Casualty Evacuation Research Articles

Feasibility of Casualty Evacuation by Unmanned Systems

Feasibility of Casualty Evacuation by Unmanned Systems

Multiple organ failure following severe battle injuries during recent conflicts: a French retrospective cohort study.

Improvements in combat casualty care have increased survival rates, but these patients are at particular risk of developing multiple organ failure (MOF). We investigated the incidence and severity of MOF in a cohort of severe combat casualties. This retrospective study included all on-duty French land army war casualties with a severe combat injury requiring intensive care unit admission during 2009-2023. Demographic data, advanced life support interventions, and outcomes were collected. Each organ failure was then analyzed during a 7-day trauma course according to the Sequential Organ Failure Assessment (SOFA) score. Of the 100 patients who met the inclusion criteria, those with persistent MOF at day 4 (MOF group) represented 22% of the total population (median SOFA score 6.0 [5.3-8.0]). Compared to those without persistent MOF, these patients were more severely injured (median Military Injury Severity Score 38.0 [interquartile range 33.0-56.8] vs 26.5 [20.0-34.0], p < 0.001) by an explosive mechanism (68.2%) and sustained more traumatic brain injury (TBI; 40.9% vs 14.1%, p = 0.013). The MOF group also received significantly more blood units (median 14.0 [8.3-24.8] vs 6.0 [0.0-12.0], p < 0.001) and massive transfusions (68.2% vs 32.1%, p = 0.002). Pulmonary and cardiovascular dysfunction were the most frequently observed trauma outcomes. A multivariable logistic regression model showed that MOF persistence at day 4 was significantly associated (odds ratios [95% confidence intervals]) with severe injuries (1.5 [1-2.3], p = 0.042). A high number of severe lesions significantly and independently increased risk of MOF persistence at day 4 after combat-related trauma. These findings are particularly relevant to current and anticipated large-scale combat operations that will challenge battlefield casualty care and evacuation.

Methodical approach to determining the main parameters of the evacuation system for the wounded with the use of different types of transport

The timeframe for evacuating the wounded is a critical factor that largely determines the fate of a wounded soldier. Even at the initial stage of the war waged by the russian federation against Ukraine, there were almost no frontline ambulances, and there was a critical shortage of ambulances. At present, despite significant efforts to provide the Armed Forces of Ukraine with weapons and military equipment, as well as material and technical means, including medical equipment and property, in particular through international technical assistance, the problem of the lack of the required number of specialised medical evacuation vehicles has not been fully resolved. From this point of view, the issue of correct formulation of requirements for the rational composition and specially equipped various types of vehicles (including sanitary transporters, ambulances), including general use, the system of evacuation of the wounded, and determining the possibility of its further improvement through the methodological apparatus is relevant. The purpose of the article is to present a methodological approach to determining the main parameters of the system of evacuation of the wounded of an operational group of troops with the involvement of various types of transport. The formation of a model of the casualty evacuation system as a mass service network (MSN) will minimise the time spent waiting for medical care by wounded personnel, determine the rational composition of forces and means of the tactical casualty evacuation system. To model the system and processes of evacuation of the wounded from the battlefield during hostilities, including their transportation to medical facilities located in the depths of the third logistics zone, the mathematical apparatus of the theory of mass service was used. In particular, we are talking about the devices of queuing systems (QS) and MSN. The existing system of military evacuation of the wounded and sick is a four-tier system in which all wounded with moderate and severe severity are evacuated. Based on this, the system of evacuation of the wounded can be represented as an MSN, which has a number of features. First of all, this MSN is an open queuing network (OQN), i.e. the flow of requests to enter the network is unlimited, homogeneous and comes from an external independent source. As a result of the calculations, data were obtained on the values of network parameters (average number of applications in queues – 119.47 applications/hour, average number of applications in the network – 158.53 applications/hour, average waiting time for applications in queues for service – 11.95 hours, average time of application stay in the network – 15.85 hours) and the parameters of each QS operating in the MSN – transmission coefficient, incoming flow intensity, load factor, average number of busy channels, average number of applications per QS, average queue length, average waiting time for an application in the service queue, average time for an application to stay in the QS. Analysing the calculated data, from the point of view of creating a rational OQN, the casualty evacuation system achieves maximum efficiency when its productivity in processing the incoming flow of requests is maximised, and the minimum values of such parameters as the number of requests for service in the queue and the number of service channels operating in the network are minimal.

