Page 102 - JSOM Winter 2021

FIGURE 1 ERST composition. FIGURE 2 Bell 412 layout. 7

Familiarization, training, and coordination with both the lay-
out of these platforms and loading protocols before patient
transport were vital in providing optimal care during trans-
port. This article will (1) review two platforms used by ERST
and CPR; (2) discuss the configurations, capabilities, and care
rendered on these platforms; (3) differentiate the two units’
training and capabilities; and (4) offer recommendations to
prepare future austere surgical and evacuation teams for oper-
ating alongside CPR personnel.

Results
transport times under 20 minutes. The Pilatus PC-12 flight
ERST and CPR transported ten patients over a multiday op- was utilized as a transport platform to a tertiary partner force
eration in September 2020: nine partner force individuals and medical facility, with an inflight time of approximately 80
one US Servicemember. The mechanisms of injury for all ten minutes for one US military casualty (Tables 1 and 2). Care
casualties included both blunt and penetrating blast injuries of patients utilizing both transport platforms required medica-
from improvised explosive devices. The ten transports on the tion administration, oxygen use, peripheral intravenous cathe-
Bell 412 were from POI to the ERST medical facility, with ter placement, and ventilator management (Table 3).

TABLE 1 Platform 1: Bell 412
Platform Description Platform Capabilities Patient Transports (10)
• Litter capacity: 2 • Two litters can be placed across the • Male (10)
• Ambulatory capacity: 14 (not including platform widthwise, allowing for the • Military age [18–30] (10)*

medical providers). 7 medical providers to care for both patients • Partner Force (9)
• The Bell 412 by Bell Textron is a utility simultaneously (Figure 2). • US military personnel (1)
helicopter of the Huey family. • The Bell 412 used by the ERST included • Urgent-Surgical (5)
• It has a max carrying weight of 5,398kg a hoist, adding the capability to extract • Priority (5)
and cabin space of 6.2m³. patients from dense terrain. • Blast injuries (10)
• The aircraft measures 3.69m long and • The platform has oxygen, power outlets, • Flight time (< 20 minutes)
3.52m tall. 8 and communications. • Ten patients were transported from POI to
the ERST in the following configurations:
• Two urgent-surgical litter with two priority
ambulatory patients
• One urgent-surgical litter with three
priority ambulatory patients
• Two urgent-surgical litter patients.
Note: Two CPR medical providers were
present on the platform for all evacuations,
and one evacuation included an ERST
registered nurse from POI in addition to the
two CPR personnel.
*Exact ages of partner force soldiers were unknown.

TABLE 2 Platform 2: Pilatus PC-12
Platform Description Platform Capabilities Patient Transport (1)
• Litter capacity: 2 • The aircraft is capable of traversing paved, • One urgent-surgical US servicemember
• Ambulatory capacity: 10 (not including grass, gravel, or dirt airfields. who sustained multiple penetrating blast
medical providers). 8 • The PC-12 is equipped with a pallet-sized injuries was transported on the PC-12
• The Pilatus PC-12 is a single-engine side cargo door, allowing for the loading of from an outstation to a regional tertiary
turboprop airplane capable of traditional litters (Figure 4). 8 care center.
passenger travel, medical assistance, cargo • There are two beds, each with its own • Flight time (80 minutes)
transport, and search and rescue missions. oxygen H-class cylinder, suction regulator, • The patient was positioned in the rear litter
• The PC-12 cabin is 5.16m long, 1.52m and power supply allowing for two bed allowing for easier access to medical
wide, and the internal cabin height is critically ill, vent-dependent patients at supplies in the rear of the platform and
1.47m (Figure 3). once (Figure 3). proximity to the cargo door for loading
• The two beds are positioned along the and unloading.
aircraft’s side, allowing for adequate • The team included two CPR providers,
working space for multiple medical an ERST critical care physician, an
providers (Figure 3). ERST critical care nurse, and a Special
Operations combat medic.

100 | JSOM Volume 21, Edition 4 / Winter 2021