MEDEVACs
The what, why and how of the MEDEVAC
The MEDEVAC (or medical evacuation) is the movement of critically wounded troops from the battlefield to a place where they can be better treated. In the 1900's it was on horseback or stretcher, but with the aid of modern technology wounded soldiers are now transported by armoured vehicle, if not by helicopter.
Below: A Sikorsky HH-60 Black Hawk Helicopter Performing a MEDEVAC
HOW IT STARTED
The MEDEVAC by helicopter first took place in World War II, when 3 pilots were ferried out of danger by a United States Army Air Force (USAAF) Sikorsky R-4 rescued 4 men who had been shot down in the jungle over 160 kilometres behind Japanese lines. The helicopter could only take one man at a time, and so the rescue operation took place over a 2 day period, with the last man just managing to be evacuated before the landing site was overrun by presumed Japanese forces (who actually turned out to be allied soldiers looking for the stricken men). But even before this aerial MEDEVACs had been taking place. When the plane became important in World War I, so too did the initiative to make this a method of transportation for the wounded. And so in 1917, the first medical airlift took place a soldier in the British Army 'Camel Corps.' He was flown to hospital after a bullet through the ankle disabled him, taking him to hospital in hours, rather than the three-day trip it would have been.
A Sikorsky R-4 "Floater", this one in use by the Royal Navy for rescues on the sea.
Even today there are still not enough MEDEVAC aircraft to lift every wounded person in need of one, so the US Army developed the CASEVAC. A CASEVAC is a MEDEVAC performed by any aircraft, generally the closest one in the area. It isn't marked by the red cross and is generally redirected from another mission. They will have limited medical facilities onboard at best. It could be anything from an MV-22 Osprey to a CH-47 Chinook. A callsign has also been developed for quick understanding. Anyone in need of either a MEDEVAC or CASEVAC will use the callsign 'DUSTOFF.' The use of one word to convey a long message saves lives because time is critical when someone is wounded.
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The US was the first country to develop the MEDEVAC system, and Major Nathan Burr, C-Company, 2-211th General Support Aviation Battalion, Minnesota Army National Guard, 1-108th Assault Helicopter Battalion, MEDEVAC pilots regard their job as "the best in the military." Colonel Eric Gagnon takes this further, saying that "From a military perspective, this is what we consider going to the Superbowl."
A Curtiss JN-4D "Jenny" converted into an air ambulance.
MEDEVACS IN THE KOREAN WAR
The first fully functioning helicopter was finally been born on the 14th of September 1939, just days after the start of WWII. Immediately the Army and Medical Corps began to see the potential it had, both as a troop-support/transport system and a MEDEVAC system. At first, the helicopters used were primitive, with the tail rotor barely being held up by thin metal struts and the casualties on stretchers covered by glass on the outside of the helicopter. The designs gradually began to become more sturdy with more room for casualties. Eventually, one helicopter made more difference than any other. The H-13 Sioux (pictured right) was able to transport 18,000 of the war's 23,000 casualties to MASHs. This gained it the nickname of the 'Angel of Mercy.' At first, the USMD was scared that too many would be shot down, thus MEDEVACs were only to take place during the day and behind friendly lines. But the pilots would not listen and frequently disobeyed this order. But this did not come without a price. MEDEVAC helicopter pilots suffered 3.3 times more casualties than any other helicopter missions in the Vietnam War.
MEDEVACS IN THE KOREAN WAR CONTINUED
The costs seemed to be worth it in the end because death rates in transit dropped from 4.5% in WWII to 2.5% during the Korean War, with the overall casualty survival rate increasing from 80.9% in WWII to 90.6% in the Korean War.
The use of MEDEVACs also lowered the stress felt by combat medics because they no longer had to look after seriously wounded men for long amounts of time. In WWII MEDEVACs consisted of a captured Fieseler Fi-156 Storch or a Piper J-3 Cub (pictured left), some of the first "Short Take-off Or Landing" (STOL) planes to exist. But otherwise, combat medics would have to look after the seriously wounded for days and sometimes weeks, as long as it took for the battle to finish and the ambulances to arrive safely.
