Evacuation Request Procedure

INTRODUCTION

Medical evacuation is the timely, efficient movement and en route care by medical personnel of the wounded, injured, or ill persons from the battlefield and other locations to medical treatment facilities (MTF). Evacuation begins when medical personnel receive the injured or ill soldier and continues as far rearward as the patient's medical condition warrants or the military situation requires. Procedures for requesting medical evacuation support must be institutionalized down to the unit level. The same format used to request aeromedical evacuation is also used for requesting ground evacuation. Procedural guidance and standardization of request procedures are taught in this lesson.

Determination to Request Medical Evacuation and Assignment of Medical Evacuation Precedence

The determination to request medical evacuation and assignment of a precedence is made by the senior military person present. This decision is based on the advice of the senior medical person at the scene, the patient's condition and the tactical situation. Assignment of a medical evacuation precedence is necessary.

The precedence assigned to the casualty(ies) provides the supporting medical unit and controlling headquarters with:

(1) Information that is used in determining priorities for committing their evacuation assets

(2) Validated information in controlling the flow so that resources will not be strained

Overclassification (The tendency to classify a wound as more severe than it actually is) remains a continuing problem

(1) When properly classified, patients will be picked up as soon as possible

(2) Pick up is consistent with available resources and pending missions

(3) Those casualties in greatest need are evacuated first and receive the necessary care required to help ensure their survival

Precedence and the criteria used in resource assignment:

(1) Priority I – Urgent

(a) Assigned to emergency cases that should be evacuated as soon as possible

(b) Casualty requires evacuation within a maximum of 2 hours

(d) Used to prevent complications of serious illness, or to avoid permanent disability

(2) Priority IA – Urgent-Surgical

(a) Assigned to patients who must receive far forward surgical intervention

(b) Goal is to save life and to stabilize casualty for further evacuation

(3) Priority II – Priority

(a) Assigned to sick and wounded personnel requiring prompt medical care

(b) Used when the individual should be evacuated within 4 hours

(d) Requirements for special treatment are not available locally

(e) Casualty will suffer unnecessary pain or disability

(4) Priority III – Routine

(a) Assigned to sick and wounded personnel requiring evacuation but whose condition is not expected to deteriorate significantly

(b) Sick and wounded in this category should be evacuated within 24 hours

(5) Priority IV – Convenience: assigned to patients for whom evacuation by medical vehicle is a matter of medical convenience rather than necessity

Unit Responsibilities in Evacuation

Unit requesting evacuation prepares for and assist's during evacuation by:

(1) Ensuring that the tactical situation permits safe and successful evacuation

(2) Having an English-speaking representative at the pickup site when evacuation is requested for non-US personnel

(3) Ensuring that the casualty(ies) are ready for pickup when the request is submitted and provide casualty information, as required

(4) Receiving backhauled medical supplies and report the type, quantity, and where they are delivered

(5) Moving patients to the safest aircraft approach and departure point or AXP if they are to be evacuated by air

(6) Ground personnel should be familiar with principles of helicopter operations

Units must:

(1) Select and prepare the landing site. It is imperative that the type and number of aircraft are known so that the landing site can be adequately cleared and marked

(a) Criteria for Landing Sites:

(i) The Landing Zone (LZ) must be free of obstructions with sufficient space for the helicopter to be able to hover and maneuver during landing and takeoff into the prevailing wind whenever possible

(ii) Definite measurements for LZs cannot be prescribed since they vary with:

* Temperature

* Altitude

* Wind

* Terrain

* Loading conditions

* Individual helicopter characteristics

(iii) 30 Meters in diameter is the minimum requirement

(iv) Marking the LZ

* Any object likely to be blown about by wind from the rotor wash should be removed

* Obstacles which cannot be removed must be clearly marked so as to be readily seen by the pilot

(v) Identifying the landing site

* When the tactical situation permits the LZ should be marked with the letter H or an inverted Y

* Panels used to mark the LZ should be securely anchored to the ground to prevent them from being blown about

* The wind should be indicated (tactical situation permitting) with a wind sock or rag tied to a stick in the vicinity of the LZ

* Smoke grenades that emit colored smoke as soon as the aircraft is sighted can be used. The color of the smoke is verified by the aircrew and confirmed by the ground personnel

(2) Personnel loading the injured will take all of their commands regarding approach, loading and unloading of the aircraft from the pilot and crew chief

(3) Brief the pilot on the position of enemy troops and directs him to other units in the area, if asked

(4) A qualified soldier guides the helicopter in the landing site using hand signals during landing and takeoff when the tactical situation permits

(5) Mark friendly positions when armed helicopter escort is provided to prevent fratricide

CAUTION: Failure to follow proper safety procedures can result in injury or death.

