1. CASUALTY EVACUATION OPERATIONS
(class and instructor introduction)

2. PURPOSE The purpose of this briefing is to
provide an overview of casualty
evacuation procedures and to
provide you the information
necessary to set up a SOP for
casualty evacuation procedures at
your respective sites
The leader should state the purpose of the block of instruction.

3. TASK: Conduct cas-evac operations
CONDITIONS: In a field environment, given an injured soldier, a radio, a combat lifesaver bag, and the desire to save their buddy’s life.
STANDARDS: Soldiers must demonstrate a general knowledge of cas-evac operations, properly format and submit a med-evac request utilizing the “nine line” format.

4. REFERENCES FM 8-10-4, Medical Platoon Leader’s Handbook (TTPs)
FM 7-20, The Infantry Battalion
CTC Trends, JRTC, Nov 97, No
CALL Newsletter, Jul 99, No. 99-6
CMTC Trends Compendium Apr 98
FM 21-11, First Aid for Soldiers
Allow the class time to read references.

5. AGENDA REDUCING COMBAT DEATHS CHS LIFESAVING MEASURES
IMPORTANCE OF THE CLS
PLANNING CONSIDERATIONS
MEDICAL TREATMENT FACILITIES
TRANSPORTATION OF CASUALTIES
CATEGORIES OF PRECEDENCE
THE MEDEVAC REQUEST

6. REDUCING COMBAT DEATHS
Majority of combat deaths occur on
The battlefield before evacuation
Takes place
80% of combat deaths occur within
First hour after initial injury
50% of combat deaths are a result
of the soldier bleeding to death
Of these 50% of combat deaths, 40%
could have lived had the bleeding
been stopped
(Places the importance of casevac in perspective)
A medical study was conducted in relation to combat deaths. Based on this study,it is evident that units fail to have an adequate CASEVAC plan that is timely and efficient. Most soldiers die due to bleeding to death. This slide is just to underscore the importance of thoughtful and thorough planning of your Casevac SOP. Most of these deaths could have been prevented if the medical plan was sufficient based on the tactical operation.
(Instructor-FYI) According to the CALL Newsletter (NTC) from Jun 97, No 97-14, 53% of soldiers DOW during battles. Sadly, most of these casualties are only 600-1,000 meters from a Medical Treatment Facility.
Before advancing to the next slide, the leader should ask the group how are deaths prevented in the medical arena based on this study. After a predetermined amount of responses, the leader should advance to the next slide.
BETTER TRAINING/SUSTAINMENT ON BASIC FIRST AID SKILLS
PROFICIENCY OF COMBAT LIFESAVERS / #s OF CLS IN THE PLATOON
KNOWLEDGE OF CASEVAC PROCEDURES / KNOWLEDGE OF CASEVAC PLAN

7. CHS LIFESAVING MEASURES
SELF-AID
BUDDY AID
COMBAT LIFESAVER
COMBAT MEDIC
TREATMENT SQUAD
The instructor should emphasize that there are five Combat Health Support lifesaving measures. All elements being practiced and well trained is key to successful casevac operations.
(FYI)
Self-aid-administer aid to self (lifesaving tasks).
Buddy aid-administer aid from a fellow soldier (member of squad)—lifesaving tasks.
Combat Lifesaver (CLS)-soldier that has successfully attended 40-hours of medical training. These soldiers augment PLT medics and are non-medical unit members selected by their commanders. A good goal is to have one CLS per rifle squad.
Combat Medic-each maneuver platoon should have one combat medic assigned that possess a 91B MOS. Within the battalion, the medical platoon provides these soldiers to sustain and prevent loss of life. These individuals are first in the Health Service Support channels who make medically substantiated decisions based on MOS-specific training.
Treatment Squad-The treatment squad are from the BAS are trained and equipped to provide ATM to the battlefield casualty.

8. WHAT IS A COMBAT LIFESAVER?
A MEMBER OF THE
SQUAD OR CREW
TRAINED, EVALUATED &
CERTIFIED IN MEDICAL SKILLS
EXPERTISE BEYOND BASIC
FIRST AID
The leader should emphasize that a combat lifesaver has the following characteristics:
A member of an infantry squad, gun crew, mortar squad, etc..
Selected by the chain of command
Trained and evaluated by medically trained and certified personnel of the 91B MOS (usually)
Able to provide medical assistance beyond the basic first aid learned at basic training and AIT (beyond basic soldier skills)

9. COMBAT LIFESAVER’S ROLE
ADDITIONAL LIFESAVING EXPERTISE
AT THE SQUAD/CREW LEVEL
EXTENSION OF THE PLATOON MEDIC
USES SKILLS & EQUIPMENT CONSISTENT
WITH HIS SECONDARY MISSION
PRIMARY MOS IS FIRST RESPONSIBILITY
The leader should emphasize that the combat lifesaver is an additional medically trained rep (although somewhat limited) on the battlefield. However, the primary mission of the combat lifesaver is his primary MOS, then being a combat lifesaver—his secondary mission.

