Operations where air superiority was not an issue and war was not sufficiently intense to generate massive flows of casualties . In this context evacuation efforts focused on Air MEDEVAC rather than Ground MEDEVAC as the main element for both forward and tactical MEDEVAC .
Currently , the evolving security environment creates challenging conditions for support due to high intensity , non-linear battlefields with high mobility on the tactical and operational level . There are increased numbers of casualties and increased mortality rates due to the progressive capabilities and kinetic effects of weapon systems , as well as the A2AD threat and the high possibility of losing air superiority . These conditions require a mind-set change with a deeper look into the necessity and potential of a new medical evacuation concept .
In a large scale warfighting scenario as mentioned above when casualty rates rise and when the tactical / operational situation prevents the employment of air assets ( due to A2AD threat , lack of air superiority , etc .) casualties will have to be moved by Ground MEDEVAC to the appropriate MTF or between MTFs . Not only movement is restricted , but also number of casualties could be challenging , leading to the consideration of mass evacuation of casualties with various types of transport like buses and trains .
The features of a large scale scenario will have a direct impact on medical evacuation ranging from higher numbers of casualties to evacuation limitations . At all times the timelines of treatment , continuum of care and best medical practices are the overarching principles of medical treatment . These factors shape the medical support and evacuation plan to provide the best and most efficient support to troops on the ground . These factors should be taken into consideration not only for planning purposes but also as the promise and obligation of all commanders . In order to overcome the inherent limitations posed by large scale conventional warfighting scenarios and at the same time to maintain the provision of medical treatment within the framework of aforementioned principles , the ground MEDEVAC concept must be rethought . A robust medical evacuation system requires the following qualities : Timeliness , Availability ( aiming for 24 hours a day , in all weather and sea states , over all terrain and in any operational scenario ), Continuity and Multinational interoperability . Extended AOO , limited use of air assets and length of evacuation routes pose a real limitation and risk of not receiving appropriate standard of emergency medical care based on clinical needs and the qualities which were mentioned above .
For maximum efficiency of resources a revised ground medical evacuation concept could reduce losses and save our soldiers . The main problem with the existing ground MEDEVAC concept is that is not tailored to extensive and large scale warfighting scenarios . Mainly in specialized documentation the ground MEDEVAC concept is described very basically . Ground MEDEVAC assets are generally considered for Forward MEDEVAC and additionally the responsibilities from Point of wounding through Role 1 are national , which has focused the MEDEVAC concept in NATO Medical Documentation on an Air MEDEVAC concept .
The precondition of the evacuation of huge casualty number foreseen in a high scale conflict is based on an increased capacity of Ground MEDEVAC assets . Thus , buses , trains , ferries , etc . must be reconsidered in order to increase both capacity and capabilities to provide medical assistance along the extended and mass evacuation . The minimum requirement for ambulances is described in terms of capacity . The capability of these assets is stated as 1-2 casualties for ambulances with advanced units as well as 2-4 casualties for basic life support ambulances . This concept is tailored to ensure the high level of medical support in conflicts but did not consider the design of new conflicts with high peaks of casualties mentioned above . Therefore the design of ambulances should be reviewed to increase the capability to evacuate high dependency casualties .
The experiences of planning and executing exercises have indicated a need for a transfer point between forward and rear area . Extended lines of communication , terrain and weather conditions , limitations in use of air assets and mass flow of casualties hinder the proper evacuation of casualties according to regulations and documentation . Casualty Exchange Point between front line and rear area of operations could help to provide appropriate medical support during the evacuation . MEDEVAC assets of the front line would be able to focus more on Forward MEDEVAC rather than Tactical MEDEVAC , as MEDEVAC assets of the rear area take over casualties already at the Casualty Exchange Point .
The Casualty Exchange Point should be colocated but not subordinated to a Corps or Divisional Role 2 / 3 MTF , this providing the possibility of accommodating airframes , trains or buses . It should have an enhanced triage and nursed bed capability and capacity which enables it to direct patients either to the Role 2 MTF accommodated with or to other identified rear area MTFs and to provide medical assistance to patients waiting to be evacuated . The waiting time for evacuation to the rear area should be planned according to the best practices , capabilities , capacities and scale of operation . Ground MEDEVAC as part of the evacuation chain became more important , as conventional large scale warfighting scenarios have arisen . A new Ground MEDEVAC concept could be the response to upcoming challenges with focus on consideration and development of means , casualty exchange points between front line and rear areas , transfer of responsibility for MEDEVAC execution to the receiving unit , review of design for ambulances and increase in interoperability and standardization of national medical assets in a multinational context .
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