UNITED STATES MARINE CORPS
Field Medical Training Battalion
Camp Lejeune
FMST
1423
Coordinate Casualty Evacuation
TERMINAL LEARNING OBJECTIVES
1.
Given multiple casualties in a combat environment,
communication equipment, nine-line medical evacuation format, and the standard
field medical equipment and supplies, coordinate casualty evacuation to
transport casualties for medical treatment, per the references. (FMST-EVAC-1423)
ENABLING LEARNING OBJECTIVES
1.
Without the aid of references, given a description
or list of capabilities, identify the echelons of care, per the student
handout. (FMST-EVAC-1423a)
2.
Without the aid of references, given a description
or title, identify ground vehicles utilized as CASEVAC platforms, per the
student handout. (FMST-EVAC-1423b)
3.
Without the aid of references, given a description
or title, identify aircraft utilized as CASEVAC platforms, per the student
handout. (FMST-EVAC-1423c)
4.
Without the aid of references, given a list of
characteristics, identify the casualty receiving treatment ships, per the
student handout. (FMST-EVAC-1423d)
5.
Without the aid of references, given a list, match
casualty carrying capacity to evacuation platforms, per the student handout.
(FMST-EVAC-1423e)
6.
Without the aid of references, given a description
or list, identify the purpose of a nine-line casualty evacuation communication,
per the student handout. (FMST-EVAC-1423f)
7.
Without the aid of references, given the necessary
equipment, transmit a nine-line casualty evacuation request, per the student
handout. (FMST-EVAC-1423g)
8.
Without the aid of references, given a description
or list, identify the casualty evacuation priorities, per the student handout.
(FMST-EVAC-1423i)
9.
Without the aid of
references, given multiple simulated casualties in a simulated combat
environment, standard field medical equipment and supplies, and individual
combat equipment, perform casualty evacuation, per the student handout.
(FMST-EVAC-1423j)
1.
OVERVIEW
Casualty
Evacuation Care (CASEVAC) is the third phase in the Tactical Combat Casualty
Care process. The care delivered in the CASEVAC phase can more closely resemble
advanced trauma life support guidelines than that in the first two phases. With
either vehicular or air evacuation of wounded casualties from the battlefield,
there is an opportunity for access to additional medical equipment not available
to the Corpsman during the first two phases. This lesson will describe the
different echelons of care, different methods of casualty evacuation, and how to
call for an evacuation.
2.
ECHELONS OF CARE
The word
echelon means a level of command, authority, or rank. The level of command for
care commences at the scene of the injury and continues until the member
receives definitive care and is discharged or returned to full duty. While this
course teaches you the skills needed to operate in Echelons I and II, there are
a total of five echelons of care (see figure 1).
|
ECHELONS |
LEVELS OF MEDICAL CARE |
RESOURCES |
|
Echelon I |
First Aid
Emergency Medical Care |
Self Aid / Buddy Aid
Hospital Corpsman
Aid Station |
|
Echelon II |
Initial Resuscitative Care
Surgical and Medical
Resuscitation |
Medical Battalion (STP/Surgical Co)
Ship Surg & Holding Cap
CRTS & FRSS |
|
Echelon III |
Resuscitative Care |
Hospital Ship
Fleet Hospital |
|
Echelon IV |
Definitive Care |
Overseas MTF |
|
Echelon V |
Restorative and Rehabilitative Care |
CONUS MTF
Veterans Hospitals |
Figure 1.
Echelons of Care
Echelon I - first aid and emergency care are the
primary objectives of care at this level. Other medical care offered at this
echelon is fluid therapy and advanced emergency procedures that will result in
patient stabilization prior to transfer to the next echelon of care. Examples
of Echelon I facilities include:
Self-aid/Buddy aid
Battalion Aid Station (BAS)
Echelon II - initial resuscitative care is the primary
objective of care at this level; saving life and limb, and when necessary,
stabilization for evacuation to Echelon III. This echelon has greater medical
capabilities than Echelon I and offers the first echelon with surgical
capability. Examples of Echelon II facilities include:
Medical
Battalion - provides surgical care for the MEF.