10. Basic Planning Considerations
Medical Evacuation
Medical Treatment Facilities
The leader should emphasize that the JTFAS should plan for all military and US personnel in there AO. You must familiarize yourself with these plans and ensure that they work for you and your mission. Medical considerations have to be thought through not only for Army personnel, but AF, Navy, Marines,Detainees, and civilians (if operating in your AO).
If dealing with detainees, security measures must be taken into consideration due to medical personnel not having an adequate amount of personnel to pull security on detainees. Additionally, civilian considerations have to be thought through as well. Are the civilians friendly to allied forces, hostile, or neutral? A plan has to be thought out in advance when dealing with non-military personnel.

11. Planning Medical Evacuation
Medical evacuation requirements and units available are listed to include their locations, missions, and attachments.
Location of casualty collecting points and ambulance exchange points are placed on overlays.
Identify routes, means and schedules (if any) of evacuation and responsibilities.
Evacuation request procedures and channels.
The instructor should emphasize that medical evacuation has to planned and rehearsed well in advance in order to save soldier lives. Unit locations, missions, and attachments have to known by all medical personnel in the case of medical evacuation being required.
For you soldiers that are going to be out there executing these patrols, some mounted/some dismounted, examine the routes that you must take. Some things may already be established by the unit you replace, but examine that patrol plan and ensure that your SOP includes contingencies like CCPs. This mission has not been operating that long. Some of the detailed instructions and plans are still being worked out,therefore it is up to you to ensure that you CASEVAC plan is as complete as possible so that in the unlikely event that casualties are taken, everyone knows that plan and how to react to save lives.
Casualty collection points (CCPs), Ambulance Exchange Points (AXPs) and any other medical related graphics need to annotated on the overlay. Other considerations include Casualty Collection Routes (CCRs), LZs (for possible air evacuation), location of the JTFAS (Joint Task Force Aid Station).
The _________ net should be common to all maneuver units and exercised accordingly. A COMEX should be executed prior to any patrols departing to ensure subordinate units have the necessary communications with medical evacuation assets, if needed. Call signs and frequencies should be provided with any operations orders, patrol plans, and CSS rehearsals. This provides redundancy in communicating medical evacuation needs.

12. Medical Treatment Facilities
Medical treatment facilities (aid stations, hospitals).
Locations and missions of appropriate medical treatment facilities.
All MTF locations should be known by all personnel.
FYI-There is a joint aid station on site at Camp Roberts. This is the primary facility that you will utilize while you are deployed there. In the event of an emergency, there is also Fleet Hospital 20 (Guantanamo Bay) available to handle more serious medical situations.

13. Redundant communications are important to timely casualty evacuation.
EXECUTION:
Casualty evacuation is a team effort. The primary duty of a combat lifesaver is the mission. Treatment of casualties is secondary. Appropriate ground and air evacuation techniques should be used based on METT-T and on patient categories of precedence (URGENT, PRIORITY, and ROUTINE).
COMMUNICATIONS:
Redundant communications are important to timely casualty evacuation.
SAFETY:
Leaders must retain common sense and attention to safety considerations despite their concern for casualties.
Team effort…I cannot stress that enough.(And)Like any team, the task that you are to perform must be rehearsed. That is the responsibility of all soldiers-not just the medics. This includes combat lifesavers, infantry squad leaders, officers, the medical platoon leader and his medics.
Medevac procedures may be very simple to handle if the casualty occurs on camp, however, for those patrols and those leeward missions you MUST have a good solid communications plan and the methods of emergency communications should be known by all.
(SAFETY/SECURITY) A key thing to remember in an emergency situation,especially whether out on patrol , QRF, or guard duty (instructor [click mouse]:” As you can tell I’ve been in the Army a long time”[click mouse]”O.K. there we go” …as I said the key is the safety and security of your personnel. Security must be maintained at all times.
This mission should be a peaceful one,but while we are talking about safety I want to reiterate something that I’m sure you will here very often…HYDRATE. Texans are no strangers to heat, but some of you may not be used to the pace of activity that you may operate at and the amount of time you may be outdoors. Special care must be taken to avoid climatic injuries. We don’t need to have to medevac personnel because they didn’t properly hydrate.
Ambulance drivers or soldiers working around MEDEVAC helicopters must keep the risks in balance

