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.
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.
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.
Heck, they might have not even met them before the mission.
That's the vast majority of the people that we fly.
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.
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?
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.
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.
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.
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.