Collect Medical Evacuation Information

Location of pickup site (Line 1)

(1) It is not necessary to encrypt grid coordinates when using secure communications equipment or channel skipping equipment

(2) To preclude misunderstanding, state that grid zone letters are included in the message.

(3) Obtain grid coordinates of the pickup site from the grid map of the operational area

NOTE: This information is required so that the evacuation vehicle crew knows where to pick up the casualty and the unit personnel coordinating the evacuation mission can plan the route for the evacuation vehicle (if casualties must be picked up from more than one location)

Radio frequency, call sign, and suffix (Line 2)

(1) Send the frequency of the radio at the pickup site, not a relay frequency

(2) The call signs (and suffix if used) on the person to be contacted at the pickup site may be transmitted in the clear

(3) Obtain radio frequency, call sign, and suffix of signal operation instructions from Signal Operating Instruction (SOI), or the Automated Net Control Device (ANCD) or radio supervisor

NOTE: This information is required so that the evacuation vehicle crew can contact the requesting unit while en-route to obtain additional information(for example, a change in situation, directions, or other information)

Number of Patients by Precedence (Line 3) Report only applicable information and use the appropriate amount(s) and brevity code(s) as follows:

NOTE: The brevity code precedes the description (A- Urgent) in the line number block under the information column of the Procedure for Information Collection and MEDEVAC Request Preparation.

(1) A – URGENT Complete (evacuate as soon as possible or within 2 hours)

(2) B - URGENT SURGICAL (evacuate within 2 hours to the nearest surgical unit)

(3) C - PRIORITY (evacuate promptly or within 4 hours)

(4) D - ROUTINE (evacuate within 24 hours)

(5) E - CONVENIENCE (medical convenience rather than necessity)

NOTE: If two or more categories must be reported in the same request, insert the proword "Break" (e.g., I now separate the text from other parts of the message) between each category. These details are obtained as part of the evaluation(s) of the patient(s), and provided by the medic or the senior person present. This information is required by the unit controlling the evacuation vehicles in order to assist in prioritizing missions when more than one is received.

Special Equipment Required (Line 4). Some of the types of equipment and their brevity codes are as follows:

(1) A - None

(2) B - Hoist

(3) C - Extraction equipment

(4) D - Ventilator

NOTE: Information on special equipment requirements are determined as part of the evaluation(s) of the patient(s), from the medic or the senior person present. This information is required so that the equipment can be placed on board the evacuation vehicle prior to the start of the mission.

Number of Patients by Type (Line 5) Report only applicable information. If requesting MEDEVAC for both types, insert the word "Break" between the litter entry and ambulatory entry.

(1) L - (Litter) plus the number of patients

(2) A - (Ambulatory [sitting]) plus the number of patients

NOTE: Obtain information on patients by type, a part of the evaluation(s) of the patient(s), and the number of patients from the medic or the senior person present. This information is required to determine the appropriate number of evacuation vehicles to be dispatched to the pickup site. The information is also needed to configure the vehicles to carry the patients requiring evacuation.

Security of Pickup Site (Wartime) (Line 6) This information is used during wartime. Use one of the following brevity codes to transmit the information concerning pickup-site security.

(1) N - No enemy troops in the area

(2) P - Possibly enemy troops in the area (approach with caution)

(3) E - Enemy troops in the area (approach with caution)

(4) X - Enemy troops in the area (armed escort required)

NOTE: This information is required to assist the evacuation crew in assessing the situation and determining if assistance is required in accomplishing the mission. More definitive guidance can be furnished to the evacuation vehicle while it is en- route (for example, the specific location of the enemy would assist the crew in planning the approach).

Method of Marking Pickup Site (Line 7), use the following appropriate brevity code(s) for the method of marking the pickup site.

