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

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

As air evacuation evolved, it became clear that specially trained personnel were needed to optimize casualty care during air transport. Because there were not enough physicians to put on every flight, Brig Gen David Grant, AAF air surgeon, proposed establishing a flight-nurse corps. Despite opposition from the Army surgeon general, the designation "flight nurse" was created for specially trained members of the Army Nurse Corps assigned to the AAF Evacuation Service. In February 1943, the first class of flight nurses graduated from Bowman Field, Kentucky. The four-week course taught aeromedical physiology, aircraft-loading procedures, and survival skills. This specialized training was the beginning of trained medical personnel providing in-flight care--the catalyst for the current AE system.

Before long, regular AE routes were established, and hospitals were built along airstrips to care for the wounded who needed to remain overnight along the route. In early 1943, AE aircraft began transatlantic flights from Prestwick, Scotland, to the United States. By the end of the same year, transpacific AE flights were returning patients to the continental United States (CONUS) via Hawaii. In 1944 a southern Atlantic route to the United States, originating in North Africa with stopovers in the Mores and Bermuda, began serving passengers. Aircraft used for AE during the war included the C-46 Commando, C-54 Skymaster, C-64 Norseman, C-87 Liberator Express, and the aforementioned C-47. In addition, bombers and tankers moved patients from forward battle zones during tactical AE.

The sheer number of patients transported during World War II reflects the great importance of AE. At its peak, the AAF evacuated the sick and wounded at a rate of almost 100,000 per month. A one-day record of 4,704 AE patients evacuated was set in 1945. In his statement on l8 June 1945, Gen of the Army Dwight D. Eisenhower said, "We evacuated almost every one of our forward hospitals by air, and it has unquestionably saved hundreds of lives--thousands of lives." General Eisenhower placed AE in a class with sulfa drugs, penicillin, blood plasma, and whole blood as a chief factor in cutting the fatality rate of battle casualties.

The risk of evacuating patients by air had been a concern since the beginning of the war. However, as AE crews gained experience, the risk of death during AE dropped to six patients in 100,000 by 1943. At the end of the war, the risk was down to one and one-half patients in 100,000, thus proving that AE was one of the most important medical advances in decreasing the mortality rate associated with warfare.

Postwar Period and a New Service

The postwar drawdown changed the face of the US military's AE system. By 1946 the system consisted of 12 aircraft at the School of Aviation Medicine and one C-47 at each of the 12 regional US hospitals. In 1947 the US Air Force (USAF) was established, receiving orders in 1949 to provide AE for the entire US military.

In May 1949, the Joint Chiefs of Staff (JCS) directed the Air Force to establish "evacuation systems" for both the Army and Air Force. On 7 September 1947, Secretary of Defense Louis E. Johnson made a policy announcement directing that the transportation of patients of the armed services would be accomplished by aircraft when air transportation was available, when conditions were suitable for air evacuation, and when there was no medical contraindication to air transport.