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Medevac

soldier16

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Hello, I apologize if this question has already been answered. Do's Canada have air medical evacuation crews? and if so which occupation handles this ( medtech , SAR ext)

Thank you for your time.cheers :cdn:
 

Loachman

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"Medevac" (MEDical EVACuation), vice "Medivac" as you originally had it in your title.

Not really, in the same way that the US Army and Air Force have.

Tac Hel does Vietnam War-style casevac, but there is a list of approved medical equipment held by the medical people for use when required. They would have to provide the Med Tech, as well.

I cannot speak for the SAR community's capabilities, but theirs is greater than ours as it is a greater part of their role.

Further, there are Forward Aeromedical Evacuation Specialists that accompany injured pers on seized-wing aircraft, but no dedicated aircraft.
 

mariomike

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soldier16 said:
Do's Canada have air medical evacuation crews? and if so which occupation handles this ( medtech , SAR ext)

Nursing Officers may be offered the opportunity to develop specialized skills through formal courses and on-the-job training, including:
•Aeromedical Evacuation Nursing
http://www.forces.ca/en/job/nursingofficer-53?olvPlayer=183s&module=cue_53_3#st

The "Nursing Officer" Merged Thread 
http://army.ca/forums/threads/4249.220;wap2
"Once you are OFP and generally completed one posting cycle as a NO you can apply for a position at the Air Evacuation Flight in Trenton. Once you are identified as someone with interest / suitable you will attempt to complete the air medical, aeromedical training program in Winnipeg and then the seven (?) week Aeromedical Evacuation  (AME) Course.  Once you have your AME wings you are then eligible for posting to the flight and if there is a position then you can be posted into it.  You can be posted to the Flight as a General Duty Nursing Officer (GDNO) in fact most of the positions are GDNO positions."

As they progress in their career, Medical Technicians who demonstrate the required ability and potential will be offered advanced training. Available courses include:
•Aero-Medical Evacuation
http://www.forces.ca/en/job/medicaltechnician-70#at

See also,

Aeromedical Evacuation ( AME )
https://www.google.ca/search?q=site%3Aarmy.ca+caf+recruiter&sourceid=ie7&rls=com.microsoft:en-CA:IE-Address&ie=&oe=&rlz=1I7GGHP_en-GBCA592&gfe_rd=cr&ei=fkMdV5CaCMmC8Qfrr4GYDg&gws_rd=ssl#q=site:army.ca+Aeromedical+Evacuation+

 

mariomike

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That's quite a change from bomb disposal.  :)

soldier16 said:
hello I have a question about about EOD or bomb disposal guys are they combat engineers or ammunition techs?





cheers thanks :cdn: :sniper:

 

MedCorps

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This is a subject of great discussion right now at the higher levels of the CAF, within the hallways of the CF H Svcs Gp HQ, RCAF, CA, CJOC and CFD. 

Lets cover some basics:

CASEVAC - Casualty evacuation - the non-medicalised evacuation of patients without qualified medical escort. Must be distinguished from Medical Evacuation. (From NATO Allied Joint Publication 4.10B - Allied Joint Doctrine for Medical Support).  In the most basic form this could be dumping Pte Bloggins on the floor of a Griffon and flying fast to medical care.

MEDEVAC - Medical evacuation - the medicalised evacuation of patients with qualified medical escort. 

There is a developing body of scientific literature (including some really recently US published stuff) which indicate that MEDEVAC vs. CASEVAC increases wounded soldier survival significantly. This data is coming out of Iraq and Afghanistan, mostly from the US (USAISR). As such it is a topic of great interest to the people who spend their time trying to figure out how to keep more wounded soldiers alive during the next war and debated with some zeal. 

So, where are we at... the CAF has the ability to put a medical technician with or without a nursing officer on a helicopter (Griffon or Chinook). There is a course called "Forward Medical Evacuation Specialist" which teaches how to care for a casualty while in flight on a helicopter. There is a small list of approved "air worthy" medical equipment which can be placed on a helicopter for casualty care. Finally we have had instances where helicopters have been assigned to the role of moving casualties from point of injury to a medical treatment facility.