14. Transportation of Casualties
When the situation is urgent you may have to transport the casualty. For this reason, you must know how to transport him without increasing the seriousness of his condition.
Transporting a casualty by litter is safer and more comfortable for him than by manual means; it is also easier for you.
Manual transportation, however, may be the only feasible method because of the terrain or the combat situation.
Transportation of the sick and wounded is the responsibility of medical personnel who have been provided special training and equipment. Therefore, unless a good reason for you to transport a casualty arises, wait for some means of medical evacuation to be provided.

15. Standard Evacuation Types
UH-60A/Q Ambulance
*An M113 series Armored Ambulance can carry 4 litters

16. UH-60Q Interior

17. Non-Standard Evacuation Types
Non Standard Assets- Always plan for non-standard evacuation assets. There should already be a plan in place for casualty incidents at Camp Roberts and the surrounding camps, however, it is the duty of each leader to be highly familiar with those plans and ensure that they are adequate for his particular mission.
(FYI)The leader should emphasize that non-standard evacuation means should be planned for (especially for MASCALs) and rehearsed, if possible. This will decrease the number of DOW casualties. SOPs for casualty marking should be common and known to all, even supporting units providing the non-standard evacuation means (for example, red chem light during hours of limited visibility, VS-17 panel for day time operations). These techniques need to be rehearsed and provided to both internal and external units supporting the battalion.
Air evacuation should always be planned for and rehearsed.
(FYI) LMTV=12 litter or 16 ambulatory; CH-47=24 litter or 33 ambulatory

18. Casualty Evacuation TTPs
USE SPECIALIZED
EQUIPMENT
POLELESS LITTER
SKED LITTER
DESIGNATE AND TRAIN
AID AND LITTER TMS
The leader should emphasize that ground casualty evacuation techniques include, but are not limited to using the following items:
Poleless litter-easy to carry on person, takes 6-soldiers (almost a squad sized element) to carry casualty once inflicted. This is the preferred and commonly used item in casualty evacuation. It is cumbersome when evacuating a casualty, but light and easy to carry when in the carrying configuration (fits in ruck sack flap, butt pack or soldier cargo pocket).
Sked litter-bulky and not conducive for light forces. Approximately 2.5 feet in length when in the carrying configuration. Takes only four personnel to carry a casualty (has handles on the four corners, as opposed to six carrying straps like the poleless litter).
Poncho-another technique is using soldier OCIE. A poncho is conducive to combat operations, easy to carry on the soldier, but cumbersome to carry when a casualty is inflicted and placed on the poncho litter. Like the poleless litter, it is cumbersome and takes up to six soldiers to carry.
A key to success is training aid and litter teams down to the squad level on the various casualty evacuation equipment. Platoon leaders should designate both a primary and alternate aid and litter team within each squad.

19. When conducting patrols, it is possible that you could receive a casualty due to either an accident or hostile action. One rapid method of transporting a casualty with minimal use of personnel is the SKED litter. If at all possible at least one should be taken while on dismounted patrol.(FYI for instructor)The SKEDS litter is made of durable plastic. It can be rolled and carried in a camouflage case. The basic litter weighs 16 pounds complete with carrying case, straps, snap link, and a 30-foot kernmantle rope.The SKEDS litter enables a single soldier to pull a casualty over most types of terrain; a field-expedient poncho litter requires two soldiers or more. Up to four soldiers can use hand loops to carry a SKEDS litter containing a seriously injured casualty across difficult terrain.
The rapidly employable lightweight litter, referred to as the SKEDS litter, is designed to be used as a rescue system in most types of terrain, including mountains, jungle, waterborne, and on snow or ice.

20. Manual Carries One-man carries Two-man carries
Casualties carried by manual means must be carefully and correctly handled, otherwise their injuries may become more serious or possibly fatal.
This carry can be used to assist him as far as he is able to walk or hop.
Other one-man carries include the Fireman’s carry, the Saddleback carry, the Arms carry, and etc.
(Support carry ) The casualty must be able to walk or at least hop on one leg, using the bearer as a crutch.

