MEDICAL EDUCATION & TRAINING CAMPUS

MEDICAL EDUCATION & TRAINING CAMPUS

Patient Movement

Medical Education & Training Campus

• Disclosures

• MSgt Gissendanner has no financial interests to

disclose regarding this subject or the contents of the

presentation

Patient Movement


• Objectives

• Explain, define and discuss the differences between

CASEVAC, MEDEVAC, and Airevac

• Explain and discuss the validation process for regulated

patient movement

• Identify the proper patient precedence and

classification

• Identify the medical stabilization and considerations for

regulated patient movement

Patient Movement


• Types of Patient Movement

• CASEVAC: Evacuation of a casualty from the forward line

of conflict (forward edge of the battle area, or FEBA).

• May expose the crew/aircraft to hostile fire

• Involves aircraft that are designated for casualty

movement

• May utilize ground based or rotary-wing transport

Patient Movement


Patient Movement


• MEDEVAC:

• Evacuation of a casualty (“patient”) from one

point of established medical care to another

point of care within the tactical theater

• Usually occurs with a rotary-wing aircraft or

tactical fixed-wing aircraft such as the C-

130

• FEVER mission

Patient Movement


Patient Movement


• Aeromedical evacuation:

• movement of a casualty (“patient”) from a

point of care within the theater to a more

rearward location, such as regional hospital or

CONUS

• Employed fixed-wing aircraft such as the C-

17 and the C-130

Patient Movement


Patient Movement


• Intra-Theater:

• Within a specific AOR, PACAF, USAFE, etc.

• Generally 1-day worth of supplies/meds

• Inter-Theater:

• From one theater to the next

• Generally 3-days worth of supplies/meds

Patient Movement


• Considerations

• Relatively short transport accomplished by

rotary-wing aircraft

• Can be conducted using vehicles or watercraft

• Casualties needing CASEVAC are, by

definition, recently injured and may be quite

unstable

CASEVAC


• Focus is on lifesaving maneuvers that enhance

survival without creating further risk to the

casualty, the mission, or the crew

• Involvement in pre-mission planning is

essential to mission success

CASEVAC


CASEVAC


• Nine Line Request - standard method of

requesting CASEVAC

• LINE 1: Location of casualty/HLZ (Helicopter

landing zone)

• LINE 2: Radio frequency and call sign

• LINE 3: Evacuation precedence

9-Line Request


• LINE 4: Special equipment requests (This line

requests specialized extraction or medical

equipment)

• LINE 5: Numbers of litter and ambulatory

patients

• LINE 6: Evacuation site security (This

indicates the level of hostile threat in the area)

9-Line Request


• LINE 7: Marking of evacuation site

• LINE 8: Casualty nationalities and combat

status

• LINE 9: NBC/Terrain specifics

9-Line Request


• Prepare casualties for flight

• Perform any urgent medical procedures while still on

the ground

• splinting

• applying dressings

• start IV lines, while still on the ground

• Protect the casualties’ ears with earplugs

• Protect the eyes with goggles or bandages

• Load the casualties – as directed by the aircrew

9-Line Request


• Considerations

• Movement of a casualty from a forward resuscitation

area to a surgical support facility

• From: Battalion Aid Station, Shock Trauma Platoon,

Forward Resuscitative Surgical Team

• To: CSH or EMEDS

• Alternatively may involve the movement of a patient

from a CSH/EMEDS to a regional staging facility

(MSF, theater air hub, aeromedical staging facility)

MEDEVAC


• Duration and scope of mission vary widely and are “

hybrids” of CASEVAC and Aeromedical Evacuation.

• For short duration missions, operational

considerations are similar to those discussed for

CASEVAC

• Longer missions requiring the use of fixed-wing

aircraft more closely resemble Aeromedical

Evacuation.

MEDEVAC


MEDEVAC


• Patient movement requested by attending

provider through local Flight Surgeon

• Submitted through TRANSCOM Regulating and

Command and Control Evacuation System

(TRAC2ES)

• TRAC2ES training required prior to gaining

access

• If TRAC2ES is unavailable, an AF 3899 will be

used

AIREVAC and TRAC2ES


• Request received by Theater Patient Movement

Request Center (TPMRC)

• Includes patient information

• History

• Current medications

• Patient movement precedence and classification

• Theater Validating Flight Surgeon at TPMRC

approves all regulated movement

AIREVAC and TRAC2ES


• Patient movement precedence

• Urgent (ASAP) - To save life, limb, or eyesight

• Priority (24 hrs) – Prompt medical care not available

or patient’s condition could deteriorate

• Routine (72 hrs) – Condition not expected to

deteriorate

AIREVAC and TRAC2ES


• Patient movement classification (PLACO)

• 1 A-C – Psychiatric

• 2 A/B – Litter

• 3 A-C – Ambulatory

• 4 A-E – Child

• 5 A-F – Outpatient

• 6 A/B – Attendant

AIREVAC and TRAC2ES


• Patient Considerations

• Ensure airway is secure

• ET Tube mandatory for any suspect airway

compromise

• Inflate cuff with Normal Saline

• CCATT will be required

• If chest tube is used, a Heimlich Valve will also be

used unless a one-way valve is inherent to the chest

drainage unit

AIREVAC and TRAC2ES


CCATT


• Patient Considerations

• Ensure airway is secure

• Heimlich Valve mandatory for all chest

tubes

• Exception - chest drainage unit has

inherent one-way valve

AIREVAC and TRAC2ES


AIREVAC and TRAC2ES


• Cervical, Thoracic, Lumbar spine

• Cleared via CT

• If CT unavailable

• Immobilized via C-Collar, spine board, etc

AIREVAC and TRAC2ES


• Hemodynamically Stable

• Hemoglobin > 8.0

• Hematocrit > 25

• No active bleeding

• If active bleed or low H&H

• CCATT can be requested to provide blood

products in-flight

AIREVAC and TRAC2ES


CCATT


• Fractures

• Splinted- Air splints are not to be used if

alternate splints are available

• Casts- Should be 48 hours old if possible

• Should bivalve if swelling is expected

• Splints are preferred

AIREVAC and TRAC2ES


• IV Fluids

• Bags preferred to bottles

• Urinary Catheter

• Ensure cuff is inflated with Normal Saline

• Medications

• Ensure patient has enough IV’s, medications

and supplies to reach destination facility

AIREVAC and TRAC2ES


• Litters

• Use NATO or Army litters only

• NATO Litter- 250 lb max weight

• Army Decon Litter- 350 lb max weight

• Nylon litters are not approved

• Use 2 litter straps (one strap on patients

mid-thigh and one on patients upper chest)

AIREVAC and TRAC2ES


Questions

MEDICAL EDUCATION & TRAINING CAMPUS

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