Based on the minutes, one of the questions that the Health Services Future Field Force Working Group is tackling is the question is the above package (a medic +/- nursing officer with some training and with some medical kit) CASEVAC or MEDEVAC?  Despite the NATO definitions provided above they are arguing that the CAF can do advanced CASEVAC but current capabilities do not cross the threshold of MEDEVAC. 

Here is the rub. The personnel are ad hoc assigned to the flight crew (as specialists) and may or may not have had collective training with the crew they are flying with. Heck, they might have not even met them before the mission. The aircraft is not always optimally configured for MEDEVAC (often because it is executing other duties). The equipment is not dedicated to the aircraft or medical equipment scaled correctly for MEDEVAC. In some versions it is a medical team being picked up with all their kit and flown out to a casualty and in other versions the crew and medical team link up sometime before flying missions and come up with tactics, techniques and procedures.

It has been suggested if the CAF is going to break the MEDEVAC threshold that we need to:

1) Assigned dedicated medical teams (Cpl and MCpl QL5A Med Tech) (likely OPCON) to tactical helicopter squadrons.
2) Continue with the Forward Medical Evacuation course after re-validation.
3) Ensure that the medical team has a maintenance of clinical readiness package for thier duties as MEDEVAC medics. 
4) Ensure the current RCAF aircraft crew gets some training in the duties and nuances of casualty pick up  / flying / drop off
5) Ensure collective training standards exist with an operational readiness verification occurs with the medical team and the helicopter crew. This would require YFR being assigned to task.
6) Have a proper scale of issue (complete with air worthiness checks) for MEDEVAC equipment assigned to a helicopter. In the more advanced MEDEVAC versions this would see some permanent fittings in the aircraft to enable casualty care.
7) Have the RCAF / CF H Svcs Gp place this into doctrine. There is mention of it in Tactical Aviation 2017 (role for Chinook not Griffon) but this has not be bought into by D Air Readiness or Air Strat Plans as a capability to be developed.

The RCAF has some concerns I am told about the concept of MEDEVAC including, YFR allocation, armament and red cross marking concerns.  I am not even sure these are real issues or have been discussed any depth. I also think the RCAF is concerned about loosing tasking flexibility in some of their aircraft if dedicated to the MEDEVAC role, which is a fair argument.

There is also the fear of the other emerging helicopter medicine topics, like "critical on route care" transport helicopters (as part of the damage control resuscitation to damage control surgery continuum) and the vogue and sexy on route damage control resuscitation (Google UK MERT). 

So there you have it... the doctrine argument du jour. I know more then you asked for... 

MC 
 

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MedCorps said:
This is a subject of great discussion right now at the higher levels of the CAF, within the hallways of the CF H Svcs Gp HQ, RCAF, CA, CJOC and CFD. 

Lets cover some basics:

CASEVAC - Casualty evacuation - the non-medicalised evacuation of patients without qualified medical escort. Must be distinguished from Medical Evacuation. (From NATO Allied Joint Publication 4.10B - Allied Joint Doctrine for Medical Support).  In the most basic form this could be dumping Pte Bloggins on the floor of a Griffon and flying fast to medical care.

MEDEVAC - Medical evacuation - the medicalised evacuation of patients with qualified medical escort. 

There is a developing body of scientific literature (including some really recently US published stuff) which indicate that MEDEVAC vs. CASEVAC increases wounded soldier survival significantly. This data is coming out of Iraq and Afghanistan, mostly from the US (USAISR). As such it is a topic of great interest to the people who spend their time trying to figure out how to keep more wounded soldiers alive during the next war and debated with some zeal. 

So, where are we at... the CAF has the ability to put a medical technician with or without a nursing officer on a helicopter (Griffon or Chinook). There is a course called "Forward Medical Evacuation Specialist" which teaches how to care for a casualty while in flight on a helicopter. There is a small list of approved "air worthy" medical equipment which can be placed on a helicopter for casualty care. Finally we have had instances where helicopters have been assigned to the role of moving casualties from point of injury to a medical treatment facility.