(1) A - Panels

(2) B - Pyrotechnic signal

(3) C - Smoke signal

(4) D - None

(5) E - Other

NOTE: This information based on the situation and the availability of materials and is provided by the medic or senior person present. The information is required to assist the evacuation aircraft crew in identifying the specific location of the pickup site. The color of the panels, smoke, or other markings should not be transmitted until the evacuation vehicle contacts the unit just prior to arrival. For security reasons, the crew should identify the color of the marking(s) and the unit should verify the color.

Patient Nationality and Status (Line 8). The codes and categories are as follows:

(1) A - U.S. military

(2) B - U.S. civilian

(3) C - Non-U.S. military

(4) D - Non-U.S. civilian

(5) E - Enemy Prisoner of War (EPW)

NOTE: The number of patients in each category need not be transmitted. Obtain this information as part of the patient evaluation(s), from the medic or senior person present. This information is required in planning for destination of facilities and the need for guards. The unit requesting evacuation support should ensure that there is an English-speaking representative at the pickup site.

NBC Contamination (Wartime) (Line 9). Use the appropriate brevity code(s) to indicate contamination:

(1) N - Nuclear

(2) B - Biological

(3) C - Chemical

NOTE: Obtain NBC contamination situation information from the medic or senior person present. Include this line only when applicable. This information is required to assist in planning for the mission. Determine which evacuation vehicle will accomplish the mission and when it will be accomplished (arrive at the pickup site). Information concerning the vehicle to be used and the time of arrival can be obtained from the evacuation unit.

Prepare a Medical Evacuation Request

During wartime, brevity codes must be used in preparing all medical evacuation requests

NOTE: Under all wartime conditions, these requests are transmitted by secure means only. Therefore, the use of nonsecure communications dictates that the request be transmitted in encrypted form.

(1) Use brevity codes listed in FM 8-10-6, Evacuation Request Procedures

(2) Brevity codes should also be in SOI (ANCD)

(3) Locally brevity devised codes are not authorized

(4) The unit preparing the request does not have access to secure communications the medical evacuation request must be encrypted

(5) Information on the form must be encrypted except:

(a) Medical evacuation line number identifier. This information is always transmitted in clear text.

(b) Call sign and suffix (Line 2) which can be transmitted in clear text

During peacetime, two line number items (Lines 6 and 9) will change. More detailed procedures for use of the peacetime request format must be developed by each local command to meet specific requirements

General rules of radio communications:

(1) Transmission Security: The following basic rules are essential to transmission security and will be strictly enforced on all military radiotelephone circuits

(2) No transmission will be made if it is not authorized by the proper authority

(3) The following practices are specifically forbidden:

(a) Violation of radio silence

(b) Unofficial conversation between operators

(d) Excessive tuning and testing

(e) Transmission of the operator's personal sign or name

(f) Unauthorized use of plain language

(g) Use of other than authorized PROWORDs

(h) Unauthorized use of plain language in place of applicable PROWORDs or operating signals

(i) Association of classified call signs and address groups with unclassified call signs

(j) Profane, indecent, or obscene language

Call Signs are used in radio communications to identify a communications facility, a command, an authority, or a unit. There are two forms of call signs: complete call signs and abbreviated call signs

Complete call signs consist of a letter - number - letter combination and a suffix and are used when:

(1) Entering a net in which you do not normally operate

(2) When so requested by the NCS or another station in the net

(3) Abbreviated call signs are used at all other times

(a) EXAMPLES:

Complete Call Sign______________________A2D28

Abbreviated Call Sign_____________________D28

(b) If no confusion exists as to which operators are on the radio net, no call signs need be used

Pronunciation of Letters and Numerals

(1) To avoid confusion and errors during voice transmission, special techniques have been developed for pronouncing letters and numerals

(2) These special techniques resulted in the phonetic alphabet and phonetic numerals. The phonetic alphabet is used by the operator to spell difficult words and thereby prevent misunderstanding on the part of the receiving operator.

(3) The phonetic alphabet is also used for the transmission of encrypted messages. For example, the cipher group CMVVX is spoken "CHARLIE MIKE VICTOR VICTOR XRAY."

(4) Numbers are spoken digit by digit, except that exact multiples of thousands may be spoken as such. For example, 84 is "AIT FOW ER," 2,500 is "TOO FIFE ZE RO ZE RO," and 16,000 is "WUN SIX TOUSAND."

