Page 124 - JSOM Fall 2020

A Case Series of
Air Force Pararescue Long-Range Ocean Rescues

Jesse W. Mix, DO *; Erik DeSoucy, DO ; Alex Hilser, NREMT-P ;
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3
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Daniel J. Houser ; Kubwimana M. Mhayamaguru, MD ; John Dorsch, DO ;
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Joshua B. Gaither, MD ; Stephen C. Rush, MD 8

ABSTRACT
Background: US Air Force (USAF) pararescuemen (PJs) per- combination of Special Operations mobility techniques, tech-
form long-range ocean rescue missions for ill or injured ci- nical rescue capabilities, and advanced prehospital medical
vilians when advanced care and transport are not available. skills are required.
The purpose of this case series is to examine the details of
these missions, review patient treatments and outcomes, and The US Coast Guard (USCG) has primary responsibility for
describe common tactics, techniques, and procedures for these coastal water rescue but is limited to approximately 300
missions. Methods: Cases in which the USAF PJs preformed nautical miles (NM) offshore because of lack of helicopter
long-range ocean rescue for critically ill or injured civilians air-to-air refueling capability, and their personnel cannot in-
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between 2011 and 2018 were identified. Case information sert via parachute. USCG aviation survival technicians (aka,
was obtained, including patient demographics, location, infil- “rescue swimmers”) are trained to provide medical care to
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tration/exfiltration methods, diagnoses, treatments, duration the emergency medical technician (EMT) level, whereas PJs
1
of patient care, patient outcome, and lessons learned. Results: are certified paramedics with additional training in invasive
A total of 14 pararescue missions involving 22 civilians were life-saving skills and PFC.
identified for analysis. Of the 22 patients, 10 (45%) suffered
burns, six (27%) had abdominal issues, four (18%) had mus- Coastal and open-ocean rescue missions are initiated after an
culoskeletal injuries, one had a traumatic brain injury, and one emergency call to the Coast Guard Rescue Coordination Cen-
had a necrotizing soft-tissue infection. Medical care of these ter. If the rescue requires transport >300 NM, they will discuss
patients included intravenous fluid and blood product resus- the mission with a USAF combat rescue officer (CRO) and
citation, antibiotics, analgesics, airway management, and es- pararescue flight surgeon (FS), or directly notify the Air Force
charotomy. The median duration of patient care was 51 hours. Rescue Coordination Center, which then assigns the mission
Conclusion: This case series illustrates the complex transpor- to a PJ squadron based on current alert posture and proximity
tation requirements, patient and gear logistical challenges, to the incident.
austere medicine, and prolonged field care (PFC) unique to
USAF PJ open-water response. Once notified, the PJ team performs mission planning and
pack-out of operator gear and medical equipment. A typical
Keywords: pararescue; open-water rescue; prolonged field team is composed of one CRO and three to six PJs, though
care; search and rescue team structure is flexible based on mission requirements. Team
members are inserted on the objective via parachute from an
HC-130 or hoist from an HH-60. Operator parachute inser-
Introduction tion is accompanied by deployment of medical supply bundles
and packaged Zodiac boats to assist in consolidation and ship
USAF PJs are the only Department of Defense asset organized, boarding. When the operators and equipment are safely on
trained, and equipped to perform full-spectrum personnel re- board, the PJs then assess, triage, and move patients; orga-
covery. Although their primary mission set is combat search nize the casualty collection point; provide care; and, finally,
1
and rescue (SAR), they are often tasked to natural disaster package the patient and perform exfiltration. Beyond the tra-
response and civil/humanitarian SAR missions in which the ditional paramedic care, PJs perform PFC including nursing
*Correspondence to: 2702 E Adams St, Tucson, AZ 85716 or j.wm.mix@gmail.com
1 Maj Mix is a board-certified family medicine and emergency medical services physician and is a pararescue flight surgeon for the 125th Spe-
cial Tactics Squadron in the Oregon Air National Guard, Portland, OR. Maj DeSoucy, USAF, is a surgical critical care fellow at Brooke Army
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Medical Center, San Antonio, TX. He has deployed twice as a pararescue flight surgeon. SSgt Hilser is a Pararescueman with the 48th Rescue
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Squadron, Tucson, AZ. An alumnus of Rice University, he has been a civilian first responder since 2008. 2d Lt Houser, USAF, is a third-year
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medical student at the Uniformed Services University, College of Medicine, Bethesda, MD. He was previously enlisted as a vehicle mechanic and
has deployed in support of Operation Enduring Freedom. Maj Mhayamaguru is a critical care air transport team physician and flight surgeon
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with the 943rd Rescue Group; an assistant professor of emergency medicine at the University of Arizona, Arizona Emergency Medicine Research
Center, College of Medicine-Phoenix, and College of Medicine-Tucson, The University of Arizona; and 943rd Rescue Group, Air Combat Com-
mand, USAF-Reserve, Tucson, AZ. Col Dorsch is a board-certified emergency medicine physician and is the 724 WG/SGP and current USAF
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pararescue medical director, Air Force Special Operations Command, USAF, Hurlburt Field, FL. Dr Gaither is a board-certified emergency
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medicine and emergency medical services physician currently serving as University of Arizona EMS Fellowship Program director and Tucson Fire
Department medical director, Tucson, AZ. Lt Col Rush is a pararescue flight surgeon for the 103rd Rescue Squadron, Westhampton Beach, NY.
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He is a member of the Committee on Tactical Combat Casualty Care and previous USAF pararescue medical director.
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