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LESSON ASSIGNMENT
LESSON 6
Medical Regulating and Patient Evacuation.
LESSON ASSIGNMENT Paragraphs 6-1--6-23.
LESSON OBJECTIVES
After completing this lesson, you should be able to:
6-1. Identity the definition of medical regulating.
6-2. Identify the definition of intratheater and intertheater
medical regulating.
6-3. Identify the USAF aeromedical elements and medical
regulating elements.
6-4. Identify the movement procedures used to move
patients in the USAF AE.
6-5. Identify the major classifications used for patients in
the USAF AE system.
6-6. Identify and compare the organizations in the USAE
AE system.
LESSON 6
MEDICAL REGULATING AND PATIENT EVACUATION
6-1. MEDICAL REGULATING DEFINED
Medical regulating is a casualty management system. It is designed to
coordinate the movement of patients from the site of injury or the onset of disease
through successive echelons of medical care to a MTF that can provide appropriate
levels of medical treatment.
6-2. THEATER ARMY MEDICAL MANAGEMENT INFORMATION SYSTEM
a. Medical Information Management System. The Theater Army Medical
Management Information System (TAMMIS) was developed to manage the medical
information of field medical units during peacetime and wartime. TAMMIS tracks
patients and manages medical information at tables of organization and equipment
(TOE) field medical units in the corps and EAC.
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b. An Automated, On-line Microcomputer System. TAMMIS is an automated,
on-line, interactive microcomputer system. It is designed to assist commanders by
providing timely, accurate, and relevant medical information.
c. Design. The design of the system focuses primarily on the automation of
wartime operations, but it also includes peacetime functions. TAMMIS supports
readiness missions while in garrison and during training exercises, thus ensuring a
rapid transition from peace to war. TAMMIS provides vertical integration of medical
information through C2 or the medical command control (MEDC2) function. Through
predetermined reports or ad hoc reporting, TAMMIS provides a data rollup capability
which contains the status of medical units, evacuation workloads, and critical resources.
TAMMIS is capable of interfacing with Department of Defense (DOD) medical
management information systems, such as the Defense Medical Regulating Information
System (DMRIS), and ultimately, the Composite Heath Care System (CHCS). TAMMIS
was adopted by DOD as the interim baseline wartime system for the quad-service
tactical medical information system.
d. Security Features. TAMMIS has security features that control user access
to the system. During system setup, the local manager establishes each user's
accessibility to each part of the system through system setup files; the user will be able
to view only the portion of the system that pertains to his job responsibilities. The local
manager can also adjust the system to accommodate local requirements and the
operating environment of his unit.
e. Modes of Relaying Information. TAMMIS can relay information between
units in various ways. The preferred method involves direct communication links
between computers through a military communications system. Because
communications cannot be assured in wartime, units can also pass information via
floppy diskette or tape delivered by courier. Both methods preclude having to re-enter
data.
f. Practically Hardware Independent. The design of TAMMIS makes it
practically hardware independent because of the use of the multi-user, multitasking
operating system (UNIX).
6-3. THE MEDICAL PATIENT ACCOUNTING AND REPORTING SYSTEM
a. Purpose of Medical Patient Accounting and Reporting. The Medical
Patient Accounting and Reporting (MEDPAR) subsystem supports facility commanders
in the management of patients and resources. The system tracks patients for casualty
reporting and personnel strength accounting purposes.
b. System Organization. The MEDPAR system is divided into menus, each
containing subcategories called menu items. Each menu item explains a procedure
within its menu. For instance, the patient admission and disposition menu contains the
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enter/update admissions and pre-admissions menu item for entering patient admission
data.
c. Medical Patient Accounting and Reporting Functions. The MEDPAR
system has the capability of communicating with other MEDPAR systems, Medical
Regulating (MEDREG), and Standard Installation/Division Personnel System
(SIDPERS). When patients are to be transferred from a hospital, coordination must be
made with MEDREG, which will coordinate with transportation units to move the
patients.
6-4. THE THEATER EVACUATION POLICY
a. Responsibility for Setting Policy. The evacuation policy is set by the
Secretary of Defense with advice from the Joint Chiefs of Staff and recommendations
from the Theater Commander. (The Surgeon General provides medical advice to the
Chief of Staff.)
b. Definition of the Army Policy. Theater evacuation policy establishes the
maximum period of noneffectiveness, hospitalization, and convalescence that patients
may be held within the theater.
c. When Period of Noneffectiveness Begins. The period of noneffectiveness
begins when a patient is admitted to a corps hospital.
d. Effect of Evacuation Policy on the Combat Health Support System. The
evacuation policy can have a domino effect in terms of the strain it exerts on the
resources of the CHS system. For example, the longer the evacuation policy, the more
beds that will be needed in theater, with the probable result that there will be a greater
need for a FH with convalescent care. More treatment, in turn, necessitates more
Class VIII medical supplies.
