# Nine liner



## jeffb

Anyone know where I can find the format for the nine liner? I have DIN access if need be.


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## George Wallace

Try the CIED site on the DIN.

I did manage to find it using the DND Search, after much frustration.

I also found it on the Internet by using Google.


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## George Wallace

Here is one link:

http://www.operationalmedicine.org/Videos/9LineMEDEVAC.htm



I suppose the next question you are going to ask will be for a MIST Report:


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## mariomike

George Wallace said:
			
		

> I suppose the next question you are going to ask will be for a MIST Report:



MIST Report

Used when handing a casualty over to a medical team


M	-	mechanism of injury (mine, GSW, RPG, RTA etc)

I	-	type of Injury (found and or suspected)

S	-	signs (pulse rate, blood pressure, respiratory rate)

T	-	treatment given (morphine, tourniquet etc)

A/C – adult/child (include age if known)

Don't take this for gospel!


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## jeffb

Perfect! Thanks gang. I tried a Google search but for some reason couldn't find it.  

And thanks for the MIST Report. That too is going into my Aide de Memoir.


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## mikeninercharlie

A modified NATO 9 liner format was adopted for use in the Spring of this year. Significant changes to categorization (vice priority) pick up / delivery time lines, and minor changes to para 8 , the nationality of the casualties.  Even the has US military signed off on the mod! 
Unfortunately, I don't the format readily available to post. as I'm several hours from my office.
Additionally, there is a NATO doc detailing changes in what was once known as the "golden hour", it should be read in conjunction with the new 9 liner...


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## jeffb

Good to know. Would you be able to post it at some point in the future?


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## mikeninercharlie

Sure. However, the earliest I'll be able to post it will be Monday evening.


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## medaid

So... anything?  Waiting on this one as well


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## ThainC

If you haven't received anything by tomorrow morning, drop me a PM here with your email and I'll email you the most recent 9 Liner/MIST in use. I've digital copies of almost all reports/returns. I'm in Gagetown, so take any time difference into consideration.


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## medaid

ThainC PM inbound. Thanks for the offer!


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## mikeninercharlie

Can you wait a couple of hours, some of us are on exercise on the 2010 host city...


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## medaid

mikeninercharlie said:
			
		

> Can you wait a couple of hours, some of us are on exercise on the 2010 host city...



Sure you're in the same city as I am and on Pandemonium, I understand


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## mikeninercharlie

here you go... Note the changes to para 3.


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## medaid

mikeninercharlie said:
			
		

> here you go... Note the changes to para 3.



Cheerios!


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## brihard

Awesome, thanks for the new format. I'd heard there had been some changes.


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## Gunner98

Does anyone know if any subsequent changes were made to this important document?


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## SupersonicMax

You can also download the JFIRE online.

http://www.fas.org/nuke/guide/usa/doctrine/dod/t0302060.pdf

Edit: Wrong link


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## blackberet17

Simian Turner said:
			
		

> Does anyone know if any subsequent changes were made to this important document?



Was just down in Fort Pickett VA, and no changes have been made to date that I could see. The US Marines we were working with, plus our own guys, provided refresher training, and it looks G2G.

Man, to have the resources the US has. Granted, it was a training scenario, but when you have to do a cas evac, and as soon as you have the first five lines out over the means, and you know the blades are turning on the chopper, it's pretty cool. Finish it, plus the MIST, and the medevac team is already in the air. Most realistic trg I've been on yet.

And the US pilots will land anywhere. On one IED strike scenario, where we had three cas, they landed those Blackhawks on a postage stamp.


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## Gunner98

What kind of escort helos were they using for the Blackhawks - other Blackhawks or Apaches?  Were the escort helos already on station or did they launch with casevac? 

Not sure that it is realistic to have rotors turning after 5 lines - they still need a mission brief and need to know what equipment to have on board. 

They do have lots of great kit but the mission risk level determines the approvals required for launch this results from assessment of ground activity, security level at HLS , do other ops with higher priority for casevac, patient census level and Operating Room status at  closest treatment facility. 

Realistic scenarios would allow some prep work before launching high priority assets.


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## PuckChaser

Escorts overseas were Apaches that launched with the Blackhawk. Line 4 is special equipment and line 5 is number of patients. The rest of the info they can get in the air as its only the nationalities of casualties and marking method.


