medical evacuation chain explained

Medical Evacuation at an Extreme Risk

Medical Evacuation at an Extreme Risk

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National and collective defence training also means preparing for an emergency, which may entail wounded servicemen and women. How can wounded personnel be rescued and treated professionally on the battlefield under extreme stress and danger? A joint exercise of the Army and the Joint Medical Service is proof that rescue operations are teamwork.

Soldiers are receiving emergency medical care at a mobile aid station.

The topic of injury plays a prominent role on the battlefield. During the “Wettiner Schwert” exercise, combat troops and military medical personnel train together how to rescue injured and wounded NATO soldiers in a war emergency.

Bundeswehr/Mario Bähr

Armoured infantry forces are trained to conduct ground manoeuvres. Sometimes mounted and mobile on a heavily armed infantry fighting vehicle, sometimes dismounted and with their rifles in their hands, they make their way through any terrain. We are in a wooded area with them. All of a sudden, we come under enemy fire. Soldiers are wounded. There are gunshot injuries. One soldier suffers a gunshot wound to his right thigh with severe bleeding. What now?

A Safe Place and First Aid

There is an infantry fighting vehicle on a forest path. Several soldiers are standing at its rear.

Following self and buddy aid, wounded personnel must be transported out of the combat zone to receive further medical care.

Bundeswehr/Mario Bähr

Under extreme pain and stress, a lot of things are going through the wounded person’s mind now: Will I survive? Who will get me out of here? The section immediately takes advantage of a short firebreak to report to the platoon leader via radio: “We have two wounded persons.” At the same time, soldiers bring the wounded to safety under cover, away from the enemy to the rear, to the casualty collection point. In the first cover, immediate lifesaving measures are taken to stop the bleeding. For this purpose, tourniquets are used for bleeding control, and a pressure bandage is applied.
Every service member is a trained mission first aid provider. The principle is being able to perform immediate lifesaving measures on fellow soldiers on operations and, if necessary, on oneself, taking into account the tactical situation. To this end, every soldier on combat operations is equipped with various first-aid supplies. All Bundeswehr soldiers have been trained by medical specialist personnel to perform immediate lifesaving measures on injured persons and receive refresher trainings on a regular basis. These initial measures are decisive for the medical evacuation chain and the survival of the wounded. There are various qualification levels of first aider training for combat forces – from the simple application of dressings to airway management and the insertion of intravenous access devices in accordance with the principles of tactical combat casualty care.

The Chain That Saves Lives

While the injured soldiers are enduring severe pain at the casualty collection point and are being attended to by fellow soldiers, in the background, the platoon leader contacts the medical team via the company operations officer. This initiates the medical evacuation chain. The medical team receives the following message: “We are at site X in the middle of a firefight and have two wounded soldiers.” How do the wounded get out of the combat zone to the first medical treatment facility? Should a combat vehicle be detached to provide protected transport?
In reality, casualty evacuation by combat troops themselves is the exception. Why? Any loss of the troops’ combat power will have an impact on the fighting. Hence, the medical team or the mobile emergency physician team will use the BOXER multi-role armoured vehicle (MRAV) with medical equipment to pick up the two soldiers from the casualty collection point.
After taking the wounded aboard, an independent medic or physician will provide first qualified care. The wounded continue to be stabilised during transport. Now, they are heading towards the role 1 mobile aid station, which is located about five kilometres behind the front.

The Transfer of the Patients

At the role 1 facility, the radio operator then receives the message: “Two category BRAVO patients will be arriving soon.” BRAVO means that they are moderately wounded. Depending on injury patterns and vital functions, patients are categorised from ALPHA (severely wounded) to CHARLIE (slightly wounded). The two patients are then brought in. At the same time, a radio message is sent to the medical cell: “We have admitted two wounded soldiers.” The medical cell communicates with the superior cell at the higher brigade level to make timely preparations for treatment at the next higher facility.
The role 1 physician will now assign treatment stations to the two soldiers within the mobile aid station and decide on their further treatment. He says: “I need an evacuation in ten minutes.” Oberleutnant [Lieutenant] Daniel Müller, umpire and medical instructor at the Army Combat Training Centre explains: “If standard NATO timelines are adhered to, the objective of providing emergency medical care within one hour will be achieved here, at role 1, at the latest.” Meanwhile, the patients have been stabilised. Evacuation to a role 2 facility for emergency surgical care begins.

Medical Specialists Are Waiting for Their Turn

In an operating theatre, physicians in green surgical gowns are operating on a training dummy.

