Page 134 - JSOM Spring 2021

cAseVAc cAre trAnsItIon
The term “CASEVAC” is used to describe this phase in- The concept for the Tactical Medicine for Mission Com-
stead of the commonly used term “MEDEVAC” because the manders course was first presented to the line leadership at
evacuation may require that the aircraft or other evacuating the Naval Special Warfare Center, which is responsible for
asset enter an area where the danger of hostile fire is imminent. teaching the SEAL Junior Officer Training Course to all officer
Some aircraft will do this and some won’t. The need for the graduates from Basic Underwater Demolition/SEAL training
mission commander to be sure that the evacuating asset will (BUD/S). The concept was approved, and with the help of the
enter a hostile fire zone is illustrated dramatically by Moore medical staff at the NSWC, the course has been taught to all
and Galloway in their book “We Were Soldiers Once and officers graduating from BUD/S since April of 1998. It is be-
Young.” During the battle of the Ia Drang Valley, the first ing taught to SEAL operational units at present. Two recent
16
large US ground action in Vietnam, the 11th Air Assault Di- innovations have been recommended by SEAL line officers
vision made contact and had taken numerous casualties. The and are in the process of being implemented. The Director of
request for helicopter evacuation was made to the designated Training at the Naval Special Warfare Center stressed the need
MEDEVAC unit, but upon learning that there was a firefight to provide course attendees with material at the course that
in progress, this unit declined to perform the evacuation. The they could use to help implement this training at the unit level.
casualties were not evacuated until the 229th Assault Helicop- A Tactical Medicine for Mission Commanders CD has been
ter Battalion, a combat air cavalry helicopter unit, was con- approved and is in production at the time that this article is
tacted, resulting in a significant delay to definitive care. being written.
It is now anticipated that training in Tactical Medicine
IntroductIon to scenArIo-bAsed PlAnnInG for Mission Commanders will be added to the SEAL Tacti-
Despite the large amount of Special Operations time and cal Training Course taught to all new SEALs after graduation
effort that has gone into developing a combat-appropriate from Basic Underwater Demolition/SEAL training. Although
trauma management plan, the bottom line remains that no this course has been developed within the SEAL community, it
single plan is optimal for all situations. This realization led to has great applicability to the other components of SOF (Rang-
the concept of scenario-based management plans. 2 ers, Special Forces, and Air Force Combat Control Teams) as
Some representative scenarios are presented in Figures 8 well as to the Marine Corps and to other conventional forces
to 15. The medical and tactical issues to be addressed in most that conduct small unit operations. Efforts are ongoing to co-
of these scenarios have been addressed previously. 8–10 Figures ordinate with other potential users of this course to demon-
8 and 9 are from the Battle of Mogadishu on 3 October 1993. strate the course to them and make course materials available
This engagement resulted in the most US casualties in a single if desired.
firefight since Vietnam (18 dead, 73 wounded). In addition,
there was a delay of 15 hours before the first wounded were the seAl tActIcAl sIMulAtor
evacuated to a Combat Support Hospital. Starting with sce- A parallel concept could be used to help develop re-
narios that have already occurred helps to raise the level of sponses to tactical problems of a non-medical nature in SEAL
interest in the discussions that ensue. operations. The aviation community makes extensive use of
Figures 10 to 12 deal with a parachute insertion and sub- flight simulators to sharpen pilots’ responses to both aircraft
sequent land warfare phase with injuries of several different emergencies and tactical problems. The SEAL community like-
magnitudes imposed on landing. The medical care of these wise makes extensive use of the SEAL Delivery Vehicle (SDV)
casualties is relatively straightforward, but they require some simulator to train new SDV pilots and navigators. There is,
difficult tactical decisions by the mission commander which however, no simulation tool currently available for non-SDV
are discussed. SEAL operations. The same scenarios used for casualty dis-
Figures 13 to 15 deal with casualty scenarios that occur cussion can be modified to present tactical problems. Figure
during diving operations. This is a very important aspect of 16 describes a ship attack in which there is an underwater
the training for SEAL mission commanders because the un- explosion, but the divers have apparently suffered only middle
derwater environment has such a large impact on the manage- ear barotrauma and can both continue with the mission. A
ment plan and because this area is virtually unaddressed in the number of tactical options may be considered by the senior
civilian medical literature. member of the swim pair: 1) ignore the possibility of addi-
As the group discusses the various scenarios, it becomes tional charges and continue with the planned operation; 2)
apparent that the appropriate care for a casualty may vary abort the operation and swim away; 3) swim away from the
based on the criticality of the mission, the anticipated time to ship and observe for possible periodicity of the charges; 4) sur-
evacuation, and the environment in which the casualty occurs. face and shoot the individual dropping the charges; 5) descend
Any management plan for a combat casualty discussed in the to the bottom of the harbor in an attempt to avoid the effects
planning phase should be considered advisory rather than di- of subsequent blasts; or 6) swim 180 degrees around to the
rective in nature, since only infrequently will an actual tactical other side of the target ship to try to gain shielding from the
situation unfold exactly as planned. effects of subsequent blasts. Several of these options may be
These scenarios illustrate that the importance of the role reasonable; others would be dramatically ill-advised.
of the mission commander in dealing with casualties is often Use of scenario-based casualty planning has led to a num-
just as important as that of the corpsman, since the unit’s ber of medical research projects designed to address unan-
emergency action must address both the medical and the tac- swered questions or shortcomings in medical technology. The
tical problems at the same time. It is obviously not possible to same thing might occur using tactical scenarios. For example,
plan for every casualty scenario that might be encountered, if the prisoner in Figure 17 is released, he might compromise
but review of several casualty scenarios most appropriate for the mission and endanger the lives of mission personnel. If
an impending operation is a valuable addition to the planning he is restrained at the location of the contact, there would be
process. no way to release him after the mission is complete without

130 | JSOM V olume 21, Edition 1 / Spring 2021
130 | JSOM Volume 21, Edition 1 / Spring 2021