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## brihard

Simian Turner said:
			
		

> What kind of escort helos were they using for the Blackhawks - other Blackhawks or Apaches?  Were the escort helos already on station or did they launch with casevac?
> 
> Not sure that it is realistic to have rotors turning after 5 lines - they still need a mission brief and need to know what equipment to have on board.
> 
> They do have lots of great kit but the mission risk level determines the approvals required for launch this results from assessment of ground activity, security level at HLS , do other ops with higher priority for casevac, patient census level and Operating Room status at  closest treatment facility.
> 
> Realistic scenarios would allow some prep work before launching high priority assets.



Line 4 gives 'special equipment required'. Other than that, a bird used primarily for CASEVAC should be pretty loaded to the gills with most of anything needed; I would contend that very few combat casualties will require equipment over and above that carried routinely in a CASEVAC bird, and that the tradeoff of faster response times is worth the slight chance that one particular piece of equipment may be missed if they're wheels up before MIST is out.

Worst case, while they're in the air and en route, the decision to scrub or to hold off pending the arrival of escorts can be made as the tactical situation is fleshed out. The 9 liner is not the only source of relevant tactical information, after all- contact reports and SITREPs should have filled in much of that anyway. If the pilot has a 4 figure grid, he doesn't need an 8 or 10 or a method of marking until he's a few minutes out. If armed escort is made a default, that also will count towards faster response.

The tactical questions in this case play second fiddle to the larger strategic issue that even small numbers of casualties have become. If we get back into a war where there IS an 'acceptable loss ratio', then it's a different matter. But with every name and face having political ramifications, the 'side of caution' would seem to be the fastest CASEVAC achievable.


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## Gunner98

I am merely indicating that based on the 325 Medical Evacuation Missions that I coordinated at the RCS JOC Med Ops desk in 2008, things did not happen that quickly for all of the 530 casualties involved.  Response times vary with location, nationality of casualties,  and the situation on the ground.  In more than a few cases the casualties were inside burning vehicles or in firefights and it was impractical to have the birds on station while extraction took place.  Without the launch authority from the JOC or TOC which took anywhere from 2 minutes to 2 hour to obtain, it did not matter how quickly the crews readied their choppers they were not going anywhere fast. 

The 9-line does not mean launch authority is automatic and depending on the nationality of the casualties and the destination med facility may change from where the helos will launch.  Without the complete MIST nobody was going anywhere.  Unless the casualties maintain heartbeats and functioning lungs, they could quickly become a routine ground transport issue.  US blood products at US facilities are normally reserved for US casualties when the US ground forces are busy.  Having one non-US casualty arrive at a facility and drain the 40 units available is not good for morale.  Likewise Afghan civilians, military or police casualties were often diverted to local medical facilities.

During 2008, most escorts from the launchpad were other Blackhawks and the Apache if available would meet up with them on approach since the speed and the range of the two helos differ significantly. Similarly an Apache sitting idle waiting for a med escort tasking is firepower that was seldom a luxury item that could not  be put to better use in a fight.


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## Armymedic

Simian, 
By your own admission, that was Afghanistan. While that may still be true in RC south (it was as of Dec 11), it has been my experience that that is not a standardized SOP across the wide range of US military operations. 

Flights for US and NATO allies tend to be launched very quickly, and info past during time of flight. Specifically I have seen this inside the US when there is no "local nationals", to be dealt with.

That being said, the report to launch time varies widely, and professional medical authorities need to ask that question of thier tactical medevac asset providers.


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## PuckChaser

The requirements seemed to get more and more stringent in RC(S) as time went on. When I got to theatre for Roto 4, we needed a full 9-liner and MIST was sent in the air. We had been told previously that only 4 lines were required and the remainder was sent in the air or as the crew was prepping. Typically you're not going to send half a 9-liner anyways, so its almost a moot point.


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## Gunner98

As has been pointed out my experience is Afghanistan-based, however, I have been on exercises and Joint Planning courses with the US before and after my deployment and the thing that often is absent is a sense of realism.  Time, space and risk are often discounted in order to speed the Major Events list along. 

As wonderfully skilled as the PJs were in Afghanistan, the one thing that the MIST often provided was whether there was a need for a physician on board or in the case of the Brits it would be a Chinook containing a surgical team.  During the busiest day I had in Afghanistan I was coordinating 7 Med Evacs simultaneously and I can assure without a MIST it was difficult to assign priority for mission assets.  Likewise on the evening of a suicide fuel truck which resulted in 34 casualties finding sufficient transport and prioritizing litter cases was a challenge.

The other thing that changed after I left which expedited evacuations was Comd ISAF instituting a strict adherence to the wonderous Golden Hour (HLS to OR), but that is a discussion for another day. 

Thanks for re-igniting this thread, it beats the heck out of thinking about year-end financial reporting and the joys of income tax season.


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