Page 44 - JSOM Spring 2020

Developing TCCC Guidelines for
Unmanned Aerial Vehicle Casualty Evacuation

Paul J. Parker, RAMC, MB BCh, BAO, DipIMC, FRCSEd, FRCSOrth, FIMC

“. . . Would a means to fly in and extract isolated personnel
without putting additional personnel in harm’s way be of value?
The answer to that question is an obvious—Yes!”
—CWO4 Michael Durrant, USA (Ret), Pilot Super Six-Four,
160th SOAR, Battle of Mogadishu, Operation Gothic Serpent, 1993

he first ever successful drone strike took place on 27 Sep- SOF or training teams working in austere, remote, and iso-
tember 1944. Under Operation “Option,” an interstate lated areas with elongated timelines and no local coalition air
TTDR-1 drone fitted with a nose-cone camera was suc- assets or close-by R2/3 medical facilities. There is a clearly
cessfully remote guided onto a Japanese gun emplacement on a need to develop new capabilities to anticipate these tasks.
Bougainville Island in the Pacific and detonated. In Vietnam, The dynamics and constraints of future conflict are often un-
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North Korea, and China between 1964 and 1974, jet-powered known. Budgetary issues are often primary concerns.
Ryan 147 “Lightning Bug” drones flew 3,345 high- and low-
level reconnaissance missions. In Vietnam, under US Navy Current doctrine is still based on (or constrained by) the 10-
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Project “Midget,” Gyrodyne Dash QH-50 anti-submarine 1-2 concept. Care under fire and tactical field care within 10
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rotary drones were secondarily deployed to rescue downed minutes, damage control surgery within 1 hour and more de-
pilots. The first recorded combat retrieval of a Special Forces finitive surgical care by 2 hours. In a decade where the appetite
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Soldier from the jungles of Vietnam was reportedly performed for risk seems to diminish each month, tactical commanders in
by a US Navy Destroyer–launched QH-50 drone. 4 the field find themselves increasingly constrained, contained,
and militarily fixed by colored maps arbitrarily overlaid with
Unmanned aerial vehicles (UAVs) have an increasing useful- 1-hour CASEVAC rings. Is there a solution?
ness, in both military and civilian life. In Sweden and the
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Netherlands, when reporting a cardiac arrest, a UAV carrying Unmanned aerial vehicles are becoming increasingly afford-
a defibrillator can be despatched to your location, using your able, reliable, and sophisticated. As noted, they are already
phone’s GPS signal as a guide, within minutes. In Rwanda used for the medical purposes of blood, drug, and AED deliv-
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and Ghana, Zipline (Zipline, Half Moon Bay, CA) drones car- ery. Interestingly, the Geneva Convention (1949) under Article
rying blood and medicines to treat postpartum hemorrhage 39 is already thought to give guidance on Medical UAVs as it
are tasked by WhatsApp or text message to remote clinics. states, “Medical aircraft may not be the object of attack.”
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To date, 23,404 automated drone deliveries have been made, It does not differentiate between manned and unmanned air-
including more than 13,000 units of blood, plasma and plate- craft. In peer-to-peer conflict, wholly medical, Red Cross–
lets. 70% of remote area blood outside the urban centers in marked drones could therefore use IFF (Identification Friend
these countries is now delivered via these means. Zipline state or Foe) transponders for protection.
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that they now have the capacity to undertake 500 such mis-
sions a day. Military feasibility studies have confirmed that The DoD has an “Unmanned Systems Integrated Roadmap
similar results can be achieved in the field. Using simple UAV 2013-2038.” The NATO workgroup publication “RTG-184
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technology, “urgent” medical supplies that took 306 minutes / STO-MP-HFM-231: Unmanned Aircraft Systems for Casu-
to deliver on foot and 61 minutes to deliver by road took only alty Evacuation: What needs to be done?” states, “The use of
21 minutes to deliver by drone. 8 UAVs for CASEVAC is ethically, legally, clinically, and opera-
tionally permissible, so long as the relative risk to the casualty
Planners and physicians face the public expectation of rapid is not increased. The employment of VTOL UAVs for casualty
casualty evacuation with a high “Western Medicine” level of evacuation will soon be a reality and eventually commonplace
care (as was the case in Afghanistan, with virtually complete in the battle-space. By conducting the research proposed in
air superiority) in future war. Our reality is one of multiple this paper, NATO members will be ready.” 12
Correspondence to parker_paul@hotmail.com
COL Parker is a consultant orthopaedic surgeon with the Parachute Field Surgical Team, 16 Medical Regiment, Colchester, UK, and senior lec-
turer in SOF medicine at University College Cork.

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