Author: Master Sgt. Joseph Stringer
Beginning in 2011, a flurry of reports and studies from Army Medical Department research teams flooded the military medical journals. Evidence pointed to a clear correlation between the medical credentialing levels of Army flight medics and the long-term survival outcomes of combat trauma patients in Afghanistan and Iraq theaters. Col. (Ret.) Robert Mabry et al. published the most influential of these studies in 2012 demonstrating that employment of Army National Guard (ARNG) flight medics trained to the Critical Care Paramedic level correlated to a 60% increase in 48-hour trauma patient survival as compared to their active-component EMT counterparts. Subsequent studies have demonstrated increased education and experience for pre-hospital transport providers, in both combat and the civilian sector, results in statistically significant improvements for clotting capability, blood-oxygen levels, correct performance of interventions, and even dramatic differences in decision-making among paramedics with varied experience levels.
In 2012, the United States Congress took note and mandated an upgrade in education and credentialing for all en route aeromedical care providers to the Critical Care Flight Paramedic (CCFP) level. Guard MEDEVAC units have faced more challenges than initially indicated finding enough personnel with the drive and academic aptitude to engage the 10-month training program and all required follow-on flight training. Command teams at all echelons struggled to keep advanced medical training as a priority when faced with resourcing competing requirements. After overcoming the early obstacles to build capacity, NGB has righted the ship with a more robust Aeromedical Evacuation team and targeted funding for both military and civilian-based schooling, bridging the gap from Combat Medic to CCFP. Close coordination between State Army Aviation Officers and State Surgeons places greater emphasis on command teams and medical providers to seek advanced schooling.
SFC Jonathan Vass (PA ARNG) practices Rapid Sequence Intubation in flight.
The transformation in MEDEVAC comes at a time when Large-Scale Combat Operations (LSCO) dominate the headlines in every military journal. A plethora of personal videos uploaded to the internet from the battlefields of Ukraine and Israel not only demonstrate heroic efforts from medics of all skill levels, but also highlight the need for improved training and more adaptive evacuation techniques. Commanders will need to re-think how to employ aeromedical assets in less-permissive environments when airspace superiority is not guaranteed. This reincarnation of an old peer-on-peer environment is where the ARNG must explore creative solutions to new problems.
Enhancing the primary capabilities of rotary-wing DUSTOFF crews from advanced search and rescue to flying intensive care units (ICUs) presents a challenge of application in the domestic operations sphere. Domestic medical emergency response forces, long used to limited hoist support, will find a robust medical capacity to complement their disaster response. In 2018, after hurricane Michael made landfall in the Florida panhandle, 39 ICU patients had to be evacuated from local hospitals via ground ambulance providers. This disaster operation overloaded domestic ambulance and hospital capacities for hundreds of miles. Future crises could see ARNG MEDEVAC and Air Guard Critical Care Air Transport Teams (CCATTs) in a joint patient movement operation from costal hospitals to inland specialty care centers before storms make landfall. The first CCFPs from Indiana and California have recently graduated the USAF CCATT program to explore the operational needs of patient movement in a joint environment. These CCFPs represent the future of the National Guard’s aeromedical evacuation community and they’re coming to a battlefield, or a natural disaster, near you.
SSG Elizabeth Fricker (CA ARNG) transfers her patient to CCATT C-17 liquid O2 System
