When I was at the R3 in Kandahar we'd get transfers from the Brits at Leatherneck. Ventilated patients came with one of their anesthesiologists on the flight, and they'd turn over to us in the trauma bay. Most of them were transfers for head injuries since they had no neurosurgical capability, but we did. I don't think they really added anything that influenced outcomes beyond what an ordinary critical care transport RN could do.
And I don't mean that as a knock on the Brits ... in fairness, nearly all of the cases we got from them were head injuries that needed urgent neurosurgical intervention; they all did terribly. They were all going to do terribly from the point of injury no matter what anybody did.
I guess my point is just that I never saw a category of patients who I thought would really benefit from a doctor in the aircraft. If they were stable enough to be transported in the first place, a nurse (or perhaps even a medic with some extra training) ought to be able to keep the vent going, the blood dripping, and the patient warm for a sub-1-hour flight.
I can't say I'm interested in seeing the US adopt that model.
I dealt directly with TCCET when I was down in Helmand province flying MEDEVAC on UH60's. They had a Chinook with an OR table, resuscitation equipment and IIRC flew with a general surgeon, EM physician, anesthesiologist and two nurses.
They billed themselves as a sort of flying Kaiser Permanente and quickly gave the higher ups in the region vagina tingles as they waxed eloquently about their "capabilities." Never mind that the vast majority of our missions in that theatre, at that point in the War, were scoop and dump point of injury flights rarely over 30 minutes, these guys were perceived as being able to provide "better" medical care than your typical Army MEDEVAC bird with an EMT/possible flight paramedic and GMO flight surgeon.
I could spot the problems a mile away, even if the higher ups couldn't, or didn't want to. By that time I had flown hundreds of MEDEVAC missions and on a thirty minute flight or less, as PGG alluded to, there is almost no need to do much of ANYTHING other than stop bleeding, needle decompress and maybe hang an IV bag (more likely IO considering the wounds we saw). So all of their extra capabilities were for naught. Added to this, even on a 40 minute flight, how are you going to perform anything other than a chest tube in the back of a helicopter which is bobbing and weaving all over the place to escape RPG and PKM fire? The whole thing was lunacy. The CH47 also is not an ideal MEDEVAC bird. They're good for CASEVAC if you have to evacuate a whole bunch of people and they were utilized this way early in OEF. But on a point of injury scoop Chinooks are too big, too loud, too high profile (RPG friendly) and create so much dust that they brown out and blow out everything within 300 meters of the landing site. The new F models were able to hover down on auto-pilot through a brown out but this TCCET bird was an antiquated D model. Just a mess.
The biggest problem, again, a tactical one which none of these hospital desperados could grasp, was that the most important aspect of a MEDEVAC mission is getting to the wounded party QUICKLY. Hence the whole "golden hour" stuff. My units had it down to a science. We eat/lived/slept on the flightline, with our gear, and radios 24/7. Our average launch time from receipt of the 9 line to wheels up was around 6 minutes. That is fast, and that, ultimately is what saved lives, not what we did in the back.
This Chinook clown car, call-sign "Tricky" was based out of Leatherneck. It was a British venture at that time. I don't know how they arranged things or if the thought ever crossed their mind but they were god-awful slow in getting in the air. I surmised that it was because they had to collect all these badge chasers from the hospital and load them onto the ACFT. It took them about 40 minutes to even spin up.
Some of my worst memories from those times were waiting by our helos, spun up, after a 9 line was sent for a chest wound (an example) and then listening over the radio as the mission was sent to Tricky. And then hearing forty minutes later that some young Marine was dead and that those ****ers never even launched. 9-line cancelled, stand down.
The army perfected MEDEVAC after 10 years of War. You don't need paramedics in the back and you certainly don't need a trauma surgeon and an OR table. I always taught my medics that less was more. Be safe, be prudent, get the guy to the Role 3 so that they can work their magic.
- ex 61N
