Page 103 - JSOM Winter 2021

FIGURE 3 PC-12 layout. simulate providing care in a moving vehicle. This training dif-
fers from standard aeromedical evacuation training through
the Joint Enroute Care Course (JECC) at the School of Army
Aviation Medicine at Fort Rucker, AL, which trains joint
military providers on static UH-60 Blackhawk simulators
throughout a 2-week course. We believe deploying transport
9
teams should train on moving vehicles as it is critical to pro-
viding effective enroute care.

The experience of the CPR providers ranged from career civil-
ian flight paramedics to former US Air Force pararescuemen.
Unlike the ERST providers, CPR providers are certified in
conducting hoist operations to extract causalities from dense
terrain. ERST filled this gap in training by conducting hoist
training operations with CPR personnel. The CPR personnel
FIGURE 4 Litter personnel training on loading a litter casualty into embedded with ERST were not advanced practitioners, so the
the PC-12.
addition of a critical care physician enhanced the medical ca-
pabilities during transports. Garne et al. showed that adding a
critical care physician to flight paramedic teams can decrease
trauma patients’ mortality due to a vaster skillset and training
10
experience. Therefore, based on this previously cited data
and personal experience, the authors recommend including
physicians on critical care air transport whenever possible to
augment enroute care.

Individual Platform Discussion – Bell 412
The Bell 412 is suitable for all patients, from convenience to
urgent-surgical. Routine training and pre-mission rehearsals
are imperative to identify logistical issues loading and un-
loading casualties into the aircraft (Figure 5). Teams should
prioritize litter positioning depending on the level of illness
TABLE 3 Medications/Therapies and Supplies/Equipment Used and positioning of medical providers to maximize patient care.
During Transport When transporting one casualty, we recommend placing the
Medication/ litter closest to the bulkhead where most medical supplies, in-
Platform Therapies Supplies/Equipment cluding electrical and oxygen connections, are located for ease
Bell 412 • Ketamine • Peripheral intravenous of access. When transporting two patients, we recommend
• Hydromorphone catheter insertion (1)
• Ondansetron • SAVeII Ventilator (5) that the more critically ill patient be placed closer to the bulk-
• Whole blood • EMMA Capnograph (5) head, for the same reason, with the medical providers located
• Philips IntelliVue between the litters. Having ambulatory, or less ill, patients lo-
Monitor (5) cated proximal to the bulkhead and litter patients farther from
• Oxygen via simple face the medical supplies may force the DCR attendant to move
mask (5)
• Resuscitative around these patients. This can make care of the litter patient
Endovascular Balloon more challenging. All litters and medical personnel should be
Occlusion of the Aorta secured before flight by any of the numerous D-rings fixed to
(REBOA) system the cabin floor.
management (1)*
Pilatus PC-12 • Ketamine • Zoll Impact Uni-Vent 731 ERST can position the DCR element far-forward with the
• Propofol* EMV+ (1)*
• Midazolam • SAVeII Ventilator (1) ground forces because of its modularity, enabling advanced
• Fentanyl • Philips IntelliVue resuscitative capabilities at the POI and enroute back to the
• Rocuronium* Monitor (1) operating room. If tactically and logistically feasible, we rec-
• Ondansetron • EMMA Capnograph (1) ommend one DCR provider, either the trauma nurse or emer-
*Unique to ERST formulary/load-out. gency medicine physician, accompany the patient from POI to
support the CPR medical providers on the Bell 412. During
one ERST patient transport, the DCR nurse remained with the
Discussion
patient from POI, performed enroute care on the Bell 412, and
ERST versus CPR Training and Experience provided patient handoff upon arrival to the surgical facility.
Before deployment, ERST undergoes rigorous training over This allowed for continuity of care from the battlefield to the
a 2-week period in prolonged field care in a limited-resource operating room.
environment, under both day and night operations. The pre-
deployment training incorporates seamless transition from An urgent medical evacuation from the POI requires signifi-
prolonged field care to tactical evacuation care by implement- cant coordination, involving ground medical providers, com-
ing transport scenarios on ground CASEVAC platforms. These mand and control personnel in multiple locations, and security
platforms include pick-up trucks, box trucks, and others to personnel. Therefore, we recommend regularly occurring,

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