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Eventually, the USMD got good at using mass helicopter MEDEVACs, a mission in June 1953 saving 700 sick and wounded Allied prisoners of war as part of Operation Little Switch. In July another 800 troops, this time part of the Republic of Korea (ROK) troops in 45 helicopters, and finally in August 1953 over 5,600 released POWs were MEDEVACed over a 33 day period.
DEVELOPMENT OF THE MEDEVAC
Ever since it was developed the MEDEVAC has been in constant use. During the Vietnam War, the main method for MEDEVAC was the US Army's main helicopter, the Bell UH-1 Huey (Pictured far right).
In 1969 alone over 200,000 troops were MEDEVACed by Huey to M.A.S.H sites to be stabilised and treated.
MEDEVACs also became faster with times for a MEDEVAC to arrive changing from 4-6 hours in Korea to just 35-40 minutes. It was in Vietnam that the callsign 'DUSTOFF' was decided upon. In 1961 the entire force for MEDEVACs consisted of 5 UH-1 Hueys from the 57th Medical Detachment. They took the callsign 'DUSTOFF,' but soon the callsign became synonymous with all MEDEVAC units.
Then during Operations Desert Shield and Desert Storm (during the gulf war), MEDEVAC by helicopter would continue to prove useful.
Over 15,000 troops were wounded in the early stages of the invasion of Kuwait by US forces. Here the US Army, Navy and Air Force all joined together to evacuate the wounded on their latest helicopters.
Overall 6 air ambulance units would be deployed to help evacuate the wounded to the Gulf War's, and modern-day, equivalent of the M.A.S.H: The Combat Support Hospital (C.S.H).
And still, the art of the MEDEVAC was being developed because evacuation speeds continued to get faster and faster with every DUSTOFF call. It was during this war that the USMD finally deemed ground ambulances ineffective, so almost all casualties were MEDEVACed by air.
But the system still needed developing. MEDEVACs by night were extremely difficult, and even in bad weather MEDEVACs were limited by the Huey's capabilities. But with the development of the UH-60 (and then HH-60) Black Hawk, many of these problems were solved. It was up-armoured, could fly further and faster, was quieter, and had all the latest navigation technologies.
But the front line was moving too fast for the M.A.S.Hs and C.S.Hs to keep up, and so the helicopters flew further than before, with some having to land next to trucks and Armoured Fighting Vehicles (AFVs) to get fuel and directions.
MEDEVACs IN IRAQ AND AFGHANISTAN
In Afghanistan the system was yet again developed, with a priority MEDEVAC system set up. All patients fell into 3 categories, A (MEDEVAC required in 90 hours or less), B (within 4 hours or less), and C (within 24 hours or less). But the dangers to the medevac are advancing because the red cross is not recognised by groups like IS and Al Qaeda. Soviet cold-war Rocket Propelled Grenades (RPGs) are easy to obtain for such groups and used regularly against MEDEVAC helicopters. The HH-60 is one of the strongest 'birds' the US owns, but if hit in the correct place by an RPG round the bird goes down, no matter the strength of the bird. This place is where the tail and the cargo cabin meet. This is also near the transmission, which is the main target of the strike. So MEDEVACs are swapping the red cross for some heavy-duty weapons such as the M134 Mini-Gun which can fire in between 2,000 and 6,000 rounds per minute, making it the second-fastest machine gun ever. It's also chambered in rifle calibre meaning it hits hard and fast. But even with the added weaponry, this is still not enough because many countries have developed ground-to-air missiles that home-in on their target. A machine gun, no matter how fast firing, is useless against this.
The M134 in action
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The USMD is responding to this threat too, adding jamming equipment and flares to confuse missiles, but this doesn't eliminate the threat. 10 Black Hawks were shot down in the War in Iraq alone with the total toll including accidents and mechanical failures being 24.
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Even so, Black Hawks are deemed to be one of the toughest helicopters the US has and is able to withstand many hits before going down. Jeffery Williams, a Black Hawk Standardisation Instructor said that "I've seen Blackhawks fly home after a gunfight that 56 armour-piercing cores (penetrator inside a 7.62 bullet) recovered from the aircraft, that doesn't include the rounds that just passed through."
