Medevac Transformation Takes Wing
Written by Colonel Robert Mitchell
The medevac challenges experienced in
Operation Enduring Freedom ranged
from increased need to force restructuring.
Aeromedical evacuation, medevac and dustoff are words commonly used to describe clearing the battlefield of the wounded and suffering, and their roots can be traced back to the Korean War. Throughout the years, medevac has played a defining role in successfully evacuating critically wounded in Korea, Vietnam, Grenada and Operations Just Cause, Desert Shield and Desert Storm. But Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have significantly changed the way medevac support is conducted and, more important, how it will support war fighting in the future.
This article will examine the challenges currently facing commanders in the execution of the medevac mission in OEF, and more important, what steps should be taken to correct them.
OPERATION ENDURING FREEDOM
On most levels, medevac support in OEF in Afghanistan has been superb, but it has not been without challenges that have recently come under the scrutiny of senior leaders in the U.S. Army and the Department of Defense. Many challenges are related to force structure and pose the biggest obstacle to the successful accomplishment of the medevac mission.
Since the commencement of combat operations in Afghanistan in late 2001, there has been a gradual need from combat aviation brigade (CAB) commanders to increase the number of medevac aircraft over time. Multiple lessons learned in theater point to an inadequate number of UH-60 Blackhawk helicopters in the air ambulance company structure.
Prior to aviation transformation in 2005, the air ambulance company consisted of 15 aircraft, 149 personnel and internal aviation unit maintenance (AVUM) capability. This organization was capable of self-deploying, establishing and conducting sustained operations, and providing scheduled and unscheduled maintenance to include 500-hour phase inspections. The unit was capable of providing four forward support medevac teams (each team consisted of three aircraft and 12 crewmembers) to each of the maneuver brigades within the division forward, with the remaining area support medevac team (three aircraft and 12 crewmembers) providing medevac coverage in the division rear on an area support basis.
During aviation transformation briefings, the Army made the decision to downsize the unit from 15 to 12 aircraft, reduce the personnel strength from 149 to 85, and finally to cut the AVUM capability. These capabilities were reorganized within the General Support Aviation Battalion (GSAB) and the Aviation Support Battalions (ASB). In simple terms, the air ambulance company was the bill payer for growth in CAB and GSAB structure.
Additionally, the Army made the decision to realign the air ambulance company and assign it as a subordinate company in the GSAB, thus removing the command and control (C2) authority within the medical chain of command. This realignment ended the long standing and historical fight of the Army Medical Department (AMEDD) with the transportation and aviation branch within the Army for command and control of medevac, which dates back to Major Charles Kelly (considered the father of Dustoff) and the Vietnam War.
The reorganization of the air ambulance company as a subordinate unit in the GSAB and a subordinate unit within the CAB was later deemed inefficient and at times ineffective in time and space in support of the ground commander. From the beginning of OEF, air ambulance support requirements did not match with organizational structure. The unit was basically fractured and essentially dissected for deployment and ultimately did not meet the true evacuation requirements for the theater.
INCREASE IN NEED
The number of medevac aircraft and support personnel has increased every year since 2001. An operation that initially required six medevac Blackhawk helicopters at the beginning of OEF has steadily increased to a requirement of 18 in 2008. This increase was due mainly to geographic coverage, an increase in the number of soldiers on the ground, and an inadequate number of combat support hospitals in theater.
Additionally, deployed medevac aircraft lacked sophisticated and up-to-date forward-looking infrared thermal imaging (FLIR) systems for low-illumination missions. CAB commanders were augmented with U.S. Air Force crews flying HH-60G Blackhawk helicopters for low-illumination missions that medevac crews could not fly. Unless the exact number of aircraft required for theater operations is 12, the Army leadership will have to continually break the company and GSABs to meet operational requirements. The Army Medical Evacuation Proponency at Fort Rucker, Ala., and the AMEDD Center and School at Fort Sam Houston, Texas, have determined that the air ambulance company should be sourced at 15 aircraft based on lessons learned and detailed analysis from OIF and OEF. Starting in 2009, Forces Command (FORSCOM) sourced both the 159th CAB and the 82nd CAB at 15 aircraft each for their OEF rotation, and plans are to continue to source deploying CABs at that number for the foreseeable future.
Another issue related to force structure that was made evident in a 2008 report from the U.S. Center for Army Lessons Learned was the adequate flight medic (68WF) support within the air ambulance company structure. During the process of aviation transformation, the decision was made to source the unit with one flight medic per aircraft, which equated to a total of 12 flight medics. Twelve assigned flight medics were completely inadequate for 24-hour sustained combat operations. Consequently, every CAB deploying to OEF departed home station with an additional six to eight ground medics for augmentation.
There are two overriding issues with the medic augmentation. First, there is insufficient time to train at home station in preparation for deployment. At the moment, there is 12 months or less dwell time for most active duty medevac units. Second, augmented medics do not attend nor graduate from the flight medic course at the U.S. Army School of Aviation Medicine (USASAM) at Fort Rucker prior to deployment.
The last issue with the air ambulance force structure that the CALL report noted is the lack of an E-7 (68WF) platoon sergeant. Dispersed FSMTs on the battlefield create the need for noncommissioned officer leadership, and the current air ambulance company structure is the only organization in Army aviation that lacks an E-7 platoon sergeant. Unlike the other aviation units assigned to a CAB that return to the forward operating base at the end of the day, FSMTs remain forward deployed in remote locations for the entire duration of the combat tour. Platoon sergeants are vital to the successful accomplishment of this very difficult and remote mission.
The Army has recognized these shortfalls in structure and is addressing each and every one of them. As of this writing, a force design update was submitted through Training and Doctrine Command to the Army to correct these deficiencies in the air ambulance company structure. These force structure improvements will go a long way in correcting the organizational deficiencies that currently exist in the air ambulance company structure. ♦
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Colonel Robert Mitchell is director of medical evacuation proponency and a senior aviation adviser to the Army surgeon general.