Contributor: CAPT Michael Vengrow, MC, USNR
Posted: 04/15/2010 12:00:00 AM EDT | 4 
It's Time to Give the Marines a Dedicated Medivac Helicopter
Are Army infantry soldiers more important than Marines as human beings or as components of U.S. defense strategy? If this strikes you as a preposterous and insulting notion in 2006, more than six decades after Iwo Jima, consider the fact that Marines still do not have a dedicated medevac helicopter—a nicety of war that is all about saving limbs and lives and that Soldiers have had for many years.
It is time to change medevac doctrine for the U.S. Marine Corps-Navy team. The doctrine is an anachronism that serves no one very well, least of all the Marines who fight on the front lines and display such incredible valor.
An Expeditionary Requirement
The mission of the Marine Corps is expeditionary by its very nature. A helicopter dedicated to the men and women of the Marines would directly support that branch’s mission. Currently, on the way back from a mission, Marine helicopters transport casualties as a lift of opportunity.
But no Marine or Navy dedicated medevac helicopters are in the U.S. inventory. In Operation Iraqi Freedom, the 1st Marine Division had one designated CH-47 helicopter for medevac. It was an embarrassment—a stripped down CH-47 with no medical equipment, no ventilator, no true stretcher capability, and in short, nothing that would even look like the kind of civilian helicopter ambulance that we are accustomed to seeing on television.
The Army’s Blackhawks have stretchers for up to six patients on a carousel with ventilator capability just like a civilian helicopter. It should be noted that the definition of a “dedicated” medevac helicopter is one that is outfitted as a true air ambulance, has a red cross on it, and seen as part of the Geneva Conventions. A “designated” medevac helicopter, on the other hand, may or may not always be used to take out casualties and it has no medical infrastructure or red cross; therefore it is not part of the Geneva Conventions.
In the future, joint operations will continue to share assets, but the Marine Corps is operationally an expeditionary/amphibious force, and as such, in conjunction with the Navy will be involved in operations that are more unilateral than in the past. The Marine Corps-Navy team has a single battle strike capability. Today, the United States is fighting a global war on terrorism and casualties are different from other wars.
USA Today reported in September 2006 that more than 1,000 American military have been killed by improvised explosive devices (IEDs) and more than half of the 20,000 wounded were the result of IEDs. These devices cause primarily loss of limb or traumatic brain injury. The majority of wounds therefore were from blast injury and not gunshot injury.
We are and have always been good at preventing mortality (loss of life), but we can do much better to prevent morbidity (everything short of loss of life, such as loss of limb or limbs, brain injury, or eye injury). The Navy has developed the Forward Resuscitative Surgical System (FRSS), but it has limited capability and falls considerably short of what is needed (it has room for one general/trauma surgeon, one anesthesiologist, and maybe an orthopedist).
The “Golden Hour”
It is said that rescuers have a “golden hour” to prevent the death of a wounded combatant. To save limb and brain function should be the first choice of a medevac mission in a war on insurgency, when the injured numbers of Marines are variable at a time. If unavailable, then the FRSS or other venue should be used. And that other venue may be another service or country of opportunity.
But if the Marine Corps-Navy team stands alone in an amphibious operation, then medevac capability has to go to the primary casualty receiving treatment ship (generally a large-deck helicopter carrier). This should be the first choice, and this department on the ship should be more robust than it is now. The FRSS has great value but does not replace the level III facility or its smaller components on land that also must be restructured.
But, remember, surgeons need to operate to keep their skills up, and deploying them for a year may not be in their and the Navy’s best interest. Add to this the reserve doctors who are generally older, more experienced, and usually subspecialists. They are routinely echelon I (first level of stabilization/care) doctors for Marine battalions—the lowest level of care. General officers in the Marine Corps will tell you that all an echelon I doctor has to do is scoop up the wounded and get them out of the area to a hospital of some kind. They don’t need any telecommunications.
This may be true in a conventional war where the casualties are in the hundreds. But in an insurgency war the injured may number as few as one to several, and because of the different type of weapon exposure, the wounded may require immediate specialized care. It would be prudent for the echelon I doctor to have satellite phone capability to communicate to appropriate specialists for movement. Why? Because the specialists are fewer in number in the battlefield environment and this works in the civilian world.
Applying what we know from the civilian world of emergency care and movement is not problematic. It just takes an adjustment in thinking. Last, using the same argument about degradation of skills, and in particular that the reserve doctor is a citizen military doctor, he or she needs the same foresight in deployment length. They, too, need the benefit of shorter rotations to 30-90 days so that they can preserve their private practices. The global war on terrorism is going to be a long war. We need all the skills that we can get.
Otherwise, the Navy will be selecting for VA or university doctors only, and in time of war that degrades the pool number and selection of skill sets. But, there is always room for improvement, and we should settle right now for the dedicated Navy helicopters that the Marines so richly deserve. If that happens, we then can move on to other challenges with the potential to save even more limbs and lives.
* Reprinted from Proceedings with permission; Copyright © 2007 U.S. Naval Institute/www.usni.org.
Captain Vengrow is a Dallas-based neurologist who served as an echelon I
doctor and later as a Task Force Surgeon Scorpion (Marine), staff CJTF 7
medical cell officer in Operation Iraqi Freedom in 2003. He has extensive
training and certification as a Surface Warfare Medical Department Officer,
Seabee Combat Warfare Specialist, and as a Marine Corps physician.
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andrea58 07/21/2010 6:25:27 AM EDT I fully agree with the article point of view about the necessity of having adequate Medevac helo assets even though I wonder if a “dedicated” asset is really what we would need at this particular moment. I mean if “dedicated” means having a flying ambulance with red cross and no other function, I really think if might be: 1. dangerous (a very nice terrorist target) and 2. not flexible and a bit restrictive (and anti-economic) at least if, like it was for us in Indian Ocean and still is on the Swedish ship that took our place in late April, it is the only helo asset present on the ship. I would rather prefer a good “designated” asset which with the technology now available can easily be done (we had a EH – 101 Helo with four stretchers and 10 seats ; on call we would go with portable ventilators, monitors, pumps etc. all devices have been tested and all have a pre arranged place to be fitted in; so it was not a flying ambulance but it did come close to it). Again, of course, this is the point of view of a “small Navy” where we cannot actually afford to have dedicated assets. All the best Andrea Tortora Capt It Navy 
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claudioalp@alice.it 07/21/2010 5:22:31 AM EDT Any difference on medical treatment must exist within army and marines. Marines need the same cures and more, for their specific activity od assault to consent other troups acts. For that reason marines must be considered as other warriors and I wish that will soon happen. Pieve di Teco, 21.7.2010 Claudio Alpaca Replies (0)
Arkwood 07/19/2010 3:34:24 PM EDT Helicopter aeromedical evac is the right of every serviceman / woman ... from all services ! Every human asset lost through inadequate evac provision is an asset lost in our quest for enduring freedom ... every life saved is an asset saved and a lesson learned in aeromedical science ! To argue against , from a cost perspective , is a cynical ignorance of the consequences of doing nothing ... as Oscar Wilde once said : ` A Cynic is one who knows the cost of everything and the value of nothing ! Replies (0)
edoctor 04/20/2010 12:03:21 PM EDT The Marines are always outrageously underfunded, and underequipped but are always given the jobs that the toughest jobs and the jobs the Army is incapable of performing. Terrorists do not recognize the Geneva conventions, so the Marines do not need a helicopter that could ONLY be used for medivac. The Marines are starved too much for this luxury, but every wounded Marines deserves the best care possible. I'll be writing my congressmen. Replies (0)
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