Provides stabilizing surgical procedures. Capable of holding patients up to 72
hours.
Casualty Receiving & Treatment Ships (CRTS) - part of
an Expeditionary Strike Group (ESG). They provide additional medical
capabilities for receiving a mass casualty (up to 50 casualties).
Shock
Trauma Platoon (STP) - small forward unit with one
physician supporting the MEF specializing in patient stabilization and CASEVAC.
No surgical capability.
Forward Resuscitation Surgical
Suite (FRSS) - the concept of an FRSS was developed in
1996 because it was recognized that Medical Battalions were too big and slow to
meet the maneuverability requirements of expeditionary warfare. This surgical
suite is pushed as far forward to be close to the combat area to allow surgical
treatment of casualties within the “golden hour” after injury. The FRSS is
staffed with 8 to 10 personnel (two surgeons, one critical care nurse, one
anesthesiologist, and four to six corpsmen). It consists of a two tent surgical
system that provides a fully powered, climate-controlled environment with enough
space for one operating room and one pre- and post-operative care room. The
shelter is equipped with cutting-edge surgical gear and takes less than one hour
to set up or break down.
Echelon III - represents the highest level of medical
care available within the combat zone. Advanced resuscitative care is the
primary objective of care at this level. Examples of Echelon III facilities
include:
Fleet
hospitals - deployable ground asset but located away
from enemy threat providing up to 500 hospital beds, 80 ICU beds, and 6 OR’s.
Hospital ships (USNS Mercy and
USNS Comfort) - deployable medical assets providing up
to 1,000 beds, 100 ICU beds, and 12 OR’s.
Echelon IV - definitive medical care is the primary
objective at this level.
Overseas Medical Treatment Facilities - offers
surgical capability found in echelon III, along with further definitive therapy
for those patients in the recovery phase who can be returned to duty within the
theater evacuation policy. A patient who cannot be returned to duty will be
evacuated to the next echelon of care.
Echelon V
- restorative and rehabilitative care is the primary objective of care at this
level.
CONUS
Military, Veteran’s and selected civilian hospitals -
provide full convalescent, restorative, and rehabilitative care to all patients
returned to the Continental United States (CONUS).
3.
METHODS OF EVACUATION
The level of urgency and the
tactical situation dictates the method of evacuation. Depending upon which
level of care you are in, Care Under Fire, Tactical Field Care, or CASEVAC Care,
will dictate how the casualty is transported. The most common forms of
evacuation are: ambulatory, manual carries, litter evacuation, ground
evacuation, air evacuation, or sea evacuation. Regardless, the casualty should
be made as comfortable as possible and kept warm and dry. If an improvised
litter is used, it should be padded and field-expedient material replaced with
conventional splints, tourniquets, and dressings as soon as feasible. A patient
with minimal injuries should be encouraged to stay in the fight if possible and
to ambulate to an area where care can be provided.
Types of litters
- there are six commonly used litters within the FMF.
Talon Litter - The Talon collapsible handle litter was developed to
meet the US Army’s urgent requirement to provide casualty evacuation. The Talon
litter allows a casualty to be transported in one vehicle then transitioned to a
standard evacuation platform without the need to transfer a casualty from one
litter to another. The Talon litter is the most commonly used litter.
Standard
Army Litter (see figure 3) - the standard collapsible litter folds along the
long axis.
Figure 3. Standard
Army Litter
Stokes
Litter (see figure 4) - affords maximum security for the patient when the
litter is tilted.
Figure 4.
Stokes Litter
Pole-less Non-rigid Litter (see figure 5) - this
litter can be folded and carried by the Field Medical Service Technician. It
has folds into which improvised poles can be inserted for evacuation over long
distances.
Figure 5.
Pole-less Non-rigid Litter
Miller (full body) Board - the Miller Board is constructed of an
outer plastic shell with an injected foam core. It is impervious to chemicals
and the elements and can be used in virtually every confined-space rescue and
vertical extrication. It fits in stokes stretcher and will float a 250-pound
person.