6-5. FACTORS AFFECTING THE EVACUATION POLICY
There are five factors that determine the evacuation policy. They are:
a. Mission, equipment, terrain, troops, and time (METT-T).
b. Number and type of patients.
c.
Evacuation assets available.
d. Availability of replacements.
e. Availability of in-theater resources.
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6-6. ADJUSTMENTS TO THE EVACUATION POLICY
a. Patients Not Requiring Treatment in an Echelons Above Corps General
Hospital. The evacuation policy may be adjusted to retain or RTD those patients who
do not require treatment in an EAC GH.
b. When Increased Patient Load is Anticipated. The evacuation policy may
also be adjusted in order to make additional beds available when increased patient
loads are anticipated. Suppose that our forces are going on the offensive or
undertaking a counterattack. In such cases, it will be necessary to lower the
evacuation policy. This will free up beds in order to prepare for operations.
6-7. PLANNING FOR MEDICAL REGULATING
Careful planning is required in order to adequately control patient evacuation to
hospitals so that there is an even distribution of patients, there is an adequate number
of beds for current and anticipated needs, and patients requiring specialized treatment
are routed to the proper MTFs.
a. Categories of Medical Regulating. There are two broad categories of
MEDREG: intra-theater and inter-theater MEDREG. Intra-theater MEDREG
encompasses movement anywhere from the corps to EAC, for example, from a CSH to
a GH. Inter-theater MEDREG occurs between EAC and CONUS.
b. Informal Medical Regulating (Tracking). Informal medical tracking of the
patient occurs from the company aid post to the BAS, from the BAS to the FMSC, and
from the FSMC to the corps hospital. The informal regulating/tracking system is used to
avoid exclusive dependence on the formal communications system.
6-8.
THE DIVISION MEDICAL OPERATIONS CENTER
a. Responsibilities. The medical group/brigade medical regulating officer
(MRO) of the division medical operations center (DMOC) coordinates and directs
patient evacuation from division level MTFs to corps level MTFs. When an ambulance
departs from the FSMC with a patient, the FSMC contacts the DMOC in order to
provide a specific set of relevant information.
b. Patient Disposition and Reports Branch. This branch of the DMOC fulfills
a number of important MEDREG and tracking functions.
6-9.
MEDICAL REGULATING PERSONNEL AND AGENCIES
a.
The Medical Regulating Officer. The MRO has three responsibilities:
(1)
Receives and consolidates evacuation requests.
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(2)
Determines resources available to move patients.
(3)
Maintains current information.
b. Patient Administration Specialist. Patient administration specialists (MOS
71G) are located in the FSMC/MSMC, DMOC, and corps hospitals.
c. The Global Patient Movement Requirements Center (GPMRC). This
office was formerly known as the Armed Services Medical Regulating Office (ASMRO).
It authorizes patient transfers to CONUS and determines the destination hospital.
d. The Joint Medical Regulating Office. The Joint Medical Regulating Office
(JMRO) is a joint agency consisting of two or more services. It regulates the movement
of patients within the TO and back to CONUS.
6-10. MEDICAL EVACUATION IN THEATER
a. The Unified Commander's Responsibilities. The unified commander is
responsible for:
(1)
Evacuation of formally captured and detained U.S. military personnel.
(2)
Evacuation of EPW and civilian internees, other detainees, and civilian
(3)
Policy and procedure for evacuation of military working dogs.
patients.
b. Department of Defense Policy on Aeromedical Evacuation. In both
peace and war, the movement of patients of the armed forces will be accomplished by
airlift, unless medically contraindicated. This assumes, of course, that AE is available
and that conditions are suitable for this mode of evacuation.
c. The Air Mobility Command. The air mobility command (AMC) is
responsible for:
(1)
All domestic AE.
(2)
Inter-theater evacuation.
(3) Intra-theater evacuation, except for evacuation from the CZ and from
routes solely of interest to the United States Navy (USN).
d. The Army Component Commander. The commander provides AE by
organic Army aircraft within the CZ.
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e. The Navy Overseas Component Commander. The commander provides
AE over routes solely of interest to the USN when USAF facilities cannot provide this
service.
