Page 101 - JSOM Winter 2021

Casualty Evacuation (CASEVAC) Platform Review and Case Series of

US Military Enroute Critical Care Team With Contract Personnel
Recovery Services in an Austere Environment

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Nathan L. Boyer, MD *; Joseph A. Mazarella, CCRN ;
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Erick E. Thronson, CEN, CFRN, FP-C ; Daniel B. Brillhart, MD 4

ABSTRACT
In a rapidly changing operational environment, in which there alternative ground and air platforms have been repeatedly
has been an emphasis on prolonged field care and limited called upon for patient transport to maintain resuscitative
evacuation platforms, military providers must practice to the and surgical capabilities throughout the AFRICOM. Special
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full scope of their training to maximize outcomes. In addition Operations Forces (SOF) operate within numerous austere
to pushing military providers further into combat zones, the environments throughout AFRICOM, in which nonstandard
Department of Defense has relied on contracted personnel to evacuation platforms may be the best, or only options, for pa-
help treat and evacuate servicemembers. This article is a ret- tient evacuation. Therefore, medical teams supporting these
rospective review on the interoperability of the expeditionary units, including those like ERST, must also adapt to the envi-
resuscitative surgical team (ERST) and a contracted person- ronment to best support the mission.
nel recovery (CPR) team in a far-forward austere environment
and will discuss actual patient transport case reviews that used
multiple evacuation platforms across thousands of miles of ter- Methods
rain. To effectively incorporate CPR personnel into a military This is a retrospective case series review of CASEVAC trans-
transport team model, we recommend including cross-training ports via contracted nonstandard air platforms by ERST and
on equipment and formularies, familiarization with CPR evac- CPR during their deployment to AFRICOM from August to
uation platforms, and mass casualty (MASCAL) exercises that December 2020. This review compares both units’ training,
incorporate the different platforms available. capabilities, and consideration for future evacuations. The
two CPR CASEVAC platforms reviewed include the Bell 412
Keywords: patient transport; air evacuation; prolonged field and Pilatus PC-12. We describe each aircraft, its capabilities,
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care; Special Operations; expeditionary resuscitative surgical and the care rendered during transport through data collected
team; contract personnel recovery; austere by the authors.
ERST, as discussed in this article, is a highly modular surgical
team that supports AFRICOM (Figure 1). This unique team
Introduction
possesses flexible capabilities, cubic weight, and personnel to
During the past 19 years, battlefield injuries have necessitated meet mission requirements. This team can provide initial re-
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urgent resuscitation and rapid transport to a surgical team suscitative care at the point of injury (POI) by the damage
across multiple dynamic environments. Military medicine control resuscitation (DCR) element, provide damage control
has adapted by placing surgical capabilities farther forward, surgery, move forward on nonlinear battlefronts, and perform
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thus increasing casualty survival. As many battlefronts – and prolonged field care for up to 72 hours. Another subset of
subsequent injuries – have moved into more austere environ- this team is the critical care evacuation team (CCET), which
ments, the need for patient movement via nontraditional plat- can immediately evacuate multiple patients after surgical sta-
forms has become relevant. 2 bilization, using platforms of opportunity, including ground
vehicles and aircraft. This transport team can be stationed
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A highly efficient patient evacuation system has been devel- at a casualty collection point or outstation, has an extensive
oped in the US Central Command (CENTCOM) theater critical care medication formulary, carries a minimum of four
over nearly two decades. Unlike these environments, the units of stored whole blood, and can continue resuscitation
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US Africa Command (AFRICOM) theater poses distinct pa- through the tactical evacuation (TACEVAC) phase of Tactical
tient transport challenges. With an area exceeding 11 million Combat Casualty Care.
square miles, over a patchwork of territory ranging from hos-
tile to permissive, distances between levels of medical care The ERST DCR and CCET used multiple air evacuation
make it impossible to implement the type of medical evacu- platforms for transport to higher levels of care immediately
ation (MEDEVAC) system in place in mature and heavily re- following an injury on the battlefield and after surgical stabi-
sourced battlefields of CENTCOM. Given the varying nature lization during their deployment. These transports were com-
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of the topography and the distances required for transport, pleted in conjunction with a CPR team onboard their aircraft.
*Correspondence to nathan.l.boyer.mil@mail.mil
1 MAJ Nathan Boyer serves as a physician in the US Army and is chief of pulmonary medicine at Landstuhl Regional Medical Center, Landstuhl,
Germany. Joseph A. Mazarella is a critical care nurse, Walter Reed National Military Medical Center Bethesda, MD. Erick E. Thronson is an
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emergency medicine nurse, Fort Bragg, NC. Dr Daniel B. Brillhart is an emergency medicine physician, Fort Hood, TX.
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