Physical Fitness Determinants of a Military Casualty Evacuation Test.

Casualty evacuation has been identified as a typical and essential single military task which every soldier should be able to perform rapidly during combat. Previous studies suggest that casualty evacuation is typically conducted by dragging and demands e.g., lean body mass and anaerobic performance. Association of physical fitness with casualty evacuation by dragging has been studied widely but previous studies lack comprehensive assessment of all physical fitness determinants. The purpose of the present study was to examine comprehensively how casualty emergency evacuation (CEE) performance associates with physical fitness and body composition. A total of 25 conscripts (20 men, 5 women) volunteered for measurements of height, weight, waist circumference, body composition, 1-min sit-ups and push-ups, grip strength, isometric bench and leg press, standing long jump, 30-s cycle ergometer test, and 12-min run test. Subjects performed a CEE test in which evacuation time (ET), heart rate, blood lactate concentration, and rate of perceived exertion were measured. In the CEE test, subjects wore combat gear (11.7 ± 1.6 kg) and dragged a doll wearing combat gear (80.2 kg) 28 m while crawling (go round two cones, Z-pattern) and 20 m upright (straightforward). Correlations and backward regression analysis were used for statistical analyses. The level of significance was set to P ≤ .05. Evacuation time lasted on average 87 ± 32 s with a peak heart rate of 184 ± 6 bpm, lactate concentration of 9.4 ± 2.7 mmol/l, and RPE of 17 ± 1. Evacuation time correlated inversely and strongly with anaerobic capacity and power (r = -0.72-0.78, P ≤ .001), but not with aerobic fitness. Inverse and strong correlations were observed between ET and maximal strength variables (r = -0.58-0.69, P ≤ .01), whereas muscular endurance and ET revealed non-significant correlations. Evacuation time correlated moderate to strongly with body fat percentage (r = 0.48, P ≤ .05) and inversely with lean body mass (r = -0.74, P ≤ .001) and body height (r = -0.53, P ≤ .01). The backward regression analysis showed that anaerobic capacity (standardized β = -0.52, P ≤ .001), fat percentage (standardized β = 0.40, P ≤ .001), and isometric leg press (standardized β = -0.25, P ≤ .1) together explained the variance of ET significantly (adjusted R2 = 0.84, P ≤ .001). This study examined thoroughly how different physical fitness dimensions and body composition relate to a CEE test performed by a combination of dragging while crawling and in upright position. Casualty emergency evacuation was discovered as a high-intensity military task, which demands most importantly high anaerobic performance, lean body mass, and maximal strength capabilities. Improving these dimensions of physical fitness should be considered highly important as CEE is essential and possibly one of the most demanding military tasks which every soldier should be able to conduct in combat. From operational perspective, it is relevant that soldiers are able to perform CEE during operations; therefore, further research is needed on how acute operational stress changes the nature of CEE and its physical determinants.

Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war.