(5) The date-time group is always spoken digit by digit, followed by the time zone indication. For example, 291205Z is "TOO NIN-ER WUN TOO ZE-RO FIFE ZOO-LOO."

(6) Map coordinates and call sign suffixes also are spoken digit by digit. To keep voice transmission as short and clear as possible, radio operators use procedure words (PROWORDs) to take the place of long sentences.

Identify Types of Medical Evacuation Request Formats and Procedures

The medical evacuation request is used for requesting evacuation support from

(1) Air ambulances

(2) Ground ambulances

Two established medical evacuation request formats (ref. 9 line MEDEVAC request)

(1) Wartime

(2) Peacetime

Differences between wartime and peacetime medical evacuation request formats and procedures

(1) Line 6 of request

(a) Change from number and type of wound, injury, or illness (two gunshot wounds and one compound fracture) in peacetime to Security of pickup site in wartime

(b) If serious bleeding is reported, the patient's blood type should be given, if known

(2) Line 9 of request

(a) Change from description of terrain (flat, open, sloping, wooded) in peacetime to NBC contamination in wartime

(b) If possible, include relationship of landing area to prominent terrain features

Differences in security between wartime and peacetime in requesting procedures

(1) Under all nonwar conditions, the safety of US military and civilian personnel outweighs the need for security: Clear text (Information not encrypted for transmission) transmissions of medical evacuation requests are authorized

(2) During wartime, the rapid evacuation of patients must be weighed against the importance of unit survivability: Wartime medical evacuation requests are transmitted by secure means only

Transmit the Request

The medical evacuation request should be made by the most direct communications means to the medical unit that controls evacuation assets. The communications means and channels used depend on the situation (organization, communication means available, location on the battlefield, and distance between units). The primary and alternate channels to be used are specified in the unit evacuation plan.

Security transmissions

(1) Under all wartime conditions, these requests are transmitted by SECURE MEANS only

(2) Nonsecure communications dictates that the request be transmitted in ENCRYPTED FORM

(3) Regardless of the type (secure or nonsecure) of communications equipment used in transmission must:

(a) Make proper contact with the intended receiver

(b) Use the effective call sign and frequency assignments from the SOI

(d) Ensure that transmission time is kept to a minimum (25 Seconds maximum)

(e) Provide the opening statement: "I HAVE A MEDEVAC REQUEST"

Receiver Acknowledgement - after the appropriate opening statement is made, the transmitting operator

(1) Breaks for acknowledgment

(2) Authentication by the receiving or transmitting unit should be done in accordance with the TSOP

Clear Text and Encrypted Transmissions

(1) If secure communications equipment is used in transmission

(a) Request will be transmitted in CLEAR TEXT

(b) However, if the communications equipment used in transmission is not secure, the request must be transmitted in encrypted form with the exception of the following:

(i) Medical evacuation line number identifier (Line 1, Line 2)

(ii) Call sign and suffix in Line 2 may be transmitted in the clear

Letter and Numeral Pronunciation

(1) Letters and numbers pronounced according to standard radio procedure

(2) Give Line Number Identifier followed by applicable information

Medical Evacuation Request Line Numbers 1 through 5

(1) Line numbers 1 –5 must be transmitted first

(2) Allows evacuation unit to begin mission without delay

(3) Lines 6 – 9 should be transmitted as soon as possible

Monitoring requirements

(1) After transmission and authentication monitor frequency

(2) Wait for additional information

(3) Relay contact information from evacuation vehicles

Relay Requests

NOTE: If the unit receiving the request does not control the evacuation means, it must relay the request to the headquarters on unit that has control, or to another relaying unit. When relaying to a unit without secure communications means:

Transmit in encrypted form

Regardless of method of transmission, must ensure relay is the exact information originally received

Transmit by secure means

Radio call sign and frequency relayed (Line 2 of the request) should be that of the requesting unit and not that of the relaying unit

If possible, intermediate headquarters or units relaying requests will monitor the frequency specified in Line 2

SUMMARY

Medical evacuation is the timely, efficient movement of the wounded, injured, or ill persons from the battlefield or other location. In this lesson, we have identified the procedures for requesting medical evacuation support. The same format used to request aeromedical evacuation is also used for requesting ground evacuation. You have been taught the procedural guidance and standardization of request procedures and should now be able to apply the knowledge in the field.