1. History and Future of U.S. Army Medical Evacuation
COL Lance Cordoni, M.D.
Chief, Medical Consultants Division
CDID, AMEDD Center & School
Health Readiness Center of Excellence

2. Disclosures The presenter has no financial relationships to disclose.
This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS.
Neither PESG,AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity.
PESG and AMSUS staff has no financial interest to disclose.
Commercial support was not received for this activity.

3. Learning Objectives:
At the conclusion of this activity, the participant will be able to:
-Discuss the history of medical evacuation in the US Army
-Discuss the advances in medical evacuation and the lessons learned from the current conflicts
-Discuss challenges facing future MEDEVAC operations

4. Obtaining CME/CE Credit
If you would like to receive continuing education credit for this activity, please visit:

5. Revolutionary War No organized system of evacuation
No dedicated evacuation platforms; used vehicles of opportunity not designed for patient comfort, safety, or treatment
“Regimental Surgeons” mostly poorly trained
Hospitals often closed due to high infection rates

6. War of 1812 Nothing much changed from Revolutionary War
Due to maritime nature of war, casualties often evacuated in boats
No Army Surgeon General at outset of war
James Tilton named ASG in June 1813
Learning from Larrey, an evacuation system began to take shape using dedicated vehicles

7. Dr. Dominique Larrey
Enlisted as a regimental surgeon in the French army in Sent to Italy to serve under Napoleon Bonaparte in 1796.
Studied ways to control post-wound or post-operation infection. Most effective method was immediate amputation.
Understood rapid evacuation and treatment were important to survival
He designed one of
the first mobile field ambulances (Ambulance Volante, or Flying Ambulance)

8. Civil War Era Only 113 Surgeons in US Army at start (12K)
24 joined Confederate Army
3 Discharged for “disloyalty”
No plan for medical evacuation in battle plans
No ambulance corps

9. MAJ Jonathan Letterman
1849 Graduate of Jefferson Medical College and joined the US Army
Significant battlefield medicine experience prior to Civil War
Was chosen by George McClellan to be the Surgeon for the Army of the Potomac and given broad power
Organized ambulance corps, medical logistics, and roles of care
The Father of Battlefield Medicine

11. As the War Progresses….
At Gettysburg in July of 1863, Surgeon MAJ John McNulty ignored orders to leave ambulances and medical equipment behind
His XII Corps was able to evacuate 20,800 casualties in under 6 hours
DOW rate decreased from 22% at Antietam to 9% after Gettysburg
In 1864, an Act of Congress was
passed adopting Letterman’s
evacuation and patient movement
tactics

12. World War I

13. World War I:
US did not enter WWI until April 1917; troops not on front lines until Spring/Summer 1918
War ended November 11, 1918
First use of mechanized ambulances
Many field expedient evacuation methods were used; horse drawn evacuation common
First Air evacuation

15. French pilot Louis Palhan is credited with the first Air evacuation of Serbian pilot Milan Stefanik in 1915

17. World War II

18. Era of Air Evacuation
Due to large distances involved, fixed-wing air evacuation became common, particularly STRATEVAC

19. Helicopter Evacuation
First recorded helicopter evacuation occurred in April 1944; a USAAF fixed-wing aircraft carrying 3 wounded British Soldiers was forced down behind Japanese lines in Burma
Over the course of 3 days, Soldiers rescued by Sikorsky YR-4B flown by LT Carter Harmon

20. However, Ground Evacuation still the Norm

21. Non-Standard Platforms still Common

22. WWII Saw Improving Survival Rates…
Advent of Penicillin
Use of Plasma and Whole Blood
Better training for Medics
Improved Evacuation System
Dedicated Flight Medics and Flight Nurses; en route care

24. Korea: Rise of the Helicopter

25. Dedicated Lift Bell 47 Helicopter pressed into service
Over 20,000 casualties evacuated by helo
Evacuated from POI and also between field hospitals and hospital ships
2 Litter casualties; little protection; no en route care
Time to definitive treatment dropped precipitously and survival increased

28. Vietnam

29. Vietnam Extensive use of rotary wing MEDEVAC.
First aircraft specifically designed for MEDEVAC (UH-1V)
Evacuation to surgical care often less than one hour
Armed escort needed in unsecured LZ
Hoist rescue needed in jungle
Advent of the standardized 9-line MEDEVAC request

30. CFR Drops as Evacuation time diminishes…..

31. Recent Conflicts (OIF/OEF/etc.)

32. Air Evacuation takes precedence..
Ground evacuation dangerous and long
SEC DEF edict to follow the “Golden Hour” principle
Rapid transfer from theater to LRMC, then CONUS
Surgical assets forward
Proof that “training saves lives” at all levels

33. MEDEVAC Rings in Afghanistan

34. Critical Care en route…

35. Vampire Program and CCATT Teams

36. Case Fatality Rates Before/After SEC Gates Policy Institution
Holcomb, et.al., Journal of Trauma, February 2006
Kotwal, et.al., JAMA Surgery, September 2015

37. Kotwal, et.al., JAMA Surgery, September 2015

38. Evacuation Lessons Learned from OIF/OEF
Training Saves Lives at all Levels
CC-FP vs 68W Flight medic
CC-RN for difficult evacuations
EM vs GMO at Role I
MERT vs Standard MEDEVAC
Blood en route is a lifesaver
“Golden Hour/Rapid evacuation DOES save lives!

39. Future MEDEVAC Ops (?)

40. Future MEDEVAC Challenges
Fiscal Constraints
Threat to remove dedicated Air Evac assets
Threat MEDEVAC pilot career field
Enemy Actions
Air superiority not assured
Mass fires resulting in huge numbers of casualties
Evacuation and Treatment assets overwhelmed
Forced reliance on Ground evacuation and and prolonged patient hold; critical care assets forward
Technological Challenges
Overreliance on technology a critical vulnerability

41. Questions?