The Navy and Marine Corps do not have the dedicated equipment or personnel to properly transport their wounded from the point of injury to definitive care. Years of fighting in the desert, where other service assets are readily available to fill this critical role, have hidden the problem from senior naval leaders. But in a high-end war at sea, for instance in the Pacific, this gap in capability will become acute and could cost the lives of Marines and sailors.
Navy medicine is partly responsible for this capability gap, because it has not done enough to articulate to service leaders the full range of combat medical care tasks and functions or request the training and equipment to do all of them organically if needed. For example, most Navy and Marine Corps leaders do not understand the difference between a medical evacuation (medevac) and a casualty evacuation. A medevac is the planned transport of a patient with medical support including enroute care, whereas a casualty evacuation is the transport of an injured service member without medical care, colloquially referred to as a “dust off.” Neither the Navy nor the Marine Corps designates specific air assets for dedicated medevac or casualty evacuation missions—they perform these evacuations with whatever asset is available at the moment. When operating in a joint land-based environment such as Afghanistan, they mostly rely on the U.S. Transportation Command’s Air Force assets or the Army’s fleet of Black Hawk helicopters.1
The Range of in-Transit Patient Care
The Air Force medevac system largely focuses on transporting patients from small, forward field surgical elements to definitive care at either a large overseas medical facility such as the Landstuhl Regional Medical Center in Germany, or a U.S.-based military treatment facility (MTF). This means the transport of wounded from the point of injury to a battalion aid station (BAS), or from a BAS to a forward surgical element, is not standardized or well supported and occasionally calls for the use of Tricare contractors.2 At sea, the equivalent situation would be transporting someone from a small screening ship to a large, surgery-capable amphibious ship. It should be a standard, well-practiced procedure, but unfortunately this is not the case. The Navy and Marine Corps need to plan now for how to meet this critical requirement in a maritime conflict over a wide geographical area. Better casualty evacuation and medevac resourcing and training will ensure critical emergency care for sailors and Marines in the “golden hour” of trauma.3
The most medically capable Navy or Marine Corps air asset is the SH/MH-60 helicopter when attached to a search-and-rescue (SAR) unit. In addition to training in recovering personnel from the water, a SAR corpsman undergoes rigorous training in providing enroute care and may be certified as a basic or advanced emergency medical technician, which allows the person to perform emergency procedures almost to the level of a licensed medical provider operating under the direction of a supervising provider.4 Every aviation command also has a flight surgeon, although each surgeon’s credentials and qualifications for trauma care vary and typically do not include aerial enroute care.
There are not enough SAR-designated H-60s to support a large-scale maritime conflict. Other Navy and Marine Corps aviation assets used for enroute trauma care are the V-22 Osprey tiltrotor aircraft, the UH-1Y Super Huey helicopter, and the CH-53D/E Sea Stallion/Super Stallion helicopter. These aircraft are not, however, outfitted with dedicated medical hardware to transport wounded patients. For example, the older UH-1N Huey’s litter kit—a stretcher and associated equipment designed to fit in a Huey along with care providers—is compatible with the newer UH-1Y, but it was never formally authorized for the UH-1Y, is not currently produced, and is largely out of stock fleetwide.5 As of May 2018, 1st Marine Air Wing (MAW) in Okinawa, Japan, had none, and only one complete kit was maintained with 3rd MAW in Miramar, California—despite the fact that humanitarian operations requiring medical care during air transport are common in the Indo-Pacific theater, such as after the 2004 tsunami in Indonesia and the 2015 earthquake in Nepal.6 It is unclear whether the CH-53K King Stallion, just now being fielded by the Marine Corps, can accommodate a standard set of patient-care transport equipment.
Better Transport for Future Conflicts
The Navy and Marine Corps need to develop new and refine existing casualty evacuation and medevac capabilities in three areas: ship-to-ship transport, ship-to-shore transport, and point-of-injury shore-to-shore transport. In other words, tactical combat casualty care for the at-sea environment must be significantly improved and standardized fleetwide.
First, the Marine Corps needs to designate more air platforms as dedicated assets for this mission, which will align aviation units more accurately with standing mission-essential task lists.7 Dedicated organic air assets for in-transit medical care also will allow medical professionals to be more realistically integrated into combat training scenarios earlier in the training cycle.8
Next, the Marine Corps needs its own enroute medical care course similar to the joint Army and Air Force course. A Marine Corps version should incorporate the flight portions of SAR corpsman training and the competencies necessary to hand off care of a wounded patient to a joint medical unit at an MTF. With such a sea service–unique course, the Marine Corps will ensure that aeromedically designated Navy doctors, nurses, and corpsmen are better trained on the aviation assets they will need in a maritime conflict. This will translate into better care for wounded service members.
Finally, the Navy and Marine Corps need to invest in aeromedical supplies that already are approved by naval aviation for use in all aircraft capable of supporting a casualty evacuation or medevac. Aside from medical kits supplied to designated SAR units, Navy and Marine Corps aircraft squadrons have no authorized medical allowances to support this type of care. For example, defibrillators—the most important lifesaving tool during cardiac arrest—are not certified for use on board naval aircraft.9 This type of gap could swiftly be rectified if the naval service developed its own robust organic capabilities.
If the services do not address these enroute medical care deficiencies, the cost to wounded sailors and Marines will be high in any future maritime conflict.
1. U.S. Marine Corps, Field Medical Training Battalion Manual, 1-127.
2. U.S. Joint Chiefs of Staff, Joint Publication 4-02: Joint Health Services, 28 September 2018, I-5. Naval Tactics and Training Publication 4-02.2M, Marine Corps Reference Publication 3-40A.7 (Formerly 4.-11.1G), 2-2 through 2-4, and 4.1.2.
3. Hannah Pham, Yana Puckett, and Sharmila Dissanaike, “Faster On-Scene Times Associated with Decreased Mortality in Helicopter Emergency Medical Services (HEMS) Transported Trauma Patients,” paper presented at the American Association for the Surgery of Trauma 76th Annual Meeting, Baltimore, MD, 9–12 September 2017.
4. U.S. Navy, NTTP 3-50.1: Navy Search and Rescue Manual, 7–4, 7.3 Medical Direction.
5. U.S. Navy, “UH-1Y NATOPS,” NAVAIR Instruction 01-110HCG-1.
6. Bhadra Sharma, “U.S. Military Wraps Up Relief Effort for Nepal Earthquake,” The New York Times, 21 May 2015.
7. U.S. Marine Corps, “Marine Aircraft Group 39 Mission Essential Task List,” “HMLA (Core) Mission Essential Task List,” “MAW (Core) Mission Essential Task List,” “VMM (Core) Mission Essential Task List.”
8. U.S. Navy, Navy Air Tactics, Techniques, and Procedures Publication (NTTP 3-22.3); U.S. Navy, “NAVMC 3500.14D: Aviation Training and Readiness,” 2–82, EVAC-3206.
9. NTTP 3-50.1, 7–4, 7.3.