Based on the minutes, one of the questions that the Health Services Future Field Force Working Group is tackling is the question is the above package (a medic +/- nursing officer with some training and with some medical kit) CASEVAC or MEDEVAC?  Despite the NATO definitions provided above they are arguing that the CAF can do advanced CASEVAC but current capabilities do not cross the threshold of MEDEVAC. 

Here is the rub. The personnel are ad hoc assigned to the flight crew (as specialists) and may or may not have had collective training with the crew they are flying with. Heck, they might have not even met them before the mission. The aircraft is not always optimally configured for MEDEVAC (often because it is executing other duties). The equipment is not dedicated to the aircraft or medical equipment scaled correctly for MEDEVAC. In some versions it is a medical team being picked up with all their kit and flown out to a casualty and in other versions the crew and medical team link up sometime before flying missions and come up with tactics, techniques and procedures.

It has been suggested if the CAF is going to break the MEDEVAC threshold that we need to:

1) Assigned dedicated medical teams (Cpl and MCpl QL5A Med Tech) (likely OPCON) to tactical helicopter squadrons.
2) Continue with the Forward Medical Evacuation course after re-validation.
3) Ensure that the medical team has a maintenance of clinical readiness package for thier duties as MEDEVAC medics. 
4) Ensure the current RCAF aircraft crew gets some training in the duties and nuances of casualty pick up  / flying / drop off
5) Ensure collective training standards exist with an operational readiness verification occurs with the medical team and the helicopter crew. This would require YFR being assigned to task.
6) Have a proper scale of issue (complete with air worthiness checks) for MEDEVAC equipment assigned to a helicopter. In the more advanced MEDEVAC versions this would see some permanent fittings in the aircraft to enable casualty care.
7) Have the RCAF / CF H Svcs Gp place this into doctrine. There is mention of it in Tactical Aviation 2017 (role for Chinook not Griffon) but this has not be bought into by D Air Readiness or Air Strat Plans as a capability to be developed.

The RCAF has some concerns I am told about the concept of MEDEVAC including, YFR allocation, armament and red cross marking concerns.  I am not even sure these are real issues or have been discussed any depth. I also think the RCAF is concerned about loosing tasking flexibility in some of their aircraft if dedicated to the MEDEVAC role, which is a fair argument.

There is also the fear of the other emerging helicopter medicine topics, like "critical on route care" transport helicopters (as part of the damage control resuscitation to damage control surgery continuum) and the vogue and sexy on route damage control resuscitation (Google UK MERT). 

So there you have it... the doctrine argument du jour. I know more then you asked for... 

MC

 

RocketRichard

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Thank for this. I was wondering what the latest is in the world of CF Medevac.


Sent from my iPhone using Tapatalk
 

SeaKingTacco

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You forgot Sea Kings. We do medevacs all of the time from ships.

I doubt the RCAF is going to inject med pers full time into helo Sqns, on the off chance we do a medevac (btw, we get our med tech from the ship. He or she escorts the patient).

We do not have enough YFR or pers to accomplish all of our primary mission sets, let alone add another mission.
 

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We do strategic MEDEVAC, and tactical CASEVAC. Everything else is done the CAF way, ad hoc.

(The Sea King evac described above is actually CASEVAC, as well)

Edit to add: MC seems to be in basement-dwelling, doctrine-writing hell. That COS date can't come quick enough.
 

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MedCorps said:
There is a developing body of scientific literature (including some really recently US published stuff) which indicate that MEDEVAC vs. CASEVAC increases wounded soldier survival significantly.

I should think that this is fairly obvious, and has been obvious for some time.

Enroute treatment by well-equipped and well-trained medical personnel is going to be far superior to mere transport. Casevac patients are supposed to be stable before transport as well, which adds a time penalty.

