Page 81 - 2022 Ranger Medic Handbook

Evacuation
SOF Aircraft Capacities
MH-60 – 2 × litter, 1 × ambulatory (optimal) OR 2 × litter only with auxiliary fuel tank OR
3 × litter (minimal en route treatment) OR 1 × litter and 2–3 × ambulatory.
MH-47 – 8 × litter (floor-loaded)
MH-6 – 1 × litter (floor-loaded) for emergency contingency only. Never plan an MH6 as a primary CASEVAC platform.
HH-60 – With carousel – 4 × litter; without carousel – 2 × litter, 1 × ambulatory
CV-22 – 5 × litter (floor-loaded) SECTION 2

General Principles of Rescue
During all rescue operations, tactical security and prevention of additional injuries (patients and rescuers) must be under
constant consideration by all participants. The principles or phases of tactical rescue include security of area/force;
assessment of rescue situation; gaining access; rendering emergency care; disentanglement/extrication; removal; stabi-
lization medical care; and evacuation. Contingency planning, training, and rehearsals should always be a consideration.
Consider anchoring of rolled vehicle to prevent shifting of weight. If possible, CCP should be established upwind from
the site. Timing of evacuation requests must be synchronized to expected timeframes of extracting and packaging of
casualties. Keep C2 informed.
Downed Aircraft Casualty Extraction Considerations
A downed aircraft can occur during any phase of tactical operation, having a dramatic effect on the operation, and
should always be an assumed contingency. The immediate concern is securing the site and suppression of enemy ac-
tions. Rescuers should identify themselves as friendly when approaching a downed aircraft. Immediate casualty care
is focused on coinciding extraction from burning aircraft and treatment of life-threatening injuries. Casualty collection
points must be at a minimum safe distance from potential ammunition cook-off. CCP should be established upwind from
site, if possible, as burning aircraft materials can be toxic. Buddy-team search parties conduct methodical searches
around crash site for thrown victims. If possible, anchor the aircraft to the ground to prevent shifting or rolling. CSAR
link-up and assumption of C2 should be rehearsed as contingency for all aircraft operations. N-95 masks should be
included in CSAR kits to protect rescuers.

Vehicular Casualty Extraction Considerations
Vehicle rollovers, IED events, and driving accidents can occur during any phase of a tactical operation. Scene security
and C2 must be established as soon as possible with the understanding that a combat engagement may continue dur-
ing rescue attempts. Suppression of enemy fire remains the primary mission at all times. Ensure the safety of rescuers
and casualties. Assess the scene situation to determine the need for additional assets. Recognize the kinematics that
produced injuries and consider the treatments/equipment required to manage casualties. Identify and manage life-
threatening conditions and defer non-life threats to later stage. Consider CS stabilization as applicable if kinematics or
MOI indicate potential spine injuries. Consider threats to rescuers and casualties to include fire in vehicle, leaking fuels/
products, ammunition cook-off, and other environmental conditions. Manage injuries IAW tactical trauma protocols with
deference to use of conventional/civilian techniques when indicated.

Confined Space/Building Collapse Extraction Considerations
Confined space rescues in the tactical setting include casualties who have fallen into wells, storage tanks, drainage
systems or trenches. Aside from the injuries incurred on initial trauma, closed spaces may contain low amounts of oxy-
gen or potentially hazardous gases or materials. Key information requirements are number of casualties and potential
hazards to patients and rescuers.
Building collapse rescue is complex, usually involves large numbers of personnel and specialized equipment, requires
knowledge of building design and will likely take an extended period of time. Security of the site is paramount. Key
information requirements are the last known positions of personnel prior to the collapse. The organization of small
search teams covering sectors is critical. Aside from trauma injuries involved with the collapse, rapid cardiovascular
compromise is the greatest life threat as victims are extracted. Sudden cardiac arrest may occur from acidosis and
hyperkalemia. Refer to the Crush Syndrome Management Protocol.
Constant awareness of the security situation, flammable materials, and additional hazards are paramount during rescue
operations.
2022 RANGER MEDIC HANDBOOK 67