CASUALTY EVAC CARE

Medical management of combat casualties (CAX) during the previous phases of care is provided in settings that are sometimes hostile but always austere, with the nearest medical treatment facility (MTF) minutes, hours, or even days away. However, at some point in the operation, special operations forces (SOF) will be recovered onto an aircraft, watercraft, or other ground asset for extraction. In some circumstances, the special operations war fighters and CAX will be extracted together. Planning for the evacuation of CAX will often require synchronization with conventional forces (CF) for air and/or ground assets. Generally when special operations assets are conducting operations in support of CF, the special operations command and control element is the focal point for this effort. As special operations assets function with a limited medical support infrastructure, detailed pre-planning and coordination for casualty evacuation (CASEVAC) and leveraging CF capabilities are vital. Elements of a viable, synchronized, and mutually understood CASEVAC plan must include:

• Planned and reconnoitered evacuation routes (operational environment considerations).

• Identified aero-medical launch requirements and hasty landing zones that support the mission.

• A robust and interoperable primary, alternate, contingency, and emergency communications plan.

• Liberal use of non-standard CASEVAC platforms.

• CASEVAC transfer points and/or projected receiving MTF.

• Thorough dissemination and rehearsal of the CASEVAC plan to all SOF and CF (down to the lowest level). Combat CASEVAC care is the care rendered once CAX have been placed aboard the aircraft, boat, or vehicle for transport to a higher level (echelon) of care.

 

Generally speaking, combat CASEVAC care is a continuation of the care that was initiated during the tactical field care phase, with some notable enhancements:

• Additional medically trained personnel may accompany the evacuation asset(s). This is important for several reasons: The special operations medic may be among the CAX; there may be multiple CAX that exceed the special operations medic’s capability to manage simultaneously; and the additional medical personnel, such as physicians or other specialists, may provide greater on-site expertise.

 

• Additional medical equipment may be available at this stage of casualty management. This equipment may be pre-staged prior to infiltration of the team. Medical resupply may also be accomplished during the CASEVAC phase. More advanced medical equipment such as blood, blood substitutes (oxygen-transporting fluids), other fluids, and oxygen (O2) may become available with the arrival of these evacuation assets. A full set of vital signs may be accomplished at this point. Electronic systems capable of monitoring the casualty’s blood pressure (BP), heart rate, pulse oximetry, and end-tidal carbon dioxide detectors may now be available and should be leveraged. Typically, this equipment and the improved environment within the evacuation asset allow for more advanced and definitive management of CAX. During this phase of care, CAX must be reassessed for an effective airway, adequate breathing, and control of hemorrhage. Temporary tourniquets may be replaced with pressure dressings or hemostatic agents; intravenous (IV) lines may be initiated. IV fluids in this phase may include whole blood, O-positive or O-negative packed red blood cells (PRBC), or blood substitutes. The need for further analgesia should be assessed and administered as necessary.

 

EVACUATION

 

Coordinate evacuation based on the casualty’s precedence: 

Priority I (Alpha) Urgent Complete

Priority IA (Bravo) Urgent Surgical

Priority II (Charlie) Priority

Priority III (Delta) Routine

Priority IV (Echo) Convenience 


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