MedCorps said:
So, where are we at... the CAF has the ability to put a medical technician with or without a nursing officer on a helicopter (Griffon or Chinook). There is a course called "Forward Medical Evacuation Specialist" which teaches how to care for a casualty while in flight on a helicopter. There is a small list of approved "air worthy" medical equipment which can be placed on a helicopter for casualty care. Finally we have had instances where helicopters have been assigned to the role of moving casualties from point of injury to a medical treatment facility.

I am not sure what a nurse would add in this role. I don't know of anybody else that puts nurses on helicopters. Do nurses ever crew wheeled ambulances?

I have actually done the medevac role a small number of times. Our machine was reserved for that purpose, kitted (although not with much), a suitably-qualified Med Tech assigned (and training conducted with us), and all pre-flight checks conducted by the oncoming crew.

The first time that I ever saw this done was in Wainwright during RV85. One of the twenty-four Twin Hueys in the doctrinal Div UTTH Squadron was parked, fully-kitted, throughout at the Div Field Hospital, with the crew languishing somewhere nearby, and ready to go.

MedCorps said:
Here is the rub. The personnel are ad hoc assigned to the flight crew (as specialists) and may or may not have had collective training with the crew they are flying with.

I would be at least mildly surprised if that were the case for a major exercise, let alone an actual op. I am very clear with people who request medevac missions. I tell them what we can do (generally casevac only as few requestors have access to the medical pers or equipment) and what we cannot do. The only true medevac missions in which I have been involved have had machine/crew/Med Tech/equipment set up as I have previously said.

MedCorps said:
Heck, they might have not even met them before the mission.

That's the vast majority of the people that we fly.

MedCorps said:
The aircraft is not always optimally configured for MEDEVAC (often because it is executing other duties). The equipment is not dedicated to the aircraft or medical equipment scaled correctly for MEDEVAC. In some versions it is a medical team being picked up with all their kit and flown out to a casualty and in other versions the crew and medical team link up sometime before flying missions and come up with tactics, techniques and procedures.

That should never happen with a medevac mission, if that is what has been requested, accepted, and tasked. That should only happen with Casevac. Medevac reduces the number of hels and crews available to support an ex around the clock - mainly crews as a minimum of two are required. Casevac is generally only provided while scheduled flying operations are ongoing, and would be done by a crew and machine diverted from a lower-pri task. This is a command decision - does the guy in charge want his assigned hels delivering troops to/from battle, or two sidelined for the duration?

TTPs are not complex - flying to the PZ and hospital is not any different from flying between any other locations. The only variable is the medical guy and the machines that go "ping". He/she has to become familiar with the aircraft, its communication system, how to move about the cabin in a manner other than rolling and the wisdom of knowing where his/her barf bag supply is (because it WILL be manoeuvring appropriately according to the tactical situation for ex/op purposes but stable for noduff ex purposes), and how to get the patient on and off.

MedCorps said:
1) Assigned dedicated medical teams (Cpl and MCpl QL5A Med Tech) (likely OPCON) to tactical helicopter squadrons.

Permanently, or only for the ex/op, as is (should be and can be, at least, and has been) done now?

MedCorps said:
4) Ensure the current RCAF aircraft crew gets some training in the duties and nuances of casualty pick up  / flying / drop off

I have no idea what those are.

MedCorps said:
5) Ensure collective training standards exist with an operational readiness verification occurs with the medical team and the helicopter crew. This would require YFR being assigned to task.

This is not complex, and does not require a lot of flying time. No YFR needs to be specifically assigned. We do not care about that as some fleets do. We are not limited by YFR. 1 CAD still does not understand that we do not differentiate between FG and FE hours. Our crews get  most of their FG time while conducting FE, and are happier doing so. Scheduling can be a challenge, as can crew and hel availability, as we are generally fairly busy. This is why we massage FAES Crse locations and dates with 426 Squadron, who run them. They now run crses in Edmonton, Petawawa, and Valcartier rather than purely in Trenton and that makes it much easier for us to support. We understand the value of these courses and do our best to provide.

MedCorps said:
6) Have a proper scale of issue (complete with air worthiness checks) for MEDEVAC equipment assigned to a helicopter. In the more advanced MEDEVAC versions this would see some permanent fittings in the aircraft to enable casualty care.