He also said that "The fuel cells are designed to be hit with a 20mm airburst before they leak. The rotor system, someone claims is “complex,” can take a 20mm round to a blade or multiple. 50 cal rounds to the rotor head without failure. The hydraulic system is armoured and triple-redundant, the fuel will extinguish fires unless the fuel is atomised. With modern helicopters, loss of tail rotor will only require a roll-on landing as long as it happens above a specific airspeed."
MEDEVACs IN THE COMMERCIAL FIELD
Ever since the MEDEVAC became an important part of the medical administrative process for the army, the doctors and physicians in the commercial field knew that this would be the method for saving those who needed immediate medical attention, or where regular ambulances could not get to.
In the early 1920's Sweden established the first-ever official air ambulance service for commercial use due to high demand. Many areas are inaccessible by car fast enough, if at all. Siam (modern-day Thailand) soon followed suite and then in 1928 the world's first formal, dedicated air ambulance service (the Royal Flying Doctor Service) was established for the MEDEVAC of patients in the Australian outback.
However, these MEDEVACs were all done by plane, and there are some places where planes cannot go, like small fields or mountain ranges. Only in 1972, after the Vietnam War had mostly drawn to a conclusion and MEDEVAC by helicopter had been proven was a Helicopter Air Ambulance system for civilian use set up in the US. Other countries soon followed.
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For now, the highest mountains were still unattainable, but not for long.
NOTABLE MEDEVAC CASES
1) Rescue of three men in 24-metre waves.
Three men (the crew of the Sean Seamour II) had their 13-metre long sailing boat swept from under them by 24 metre high (80 feet) waves. They were around 360 miles off the coast of North Carolina when they were hit by Sub-tropical Storm Andrea in 2007. Their boat starts to take on water and the three evacuate onto a small life raft. This life-raft is now their only means of survival, but it is constantly being flipped by almost 150 km/h winds. They were rescued by a US Coast Guard (USCG) version of the Black Hawk, The MH-60 T Jayhawk. All three sailors had hypothermia, but the Captain of the vessel had 11 broken ribs as well.
2) The MEDEVAC of Joe Vorster
Joe Vorster was in Grade 2 when his school took him to the local swimming pool to learn how to swim. But rather than starting them off in the kid's pool, they put the kids straight in the regular pool. Joe and his friends were playing around when one pushed him underwater. He was underwater for 2-3 minutes before someone discovered him and dived in. They got him out and began to perform CPR. A helicopter (the Eurocopter 135P2+) soon arrived and took him to the nearest hospital. "I remember waking up in the helicopter, and I remember they gave me a small teddy with a helicopter on it, but I don't remember much else." Joe said.
Soon after MEDEVACs became a reality on mountains too. Mount Everest has long been the source of danger and death, with more than 300 people dying making the attempt to climb it. With such a high death toll, helicopters seemed to be the way to help save some of these people and stopping the death toll climbing even higher. But the air surrounding the mountain was too thin, with multiple helicopter crashes taking place on and around Mount Everest. But soon, even Everest became reachable, with the evacuation of Beck Weathers off Everest at Camp 2 situated at 6096 metres (20,000 feet). Many calls for help were radioed from Everest for Beck, who had spent a night in the death zone and had somehow survived, although frostbitten (the Death Zone is anything above 8,000 metres. It is where the brain and cells start to die one by one. 12 people died on Everest this year, with 7 of them dying in the Death Zone).
Lieutenant Colonel Madan K.C in front of his helicopter.
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With Beck Weathers at 20,000 feet, this was outside the service ceiling of many helicopters. But soon a Lieutenant Colonel from the Royal Nepalese Army Ecureuil (Squirrel) AS350 B2 to Camp 2, nearly a kilometre above his helicopter's service ceiling. To get up to Camp 2, Madan K.C had to use his own rotor wash to get his helicopter higher, falling into crevasses then using rotor wash from the ice to get himself out again. He eventually made it, but in taking off his helicopter had to slide down a cliff using its rotor wash until he could low enough to fly normally. He got lucky this time, but a year later he would crash while attempting to land at Base Camp. He and his co-pilot were unhurt.
