Page 104 - JSOM Winter 2021

FIGURE 5 Litter team unloading a casualty from the Bell 412 after UH-60 Blackhawk, with which most rotary wing enroute mil-
being evacuated from the battlefield. itary medical personnel are familiar with.

Individual Platform Discussion – Pilatus PC-12
The PC-12 contained two removable stretchers. However, lit-
ters can also be loaded and placed on top of the stretchers via
the side cargo door. We recommend that the more critically ill
litter patient be loaded into the rear of the PC-12, allowing
for more rapid egress via the cargo door once at the intended
destination. ERST uses the North American Rescue Talon
Collapsible Litters (https://www.narescue.com/talon-ii-model
-90c-litter.html) for transport. However, the PC-12 removable
litters have an eight-point harness and adjustable headrest.
While this has some advantages for enroute transport, such as
raising the head of the bed for ventilator-associated pneumo-
nia prevention and intracranial pressure precautions, it would
require the ERST to transfer the patient from a Talon litter to
the PC-12 litter. As an alternative, the transport team removed
the PC-12 litter, placed it on the ground, and fixed the Talon
realistic rehearsals involving all parties before combat opera- litter to the PC-12 stretcher using standard litter straps. The
tions that focus on loading/unloading procedures, hoist opera- team elevated the stretcher’s head of the bed, placing the Talon
tions as instructed by CPR personal, and roles of all providers litter in a reverse Trendelenburg position (Figure 6).
on the aircraft. Teams should train with increasing intensity
until members are familiar and capable in all phases from POI FIGURE 6 ERST CCET and CPR transporting a patient via
the PC-12.
to evacuation outside of theater.
CPR medical providers render advanced life support-level care
and serve as the subject matter experts for the onboard equip-
ment, medical supply loadout, and flight crew functions. Ad-
ditionally, the CPR medical personnel are certified to operate
the hoist for patient extraction, which provides vital capability
in restrictive terrain and can be a valuable option when no
hasty landing zone is available. When a DCR provider remains
with a casualty from POI, he or she must be competent in per-
forming hoist operations, securing the litter in the aircraft, and
being comfortable with hoisting in both day and night opera-
tions. We recommend engaging in progressive and challenging
hoist training before any combat operation.
The PC-12 is ideal for remote patient transport because of the
Coordination of patient loading and verbal handoff before large cargo door for patient loading and the ability to utilize
transport was paramount as rotor noise and chaos on the bat- small airfields and non-traditional landing strips due to its
tlefield make communication challenging. The addition of the short take-off and landing distance. Casualty rehearsals before
DCR nurse on the CPR flight allows for a face-to-face patient missions are imperative to identify logistical issues in loading
handoff upon arrival to the surgical facility, increases the num- casualties into the PC-12. Teams should prioritize litter posi-
ber of capable medical personnel on board and at the receiv- tioning depending on the level of illness, mechanism of injury,
ing facility, and potentially offers a broader scope of practice and positioning of medical providers to maximize patient care.
in-flight. If tactically feasible, we recommend allowing DCR Also, unlike rotary medical aircraft, the pressurized cabin al-
personnel to remain with critically ill casualties transported lows for stethoscope auscultation, communication between
from POI. team members without special equipment, and operation
without ear protection while inflight.
Transporting additional providers, along with critically in-
jured patients, requires judicious space management. Medical Litter teams of three or four personnel should rehearse load-
teams and CPR personnel must coordinate and train to load ing and unloading of litters, as once they are in the aircraft,
only those supplies, medications, and pieces of equipment that there is little room to manipulate patients due to low over-
effectively augment capabilities while avoiding unnecessary head clearance. This training should help to minimize time
redundancy. Loading redundant equipment from the POI re- spent loading and unloading, maximizing time spent caring
duces working space within the aircraft. It also deprives the for patients. When loading two casualties, the more critically
remaining ground personnel of that equipment with no added ill patient should be loaded second. The two patients can be
benefit to the patient in-flight. oriented multiple ways in the platform. Ideally, teams will po-
sition medical bags in the rear and place the patient’s head
The main limitation of the Bell 412, in comparison to other toward the back of the plane to allow quick access to sup-
medical rotary wing aircrafts, is space available for medical plies (Figure 3). Other orientations include keeping the head
care. Two litter patients on the aircraft leave little room for of both patients toward the middle so that one medical pro-
medical providers. This contrasts with the more spacious vider can manage both airways without moving through the

102 | JSOM Volume 21, Edition 4 / Winter 2021