I cannot comment on the suitability of the equipment that is in the inventory and available, as that is obviously not our role. The airworthiness aspect is not a significant problem (although sometimes annoying and rant-inducing), and should be fairly quick once a new piece of equipment is identified - as long as it is not done at the last minute. Nothing is "permanently fitted" in a helicopter, nor should it be. You want to be able to move it if the helicopter breaks, and we will never have enough helicopters.

MedCorps said:
7) Have the RCAF / CF H Svcs Gp place this into doctrine. There is mention of it in Tactical Aviation 2017 (role for Chinook not Griffon) but this has not be bought into by D Air Readiness or Air Strat Plans as a capability to be developed.

I am not sure what is needed in that regard, at least from our side. It's just one of many traditional Tac Hel tasks.

I also do not see any need to paint bright red and white aiming points on any of our machines while trying to pretend that there is any protective value to them. Nobody that we are ever likely to fight is going to respect them. Their only value might be to draw fire to unimportant parts of the machine, like the cabin doors, rather than engines, fuel tanks, front-seaters etcetera. Unfortunately for the Med Techs and patients, though, they are on the other side of those markings. The USAF medevac guys do not suffer any such illusions about red crosses, but they are CSAR anyway. Both HH60s operating together are armed with one GAU-21 M3 Browning .50 caliber machinegun per side and self-escort. The PJs who treat casualties are armed with M4 carbines and know how to use them very well. I have an enormous amount of respect for those guys - Pilots, PJs, and the whole organization. They were very effective and very efficient and very dedicated. The US Army UH60s are marked and unarmed, so each one operates with an AH64 as escort. I view that as inefficient and inflexible, as only half of the pair can carry and treat patients. The two US Army units with which I dealt in KAF did not come close to the standard of the USAF guys, at least in non-medical terms. They seemed disorganized and disconnected. I'd much prefer to be armed and unmarked, although the Griffon lacks space and power for real weapons plus Med Tech, equipment, and patient, and Chinook is unsuitable because of its size.

Should/could we take this role on? Yes, sure, add it to the list, but not as a highly-specialized role as it will take resources away from something else and we are hard-pressed to meet demand as it is. The Griffon is fine for this role in a training-only environment, but not in an operational one where a threat is present. There is no additional training bill for the aircrew, a very limited one for the Med Techs, and probably a cost for the fancy medical kit - and a much bigger cost for a suitable helicopter.
 

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Rider Pride said:
We do strategic MEDEVAC, and tactical CASEVAC. Everything else is done the CAF way, ad hoc.

(The Sea King evac described above is actually CASEVAC, as well)

Edit to add: MC seems to be in basement-dwelling, doctrine-writing hell. That COS date can't come quick enough.

:nod:

CAF Forward Aeromedevac (AME) doctrine is still churning (at least for the last eight years I know of, as I was a staff officer supporting the RCAF Command Flight Surgeon re-write Fwd AME doctrine).

Rider Pride notes the Strat Medevac the CAF conducts.  This is usually accomplished with the CC-144 Challenger (all on-board MED and PMED devices used by the aeromedically-trained med staff have been technically and operationally cleared for use on board the aircraft type [TAC and OAC for those familiar with the airworthiness terminology]).  Unless there are appropriately trained (aeromedically trained) med personnel on board with suitable (approved) medical equipment required to provide the level of medical support, it won't be considered AME (Forward or otherwise).

Loachman, the certification that MedCorps refers to in his point 6 is not "not a significant problem" as you imply...the fact that the clearance issues continue to be worked for a period approaching a decade indicated that some of the challenges can be, and indeed are...significant.  Technical airworthiness often is not 'purely technical' and then when added to the operational/tactical doctrinal machinations make the whole effort rather energy-draining.  Would one consider that equipment specifically made for aeromedical purposes should be relatively easy to certify on any number of different aircraft?  Well, I would have thought so when I started working the FwdAME file daily, but 'pragmatic realism' kicked in pretty soon, and I quickly appreciated that Aero-Medical Evacuation was likely going to be more difficult than getting any combination of the three services interoperating even remotely capably.