21. Manual Carries (One Man)
Fireman’s Carry
Support Carry
Arms Carry
Pistol-belt Carry and Drag
Neck Drag

22. TWO-MAN SUPPORT CARRY

23. TWO-MAN SUPPORT CARRY (cont)
Other two-man carries include the two-man arms carry, the two-man fore and aft carry, and so on. These carries can be practiced as part of a normal battle-focused PT program.

24. Manual Carries (two man)
Two man support carry
Two man arms carry
Two man fore-and-aft carry
Two hand seat carry

25. CATEGORIES OF PRECEDENCE FOR EVACUATION
URGENT-PATIENT WHO SHOULD BE EVACUATED AS SOON AS POSSIBLE AND WITHIN TWO HOURS TO SAVE LIFE, LIMB, OR EYESIGHT.
PRIORITY-PATIENT WHO SHOULD BE MOVED WITHIN FOUR HOURS OR HIS/HER CONDITION WILL DETERIORATE TO SUCH A DEGREE THAT HE WILL BECOME URGENT.
ROUTINE-PERSONNEL WHOSE CONDITION IS NOT EXPECTED TO WORSEN SIGNIFICANTLY AND WHO WILL REQUIRE EVACUATION IN THE NEXT 24 HOURS.
The leader should emphasize the listed categories of precedence and the criteria used in their assignment. The following slides cover these three categories of precedence for evacuation.
URGENT-The leader should emphasize that these types of casualties should be evacuated to prevent complications of serious illness, or to avoid permanent disability.

26. MEDEVAC REQUEST FORMAT
LINE ITEM/BREVITY CODES
1 Location of pickup site
2 Frequency/Call sign of pickup site
3 Number of patients by precedence
A - URGENT
C - PRIORITY
D - ROUTINE
4 Special equipment
A - NONE
B - HOIST
C - EXTRACTION EQUIPMENT
D - VENTILATOR
5 Number of patients by type
L + # LITTER
A + # AMBULATORY
6 Security of pickup site
N - NO ENEMY
P - POSSIBLE ENEMY
E - ENEMY IN AREA
X - ARMED ESCORT NEEDED
7 Method of marking pickup site
A - PANELS
B - PYROTECHNICS
C - SMOKE
D - NONE
E - OTHER
8 Patient nationality and status
A - US MILITARY
B - US CIVILIAN
C - NON US MILITARY
D - NON US CIVILIAN
E - EPW
9 NBC contamination
N - NUCLEAR
B - BIOLOGICAL
C – CHEMICAL
The leader should emphasize that battle roster numbers reduce the amount of time spent sending in soldier demographics. Company battle roster numbers are maintained by the company CP.

27. LOCATION OF THE PICKUP SITE
LINE 1
LOCATION OF THE
PICKUP SITE
The leader should transmit the grid coordinates of the pickup site by the most secure type of communications available or by whatever means and been coordinated with the element the requester is to call.
This is required so evacuation vehicles know where to pickup patients. Also, so that the unit coordinating the evacuation mission can plan the route for the evacuation vehicle (if the evacuation vehicle must pick up from more than one location).

28. RADIO FREQUENCY/CALL SIGN AND SUFFIX
LINE 2
RADIO FREQUENCY/CALL SIGN AND SUFFIX
The leader should encrypt( or by secure means) the frequency of the radio at the pickup site, not a relay frequency. The call sign (and suffix if used) of person to be contacted at the pickup site may be transmitted in the clear.
This information is required so that evacuation vehicle can contact requesting unit while enroute (obtain additional information or change in situation or directions).
SOI and ANCD

29. NUMBER OF PATIENTS BY PRECEDENCE
LINE 3
NUMBER OF PATIENTS BY PRECEDENCE
The leader should report only applicable information and encrypt the brevity codes (ACD). If two or more categories must be reported in the same request, insert the word “BREAK” between each category.
This is required by unit controlling the evacuation vehicles to assist in prioritizing missions.
BREVITY CODES:
A- URGENT
C -PRIORITY
D -ROUTINE

30. SPECIAL EQUIPMENT REQUIRED
LINE 4
SPECIAL EQUIPMENT REQUIRED
BREVITY CODES:
A NONE
B HOIST
C EXTRACTION EQUIPMENT
D VENTILATOR
The leader should utilize the applicable brevity codes (ABCD). This is required so that the equipment can be placed on board the evacuation vehicle prior to the start of the mission.

