Page 45 - JSOM Spring 2020

TR-HFM-184 also sets out “Safe Ride Standards for Casu- forward to an FOB where a wounded soldier is extremity in-
alty Evacuation using Unmanned Aerial Vehicles” and notes jured, without a clear CASEVAC timing or plan, and without
clearly, “The use of UAVs for CASEVAC will take place as the benefit of the air superiority of previous campaigns. The
soon as cargo UAVs or optionally-piloted conventional air- tactical commander makes the decision to place the Soldier
craft are available on the battlefield, it is up to NATO and into the drone to fly back to the base area. He asks the TCCC
the nations to be ready.” These safe ride standards include re- provider or qualified medic (18-D) to prepare the patient for
straint and safety issues, maximum G loading (2G), maximum transport. What are the medical considerations? C-A-Ts 1 or
rate of application of G (0.25G/sec), and acceptable noise, vi- 2? Junctional tourniquet or pneumatic tourniquet applied
bration, and egress levels. 13 with altitude considered losses and gains? Antibiotics given;
TXA autoinjector ready, warmed blood (premixed cells and
Such drones already exist. The US Dragonfly DP 14 Hawk is plasma) in a single robust bag securely hung and ready for
a twin-rotor drone with VTOL self-launch/recover capability a flight of up to 2G with maximal 0.25G/sec application. A
and a 5-minute “hot-on-pad” launch time. It has a top speed of remote monitor connected to the on-board generator and en-
105 knots (Cruise 72Kt) and is nap of the earth flight capable crypted data transmitter, the physiology-driven remote syringe
with non–line of sight navigation if no GPS. All terrain landing driver filled with enough analgesia for the journey? Oxygen
(<15°) and a 2.4-hour endurance capability are standard. It delivery system primed, in-drone overhead camera monitor on
also has 4.5Kw on-board generator. This UAV can carry with and compartment warming engaged?
ease a lone patient but no attendant. The ducted-fan Israeli
14
Tactical Robotics Cormorant UAV can carry two patients For truncal or head-injured patients, balancing the risk of
and already meets IDF and NATO RTG-184 MEDEVAC and death of remaining at the Field Medic/R1 level for 24–36
CASEVAC standards. It cruises between 100 and 120 knots hours versus rapid drone CASEVAC will be problematic. Tele-
and has a 5-hour loiter time. It has two laser altimeters, a Dop- medicine may be of use, but a physiological scoring system
pler altimeter for use in dust/brown-out situations, GPS, and allied to mechanism of injury on the other side of the checklist
inertial/electro-optical navigation sensors. 15 might be of more use. Junctional tourniquets such as the AAJT
are already known to be as effective as Zone 3 REBOA and
The Bell 247 Vigilant drone, based on Bell 280 Valor technol- are much more easily applied. Intra-abdominal hemostatic
19
ogy, has a 13,000-lb payload and can cruise at 250 knots. It foams continue to be developed. The far future may allow for
16
has a 1,400–nautical mile range, a 11- to 15-hour loiter time, remote ventilation and in-transit cooling.
and an in-flight refueling capability. Two fit easily in a C-17.
The V280 is the replacement for the MV/CV-22 Osprey as part Level 1 UAVs where there is the physical space for en route
of the US Army Future Vertical Lift Program. Its top speed is care with a TCCC provider is the next step. I-Gel airway
over 300 knots. As with the UK Medical Emergency Response management, peripheral nerve catheter placement and active
Team (MERT) and In-Flight Surgery (IFS) program in CH- wound care are now all possible. However, it is obvious to
47s and CV-22s, this would clearly allow for physician-led en field commanders that their troops will need to be as comfort-
route team care on the V-280 and perhaps the V-247. 17 able psychologically climbing into this drone as into a CH-47.

Military UAV concepts of operation generally include; auton- Level 2 will equate to UK MERT care with physician led en
omous transit from start-point, to pick up point, to medical route interventions. This team can now deliver endotracheal
unit. Collision avoidance, avoidance of no-fly zones, and me- intubation, mechanical ventilation, and advanced resuscita-
teorological data, are all remotely and ready-factored in. This tion skills, including thoracostomy, fibrinogen, and calcium
should allow us to completely change our standard doctrinal administration and ISTAT sampling. The on-board physician
10-1-2 approach. Tactical field care would be immediately fol- can also make the clinical decision to overfly a R2 and transit
lowed by transport to surgery. Given that larger drones can fly to a CT-equipped R3 with a head-injured patient by interfac-
at close to 300 knots, this means that the receiving R2 could ing directly with the on-board drone control system.
be in a different country yet only 30 minutes away. In-flight
TCCC or critical care could be automatically delivered, and Level 3 UAVs allow for in-flight Damage Control Surgery. Some
for us, this is the key. Autonomous en route care was exam- countries already have this capability onboard their standard
ined previously, well over a decade ago. The DARPA Trauma manned-pilot airframes. IFS or in-flight surgery is therefore al-
Pod project was funded at $12 million in 2005. It turned out ready a reality. Pilot hours are more rigidly controlled than sur-
to be more useful for on-site minimally invasive prostatic sur- geons, but again end-user belief in airframe reliability remains
gery (MIS), than remotely performed surgery on the battle- key. A surgical team can hover in a holding pattern close to the
field. We should perhaps look again. troops in contact and land on when called. Laparotomy and
18
vascular control procedures including Zone 1 REBOA, resusci-
What levels of care can be delivered? For the purposes of dis- tative thoracotomy and aortic clamping are performed in flight
cussion, it may be reasonable to divide levels of UAV care into on the way to R3 in a western intensive care level hold.
the following:
UAV advantages are therefore; cost, an expendability that ob-
• Level 0: lone patient viously alters once a casualty is on board, increased reliability
• Level 1: en route TCCC provider with the removal of all human error, an intrinsic hover time
• Level 2: en route interventional care and an ability to place forward, combining stealth with rapid
• Level 3: en route surgical care casualty extraction. A UAV has the patience to sit on the roof
of a Patrol House for many weeks without boredom support-
Level 0 transport is the most likely in the near future. A large ing a team. There is also the possibility of UAV active/passive
cargo drone in 2020 will have brought ammunition and water self-defense during transfer to Role 2/3 care.

TCCC Guidelines for UAV Casualty Evacuation | 41