Improvised Litters (see figure 7)
- used for moving a casualty when a standard litter is not available, the
distance may be too great for manual carries, or the casualty may have an injury
that would be aggravated by manual transportation. These litters are to be used
in emergency situations only and must be replaced by standard litters at the
first opportunity.
Blouse / Flak Jacket Litter |
Rolled Blanket Litter |
Figure
7.
Improvised Litters
Procedures for Carrying Litters
1.
When moving a patient, the litter bearers must make
every movement deliberately and as gently as possible. The command “steady”
should be used to prevent undue haste.
2.
The rear bearers should watch the movements of the
front bearers and time their movements accordingly to ensure a smooth and steady
action.
3. The litter must be kept as level as possible at all
times, particularly when crossing obstacles such as ditches.
4. Normally, the patient should be carried on the
litter feet first, except when going uphill or up stairs
5. When the patient is loaded on a litter, his
individual equipment is carried by two of the bearers or placed on the litter.
When available, use Marines as your litter bearers.
4. GROUND EVACUATION PLATFORMS
M997 Ambulance
- HMMWV frame with armor protection for crew and patients. It is capable of
transporting up to 4 litter or 8 ambulatory patients. (See figure 8)
Figure 8. M997
Ambulance
M1035 Ambulance
- HMMWV frame with removable soft-top. It is capable of transporting 2 litter
and 3 ambulatory patients. (See figure 9)
Figure 9.
M1035 Ambulance
MK
23 7 Ton - non-medical vehicle that may be utilized for casualty
transportation when available. It is capable of transporting 10 litter or 20
ambulatory patients. (See figure 10)
Figure 10.
MK 23 7 Ton Truck
5.
AIR EVACUATION PLATFORMS
CH-46 Sea Knight
- Medium lift helicopter used to transport personnel and cargo
(being phased out by the MV-22 Osprey Tilt Rotor Aircraft).
- When
configured for litter racks, able to carry 15 litters or 22 ambulatory patients.
Figure 11.
CH-46 Sea Knight
CH-53 Super Sea Stallion
- Medium/Heavy lift helicopter used to transport personnel and
cargo.
- When configured for litter racks, able to carry 24 litters or
up to 37 ambulatory patients. When the centerline seating is added, up to 55
ambulatory patients can be carried.
Figure 12.
CH-53
Super
Sea Stallion
UH-1 Huey
- Light transport helicopter used to transport personnel and
cargo.
- When configured for litter racks, able to carry 6
litters or up to 10 ambulatory patients.
Figure 13.
UH-1 Huey
MV-22
Osprey
-
Tilt-rotor aircraft that takes off and lands
vertically but flies like a plane. This aircraft is designed to eventually replace the
CH-46.
- When
configured for litter racks, able to carry 12 litters or 24 ambulatory casualties.
Figure 14.
MV-22 Osprey
NOTE:
The Marine Corps does not have dedicated CASEVAC aircraft. Any of its
aircraft can be utilized as a “lift of opportunity” upon completion of its
primary mission. The use of helicopter evacuation provides a major advantage
because they greatly decrease the time between initial care and definitive
treatment thereby increasing the casualty’s chances of survival. Figure 15
below reflects USMC assets as well as those available through the Army and Air
Force.
