Page 89 - JSOM Summer 2024

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and maintaining the patient until the next level of care. UH- teams could augment Military Treatment Facilities (MTFs), of-
60M flight medical teams could doctrinally care for a maxi- fer medical assistance during transport from other evacuation
mum of four patients, but operationally support care for two platforms, perform critical care transport between MTFs, or
patients given vertical space limitations. 15,16 Crews primarily provide in-flight damage control care at the point of injury
provided Tactical Combat Casualty Care; however, they had (including procedures such as resuscitative thoracotomy, lapa-
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the capability of offering more advanced care when appro- rotomy, and extremity fasciotomy). Less commonly, the CH-
priately resourced. Access to DCR/DCS was delayed until the 47 has even been used by the United States Air Force Tactical
patient was transferred to a Role 2 Surgical Team or Role 3 Critical Care Evacuation Teams (TCCETs); these teams include
Medical Treatment Facility because a surgical team could a critical care or emergency physician, a certified registered
not be carried far-forward on the UH-60M platform. While nurse anesthetist, and an emergency room nurse to provides
these crews and capabilities were sufficient for counterinsur- critical care at the point of injury from rotary-wing aircraft. 28
gency operations in the relatively condensed geography of the
CENTCOM area of responsibility, optimizing support to SOF In 2011, the Defense Health Board recommended that the U.S.
in AFRICOM will require these crews to be extended beyond develop advanced TACEVAC care capability modeled off of
their current capabilities and capacity. the MERT approach using the most capable platform, such
as the CH-47. In 2023, the director of the Medical Evacua-
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The aeromedical casualty evacuation continuum during the tion Concepts & Capabilities Division similarly advocated for
GWOT routinely involved multiple assets that moved patients CASEVAC considerations to be explicitly “planned, synchro-
from the point of injury to definitive in-theater care. The UH- nized, trained and rehearsed” to meet the evacuation needs of
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60M would provide short-distance aeromedical evacuation, future battlefields. Despite the aforementioned successes and
and the mission of the fixed-wing C-130 aircraft was primar- these decade-old recommendations, the U.S. military has yet to
ily the intra-theater transfer of casualties. This model is chal- officially adopt the CH-47 to be explicitly used for MEDEVAC
lenging in AFRICOM; while air superiority exists in theater, or TACEVAC.
the nature of the activities and sheer geographic size demands
that evacuation assets have a smaller footprint with the capa- Unique Benefits of the CH-47
bility to cover more considerable distances. The requirements
of the UH-60M/C-130 model, classically used in CENTCOM, Compared with the UH-60M, the CH-47 has increased capa-
can be met by a CH-47/C-130 model, which could augment bilities to accommodate far-forward care delivery while pro-
UH-60Ms to provide DCR/DCS aeromedical evacuation and viding ICU-level treatment in-flight across large geographic
intra-theater rotary-wing critical care air transport platform. distances in AFRICOM (Table 1). These advantages include a
larger fuselage space to increase the number and technological
capabilities of medical providers, a higher lift capacity for the
Prior CH-47 Medical Uses
transport of critical care resuscitative medical equipment, the
The U.S. military classifies the CH-47 as a cargo and heavy ability to transport more combat casualties per flight—up to
lift transport helicopter that can be used as an ad hoc casualty 24 litters or 33 fully equipped ground troops, compared with
evacuation (CASEVAC) platform during unexpected mass ca- four litters or 11 fully equipped ground troops—and a faster
sualty events. However, the CH-47 has been used by the Ca- cruising speed to maneuver throughout the battlespace. 31,32
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nadian and British militaries to field the Medical Emergency The CH-47’s ability to accommodate a larger medical team
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Response Team (MERT). This aeromedical platform was footprint and increased life-saving equipment allows for a
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used by the British Armed Forces in Afghanistan and by the higher level of trauma and resuscitative management while
Canadian Armed Forces during Operation Presence in Mali. 20 en route to the next role of care. Furthermore, the confined
space of the UH-60M has been shown to increase the risk of
Conventionally, the British fielded the MERT with a flight nurse lower-body injury, partly due to awkward positions in the air-
and flight paramedic; however, they introduced the MERT-E craft, so using CH-47s in rotation with UH-60Ms could re-
model with an in-flight physician in 2006, which improved duce this risk. 33
patient survival. Including an emergency or anesthesiology-
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trained physician within the MERT-E enabled a “scoop and The CH-47’s expanded and modular fuselage allows a vari-
play” formula of medical care, where resuscitation mea- ety of configurations that are critical for pre-hospital trauma
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sures could begin during transport. Furthermore, the addi- and resuscitative care or useful for rotary-wing critical care air
tion of other advanced providers facilitated triage, medical transport. Table 2 shows a possible basic equipment list for
decision-making support, and leadership capabilities in-flight. 21 the CH-47 to accomplish either mission set. Additionally, the
CH-47 could be outfitted with an internal bio-isolation unit
Overall, patients with less severe injuries showed no differences to deal with patients affected by highly infectious diseases or
between the various transport platforms, but those patients bioweapons, both potential threats in AFRICOM.
with severe but survivable injuries had decreased mortality with
physician-assisted transport. Specifically, the British MERT-E The equipment could be stored within the labeled aid bags and
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platform showed improved patient mortality and hemody- hang bags of transported surgical team members and mod-
namic stability with resuscitation using blood products. 24,25 ulated onto a rail system within the fuselage of the CH-47
Beyond administering pre-hospital blood products, MERT-E for ease of access, efficiency of use, and interchangeability be-
allows for the placement of advanced airway devices in trauma tween mission sets. An analogous rucksack system is depicted
patients with the presence of a consultant-grade anesthetist. 26 in Figure 1 (left) by the Canadian MERT. Similarly, the U.S.
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Army provides an example in Figure 1 (right) of a modeled
Similarly, after-action reports from the U.S. military’s elite Sur- litter set up in a CH-47 with a potential medical equipment
gical Resuscitation Teams showed that physician-supplemented rail system within the fuselage. This modeled set-up has four

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