6-11. PATIENT MOVEMENT PRECEDENCE
Overclassification must be avoided. It is important to the patient's welfare to
properly assign patient movement precedence. Overclassification must be avoided to
prevent unnecessary hardship to patients on flights that might be diverted. Proper
evaluation can also avoid unnecessary, costly, hazardous, or special flights.
6-12. THEATER AEROMEDICAL EVACUATION (PRECEDENCE CLASSIFICATION)
The three classifications of patients are given below. The "urgent" classification
is not used for psychiatric cases or for terminal cases with very short life expectancy.
a.
b.
c.
Urgent. Emergency cases that must be moved immediately:
(1)
To save life or limb.
(2)
To prevent complication or a serious illness.
Priority.
(1)
Patient requires prompt medical care not available locally.
(2)
Evacuate within 24 hours and delivered with least possible delay.
Routine.
(1)
Evacuate within 72 hours.
(2)
Use routine or scheduled flights.
6-13. AEROMEDICAL EVACUATION ELEMENTS
a. The Aeromedical Evacuation Coordination. The AE system does not own
any aircraft. Aeromedical evacuation movements are requested through the
Aeromedical Evacuation Coordination Center (AECC), the brain of the USAF's AE
center. The AECC manages the AE system and is responsible for overall planning,
coordinating, and directing of AE.
b. Aeromedical Evacuation Liaison Team. The aeromedical evacuation
liaison team (AELT) is the communications link between the user service and the AE
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system. To ensure smooth patient flow, the AELT is collocated with the user service
(which can be an MTF). The AELT consists of two medical service corps officers, one
flight nurse, and three radio operators.
6-14. MOBILE AEROMEDICAL STAGING FACILITY
a. Defined. The mobile aeromedical staging facility (MASF) is a temporary
holding facility equipped and staffed to receive patients, sustain life, and
administratively process patients. The MASF is the entry point of patients into the
USAF's AE system.
b. Location. The MASF is normally located near the runways or taxiways of
airfields or forward operating bases, where tactical airlift aircraft resupply combat
forces.
c.
Facility.
Strength, Staffing, and Capabilities of the Mobile Aeromedical Staging
(1)
Authorized strength: 39.
(2) Types of personnel authorized: flight nurses, aeromedical technicians,
radio operators, and ground ramp operators.
(3)
d.
Physicians: none, but can be called in as required.
Mobile Aeromedical Staging Facility Capabilities.
(1)
Patients: 50 patients, for 4 to 6 hours, no overnight holding capability.
(2)
Organic patient transport: none.
(3)
Patient food service: none.
(4)
Special equipment/supplies: must be provided by MTF.
e. Functions of the Mobile Aeromedical Staging Facility. Six functions of
the MASF are to:
(1)
Receive casualties requiring AE from forward medical elements.
(2)
Provide supportive nursing care to casualties awaiting airlift.
(3)
Prepare administrative paperwork.
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(4)
Assist AE crews in configuring aircraft to receive litter and ambulatory
(5)
Notify the AECC when AE aircraft has departed.
(6)
Provide status and capability reports to AECC.
patients.
f. Responsibilities of the Originating Military Treatment Facility. The
originating MTF provides transportation to MASF, supplies and equipment, and guards
or attendants.
6-15. AERO5EDICAL EVACUATION CREWS
The usual AE crew consists of two flight nurses and three AE technicians. There
are no physicians in an AE crew. The AE crew prepares patients for evacuation and
provides limited in-flight nursing care.
6-16. THE STRATEGIC AEROMEDICAL EVACUATION SYSTEM
a. Definition. The strategic AE system provides patient evacuation between
the TO and another theater or between the TO and CONUS.
b. Aircraft. The aircraft normally used are the C-131 (Hercules), the C-141B
(Starlifter), and the B-767.
c.
The Aeromedical Staging Facility.
(1)
Location: strategic interface airfields (normally EAC).
(2)
Capacity: 50 to 250 beds.
(3)
Overnight holding capacity: cots and beds for overnight patients.
6-17. DOMESTIC AEROMEDICAL EVACUATION SYSTEM
The domestic AE system airlifts patients from aerial ports of entry or debarkation
to and between federally operated medical facilities in CONUS. This includes AE from
near-offshore installations.
6-18. RESPONSIBILITIES OF THE ATTENDING PHYSICIAN
a. Diagnosis and Decision to Transfer. The attending (referring) physician
makes the diagnosis and the decision to transfer the patient. He is responsible for all
medical care until the patient reaches the destination facility.
