New York chapter history of Military Medicine Award: U.S. Army Medical helicopters in the Korean War

Military Medicine, Apr 2001 by Driscoll, Robert S

After the surgeon approved the request, a mission order was relayed to the helicopter detachment. Before relaying the mission order, however, the request had also gone through a priority evaluation established by the Eighth Army Surgeon, as follows: "casualties in shock, who have been in shock, and those with continuing hemorrhage; all traumatic amputations; open fractures of long bones, complicated by shock or hemorrhage, or without complete and comfortable immobilization; wounds of the extremities with impaired blood supply, or with a tourniquet in place, or with history of tourniquet applications; wounds with extensive muscle damage; abdominal wounds; all sucking chest wounds; chest wounds in which there is any degree of respiratory difficulty or dyspnea; all thoracicoabdominal wounds; maxillofacial or neck wounds that are severe or in which there is respiratory difficulty; head injuries in coma with signs of increased intracranial pressure; and suspected gas gangrene."13

The task of prioritizing evacuation missions put a life-anddeath decision burden on surgeons because of the limited number of medical helicopters in Korea. Before sending a helicopter, each surgeon had to consider the nature and severity of the patient's condition, the number of available helicopters, and the number of all patients requiring evacuation.

After the patient criteria were met, landing site requirements needed coordination. "The landing site needed to be in a defiladed [open] area, and free from overhead obstructions, such as wires and trees; the area should be clear of artillery units; landing pad should be in a circle of fifty feet in diameter, clearly marked by white rocks or other suitable material, and on level ground; the circle should be marked with a standard red cross panel; a standard color smoke grenade should be used for signaling; [and] the area should be within a few feet of the medical tent or bunker."14 These criteria were not always observed, and in general, ground troops had misconceptions about the ability of the helicopter (Fig. 4).

After the patient and landing criteria had been met, each helicopter detachment commander made the decision of whether or not a mission would be attempted. The final authority on whether or not the mission could be completed rested with the pilot. If there was a reasonable possibility of completion, the mission was attempted.

Despite this cumbersome process, it "was extremely effective.... It was not uncommon for a helicopter to be airborne within eight to ten minutes after the patient reached a medical installation [battalion aid station]. Often he was on an operating table at a surgical hospital within an hour after he suffered the wound."15

The final aspect of the evacuation cycle was preparing the patient for movement. With no medical attention available while in flight, the patient needed all hemorrhaging controlled and treatment for shock initiated; systolic blood pressure needed to be at least 80 mm Hg; the patient must have an adequate airway; any patients with maxillofacial injuries needed to be placed in a prone position to prevent aspiration of vomit should the patient become air sick; fractures were immobilized; pain medications were given; and all chest wounds were tightly bandaged. In general, any medical care that might be needed in flight had to be attended to before takeoff.