31. NUMBER OF PATIENTS BY TYPE
LINE 5
NUMBER OF PATIENTS BY TYPE
The leader should report only applicable information and encrypt the brevity code. If requesting MEDEVAC for both types, insert the word “BREAK” between the litter entry and ambulatory entry.
This is required so that the appropriate number of evacuation vehicles may be dispatched to the pickup site. They should be configured to carry the patients requiring evacuation.
BREVITY CODES:
L + #Patients Litter
A + #Patients Ambulatory

32. SECURITY OF PICKUP SITE (WARTIME)
LINE 6
SECURITY OF PICKUP SITE (WARTIME)
BREVITY CODES:
N NO ENEMY
P POSSIBLE ENEMY TROOPS IN AREA (APPROACH WITH CAUTION)
E ENEMY TROOPS IN AREA (APPROACH WITH CAUTION)
X ENEMY TROOPS IN AREA
(ARMED ESCORT REQUIRED)
The leader should emphasize that the information for security of pickup site should be given in brevity codes (NPEX). This information is required to assist the evacuation crew in assessing the situation and determining if assistance is required. More definitive guidance can be furnished the evacuation vehicle while it is en route (specific location of enemy to assist an aircraft in planning its approach).

33. NUMBER AND TYPE OF WOUND, INJURY, OR ILLNESS (PEACETIME)
LINE 6
NUMBER AND TYPE OF WOUND, INJURY, OR ILLNESS (PEACETIME)
The leader should emphasize that information specifically regarding patient wounds by type (gunshot or shrapnel) should be transmitted. Report serious bleeding, along with patient blood type, if known.
Required to assist evacuation personnel in determining treatment and special equipment needed.
GIVE SPECIFIC INFORMATION, GUNSHOT WOUND, BLEEDING AND BLOOD TYPE IF KNOWN

34. LINE 7 METHOD OF MARKING PICKUP SITE
BREVITY CODE:
A PANELS
B PYROTECHNIC SIGNAL
C SMOKE SIGNAL
D NONE
E OTHER
The leader should emphasize the method of marking the pickup site should be encrypted in brevity codes (ABCDE).
This information is needed to assist the evacuation crew in identifying the specific location of the pickup site. Note that the color of panels or smoke should not be transmitted until the evacuation vehicle contacts the unit (just prior to its arrival). For security, the crew should identify the color and the unit verify it.

35. LINE 8 PATIENT NATIONALITY AND STATUS
ENCRYPT BREVITY CODE:
A US MILITARY
B US CIVILIAN
C NON-US MILITARY
D NON-US CIVILIAN
E EPW (Detainee)
The leader should emphasis that the number of patients in each category need not be transmitted. Encrypt only the applicable brevity codes (ABCDE).
This information is required to assist in planning for destination facilities and need for guards. Unit requesting support should ensure that there is an English speaking representative at the pick-up site.

36. LINE 9 NBC CONTAMINATION (Wartime)
ENCRYPT BREVITY CODE:
N NUCLEAR
B BIOLOGICAL
C CHEMICAL
The leader should include this line only when applicable. Encrypt the applicable brevity codes of NBC.
Required to assist in planning for the mission. (Determine which evacuation vehicle will accomplish the mission and when it will be accomplished).

37. LINE 9 TERRAIN DESCRIPTION (PEACETIME)
The leader should emphasize that this includes details of terrain features in and around proposed landing site. If possible, describe relationship of site to prominent terrain feature (lake, mountain, tower).
Required to allow evacuation personnel to assess route/avenue of approach into area. Of particular importance if hoist operation is required.
INCLUDE DETAILS OF TERRAIN FEATURES IN AND AROUND PROPOSED LANDING SITE

38. Example “Badger03 this is Badger76 MEDEVAC 9 line follows—over”
“This is Badger03 send it –over”
“line 1-- UV
“line in the red, badger76
“line 3-- 1C
“line 4-- A
“line 5-- 1A
“line 6-- N
“line 6-- 1, broken ankle compound fracture (peacetime)
“line 7-- C
“line 8--A
“line 9-- NONE
“line 9-- Open field no power lines.(peacetime)
“Over”
“This is Badger03 roger out”

39. SUMMARY REDUCING COMBAT DEATHS CHS LIFESAVING MEASURES
IMPORTANCE OF THE CLS
PLANNING CONSIDERATIONS
MEDICAL TREATMENT FACILITIES
TRANSPORTATION OF CASUALTIES
CATEGORIES OF PRECEDENCE
THE MEDEVAC REQUEST
The instructor should provide a summary of the presentation to remind the class of the key points of the topics that were discussed and ask for questions pertaining to the block of instruction. End on a positive note!