Page 88 - JSOM Summer 2024

Adoption of the CH-47 to

MEDEVAC Special Operations Forces in USAFRICOM

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Ryan M. Leone, MSc *; Mason H. Remondelli, BS ; Sheldon S. Smith, BS ;
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Brandon J. Moore, BS ; Shelbi L. Wuss, BS ; Matthew D’Angelo, DNP 6
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Introduction
The U.S. is pivoting to future conflicts requiring multi- domain, evacuation approaches in the theater. When coupled with dis-
large-scale combat operations (LSCOs). As such, military persed personnel and limited rescue options, distance conveys
medical planning, resourcing, and training have shifted focus a high mortality risk to those who are injured in the theater. 6,7
away from the counterinsurgency efforts utilized in the global
war on terrorism (GWOT). This is an appropriate redirec- Prior medical evacuations from the AFRICOM theater have
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tion, especially given the tremendous casualty estimates under predominantly been due to non-battle injury and disease, with
simulated Indo-Pacific conflicts. However, irregular warfare one study finding that 97% of transports were for disease or
and low-intensity conflicts remain a threat in the shadow of non-battle injuries. Of those evacuated due to trauma, 22%
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LSCOs and prompt specific evacuation needs. 2 were gunshot wounds, and 24% were sports injuries. Further,
29% of cases required wound debridement, and 22% required
The U.S. maintains a diplomatic and military presence through- fracture or joint dislocation reduction. Based on an analysis
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out many remote regions. The nation projects power through of combat casualties in Ukraine, it can be extrapolated that
Special Operations Forces (SOF) to protect national interests the injury severity score could be higher in future kinetic sce-
and provide regional stability. To complete these missions, SOF narios in AFRICOM due to modern weaponry, drones, and
often operate in austere environments far from definitive care advanced technology. Non-state actors and militia groups may
facilities. 3 utilize drones or even chemical, biological, and nuclear weap-
ons of mass destruction, while state-funded private actors like
Although the long-distance challenge is not unique to the U.S. Russia’s Wagner Group have been supplying ground-to-air
Africa Command (AFRICOM) and U.S. Indo-Pacific Com- missiles to Sudan’s paramilitary forces. 10–12 This underscores
mand (INDOPACOM) theaters, we anticipate that regional the necessity of advanced provider-assisted transport, and the
air superiority in AFRICOM will enable unconstrained aero- requirement for sufficient space to transport them. More
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medical evacuation. For this reason, SOF in AFRICOM could specifically, the types of injuries that may be encountered in
benefit from larger flight medical teams with greater capac- AFRICOM demand an aeromedical evacuation platform to
ity, in-flight damage control resuscitation or surgery (DCR/ address trauma, toxic exposures, or even severe infectious
DCS) capabilities, and faster transport to definitive care. The diseases.
U.S. military should augment its regional medical evacuation
(MEDEVAC) platform with CH-47 Chinooks (Boeing, Rid-
ley Park, PA; https://www.boeing.com/defense/ch-47-chinook Aeromedical Evacuation Approaches
#overview) to improve these medical capabilities. The aeromedical platform of choice throughout the campaigns
in support of the GWOT was focused mainly on the UH-60M/
AFRICOM Theater Characteristics HH-60M platform (Sikorsky, Stratford, CT; https://www.
lockheedmartin.com/en-us/products/sikorsky-black-hawk-
U.S. interests in Africa are continuously threatened, with helicopter.html). The platform includes the UH-60M for
contributions from weak regional governance, unequal civil MEDEVAC (which bears a red cross without carrying weap-
development, disease, violent extremism, crime, conflict, and ons to align with Geneva Convention protections), the MH-60
food insecurity. The weaponization of these threats by state for tactical evacuation (TACEVAC) without such protections,
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and non-state actors, alongside the dispersed nature of deploy- and the HH-60 for combat search and rescue. This platform
ments across 22 African nations, places Operators assigned to and its variations will be referred to hereafter as the UH-60M
Special Operations Command Africa (SOCAF) at risk. 5 for simplicity.

These threats are particularly troubling when viewed through a The UH-60M medical crew was conventionally composed of
medical evacuation lens. The “tyranny of distance” complicates one flight paramedic whose primary focus was en-route care

*Correspondence to rml2207@cumc.columbia.edu
1 2LT Ryan M. Leone is a medical student at Columbia University Vagelos College of Physicians and Surgeons, New York, NY. 2LT Mason H.
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Remondelli, 2LT Sheldon S. Smith, and 2LT Shelbi L. Wuss are medical students in the School of Medicine, The Uniformed Services University
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of the Health Sciences, Bethesda, MD. MAJ (Ret) Brandon J. Moore is a postgraduate student at Columbia University, School of General Studies,
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New York, NY. COL Matthew D’Angelo is Chief of the Division of Nurse Anesthesiology at the University of Maryland, Baltimore, MD.
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