Like Rider Pride says, poor MedCorps needs a posting COS soon!  ;)

Cheers
G2G 
 

Blackadder1916

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soldier16 said:
. . .  Do's Canada have air medical evacuation crews? and if so which occupation handles this ( medtech , SAR ext)

This may be of some interest to you.

http://www.forces.gc.ca/en/training-establishments/international-training-programs-courses/aeromedical-evacuation-course.page
Aeromedical Evacuation Course

Aim

The Canadian Forces (CF) Aeromedical Evacuation (AE) course prepares qualified medical personnel to perform the duties and responsibilities of an Aeromedical Evacuation Crew Member (AECM) during peacetime/conflict operations and national/international emergencies.  These duties/responsibilities will be performed onboard fixed wing aircraft during strategic and tactical AE missions.

Course Outline

Training is divided into three main blocks: General AE Knowledge; Strategic AE; and Tactical AE.  The content and study materials on the Aeromedical Evacuation Course are entirely unclassified in nature.  Human Performance in Military Aviation will be emphasized during training and perform the duties and responsibilities of a Medical Crew Director and Team Member. Crew Members will maintain, secure, operate and troubleshoot medical equipment used onboard CF AE platforms including: intravenous infusion pump; patient oxygen systems; patient comfort devices; patient physiologic monitoring devices; patient restraints; chest tube drainage system; cardiac monitor and defibrillator; hand-held resuscitator; and suction devices. They will learn to plan and provide care from originating to destination medical facility, to compensate for the stresses of the flight environment and to manage in-flight medical complications.  They will use various AE configurations on the CC-150 Polaris (Airbus A-310) and CC-130 Hercules H model.  They will practice with the Spectrum beds on the CC-150, as well as configure the CC-130 for floor and tier loading.  They will utilize the aircraft systems including oxygen, communications and electrical systems.  In addition, they will respond to aircraft emergencies using the respective aircraft life support equipment.  They will perform their duties and responsibilities during all phases of a Tactical AE mission including embarking and deplaning of casualties using both floor and tier loading methods. CC-130 simulated missions in the Cargo Compartment Trainer and during Engine Running Operations are scheduled for this portion of the course.  Simulated patients and missions will be used for training.

Course Capacity / Rank

The Aeromedical Evacuation Courses is normally run with a maximum of 12 students per course.  Candidates can be Officers and/or Non-Commissioned Members.

Course Prerequisites

International students must be equivalent to one of the following Canadian Forces military occupations: Medical Officer, Nursing Officer, Physician Assistant or Medical Technician. International students must be able to read, comprehend, verbally communicate and receive instructions in English. International students must be medically and dentally fit for aircrew employment in accordance with the standards of their own Air Forces.  They must have attended aeromedical physiology training in Canada or their own country.  International students are expected to arrive on course with seasonally appropriate flying clothing, military identification, military identity disks (dog tags), travel visa and a valid passport.

Course Duration / Frequency

426 Transport Training Squadron has the capacity to run two Aeromedical Evacuation Courses per year and compromised [sic] of approximately 56 training days extending over ten calendar weeks.

Location

The Aeromedical Evacuation Course is conducted at 8 Wing/Canadian Forces Base Trenton located on the shores of Lake Ontario.  Visit the link at www.cfbtrenton.com for information about the Base, and www.city.quintewest.on.ca/ for surrounding area information.

At 56 training days, the course is considerably longer than when I did it a long, long time ago - IIRC it was 21 training days which included the flying training missions.