Extremity tourniquets have proven to be lifesaving in both civilian and military settings and should continue to be used by first responders for trauma patients with life-threatening extremity bleeding. This is especially true in combat scenarios in which both the casualty and the first responder may be confronted by the imminent threat of death from hostile fire as the extremity hemorrhage is being treated. Not every extremity wound, however, needs a tourniquet. One of the most important aspects of controlling life-threatening extremity bleeding with tourniquets is to recognize what magnitude of bleeding requires this intervention and what magnitude of bleeding does not. Multiple studies, both military and civilian, have shown that tourniquets are often applied when they are not medically indicated. Overuse of extremity tourniquets has not caused excess morbidity in either the recent conflicts in Iraq and Afghanistan or in the US urban civilian setting. In the presence of prolonged evacuation, however, applying a tourniquet when it is not medically indicated changes tourniquet application from being a lifesaving intervention to one that may cause an avoidable amputation and the development of an array of metabolic derangements and acute kidney injury collectively called prolonged tourniquet application syndrome. The recent literature was reviewed for papers that documented the complications of tourniquet use resulting from the prolonged casualty evacuation times being seen in the current Russo-Ukrainian war. The literature was also reviewed for the incidence of tourniquet application that was found to not be medically indicated, in both the US civilian setting and from Ukraine. Finally, an in-person meeting of the US/Ukraine Tourniquet Working Group was held in Warsaw, Poland, in December of 2023. Unnecessary loss of extremities and life-threatening episodes of prolonged tourniquet application syndrome are currently occurring in Ukrainian combat forces because of nonindicated tourniquet use combined with the prolonged evacuation time seen in the Russo-Ukrainian war. Specific numbers of the complications experienced as a result of tourniquet use by Ukrainian forces in the current conflict are treated as classified information and are not available, but multiple sources from the Ukrainian military medical personnel and from the US advisors providing medical assistance to Ukraine have all agreed that the problem is substantial. Unnecessary tourniquet morbidity might also occur in US forces in a variety of potential future combat scenarios in which evacuation to surgical care is delayed. Prehospital trauma training programs, including but not limited to tactical combat casualty care, place insufficient emphasis on the need to avoid leaving tourniquets in place when they are not medically indicated. This aspect of training should receive emphasis in future Tactical Combat Casualty Care (TCCC) and civilian first responder curriculum development. An interim ad hoc training solution on this topic is available at the websites noted in this articles. Additional training modalities may follow in the near future. Therapeutic/Care Management; Level V.

Ketamine Use for Palliative Care in the Austere Environment: Is Ketamine the Path Forward for Palliative Care.

The goal of palliative care is to focus on the holistic needs of the patient and their family versus the pathology of the patient's diagnosis to reduce the stress of illness. U.S. servicemembers deployed to austere environments worldwide have significantly less access to palliative care than in military treatment facilities in the U.S. Preparation for future conflicts introduces the concept of prolonged medical management for an environment where urgent casualty evacuation is impossible. Ketamine is currently widely used for analgesia and anesthesia in the care of military service members and its use has increased in combat zones of Iraq and Afghanistan due to the favorable preservation of respiratory function, minimal changes in hemodynamics, and lower pain scores compared to opioids. Ketamine acts as a non-competitive antagonist on N-methyl-D aspartate (NMDA) receptors. Its anesthesia and analgesic effects are complex and include both presynaptic and postsynaptic neurons in brain and spinal cord. The use of palliative care to minimize suffering should not be withheld due to the logistical boundaries of austere military environments or lack of guidelines for recommended use. The use of ketamine for palliative care is a new clinical management strategy to provide both sedation and pain management for an acute pain crisis or comfort measures for the terminally ill. This makes ketamine an attractive consideration for palliative care when managing critically wounded patients for an extended time.

Quantifying the essential tasks of offshore wind technicians.

Offshore wind technicians (WTs) have been identified as having an occupation with varying physical demands. Therefore, in order to assess WTs capability to undertake the job, there was a need to identify and quantify the physical requirements of the essential tasks. To establish the essential tasks and quantify the associated minimum physical demands of being an offshore WT. Wind Farm organisations (n = 10) across five countries, undertook a multi-modal observational approach comprising of semi-structured interviews (n = 45), focus groups (n = 14), survey (n = 167). In addition, observations, objective measurements, video footage and standard operating procedures were reviewed. A service campaign was broken down into component tasks, and analysed in terms of technical specifications, e.g. equipment, frequency, duration, rest breaks, clothing ensembles, and the methods of best practice for undertaking each of the tasks. Task descriptions were produced and minimum performance standards recommended. The job tasks associated with WTs can be broken down into two categories and five areas of work (Essential infrequent = casualty evacuation and prolonged ladder climbing; Essential frequent = short ladder climbs, manual handling and working in restricted spaces). The results presented constitute work carried out in Phases 1 and 2 of a three phased work programme to establish a physical employment standard required by WTs working in offshore wind. These findings will underpin the development of a minimum performance standard for the global offshore wind industry.

