Page 85 - JSOM Winter 2022

Military Medical Evacuation
After the Benghazi Embassy Attack

Implications for Military Support of Diplomatic Missions

Seshidar Tekmal, MD *; Casey Lockett, MD ; Brit Long, MD ; Steven G. Schauer, DO, MS 4
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ABSTRACT
Background: The Department of State has the primary respon- Introduction
sibility of diplomatic operations in foreign countries. The US
military often supports these missions and, when needed, may Background
be called upon to provide security in the event of changes in US Africa Command (AFRICOM) was activated in 2007 and
the host nation’s government stability. The US military was numbers approximately 8,000 personnel. AFRICOM has of-
requested to help evacuate the consulate in Benghazi after the ficially engaged in operations in multiple African countries in
attack on September 11, 2012. The medical requirements to various forms. Much of the operations AFRICOM is charged
support such a mission remain unclear, and data are lacking. with are based on advise, assist, accompany, and enable opera-
We sought to describe the medical care required during this tions (ie, Continental Staff System directorate J3). Many of the
evacuation mission. Methods: This is a secondary analysis of operations conducted in Africa involve small contact traveling
a previously described dataset from the United States Trans- teams, Special Operators, and diplomatic missions, all without
portation Command (TRANSCOM) Regulating Command the large medical evacuation apparatus featured in Operation
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& Control and Evacuation System (TRAC ES) from 2008 to Iraqi Freedom and Operation Enduring Freedom. Further-
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2018, with a focus on cases involving the evacuation after the more, civilians from the Department of Justice, Department
Libyan consulate attack in September 2012. Within our data- of Agriculture, and Department of State are attached to such
set, we isolated all cases of evacuation from the attack on US units. Conversely, much of the operations are led by the De-
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government facilities in Benghazi. We describe the available partment of State with military attachments. Although multi-
data within TRAC ES, including the free text information ple options may exist for evacuation, given these partnerships,
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placed by the initiating medical personnel. Results: We iden- coordination of assets may be intricate. The Theater Patient
tified three cases of evacuations within TRAC ES associated Movement Requirement Center coordinates medical evacua-
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with the Benghazi consulate attack. All cases were evacuated tions with nongovernment organizations or private firms, such
from host nation hospitals to Landstuhl Regional Medical as International SOS, usually by civilian aircraft evacuation.
Center (LRMC) by military aircraft under urgent status. Case Evacuations by military air assets are also an option; however,
1 was an adult male injured by an undocumented mechanism. the large distances limit the types of aircraft capable of per-
He was found to be in severe shock, received four units of forming these evacuations.
blood prior to transport, and was intubated. Case 2 was an
adult male injured by an undocumented mechanism. He had Unstable patients face the challenge of being transported to
documented smoke inhalation injury and was found to be local hospitals, which may suffer from variable medical care
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coughing up black sputum. Case 3 was an adult male injured standards compared with US hospitals. Once this stage of
by an undocumented mechanism. He had a compound radial medical care is complete, casualties face another challenge
fracture with an external fixator in place and subsequently de- with their care: patient relocation. Because of Africa’s signifi-
veloped compartment syndrome. He was intubated prior to cantly large area of operations, the use of rotary wing aircraft
transport. Conclusions: Our case series focuses on the unique is limited, and evacuation out of theater to higher levels of
aspects of military support of diplomatic missions in countries care more commonly requires fixed-wing–based missions, thus
lacking a stable government—specifically, what transpired in limiting options in decreasing transport times. Despite many
Benghazi. Such events showcase areas of potential collabo- discussions, expanding medical and surgical coverage farther
ration between the Department of State and the Department forward to US personnel, the methods of providing medical
of Defense in coordinating medical evacuations for casualties care to US personnel—both military and civilian—remain
sustained during diplomatic missions. challenging.

Keywords: Libya; Benghazi; embassy; attack; military; evacuation The tenuous diplomatic mission in Libya circa 2011–2012
was not wholly uncharacteristic for other Department of
State engagements on the African continent at the time. An-
ecdotal recounting by personnel present around the period
*Correspondence to seshidar.r.tekmal@gmail.com
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1 CPT Seshidar Tekmal and CPT Casey Lockett are affiliated with Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston, TX.
3 MAJ Brit Long is affiliated with Brooke Army Medical Center, Joint Base San Antonio–Fort Sam Houston, and Uniformed Services University
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of the Health Sciences, Bethesda, MD. MAJ Steven G. Schauer is affiliated with Brooke Army Medical Center, Joint Base San Antonio–Fort
Sam Houston, Uniformed Services University of the Health Sciences, Bethesda, and the US Army Institute of Surgical Research, Joint Base San
Antonio–Fort Sam Houston.
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