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b. Patient Movement Precedence. The attending physician makes the
assignment as to patient movement precedence.
c. Patient Classifications. The attending physician determines the patient's
classification for evacuation.
(1)
Class 1: neuropsychiatric patient.
(2)
Class 2: litter patient (other than psychiatric).
(3)
Class 3: ambulatory patient.
(4)
Class 4: infant.
(5)
Class 5: outpatient.
(6)
Class 6: nonpatient.
6-19. A MEDICAL REGULATING SYSTEM SCENARIO
a. Patient Evacuation to the Forward Support Medical Center. The
hypothetical patient in question is to be evacuated to the FSMC and stabilized. The
patient will require surgery and evacuation. The FSMC notifies the DMOC. The DMOC
coordinates with the group MRO.
b. The Patient Administration Disposition Request. The patient
administrator (PAD) relays the request to evacuate to the MRO at the medical group.
c. From Medical Regulating Officer to Medical Brigade Medical Regulating
Office. The group MRO relays the need to evacuate the patient to the medical brigade
MRO who contacts the JMRO to obtain a bed for the patient. The JMRO locates the
bed and specialty service, if required, and relays the information back to the MRO.
d. From Medical Regulating Officer to Aeromedical Evacuation Liaison
Team. The MRO contacts the AELT to prepare AE transportation. When the request
is received by the AELT, a radio call is made to the AECC.
e. Back to the Patient Administration. The MRO then relays the information
back to the PAD. The patient is then transported, having arrived 2-4 hours prior to
aircraft arrival to allow for MASF personnel to conduct administrative duties and triage.
6-20. JOINT CASUALTY EVACUATION OPERATIONS IN THE COMBAT ZONE
Regardless of the circumstances that may require the National Command
Authority to enlist the services of the Army's light forces, the next contingency will
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almost certainly require a rapid deployment into an undeveloped theater, necessitating
detailed logistics planning. This logistics strategy will be punctuated by a health service
support (HSS) plan that particularly addresses the issue of casualty evacuation.
a. Austere Division and Corps Medical Support. Forced-entry operations
and establishment of a lodgment present unique challenges for medical units. With no
corps level medical support immediately available, and perhaps only an austere tailored
package of division Level II support during the initial phases of the operation, medical
units must rely on the USAF's theater airlift resources to evacuate casualties.
b. The United States Air Force's Airlift Services. At the Joint Readiness
Training Center (JRTC), units quickly recognize the invaluable service that USAF airlift
can provide in accomplishing casualty evacuation. Unfortunately, the exploitation of
these valuable assets is not well publicized and, consequently, the Army units may be
unfamiliar with the coordination necessary for proper execution.
c. Violation of Combat Health Support Principle of Continuity of Care.
Most units are inclined to load casualties on any aircraft arriving at the airhead. While
this may seem efficient, it violates an absolute principle of CHS operations, that of
continuity of care. Loadmaster and aircraft crews are neither capable nor qualified to
provide the medical care necessary for preserving life. Will they be able to maintain an
intravenous line on patients suffering from hypovolemic shock? Can they manage the
flow rate of oxygen? Can they administer analgesics or other medication? Will they be
able to change bandages or perform chest decompression in the event thoracic injuries
escalate into a pneumothorax? Are they trained to maintain an airway? And to further
complicate matters, without previous coordination, who is responsible for accepting
casualties from this aircraft at its arrival airfield? The benefit of evacuation never
obviates the need for continuity of care and certainly would not be worth the number of
severely wounded who would not survive the flight without treatment while en route to
definitive care facilities.
6-21. INTRA-THEATER ORGANIZATION
Most logistics planners are familiar with the role of the USAF in conducting
theater, strategic, and CONUS AE. The use of aircraft such as the C-141 B Starlifter or
C-9 Nightingale for casualty evacuation from corps hospitals to EAC is generally
understood. Brigade and battalion staffs, however, may not be aware that the USAF,
specifically Air Combat Command, maintains units solely dedicated for casualty
evacuation even within the division area of operations (AO).
a. United States Air Force's Worldwide Aeromedical Evacuation Mission.
The mission of the USAF worldwide AE system is to transport casualties by fixed-wing
aircraft, under medical supervision, from forward airfields in the CZ to points of
definitive medical care within the CZ. From the CZ, casualties are transported to
medical care within the EAC (intra-theater) and from EAC to CONUS (inter-theater).