AEROMEDICAL EVACUATION OF VIETNAM’S LEVEL-2 FIELD HOSPITAL IN THE UNITED NATIONS MISSION IN SOUTH SUDAN: A RETROSPECTIVE STUDY

Objectives: To describe the characteristics of aeromedical evacuation (AE) operations in the United Nations Mission in South Sudan (UNMISS) carried out by Vietnam’s Level-2 Field Hospital (L2FH). Methods: A retrospective, descriptive study on the data from all AE activities of the Aeromedical Evacuation Team (AMET) of Vietnam’s L2FH from October 2018 to March 2022 in Bentiu, South Sudan. Results: 31 AE patients were collected with 1 case of casualty evacuation (CASEVAC), 14 cases of emergency medical evacuation (MEDEVAC), and 16 cases of non-emergency MEDEVAC. The mean age was 38.8 ± 8.4 years old, and the majority were male (83.9%). Patients were mainly from troop-contributing countries (TCCs) (67.7%). All cases belonged to the non-battle injury group, the majority was illness (93.5%). 6 infectious cases underwent AE, of which 2 patients were diagnosed with suspected severe COVID-19. Most patients needed medical officer escorts (29/31). The mean time from AE approval to patient referral for emergency MEDEVAC was 1.8 ± 0.4 hours, and for non-emergency MEDEVAC was 12.5 ± 7.9 hours. All cases were successfully transferred without any complications during AE. Conclusion: All patients under AE were not due to combat injury and mainly belonged to internal medicine disease, which raises the importance of training and experience exchange in both trauma and non-trauma air transport.

A reconfigurable multi-terrain adaptive casualty transport aid base on Watt II six-bar linkage for industrial environment.

Introduction: This paper presents the Reconfigurable Multi-Terrain Adaptive Casualty Transport Aid (RMTACTA), an innovative solution addressing the critical need for rapid and safe pre-hospital casualty transport in industrial environments. The RMTACTA, leveraging the Watt II six-bar linkage, offers enhanced adaptability through six modes of motion, overcoming the limitations of traditional stretchers and stretcher vehicles by facilitating navigation across narrow and challenging terrains. Methods: The RMTACTA's design incorporates two branching four-bar mechanisms to form a compact, reconfigurable Watt II six-bar linkage mechanism. This setup is controlled via a single remote rope, allowing for easy transition between its multiple operational modes, including stretcher, stretcher vehicle, folding, gangway-passing, obstacle-crossing, and upright modes. The mechanical design and kinematics of this innovative linkage are detailed, alongside an analysis of the optimal design and mechanical evaluation of rope control. Results: A prototype of the RMTACTA was developed, embodying the proposed mechanical and kinematic solutions. Preliminary tests were conducted to verify the prototype's feasibility and operability across different terrains, demonstrating its capability to safely and efficiently transport casualties. Discussion: The development of the proposed Reconfigurable Multi-Terrain Adaptive Casualty Transport Aid (RMTACTA) introduces a novel perspective on the design of emergency medical transport robots and the enhancement of casualty evacuation strategies. Its innovative application of the Watt II six-bar linkage mechanism not only showcases the RMTACTA's versatility across varied terrains but also illuminates its potential utility in critical scenarios such as earthquake relief, maritime rescue, and battlefield medical support.

Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs Than They Save.

Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy-limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6 hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet application was appropriate in 24.6% of the wounded with tourniquets in one recent publication by a Ukrainian vascular surgeon. The longer a limb tourniquet is in place raises the risk of compartment syndrome, vascular thrombosis, rhabdomyolysis, and irreversible myonecrosis resulting in major tissue loss and often necessitating limb amputation. If bleeding is controlled with a tourniquet, attempts to remove the tourniquet as early as possible to avoid the negative consequences are essential. Training in tourniquet use without explaining possible limb loss and other complications resulting from tourniquets left in situ more than 2 hours makes use risky. Tourniquets should be loosened at one hour if the tactical situation allows, and the injury assessed to determine if major bleeding persists or to determine if other methods of hemostasis would be effective. Ukraine must improve the training so that everyone becomes aware of the risks of prolonged or improper tourniquet use. This tourniquet training information must be transmitted to military medical leaders, Ukrainian military medics, civilian volunteers, volunteers in Ukraine, and NATO trainers in allied countries conducting medical training for Ukrainian soldiers. A trauma registry and tracking through echelons of care can enhance performance improvement through timely feedback.

Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites

With the miniaturization of ultrasound and the development of artificial intelligence, its application in disaster scenes and pre-hospital emergency care has become more and more common. This study summarizes the literature on portable ultrasound in pre-hospital emergency and disaster scene treatment in the past decade and reviews the development and application of portable ultrasound. Portable ultrasound diagnostic equipment can be used to diagnose abdominal bleeding, limb fracture, hemopneumothorax, pericardial effusion, etc., based on which trauma can be diagnosed pre-hospital and provide guiding suggestions for the next triage and rescue; in early rescue, portable ultrasound can guide emergency operations, such as tracheal intubation, pericardial cavity puncture, and thoracic and abdominal puncture as well as improve the accuracy and timeliness of operation techniques. In addition, with the development of artificial intelligence (AI), AI-assisted diagnosis can improve the diagnosis level of ultrasound at disaster sites. The portable ultrasound diagnosis system equipped with an AI robotic arm can maximize the pre-screening classification and fast and concise diagnosis and treatment of batch casualties, thus providing a reliable basis for batch casualty classification and evacuation at disaster accident sites.

Why students engage in simulation and how it prepares them for work

In the future, learning will take the shape of a story, a play, a game; involving multiple platforms and players; driven by dialogue and augmented with technology, an interplay of immersive experiences, data, and highly social virtual worlds (Lee et al., 2021). Employers seek graduates who demonstrate attributes that organisations require to develop in the future. As students transition out of higher education, they should have the ‘abilities and capabilities to maintain employment’ (Asiri et al., 2017 p. 2). The transition out of university can be perceived as particularly stressful, with uncertainty about what is required for a successful career (Jackson and Tomlinson, 2020). This is exacerbated in the post Covid-19 environment when, even as the graduate job market has started to recover, students’ confidence about finding a job after graduation remains low (Curnock Cook, 2022). Our simulation methods are aligned to the theories that underpin these transitions, and designed to support students ‘becoming’ professionals in their field. Simulations can be designed for cognitive absorption, the psychological concept of flow and deep absorption in learning (Kukulska-Hulme et al., 2022). Premised on the innovation of best learning moments, the student tasks shared in this workshop engender deep involvement, through memorable learning activities. This reflects the ‘ways of working’ of the Learning Development (LD) community, and evidence suggests that reflective practice, learning complex skills and scaffolding learning are the transferable aspects of these technologies (Chernikova et al., 2020). Widening participation research has provided evidence that students’ movements in and out of experiences such as care, work and studies are dynamic, non-sequential and context-dependent (Holley and Priego-Hernández, 2021). With the move to hybrid learning, students want their learning materials to be well-designed. However, 43% of students do not perceive their learning materials to be engaging/motivating (Killen and Didymus, 2022). Immersive technology and simulation may offer the solution to this disconnect, as simulations offer an immersive and embodied experience (Bayne 2004; Bayne et al., 2019). Signature pedagogies (Thomson et al., 2012) for professions can provide a means for institutions to achieve the requirements of Office for Students’ B3 (2022) which is now assessing student continuation, degree outcomes, including differential outcomes for student characteristics, and, framing this workshop, graduate employment and progression to professional jobs and postgraduate study. Learning Developers have a pivotal part to play operationalising actions that result into students’ graduate outcomes, and responding to this, our workshop invited participants to experience three types of simulation: a) a business game; b) a mass casualty evacuation; and c) a community project responding to a scenario.

Evaluation ofTopical Off-the-Shelf Therapies to Reduce the Need to Evacuate Battlefield-Injured Warfighters.