Role 2 is the next medical treatment facility following the mobile aid station. The patients receive emergency surgical care here. During the exercise, surgery is performed on training dummies.

Bundeswehr/Mario Bähr

After an hour and a short transport time, the patients arrive at the next medical treatment facility, the role 2B. B stands for basic. This facility, which consists of tents and containers, comprises different medical departments such as an emergency room, radiology components, laboratory diagnostics, intensive care medicine or surgery and can be supplemented depending on the mission and operational requirements. It is comparable to a district hospital in Germany.
The patients are already expected in the emergency room and immediately taken to the surgical department. It represents the core of the role 2 capabilities: emergency surgical care. In an adjacent part of the facility, the patients having undergone surgery come round from the anaesthetic, are stabilised and prepared for transport to a higher treatment facility in the country of deployment.

Well-Prepared Thanks to Realistic Exercise Scenario 

The scenario is quite realistic. Nevertheless, this battle is not a real incident but the “Wettiner Schwert” exercise in Letzlinger Heide. Here, combat troops train the medical evacuation chain so that the NATO Response Force Land (2022-2024), NATO’s Very High Readiness Joint Task Force, and the Joint Medical Service are prepared for an emergency. Every second counts. During the exercise, it becomes apparent that it is not just about being able to fight effectively and professionally but also about providing military personnel with the best medical care that modern armed forces have to offer.

Duration of Stay near the Front Has to Be Kept Short

An armoured medical vehicle is driving by quickly on a forest path.

In the medical evacuation chain, speed and the use of the right rescue assets in the right place at the right time are crucial.

Bundeswehr/Mario Bähr

How can the emergency medical system be successful? The duration of stay at medical treatment facilities close to the front must be kept particularly short. After all, in a national and collective defence scenario, a large number of casualties are expected within a short period of time. A close-meshed transport network is required. It can bring about relief in the individual phases of the chain. The aim is to bring injured persons to the secure rear area as quickly as possible. It is also a matter of using the right rescue assets in the right place at the right time.

“The medical evacuation chain is a long proven and trained concept that is also applied by NATO and regularly trained as part of exercises such as “Wettiner Schwert 22”,” Oberstarzt [Colonel, Medical Corps] Dr Philipp Géronne, Commander, 1 Medical Regiment, explains. In the current NRFNATO Response Force (L), his task is to command and control the Medical Task Force, in which all role 2 medical facilities, patient evacuation forces and medical logistic facilities are combined. “The level of training is very high, both among combat troops and medical personnel. The same applies to the motivation and commitment of the servicemen and women deployed. All of these factors combined account for the success of the medical evacuation chain during the “Wettiner Schwert” exercise,” the physician sums up the positive result of the joint certification exercise at the Combat Training Centre.

From First Aid to Role 2B

  • A wounded soldier is lying on a forest path. His fellow soldiers are rushing to his assistance.

    Symbolic image: If military personnel are wounded in combat, every second counts. The first important steps to ensure a high chance of survival are to move the wounded to cover and to administer first aid to them.

    Bundeswehr/Uwe Henning
  • An infantry fighting vehicle is standing on a forest path. A soldier is shouting out of the open rear ramp.

    Combat troops take their injured fellow soldiers to the casualty collection point. The medical team arrives there at the same time and picks up the soldiers for further transport to the mobile aid station.

    Bundeswehr/Mario Bähr
  • A camouflaged wheeled armoured medical vehicle with a red cross in a white circle is speeding across a field.

    The medical team stabilises the patients while still in the BOXER MRAV with medical equipment and takes them to the first treatment facility, the role 1 mobile aid station.

    Bundeswehr/Mario Bähr
  • Several green tents, military vehicles and containers with the red cross symbol are standing in an open area.

    The role 1 mobile aid station is located about five kilometres behind the front. It is compact, rapidly deployable and consists of tents, vehicles and containers. Wounded soldiers are brought here by the medical team, for example.

    Bundeswehr/Mario Bähr
  • The open rear of an ambulance. A wounded person on a stretcher is being lifted out of the vehicle by soldiers.

    The medical evacuation company takes the wounded from the mobile aid station to the next higher treatment facility, the role 2B. It has a modular structure and comprises different medical departments.

    Bundeswehr/Mario Bähr
  • In an operating theatre, two physicians in green surgical gowns are operating on a training dummy that is cut open.

    During the “Wettiner Schwert” exercise, training dummies and fake blood are used to make the scenario as realistic as possible. Even surgical procedures can be performed realistically on the dummies.

    Bundeswehr/Mario Bähr
by Peter Müller