loading temperature, altitude, wind, terrain, loading conditions, and individual helicopter conditions, and individual helicopter characteristics.characteristics.

84

Helicopter LZs Removing or marking obstructions:Removing or marking obstructions:

– Any object likely to be blown about by the wind Any object likely to be blown about by the wind from the rotor should be removed from the from the rotor should be removed from the landing arealanding area

– Obstacles, which cannot be removed and may Obstacles, which cannot be removed and may not be readily seen by a pilot, must be clearly not be readily seen by a pilot, must be clearly marked marked

– Red lights are normally used at night to mark all Red lights are normally used at night to mark all obstacles that cannot be easily eliminated obstacles that cannot be easily eliminated within a LZwithin a LZ

85

Helicopter LZs

In combat situations, it is impractical to In combat situations, it is impractical to mark the tops of obstacles at the mark the tops of obstacles at the approach and departure ends of an LZ.approach and departure ends of an LZ.

If obstacles or other hazards cannot be If obstacles or other hazards cannot be marked, pilots should be advised of marked, pilots should be advised of existing conditions. existing conditions.

In a training situation or at a rear area LZ, In a training situation or at a rear area LZ, red lights should be used to mark red lights should be used to mark obstructions.obstructions.

86

Identifying the LZ

When the tactical situation permits, mark When the tactical situation permits, mark with the letter “H” or an inverted “Y”with the letter “H” or an inverted “Y”

Panels must be secured to the ground to Panels must be secured to the ground to prevent them from being blown about by the prevent them from being blown about by the rotor wash.rotor wash.

Firmly driven stakes will secure the panels.Firmly driven stakes will secure the panels.

87

Identifying the LZ

A small wind sock or rag tied to a stick in the A small wind sock or rag tied to a stick in the vicinity of the LZvicinity of the LZ

A soldier standing at the upwind edge of the A soldier standing at the upwind edge of the site with their back to the wind and arms site with their back to the wind and arms extended forward.extended forward.

Colored smoke grenades; color identified by Colored smoke grenades; color identified by the aircrew and confirmed by ground.the aircrew and confirmed by ground.

In night operations there are many factors In night operations there are many factors that need to be considered.that need to be considered.

88

LZ Semifixed Base Ops (Day)

89

LZ Semifixed Base Ops (Night)

90

Field Expediant LZ (Day)

Additional Touchdown Points As Required for Other Helicopters in the Formation

91

Field Expediant LZ (Day)

Additional Touchdown Points As Required for Other Helicopters in the Formation

92

Field Expediant LZ (Night)

93

Field Expediant Inverted LZ (Night)

94

Nonmedical Vehicles

Ambulances are often not available.Ambulances are often not available.

Are to few in number.Are to few in number.

Are incapable of evacuating casualties over Are incapable of evacuating casualties over certain types of terrain.certain types of terrain.

Most units have vehicles that can be used to Most units have vehicles that can be used to transport casualties.transport casualties.

Some amphibious cargo and personnel Some amphibious cargo and personnel vessels can be used for this purpose. vessels can be used for this purpose.

95

Nonmedical Vehicles

Patient evacuation includes providing en Patient evacuation includes providing en route medical care to the casualty being route medical care to the casualty being evacuated.evacuated.

A casualty moved on a nonmedical A casualty moved on a nonmedical vehicle without en route medical care, is vehicle without en route medical care, is considered to be considered to be transportedtransported not not evacuated.evacuated.

96

Mass Casualty Situations

Contingency plans must be created and Contingency plans must be created and should include:should include:– Non-medical assetsNon-medical assets– Evacuation routes and MTFsEvacuation routes and MTFs– Ambulance and medical equipment exchangesAmbulance and medical equipment exchanges– Capability to provide en route careCapability to provide en route care– C² C²

Bradley Infantry Fighting Vehicle (BIFV)

76

98

Light Medium Tactical Vehicle (LMTV)

77

99

M1114 HMMWV

78

100

M1114 Loading

81

U.S. Army and U.S. Air Force Medical and Non-Medical

Aircraft

HH 60 (Pave Hawk)

82

CH 46 (Sea Knight)

83

CH-47 (Chinook)

84

CH 53 (Sea Stallion)

85

C-130J Hercules

86

107

C-9A Nightingale

108

C-141B Starlifter

109

C-5B Galaxy

110

C-17 Globemaster III

111

KC-135 Stratotanker

112

KC-10 Extender

113

Summary

Rapid evacuation is essential, especially Rapid evacuation is essential, especially when life is at stake.when life is at stake.

A thorough knowledge of evacuation A thorough knowledge of evacuation equipment, techniques and procedures is equipment, techniques and procedures is essential for soldier medics to be able to essential for soldier medics to be able to save lives and conserve the fighting save lives and conserve the fighting strength of our Army.strength of our Army.

114

Questions?Questions?