Military Capabilities

US develops new MEDEVAC technique for Africa ops

16 October 2013
US medical staff attend to wounded patients on a C-17 MEDEVAC flight out of Iraq in 2006. The lack of a forward surgical capability on the ground in Africa has forced the military to adopt a different casualty evacuation technique that involves giving a normally rotary-wing-bound TCCC team a surgical capability and deploying them on fixed-wing MEDEVAC transport aircraft. This hybrid outfit is known as an ECCATT. Source: US Air Force

The US has developed a new medical evacuation (MEDEVAC) concept for operations in Africa as a result of lessons learned from the 2012 attack on its consulate in the Libyan city of Benghazi, a senior US Air Force (USAF) officer disclosed on 16 October

Speaking at the IQPC MEDEVAC conference in London, Colonel Jay Neubauer, commanding surgeon of US Air Force Europe (USAFE), said that a new 'hybrid' casualty evacuation system has been devised to better cope with an incident such as the 11 September attack on the consulate, in which the US Ambassador and three of his staff were killed.

"[The attack] was a defining moment for the US and [Africa Command]. On that day we found that we could not respond quickly enough - either to fight or to move critically ill patients. That gave us the requirement to develop a capability to respond quickly to needs throughout Africa, particularly at embassies, including a '911' medical and evacuation capability," he explained.

According to Col Neubauer, the peculiarities of operating in Africa meant that the US military had to devise a wholly new MEDEVAC concept, rather than just transplant the systems that were largely developed in Iraq, and which are currently being used to good effect in Afghanistan.

"Africa is different for us. Whereas in Afghanistan and Iraq we had stable platforms available on the ground, in the form of field surgical teams and treatment facilities, etc; it is not that way in Africa. Africa is huge, and if you have to base something outside of Africa to go into Africa you have the tyranny of time and distance.

"Typically, where we choose to be [in Africa], the host nation standard of care is not up to Western levels. The environment does not support putting in large force numbers [especially medical] that far forward. So we end up with a forward damage control-gap, which has a knock-on after-effect [on the rest of the patient's care]," he noted.

"In places like Benghazi [where there are hostilities], it may not be in our interest to take patients downtown to the local hospital, so we do not have that surgical resuscitative capability that we have grown to rely on when we talk about the continuum of care in other theatres. The bottom line is that the model we have used for Afghanistan and Iraq just does not work for Africa, so we have had to come up with a different solution."

The MEDEVAC process in Afghanistan (and previously Iraq) follows a strict process of point of injury first-aid (Role 1), forward location surgery by Expeditionary Medical Support (EMEDS) personnel (Role 2), and rotary-winged (usually) airlift to Craig Joint Theater Hospital at Bagram Airfield (Role 3), fixed-wing airlift to the Landstuhl Regional Medical Center (LRMC) in Ramstein, Germany, (Role 4) before transportation back the United States.

With very few (conventional) forces on the ground, and with no organic medical facilities or airlift assets in its entire area of operations (AO), US Africa Command (AFRICOM) has up until now had to rely on a somewhat more ad-hoc approach to casualty care and evacuation that includes commercial aero-medical evacuation operators, local governmental air ambulances, or the occasional USAF Lockheed Martin C-130 Hercules or Boeing C-17 Globemaster III transport aircraft that happens to be passing through. None of these options is suitable for a dynamic situation such as that which unfolded in Benghazi.

The USAF looked at a number of options to enhance its MEDEVAC capabilities in the AFRICOM AO, but none of them were really what was required. "To bridge the [forward surgical and MEDEVAC] gap we started off with the notion that we could take one of our mobile forward surgical teams and put it on a [C-130 or C-17] aircraft, equipped to operate far forward on 10 surgical casualties," said Col Neubauer. "The problem though is that these teams are usually ground-based and so used to working out of a tent with a base infrastructure and medical capability around them to support them. Also, they are used to having a post-care capability functioning alongside them, and they have no 'on-call' capability."

Instead, the USAF decided to take the non-surgical rotary-wing based Tactical Combat Casualty Care (TCCC or T-Triple C) evacuation team developed in Afghanistan, and to give it a surgical capability to stabilise the patient and a fixed-wing platform to give it the range. The result is the Enhanced Critical Care Air Transport Team (ECCATT).

"It is designed very much to be a scoop-and-go [service] for those missions where we have to get in and out [quickly], and where we don't have the time to set up surgical teams on the ground," the colonel noted.

"We use the aircraft as a building of opportunity to allow the teams to do their damage control surgery either on the ground or en route to [the LMRC]. It addresses the surgical care gap and the need to transport unstable patients out of theatre," he said, adding: "This is really pushing the boundaries of our doctrinal envelope for us - in the conventional military we have never gone on to the movement of unstable and unvalidated patients in large fixed-wing aircraft in the past."

According to Col Neubauer, the first ECCATT team is already trained and stationed at Ramstein Airbase. Validation exercises will begin in the coming months and a concept of operations (CONOPS) will be drawn up over the next couple of years. "Eventually we will put this into our doctrinal tricks-of-the-trade," he said.


The development of a new MEDEVAC concept for AFRICOM comes at a time when the United States is becoming increasingly focused on the continent, largely in response to the attack on its consulate in Benghazi.

Over recent months, hundreds of US Marines have been deployed to bases across southern Europe to be used for quick intervention missions in North Africa under the auspices of the newly created Special Purpose Marine Air-Ground Task Force-Crisis Response, should the need arise. Also, US special operations forces are increasingly active in northern and eastern Africa in operations against Islamic militants in the region.

The recent raids by US special forces in Libya and Somalia indicate an increased willingness by the US government to use ground troops in the region, and a move away from the exclusive use of unmanned aircraft for such high-risk operations.

If so, this opens up the possibility of increased casualties, making the work done by the USAF and AFRICOM in enhancing their MEDEVAC capabilities all the more important.

(1087 words)
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