Along with a change in AE training, the organization of AE medical assets has also apparently changed from the days when I occasionally flew as medical crew.  Back then it was a secondary duty at locations (primarily the AIRCOM bases) scattered across the country.  This is from the October 17, 2008 issue of "The Contact", the base newspaper of CFB Trenton.

http://thecontactnewspaper.cfbtrenton.com/archives/2008/03_October_2008/oct_17_2008/thecontact_oct_17_2008.pdf
Aeromedical Evacuation Crew

Personnel from 8 Wing/CFB Trenton’s newest unit, The Canadian Forces Aeromedical
Evacuation Flight (CF AE Flt) gave flight line tours of the four aircraft they normally use
during their missions; the CC-144 Challenger, the CC-150 Polaris, the CC-177
Globemaster III and the CC-130 Hercules. The Canadian Forces Aeromedical Evacuation
Flight (CF AE Flt), had their official Stand Up on Thursday, October 9, 2008. The CF AE Flt
has been created by amalgamating smaller groups of Canadian Forces Aeromedical
assets across the country into one dedicated Aeromedical section here in Trenton. The
role of the new Flight is to provide timely Aeromedical support to soldiers involved in
operations nationally and internationally. The Flight consists of 10 teams of Aeromedical
nursing officers and medical technicians, as well as command and support positions.
These Aeromedical evacuation crew members (AECM) perform AE’s, which is a flight
devoted to transfer a patient from one location to another with the provision of medical
care. The bulk of the Flight’s AE’s consist of bringing soldiers home from Landstuhl
Regional Medical Center, Germany (LRMC), after being evacuated from Afghanistan.
However, the Flight’s teams also provide care wherever CF Members are located.

Perhaps someone more in the know may be able to provide an up to date perspective on the flight's current organization and activity.

And this from 2012 is about the flight receiving the CF Unit Commendation.
http://www.trentonian.ca/2012/09/26/rcaf-commander-recognizes-cfb-trenton-personnel

 

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Good2Golf said:
...CAF Forward Aeromedevac (AME) doctrine is still churning (at least for the last eight years I know of, as I was a staff officer supporting the RCAF Command Flight Surgeon re-write Fwd AME doctrine).

I stand corrected - there has been progress. 

AME is now known as AE.
 

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Good2Golf said:
Loachman, the certification that MedCorps refers to in his point 6 is not "not a significant problem" as you imply...the fact that the clearance issues continue to be worked for a period approaching a decade indicated that some of the challenges can be, and indeed are...significant.  Technical airworthiness often is not 'purely technical' and then when added to the operational/tactical doctrinal machinations make the whole effort rather energy-draining.  Would one consider that equipment specifically made for aeromedical purposes should be relatively easy to certify on any number of different aircraft?  Well, I would have thought so when I started working the FwdAME file daily, but 'pragmatic realism' kicked in pretty soon, and I quickly appreciated that Aero-Medical Evacuation was likely going to be more difficult than getting any combination of the three services interoperating even remotely capably.

Maybe I've been lulled into a false sense of optimism (that NEVER happens) lately after having had a couple of good experiences regarding airworthiness matters. One would think that operational lifesaving measures might just move through the process a little faster.

Good2Golf said:
AME is now known as AE.

They've been calling them "FAES" (Forward Aeromedical Evacuation Specialist) Courses on their requests to us for the last few years, and they seem to run more that two annually. It's been awhile since we've received any, though, so maybe it averages out that way.

 

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Maybe I've been lulled into a false sense of optimism...

???

Who are you, and what have you done to the real Loachman?
 

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It's alright. It passed quickly, but it had me worried, too, for a little while.

What an odd feeling. Almost scary.
 

MedCorps

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Loachman said:
I should think that this is fairly obvious, and has been obvious for some time.

Enroute treatment by well-equipped and well-trained medical personnel is going to be far superior to mere transport. Casevac patients are supposed to be stable before transport as well, which adds a time penalty.

I think obvious is not always obvious, especially in pre-hospital medicine.  For instance when we look at advanced Paramedics (EMT-P or ACP) there are some issues that have been discovered.  Intubation (the process of securing an airway by placing a tube into the trachea via the mouth), starting an IV and giving a liter or two of solution and placing people on spine board have been the gold standard of pre-hospital trauma care years. Heck, secure airway, give fluids to restore blood pressure and immobilize in case they have a spinal injury... what could go wrong. It turns out lots! When examined in large studies it turns out that they all contribute to higher overall levels of mortality in pre-hospital urban civilian setting and, broad brush, many services are moving away or minimizing these procedures for routine trauma care.

