It's time to give the Marines a dedicated medevac helicopter.
Are Army infantry soldiers more important than Marines as human beings or as components of U.S. defense strategy'.' If this strikes you as a preposterous and insulting notion in 2006, more than six deeades after Iwo Jima, eonsider the fuel that Marines still do not have a dedicated medevae helicopter-a nicety of war that is all about saving limbs and lives and that Soldiers have had for many years.
It is time to change medevae doctrine for the U.S. Marine Corps-Navy team. The doctrine is an anachronism that serves no one very well, least of all the Marines who light on the front lines and display such incredible valor.
An Expeditionary Requirement
The mission of the Marine Corps is expeditionary by its very nature. A helicopter dedicated to the men and women of the Marines would directly support that branch's mission. Currently, on the way back from a mission. Marine helicopters transport casualties as a lift of opportunity. But no Marine or Navy dedicated medevae helicopters are in the U.S. inventory. In Operation Iraqi Freedom, the 1st Marine Division had one designated CM-47 helicopter for medevae. It was an embarrassment-a stripped down CH-47 with no medical equipment, no ventilator, no true stretcher capability, and in short, nothing that would even look like the kind of civilian helicopter ambulance that we are accustomed to seeing on television.
The Army's Blackhawks have stretchers for up to six patients on a carousel vv ith ventilator capability just like a civilian helicopter. It should be noted that the definition of a "dedicated" medevae helicopter is one that is outfitted as a true air ambulance, has a red cross on it. and seen as part of the Geneva Conventions. A "designated" medevae helicopter, on the other hand, may or may not always be used to take out casualties and it has no medical infrastructure or red cross; therefore it is not pan of the Geneva Conventions.
In the future, joint operations will continue to share assets, hut the Marine Corps is operationally an expeditionary/amphibious force, and as such, in conjunction with the Navy will be involved in operations that are more unilateral than in the past. The Marine Corps-Navy team has a single battle strike capability. Today, the United States is fighting a global war on terrorism and casualties are different from other wars. USA Today reported in September 2006 that more than 1.000 American military have been killed by improvised explosive devices (IEDs) and more than half of the 20,000 wounded were the result of IEDs. These devices cause primarily loss of limb or traumatic brain injury. The majority of wounds therefore were from blast injury and not gunshot injury. We are and have always been good at preventing mortality (loss of life), but we can do much better to prevent morbidity (everything short of loss of life, such as loss of limb or limbs, brain injury, or eye injury). The Navy has developed the Forward Resuscitative Surgical System (FRSS), but it has limited capability and falls considerably short of what is needed (it has room for one general/trauma surgeon, one anesthesiologist, and maybe an orthopedist).
The "Golden Hour"
It is said that rescuers have a "golden hour" to prevent the death of a wounded combatant. To save limb and brain function should be the first choice of a medevac mission in a war on insurgency, when the injured numbers of Marines are variable at a time. If unavailable, then the FRSS or other venue should be used. And that other venue may be another serviee or country of opportunity.
But if the Marine Corps-Navy team stands alone in an amphibious operation, then medevac capability has to go to the primary casualty receiving treatment ship (generally a large-deck helicopter carrier). This should be the first choice, and this department on the ship should be more robust than it is now. The FRSS has great value but does not replace the level III facility or its smaller components on land that also must he restructured. But. remember, surgeons need to operate to keep their skills up. and deploying them for a year may not he in their and the Navy's best interest.
Add to this the reserve doctors who are generally older, more experienced, and usually subspecialists. They are routinely echelon I (first level of stabilization/ care) doctors for Marine battalions-the lowest level of care. General officers in the Marine Corps will tell you that all an echelon I doctor has to do is scoop up the wounded and get them out of the area to a hospital of some kind. They don't need any telecommunications. This may be true in a conventional war where the casualties are in the hundreds. But in an insurgency war, the injured may number us few as one to several, and because of the different type of weapon exposure, the wounded may require immediate specialized care.
It would be prudent for the echelon I doctor to have satellite phone capability to communicate to appropriate specialists for movement. Why? Because the specialists are fewer in number in the battlefield environment and this works in the civilian world. Applying what we know from the civilian world of emergency care and movement is not problematic. It just takes an adjustment in thinking.
Last, using the same argument about degradation of skills, and in particular that the reserve doctor is a citizen military doctor, he or she needs the same foresight in deployment length. They, too, need the benefit of shorter rotations to 30-90 days so that they can preserve their private practices. The global war on terrorism is going to be a long war. We need all the skills that we can gel. Otherwise, the Navy will be selecting for VA or university doctors only, and in time of war that degrades the pool number and selection of skill sets. But, there is always room for improvement, and we should settle right now for the dedicated Navy helicopters that the Marines so richly deserve. If that happens, we then can move on to other challenges with the potential to save even more limbs and lives.
Captain Vengrow is a Dallas-based neurologist who served as an echelon I doctor and later as a Task Force Surgeon Scorpion (Marine), staff CJTF 7 medical cell officer in Operation Inu|i Freedom in 2003. He has extensive training and certification as a Surface Warfare Medical Department Officer, Seabee Comhat Warfare Specialist, and as a Marine Corps physician.