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b. Aeromedical Evacuation Squadron. An aeromedical evacuation squadron
(AES) is composed of operational medical elements that conduct AE through an
interrelated network.
c. Aeromedical Evacuation Liaison Team. Ideally, an AELT is collocated
with the Army medical units in the division and corps AO. The six members of the
AELT include two Medical Service Corps officers who control AE operations, a Nurse
Corps officer who provides clinical and patient preparation support, and three
communications specialists who operate the team's high-frequency radio systems that
provide the direct channel between the requesting unit and the AECC. The team is
organized to provide 24-hour continuous operations. The AELT can be tailored,
depending on the mission, but perhaps its most pertinent feature is its flexibility in
deploying readily with any of the Army's airborne, air assault, and light infantry divisions.
The AELTs can insert with the initial forces arriving in the CZ and immediately facilitate
casualty evacuation by communicating with the AECC to coordinate the use of aircraft
arriving at the airhead. It is certainly preferable to plan a staging time for the first
"casualty back haul" following combat operations. But the AELT gives medical units a
distinct advantage in their ability to adjust their plans and communicate their needs to
the AECC based on enemy contact, accessibility of casualties, or other unforeseen
events. Additionally, AELT's provide direct support to the treatment squads within the
BASs or medical companies in both triaging and packaging patients with special
consideration for pressurized flight.
d. C-130 Hercules. The most commonly used and preferred aircraft for
evacuation within the CZ zone is the C-130 Hercules. The C-130 can land and take off
on short, unimproved runways, facilitating rapid transportation of personnel and
equipment. When these aircraft are properly coordinated through the AECC, they may
arrive configured with litter stanchions and an AE nursing crew tailored to support the
needs of the patients. A C-130 configured with litter stanchions for patient evacuation
can accommodate a maximum of 74 litters or 92 ambulatory patients. A mix of 50
litters and 27 ambulatory patients is also possible. With consideration to crew
composition, medical equipment, and patient baggage, patient loads should generally
not exceed 50 litters. Should rapid loading be required without internal configuration of
the aircraft, the C-130 floor can be loaded with 15 litter patients.
e. Reconfiguring an Aircraft. As the force buildup continues and the airhead
expands, the AELT has visibility and access to most other USAF aircraft arriving in the
AOs. This provides the combat commander with tremendous added flexibility in
properly evacuating his patients. Following combat off loads on the flight landing strip,
a seasoned AE crew can reconfigure an aircraft for patient evacuation, using litters
stowed in its cargo compartments, in approximately 15 minutes.
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6-22. COORDINATION OF INTRA-THEATER EVACUATION
a. Aeromedical Evacuation Control Center (AECC). The theater AE system
does not possess a dedicated fleet of evacuation aircraft. Aeromedical evacuation
movements are requested through the theater airlift request system just like any other
airlift request. When a medical unit announces that stabilized patients are ready for
movement, the AELT communicates this requirement to the AECC. The AECC is the
operations center where the overall mission planning, coordinating, and the monitoring
occurs. The AECC is a function of the theater air operations center and coordinates
directly with the air mobility element for airlift execution.
b. Aeromedical Evacuation. When a mission is scheduled, the AECC
transmits the mission data and other pertinent information back to the AELT as well as
to other elements in the AE system. When an AE mission is requested and identified,
an AE crew is alerted to support the mission. AE crews provide the in-flight supportive
nursing care aboard the evacuation aircraft. These crews are responsible for ensuring
that aircraft are properly configured and loaded. An individual AE crew consists of five
personnel: two flight nurses and three aeromedical technicians. The crew can be
tailored, however, depending on the mission.
6-23. EXECUTION OF INTRA-THEATER EVACUATION
a. Detailed Plan for Preparation, Movement and Staging, and Loading
Phases of Aeromedical Evacuation Needed. Now that a network has been
established for effective coordination of AE assets, what are some of the techniques
and procedures applicable to proper execution? As is always the case, detailed
planning is an absolute necessity in ensuring mission accomplishment. The patient
evacuation plan should address three separate phases: preparation, movement and
staging, and loading.
b.
Preparation for Aeromedical Evacuation.
(1) Verifying documentation. Attending medical personnel and PAD
specialists must first ensure all required documentation be completed on evacuees.