Immediate evacuation of burn casualties can be challenging in austere environments, and it is predicted to be even more difficult in future multi-domain battlespaces against near-peer foes. Therefore, a need exists to treat burn wounds at the point of injury to protect the exposed injury for an extended period. In this study, we compare two commercially available FDA-approved therapies to the current gold standard of care (GSOC), excisional debridement followed by the application of split-thickness skin graft, and the standard for prolonged field care, silver sulfadiazine (SSD) cream. The shelf-stable therapies evaluated were irradiated human skin (IHS) allograft and polylactic acid (PLA). Our objective was to study whether they have the potential capability to reduce the need for evacuation to a burn center for surgical intervention so that the combat power can be preserved in the field. Sixteen burns (50 cm2) were created on the dorsum of four anesthetized swine. All materials were sterile, but a sterile field was not utilized in order to simulate the prolonged field care setting. The wounds were then treated with PLA, IHS, and SSD cream, and the remaining wounds (designated GSOC) were also treated with SSD cream. On post-operative day (POD) 3, sterile surgical debridement and skin grafting (1:4) were performed on the GSOC wounds. Burn healing was followed for either PODs 10, 14, 21, or 28, wherein one animal was humanely euthanized at each time point; each represented a time point of the healing process. A full-thickness excisional biopsy was taken from each wound immediately after euthanasia to give a cross-section view of the wound edge to edge. Wound healing was determined by the histological analysis of wound re-epithelialization, epidermal thickness, rete ridges, and scar elevation index and macroscopically using noninvasive imaging systems. The PLA and IHS treatments did not need to be reapplied to the wounds during the course of the experiment, unlike SSD, which was reapplied at each assessment time point. In terms of re-epithelialization, on POD 10, IHS and SSD were similar to the GSOC; on POD 14, all treatments were similar; on POD 21, PLA and IHS were similar to SSD; finally, on POD 28, re-epithelialization was similar in all groups. On POD 28, scar elevation index and rete ridges/mm were similar to all groups, and epidermal and dermal thickness for PLA and IHS were similar to GSOC. This preclinical study demonstrated that the use of the PLA and the IHS dressings resulted in similar outcomes to the GSOC-treated burns in several key metrics of wound healing. These therapies represent a potentially useful tool in current and future battlespaces, where surgical intervention is not possible. The products are lightweight and, more importantly, stable at room temperature for their entire shelf lives. This would allow for easy storage and transport by medical practitioners in the field.

French Military Neurosurgery: At Home and Abroad.

The origins of military neurosurgery are closely linked to those of neurosurgery in France and more particularly in Paris. The history of the field starts with its origins by 2 men, Thierry de Martel and Clovis Vincent. The first note about the creation of military neurosurgery was in 1942, when Marcel David was reassigned from the Sainte Anne Hospital to practice at the Val-de-Grâce Military Hospital. David trained the first military neurosurgeon. The field of military neurosurgery was subsequently developed at the Val-de-Grâce Military Hospital, at Sainte Anne Military Teaching Hospital in Toulon in 1990 and then at Percy Military Teaching Hospital in 1996. Over 29 military neurosurgeons were trained in these institutions. Since 2000, French military neurosurgeons have been deployed from France in the Mobile Neurosurgical Unit. This Mobile Neurosurgical Unit represents 12% of all medical evacuation of casualties categorized as the high dependency level. Neurosurgeons were able to adapt to asymmetrical wars, such as in the Afghanistan campaign where they were deployed in the Role 3 medical treatment facility, and more recently in sub-Saharan conflicts where they were deployed in forward surgical roles. To manage the increasing craniocerebral war casualties in the forward surgical team, the French Military Health Service Academy established a training course referred to as the "Advanced Course for Deployment Surgery" providing neurosurgical damage control skills to general surgeons. Finally, military neurosurgery is reinventing itself to adapt to future conflicts through the enhancement of surgical practices via the addition of head, face, and neck surgeons.

Casualty Evacuation in Korea, 1950-53: The British Experience.