|
AIRCRAFT |
|
TYPE |
SERVICE |
LITTER |
AMBULATORY |
ATTENDANTS |
|
UH-60 Blackhawk |
USA |
7 |
7 |
1 Medic |
|
CH-47 Chinook |
USA |
24 |
33 |
2 Medic |
|
UH-1 Huey |
USMC |
6 |
10 |
1 Corpsman |
|
CH-46 Sea Knight |
USMC |
15 |
22 |
2 Corpsmen |
|
CH-53 Super Sea Stallion |
USMC |
24 |
37 |
2 Corpsmen |
|
MV-22 Osprey |
USMC |
12 |
24 |
2 Corpsmen |
|
MEDICAL GROUND VEHICLES |
|
TYPE |
SERVICE |
LITTER |
AMBULATORY |
ATTENDANTS |
|
M997 HMMWV |
USA/ USMC/
USAF |
4
|
8
|
1 Corpsman |
|
M1035 HMMWV |
USA/ USMC/
USAF |
2
|
3
|
1 Corpsman |
|
VEHICLES OF OPPORTUNITY (GROUND) |
|
TYPE |
SERVICE |
LITTER |
AMBULATORY |
ATTENDANTS |
|
MK 23
(7-Ton Truck) |
USMC |
10 |
20 |
None |
| |
|
|
|
|
|
Figure 15. Ground/Air CASEVAC Platform Data
Description
 Figure 16.
LHD Wasp Class
Figure 17.
LHA Tarawa Class
|
6.
CASUALTY RECEIVING TREATMENT SHIPS
Specific ships within an Amphibious Task Force are designated as
Casualty Receiving Treatment Ships (CRTS).
LHD/LHA
- Amphibious Assault Ships whose primary differences, for our purposes, are
their medical capabilities (see figures 16 and 17).
Mission
-
Assault via helo, landing craft, and amphibious vehicle.
- Primary amphibious landing ships for MEF’s,
MEB’s, and MEU’s.
- Primary CRTS
Transport capabilities
- Flight deck with large internal hangar deck and well deck.
- May receive casualties via
helicopter or waterborne craft.
Medical Capabilities
LHD:
Largest
medical capability of amphibious ships
- Operating Rooms (6)
- ICU Beds (17)
- Ward Beds (47)
- Overflow beds (60)
LHA:
Second
largest medical capability of amphibious ships
- Operating Rooms (3)
- ICU Beds (17)
- Ward Beds (48)
7.
CASEVAC PRIORITIES
(see figures 18-20)
Once a patient has been triaged and
stabilized at the BAS, should that patient require further or additional medical
treatment, he/she will be prioritized for evacuation from the BAS to the next
higher echelon of medical care. While evacuating patients, ensure that they are
kept warm to prevent hypothermia! The priority levels are as follows:
Urgent
Evacuation
-
Evacuation to next higher echelon of medical care is needed to save life or
limb.
-
Evacuation must occur within two hours.
Urgent
Surgical Evacuation
- Same criteria as Urgent. The difference is that these patients
need to be taken to a facility with surgical capabilities.
Priority
Evacuation
- Evacuation to next higher echelon of medical care is needed or
the patient will deteriorate into the URGENT category.
-
Evacuation must occur within four hours.
Routine
Evacuation
- Evacuation to the next higher echelon of medical care is needed
to complete full treatment.
-
Evacuation may occur within 24 hours.
Convenience
- Used for administrative patient movement.
|
URGENT/URGENT SURGICAL - 2 Hours or Less
Life threatening injuries such as temporarily corrected hemorrhage,
temporarily controlled airway injuries, or temporarily controlled
breathing issues.
Examples include (but not limited to) patients with:
Tourniquets
Needle Decompression
Chricothyroidotomy
Major Internal Bleeding
(Figure 18) |
|
PRIORITY - 4 Hours or less
Potentially life threatening
injuries such as compensated shock, fractures causing circulatory
compromise, and uncomplicated but major burns.
Examples include (but not limited to) patients with:
Compensated Shock
Broken arm with loss of distal pulse
2nd degree burns to a large portion of the
abdomen or extremities
(Figure 19)
|
|
ROUTINE - 24 Hours or less
Injuries so insignificant or
extreme that chances of survival are not based on evacuation time.
Examples include (but not limited to) patients with:
Abrasions
Cardiac Arrest
Massive Head Trauma
Small Fractures
Frostbite
2nd /3rd degree burns >70% BSA
(Figure 20) |
8.
NINE LINE CASEVAC
A nine-line CASEVAC request is a
standard format used by the Armed Forces for coordinating the evacuation of
casualties. CASEVAC request transmissions should be by
the most direct communication means available to the medical unit controlling
evacuation assets. The means and frequencies used will depend on the
organization, availability, and location in the area of operations as well as
the distance between units.