Medical units should possess Department of Defense (DD) Forms 601 and 602, Patient
Evacuation Manifest and Patient Evacuation Tag, and the forms must be properly
annotated for AE missions. If these forms are not available, a manifest can be created
for the AE crew, which lists each patient's name, rank, social security number, unit,
patient classification, destination facility, and an emergency point of contact. A DD
Form 1380, U. S. Field Medical Card, may be used in lieu of a patient evacuation tag, if
necessary. However, it must indicate primary and secondary diagnoses, correct patient
data, and special orders for en route care, medications, and diet.
(2) Packaging of patient. It is a Army unit responsibility to properly
"package" the patient. Tactical aircraft will not arrive with many amenities and normally
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will require significant support from the originating medical facility. A litter patient
should be prepared with two blankets and two litters straps. The attending physicians
must ensure that 1 to 3 days' supply of medications and rations accompany their
patients. Patients are transported with their valuables, personal effects, chemical
protective gear, and medically essential items. Baggage is usually restricted to 66
pounds per patient.
(3) Organizing and inspecting loading teams, drivers, transportation, and
equipment. Next, loading teams, drivers, transportation, and equipment must be
organized and inspected. Backward planning will solidify the schedule, and rehearsals
will affix responsibilities for each member in the operation and identify possible
contingencies.
c. Movement and Staging. United States Air Force liaison teams normally
prefer that staging occur no less than 1 hour before the arrival of the aircraft. This
ensures the mission is still valid and prevents delays in loading that subject the aircraft
to greater hazard and restricts other operations on the flight landing strips. If the airfield
is not in the immediate AO, map and route reconnaissance will be necessary to
determine scheduling for each phase of the operation. Security escorts should be
available for the reconnaissance and during movement to the staging area. Upon
arrival at the airfield, a site should be selected that will provide ready access to the
aircraft. If there are several aircraft in one serial arriving at the airfield, it is usually most
appropriate to plan the AE mission on the last aircraft arriving on the flight landing strip.
Units must also coordinate with the airfield combat control team (CCT) or responsible
airfield operations element to position the staging facility in an area that best
accommodates the operation. The CCT leader may allow the use of his operational
area depending on the tactical situation.
d.
Loading.
(1) Positioning personnel and vehicles. Patients, personnel, and vehicles
should be no closer than 60 feet from the edge of a taxiway or 100 feet from the edge
of a runway. When the aircraft arrives, a CCT or qualified aircraft marshal will position
the aircraft.
(2) Control points. Once the staging area has been established, control
personnel prepare for load operations. Three control personnel are necessary for
efficient loading. Control point one is normally a member of the USAF flight medical
crew. This individual is positioned on the ramp of the aircraft and is the focal point for
the entire operation. Control point one will communicate movement of patients using
hand and arm signals. Control point two is a member of the medical team and is
positioned at the safe vehicle distance (approximately 50 feet) from the rear of the
aircraft. Control point two manages the smooth flow of casualties either directly from
the staging facility or from vehicles he directs to his point directly on the flight landing
strip. Control point three is responsible for the entire operation. He conducts final
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checks on each departing patient and ensures continuity of care and completion of
administrative data. Control point three supervises organization of litter teams,
movement of vehicles, and handling of patients.
(3) Aircraft arrival. When the aircraft arrives, personnel need to remain
alert and watch for wingtip clearance. The staging team will signal the aircraft
marshaled to indicate proper wingtip clearance and make sure the aircraft is properly
positioned IAW the plan. For tactical operations, the aircraft will most likely remain
running. Once the ramp is lowered, one person should approach the aircraft. Two
individuals will be on the ramp: the aircraft loadmaster and the AE medical crew
director. The AE medical crew director needs the manifest, patient load numbers (both
litter and ambulatory), and any other pertinent data.
(4) Loading patients. The AE medical crew director will notify the load
teams when the aircraft is prepared for loading. This could be as soon as the ramp
touches the ground if the mission is strictly to conduct casualty evacuation. Ambulatory
patients are loaded first and should be accompanied by no less than two medical
personnel to assist them onto the aircraft. Medical condition of patients will dictate if
more personnel are necessary. Litter patient load teams should be organized as fourman teams until they reach control point two, then switch to two-man teams as they
approach the rear of the aircraft. The tailgate ramp will only accommodate a two-man
litter carry, and litter patients should be loaded feet first. As is the case with all casualty
evacuation missions, the most critically wounded should be loaded last to make them
readily accessible at the arrival airfield.
(5) Time factors. It requires approximately 5 minutes per litter patient and 3
minutes per ambulatory patient for loading. A load team for ten ambulatory patients
and ten litter patients should require no fewer than ten personnel.
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