Second to this, obvious is not obvious to everyone. It is hard to convince anyone at ADM(RS) (the new and improved CRS) or CFD, CProg or the bean counters that it is obvious especially when trying to justify a new expensive, PY requiring capability. Anecdotes do not create quantitative data sets.

I would also argue in most pre-hospital systems (and many military situations) that having a stable casualty for CASEVAC from point of injury would be the exception to the rule. My experience has been that most of these unfortunate souls are in crap shape and actively dying.

Loachman said:
I am not sure what a nurse would add in this role. I don't know of anybody else that puts nurses on helicopters. Do nurses ever crew wheeled ambulances?

STARs in Alberta has a medic / nurse helicopter crew. As does Orange in Ontario does when doing pediatric transport. It is also pretty common in the US and some of Europe.

I think that the current CAF thought is that Forward AE should be QL5A Med Tech driven, Critical Care Fwd AE (en route care) should be Critical Care Nursing Officer driven (if that becomes a capability) and if we go all the way, damage control resuscitation Fwd AE (MERT) should be GDMO-Emergency Medicine or MED-SPEC-Anesthesia driven.   

Loachman said:
TTPs are not complex - flying to the PZ and hospital is not any different from flying between any other locations. The only variable is the medical guy and the machines that go "ping". He/she has to become familiar with the aircraft, its communication system, how to move about the cabin in a manner other than rolling and the wisdom of knowing where his/her barf bag supply is (because it WILL be manoeuvring appropriately according to the tactical situation for ex/op purposes but stable for noduff ex purposes), and how to get the patient on and off.

Ah, you missed the most important part of the MEDEVAC mission variable... the casualty!  Again in reading the training that pilots from Orange get they might argue with you, especially if flying MEDEVAC versus CASEVAC. As dedidated "air ambulance" pilots they get instruction on planning flights for casualties with increased intraocular pressure, pneumothorax, decompression illness, violent tendencies, and intracranial bleeding for example. This involves a package on flight physiology, common patho-physiology which is exacerbated by flight, and ways to mitigate exacerbating these conditions by altering ones flying techniques and procedures. The medic / nurse and the pilot need to come up with an optimal flight profile for the casualty (who is the mission). How do you fly a 22 year old infantryman with a rib fracture and a small traumatic pneumothorax? The 65-year-old with a mild chronic obstructive pulmonary disease exacerbation and an oxygen saturation of 93% on room air? The 8-year-old with otitis media? Do you make a quick unplanned landing in flight to allow the Medics to decompress a chest with a chest tube, electrically shock a patient in V. Tach, or sort out a REBOA which as shifted or do you "push through to the MTF which is X minutes away?" These are not always simple answers. 

Something to think about... interesting comments.

MC
 

MedCorps

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Good2Golf said:
Loachman, the certification that MedCorps refers to in his point 6 is not "not a significant problem" as you imply...the fact that the clearance issues continue to be worked for a period approaching a decade indicated that some of the challenges can be, and indeed are...significant.  Technical airworthiness often is not 'purely technical' and then when added to the operational/tactical doctrinal machinations make the whole effort rather energy-draining.  Would one consider that equipment specifically made for aeromedical purposes should be relatively easy to certify on any number of different aircraft?  Well, I would have thought so when I started working the FwdAME file daily, but 'pragmatic realism' kicked in pretty soon, and I quickly appreciated that Aero-Medical Evacuation was likely going to be more difficult than getting any combination of the three services interoperating even remotely capably.

I am told by the medical regulation folks that it gets even more complex when the medical device was licensed by Health Canada for hospital use or ground EMS use and now you want to use it on a helicopter or fixed wing aircraft.  It becomes expensive to get these things through the Health Canada and RCAF air worthiness testing hoops. 

There are also some things that make the RCAF airworthiness folks understandably nervous, like defibrillation and transcutaneous pacing (the application of electricity), anything to do with oxygen, battery diathermy and ultrasound emissions (such as FAST) on an aircraft.

MC
 
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