The Korean War was the first conflict in which helicopters were used extensively for casualty evacuation but their contribution to medical evacuation at that time is disputed. On the one hand, many cases undoubtedly survived because of helicopter transportation; on the other, the proportion of casualties evacuated appears to have been small and difficult to determine precisely. Taking the British army as a case study, this article looks more closely at arrangements for casualty evacuation in Korea, assessing the role of helicopters in relation to other elements of the evacuation system and its operation as a whole. The article is divided into several sections. The first examines the command structure of the medical system in Korea, which extended as far back as hospitals in Japan. It shows how medical support for British forces was closely integrated with that of other Commonwealth forces. It notes that rapid and effective integration was a major factor in the success of medical evacuation because it allowed ideas and equipment to be shared easily and because it fostered a spirit of cooperation. This section also highlights the Second World service of all senior Commonwealth medical officers as a factor conducive to integration. The second section provides an overview of the chain of evacuation from the frontline to hospitals in Japan. It describes the functions of the different medical institutions along the chain and how they were connected. Among other things, it shows how the chain for British and Commonwealth troops intersected with medical units of the United States such as Mobile Army Surgical Hospitals and hospital trains. In the third section of the article, there is a detail examination of evacuation by helicopter, describing how it was arranged, what its limitations were, and what types of casualty were evacuated. It estimates the proportion of casualties that were evacuated by this means. The fourth and fifth sections highlight the importance of command decisions in the effective working of the evacuation system. The fourth concentrates on the evolution of a system of forward treatment of minor cases, looking at the challenge posed by disease and other non-battle casualties. The fifth and final section of the article describes how the system of evacuation functioned as a whole, including the different means used to carry the sick and wounded in addition to helicopters. It stresses the importance of coordination between these different elements and places particular emphasis on the value of wireless communications. The article concludes that the success of casualty evacuation in Korea depended less on any single method of transportation than on effective command and control. In this respect, communication between constituent units of the evacuation chain and cooperation between British and other UN forces was crucial. Of equal and perhaps even greater importance was the decision to implement a policy of forward treatment of sickness and minor injuries. Without such a policy, the lines of evacuation would inevitably have become congested, having a detrimental effect on casualty survival rates. This policy drew on the lessons of the two world wars which were still relatively fresh in the minds of medical commanders. Although far less striking than the advent of the helicopter, prior knowledge of coalition warfare and the handling of mass casualties was crucial to medical success. If there is a lesson to be learned from the Korean War for own times, it is probably this.

Prehospital Lessons From the War inUkraine: Damage Control Resuscitation andSurgery Experiences From Point of Injury to Role 2.

The ongoing war in Ukraine presents unique challenges to prehospital medical care for wounded combatants and civilians. The purpose of this article is to identify, describe, and address gaps in prehospital care, casualty evacuation, and medical evacuation throughout Ukraine to share lessons for other providers. Observations and experiences of medical personnel were collected and analyzed, focusing on pain management, antibiotic use, patient assessment, mass casualty triage, blood loss, hypothermia, transport immobilization, and clinical governance. Gaps identified include limited access to pain management, lack of antibiotic guidance, inadequate patient assessment and triage, access to damage control resuscitation and blood, challenged transport immobilization practices, and challenges with clinical governance for both local and foreign providers. Improved prehospital care and casualty and medical evacuation in Ukraine are required, through increased use of empiric pain management, focused antibiotic guidance, enhanced patient assessment and triage in the form of training, access to prehospital blood, and better transport immobilization practices. A robust and active lessons learned program, trauma data capture, and quality improvement process is needed to reduce preventable morbidity and mortality in the war zone. The recommendations presented in this article serve as a starting point for improvements in prehospital care in Ukraine with potential to change prehospital training for the NATO alliance and other organizations operating in similar areas of conflict. Graphical Abstract.

Flying against the clock – risk management and resilience in Arctic search and rescue and casualty evacuation flights

Despite the successful conclusion of the 2011 Arctic Search and Rescue Agreement, the resources available for search and rescue operations in the High North remain limited. Rescue flights are time critical. Survival times – especially in the Arctic – are severely curtailed by the environment. At the same time, clinical evidence supports the need to provide critical casualty care within the first, or ‘golden’ hour following injury. The selection, training and management of personnel lies at the heart of addressing the risks attendant upon both flying and rendering appropriate casualty care under such circumstances. Despite technological advances, human decisions remain pivotal. This paper examines recent advances in decision enhancement techniques and their application in improving the safety and resilience of future Arctic rescue flight operations.

