Challenges of Aeromedical evacuation in the post-cold-war era

Aerospace Power Journal, Winter, 2001 by Bruce Brig Gen Green

BRIG GEN BRUCE GREEN (*)

Editorial Abstract: Arguably, aeromedical evacuation (AR) is the most important and visible aspect of aerospace medicine. In this article, General Green recounts the 80-year history of AE and discusses current and future challenges that face this community. In order to support our war-fighting expeditionary forces in both peace and war, aerospace medical professionals are adopting a strategy of mainstreaming AR and employing the full spectrum of lift to support its mission.

AIR FORGE AEROMEDIGAL evacuation, the transportation of patients under the supervision of AE crew members on fixed-wing aircraft, enjoys a proud heritage that spans more than 80 years. The AE system has been instrumental in saving the lives of thousands of America's soldiers, sailors, airmen, and marines throughout every contingency in which our country has engaged since World War I. In addition, during both war and peace, AE has moved thousands of family members who required medical care beyond that available in their local communities. The AE system is made up of AE crews; command and control ([C.sup.2]) elements; mobile/fixed patient-staging facilities; and a multitude of communications, logistics, and support components. Today, the AE system faces new and demanding challenges. In order to ensure the effective and efficient operation of AE in the new millennium, a major transformation of AE, led by Air Mobility Command (AMC), is now under way. A brief history of AE will set the stage for that transformation.

An Illustrious History

The concept of moving the wounded by air began almost simultaneously with the concept of fixed-wing aircraft flight. (1) Shortly after the Wright brothers successfully flew their first airplane, two US Army medical officers, Capt George H. R. Gosman and Lt A. L. Rhodes, designed an airplane to transport patients. Using their own money, they built and flew the world's first air ambulance at Fort Barrancas, Florida, in 1910. Unfortunately, on its first test flight, it flew only 500 yards at an altitude of 100 feet before crashing. This flight, followed by Captain Gosman's unsuccessful attempt to obtain official backing for the project, proved to be only the beginning of many challenges for the new concept.

World War I Era

Air evacuation was very limited during World War I; however, it was remembered most as the time during which air-ambulance design made significant progress by trial and error. A French medical officer, Dr. Eugene Chassaing, first adapted French military planes for use as air ambulances by inserting two patients side by side into the fuselage behind the pilot's cockpit. The first actual evacuation of wounded in airplanes specifically equipped for patient movement occurred in Flanders in April 1918, using a modified Dorand II aircraft.

The United States began to use airplanes for evacuating the injured from the battlefield in World War I but found it difficult to use planes not designed for patient airlift. Specifically, the fuselages were too small to accommodate stretchers, and the open cockpits exposed patients to the elements. As a result, the US Army Medical Corps used airplanes primarily to transport flight surgeons to the site of airplane accidents to assist in the ground transportation of casualties.

By war's end, the US Army realized the need to transport the wounded by air. In 1918 Maj Nelson E. Driver and Capt William C. Ocker converted a Curtiss JN-4 Jenny biplane into an airplane ambulance by modifying the rear cockpit to accommodate a standard Army stretcher carrying an injured person in a semireclined seat. The modification allowed the US Army to transport patients by airplane for the first time. This success led to an order directing all military airfields to have an air ambulance.

Between the World Wars

The success of the Jenny air ambulances during World War I paved the way for the further development of air evacuation, with several other types of aircraft converted successfully for this purpose. In 1920 the DeHavilland DH-4 aircraft modification allowed it to carry a medical attendant and two side-by-side patients in the fuselage. Shortly thereafter, the Cox-Klemmin aircraft became the first plane built specifically as an air ambulance, carrying two patients and a medical attendant enclosed within the fuselage. The building of the Curtiss Eagle in 1921 allowed the transport of four patients on litters and six ambulatory patients. Unfortunately, in its first year of service, an Eagle crashed during an electrical storm, killing seven people.

Despite the crash setback, aeromedical transportation continued to progress. In 1922 the US Army converted the largest single-engine airplane built at the time, the Fokker F-IV, into an air ambulance designated the A-2. In the same year, a US Army physician, Col Albert E. Truby, listed the potential uses of the airplane ambulances as follows:

* Transportation of medical officers to the site of crashes and evacuation of casualties from the crash back to hospitals.