The information must be clear,
concise, and easily transmitted. This is done by use of the authorized brevity
code. The authorized brevity code is a series of phonetic letters, numbers, and
basic descriptive terminology used to transmit CASEVAC information. These codes
indicate the standard information required for a CASEVAC commonly known as the
“9 Line”. This message is verbally transmitted in numerical “line” sequence
utilizing the following brevity codes:
Line 1 - Location
- location of the Landing Zone (LZ) where the casualties are to be picked up.
This information will be transmitted in the form of an eight digit grid
coordinate.
Line 2 - Radio Frequency, Call
Sign - radio frequency and call sign that will be used
by the ground unit at the LZ. You should know this information before every
operation.
Line
3 - Precedence (Urgent, Urgent Surgical, Priority, Routine)
- number of casualties by precedence. Use the following codes:
Alpha - Urgent
Bravo - Urgent Surgical
Charlie - Priority
Delta - Routine
Echo - Convenience
Line
4 - Special Equipment - identifies any special
equipment that will be needed, such as a hoist in the case where a helo cannot
land. Use the following codes:
Alpha - none
Bravo - hoist
Charlie - extraction equipment
Delta - ventilator
Line
5 - Number of Patients by Type - number of patients
who are ambulatory and the number of litter patients. This determines whether
or not the helo should be configured to carry litters. Use the following codes:
Lima - litter patients
Alpha - ambulatory patients
Line
6 - Security of Pickup Site - whether or not the enemy
is near the LZ. If all of your casualties are routine and the LZ is not
secured, then you may not get your requested CASEVAC approved. Use the
following codes:
November - no enemy troops in area
Papa - possible enemy troops (approach with caution)
Echo - enemy troops in area (approach with caution)
X-Ray - enemy troops in area
(armed escort required)
Line
7 - Method of Marking Pickup Site - method that you
will use to mark your LZ and then ask the pilot to identify. Use the following
codes:
Alpha - panels
Bravo - pyrotechnic signal
Charlie - smoke signal
Delta - none
Echo - other
Line
8 - Patient’s Nationality and Status - patients’
nationality and status. Use the following codes:
Alpha - US military
Bravo - US civilian
Charlie - non US military
Delta - non US civilian
Echo - enemy prisoner of war
Line
9 - NBC Contamination - whether the LZ has been
contaminated with NBC agents. Use the following codes:
November - nuclear
Bravo - biological
Charlie - chemical
|
Example: During a routine
patrol your platoon takes two casualties.
One receives a gunshot wound to his right arm.
The other receives a gunshot wound to his abdomen and has signs and
symptoms of shock associated with internal hemorrhage.
While you perform initial treatment, members of your platoon
determine that the closest potential landing zone for a helicopter is 300
feet to the West. Its grid
location on the map is DH 1234 5678.
Your call sign is Blue Thunder and your unit is operating on the
frequency 99.65. Your unit
commander informs you that the site is secure and will be marked with
green smoke. The following
would be your nine line radio CASEVAC Request transmission:
Line 1: DH 1 2345678
Line
2: 99.65 Blue Thunder
Line
3: 1 Bravo, 1 Charlie
Line
4: Alpha
Line
5: 1
Lima, 1 Alpha
Line
6: November
Line
7: Charlie
Line
8: 2 Alpha
Line
9: None |
Figure
21. Nine-Line Casualty Evacuation
Request Example
REFERENCES
Pre-hospital Trauma Life
Support, Medical Edition, 6th Edition, Chapter 22
Medical Evacuation In A Theatre
of Operations, FM 8-10-6, Ch 5, 7-11
REV: July 2008
CASEVAC Review
1. Identify three different
facilities that fall under the second echelon of care.
2.
How many litter patients can be carried in an M-997
vehicle.
3.
Describe the difference between the Urgent and
Urgent Surgical categories.
4. In relation to the nine line
CASEVAC request, what are “authorized brevity codes”?
|