Casualty evacuation in arctic and extreme cold environments: A paradigm shift for traumatic hypothermia management in tactical combat casualty care

ABSTRACT In Arctic or extreme cold environments of Alaska, trauma care is complicated by large expanses of geography and lack of forward-positioned resources. This paper presents four hypothetical vignettes highlighting austere cold medical priorities: (1) traumatic hypothermia management as part of Tactical Combat Casualty Care (TCCC) is clinically and tactically important and hypothermia needs to be reprioritized in the MARCH algorithm to MhARCH; (2) at present it is unknown which TCCC recommended medical equipment/supplies will function as designed in the extreme cold; (3) ensuring advanced resuscitative care measures are available serves as a temporal bridge until casualties can receive damage control resuscitation (DCR); and (4) current systems for managing traumatic hypothermia in TCCC and casualty evacuation (CASEVAC) are insufficient. In conclusion, numerous assessments recognise the DoD’s current solutions for employing medical forces in Arctic operations are not optimally postured to save lives. There should be a joint standard for fielding an arctic supplement to current medical equipment sets. A new way of thinking in terms of an “ecosystem” approach of immediate casualty protection and movement in CASEVAC doctrine is needed to optimise these “Golden Minutes.”

Особенности проведения медицинской эвакуации пациентов в условиях временного ограничения на федеральном уровне полетов гражданской авиации, в том числе из-за рубежа

Summary. The aim of the study is to analyze and to substantiate alternative ways of solving problematic issues of medical evacuation of patients and casualties in conditions of temporary restriction of civil aviation flights. Materials and research methods. Materials of the study: practical experience of the specialists of the Center of sanitary aviation and emergency medical care of “Zashchita” Disaster Medicine Center of Federal Medical Biophysical Center named after A.I.Burnazyan of the Federal Medical and Biological Agency of Russia, as well as LLC “Medaero-Service”; statistical data on the field work of teams of the Center of sanitary aviation and emergency medical care on medical evacuation of patients from closed airspace areas; data from the official websites of the Federal Air Transport Agency, of Government and Ministry of Foreign Affairs of the Russian Federation, of Border Service, of Federal Tourism Agency, and assistance companies; electronic database of regulatory legal documents. Research methods: analytical, method of direct observation, comparison, description. Results of the study and their analysis. Results of the study, characterizing the problematic issues of medical evacuation of patients and victims in conditions of temporary restriction of civil aviation flights regime, are presented. The main ways of optimization of medical evacuation of patients and victims at the federal level during the period of air traffic limitation have been suggested and substantiated.

Inter-Rater and Intra-Rater Reliability of Return-to-Work Screening Tests for UK Firefighters Following Injury.

The aim of this study was to assess the inter-rater and intra-rater reliability of a return-to-work (RTW) screening test to be used on UK firefighters following injury. The inter rater and intra-rater reliability of eight tasks involved in a screening test was used to assess readiness to RTW for UK firefighters following injury. These tasks included the following: (1) putting on and removing a breathing apparatus set (BA), (2) a ladder lift simulation, (3) a ladder carry simulation, (4) a light portable pump (LPP) lift and carry simulation, (5) a hose run, (6) a ladder climb with leg lock, (7) a casualty evacuation and (8) a confined space crawl simulation. The inter-rater reliability between each individual screening task was interpreted as Excellent (ICC = 0.94-1.00) for eleven (68.75%) of the screening task videos and as Good (ICC = 0.75-0.88) for five (31.25%) of the screening task videos. Intra-rater reliability was interpreted as Excellent (ICC = 1) for twenty-six participants (74.3%), Good (ICC = 0.76-0.88) for eight participants (22.9%) and Moderate for one participant (2.8%). Due to the reliability of this screening test, it allows conclusions to be made from the results which can inform a RTW decision for a firefighter.