Page 78 - 2021 Advanced Ranger First Responder Handbook

Evacuation
Special Operations Forces (SOF) Aircraft Capacities
MH-60 – 2 x litter, 1 × ambulatory (optimal) OR 2 × litters only with auxiliary fuel tank OR 3 × litter (minimal en route
treatment) OR 1 × litter and 2–3 × ambulatory.
MH-47 – 8 × litter (floor-loaded)
MH-6 – 1 × litter (floor-loaded) for emergency contingency only. Never plan an MH-6 as a primary CASEVAC platform.
HH-60 – With carousel – 4 × litter; without carousel – 2 × litter, 1 × ambulatory
CV-22 – 5 × litter (floor-loaded)

General Principles of Rescue
During all rescue operations, tactical security and prevention of additional injuries (patients and rescuers) must be under
constant consideration by all participants. The principles or phases of tactical rescue include security of area/force;
assessment of rescue situation; gaining access; rendering emergency care; disentanglement/extrication; removal; stabi-
lization medical care; and evacuation. Contingency planning, training and rehearsals should always be a consideration.
Consider anchoring of rolled vehicle to prevent shifting of weight. If possible, casualty collection point (CCP) should
be established upwind from the site. Timing of evacuation requests must be synchronized to expected timeframes of
extracting and packaging of casualties. Keep C2 informed.
Downed Aircraft Casualty Extraction Considerations
A downed aircraft can occur during any phase of tactical operation, has a dramatic effect on the operation, and should
always be an assumed contingency. The immediate concern is securing the site and suppression of enemy actions.
Rescuers should identify themselves as friendly when approaching a downed aircraft. Immediate casualty care is fo-
cused on coinciding extraction from burning aircraft and treatment of life-threatening injuries. Casualty collection points
must be at a minimum safe distance from potential ammunition cook-off. CCP should be established upwind from site,
if possible, as burning aircraft materials can be toxic. Buddy-team search parties conduct methodical searches around
crash site for thrown victims. If possible, anchor the aircraft to the ground to prevent shifting or rolling. Combat Search
and Rescue (CSAR) link-up and assumption of C2 should be rehearsed as contingency for all aircraft operations. N-95
masks should be included in CSAR kits to protect rescuers.

Vehicular Casualty Extraction Considerations
Vehicle rollovers, IED events, and driving accidents can occur during any phase of a tactical operation. Scene security
and C2 must be established as soon as possible with the understanding that a combat engagement may continue dur-
ing rescue attempts. Suppression of enemy fire remains the primary mission at all times. Ensure the safety of rescuers
and casualties. Assess the scene situation to determine the need for additional assets. Recognize the mechanisms
that produced injuries and consider the treatments/equipment required to manage casualties. Identify and manage
life-threatening conditions and defer non–life threats to later stage. Consider cervical spine stabilization as applicable
if the mechanism of injury indicates potential spine injuries. Consider threats to rescuers and casualties to include fire
in vehicle, leaking fuels/products, ammunition cook-off, and other environmental conditions. Manage injuries per IAW
tactical trauma protocols with deference to use of conventional/civilian techniques when indicated.
Confined Space/Building Collapse Extraction Considerations
Confined space rescues in the tactical setting include casualties who have fallen into wells, storage tanks, drainage
systems, subterranean systems or trenches. Aside from the injuries incurred on initial trauma, closed spaces may con-
tain low amounts of oxygen or potentially hazardous gases or materials. Key information requirements are number of
casualties and potential hazards to patients and rescuers.
Building collapse rescue is complex, usually involves large numbers of personnel and specialized equipment, requires
knowledge of building design, and will likely take an extended period of time. Security of the site is paramount. Key
information is the last known position of personnel prior to the collapse. The organization of small search teams covering
sectors is critical. Aside from trauma injuries involved with the collapse, rapid cardiovascular compromise is the greatest
MISC life threat as victims are extracted. Sudden cardiac arrest may occur from acidosis and hyperkalemia. Get help from a
Ranger Medic.
Constant awareness of the security situation, flammable materials, and additional hazards are paramount during rescue
operations.
68 SECTION 7 MISCELLANEOUS PROTOCOLS