# Afghanistan MEDEVAC Process



## AWP (Dec 18, 2022)

Something that I never thought about despite my years in country, is how did the MEDEVAC process work in Afghanistan? So...Bagram had Craig Hospital and I know places like Salerno and Fenty/ J-bad had some form of hospital or casualty care "place."

How did those fit together? The FOBs took lightly wounded or stabilized badly wounded until they could travel to Bagram? Badly wounded went straight to Bagram because a higher level of care was available or...what? I'm clearly ignorant of the process and trying to learn, even if it is over 7 years after the fact. I'm sure it even changed over time depending on force structure, MEDEVAC assets, a whole host of factors I'm guessing.

I should probably stop thinking about that damn country, but here we are.


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## Andoni (Dec 19, 2022)

AWP said:


> Something that I never thought about despite my years in country, is how did the MEDEVAC process work in Afghanistan? So...Bagram had Craig Hospital and I know places like Salerno and Fenty/ J-bad had some form of hospital or casualty care "place."
> 
> How did those fit together? The FOBs took lightly wounded or stabilized badly wounded until they could travel to Bagram? Badly wounded went straight to Bagram because a higher level of care was available or...what? I'm clearly ignorant of the process and trying to learn, even if it is over 7 years after the fact. I'm sure it even changed over time depending on force structure, MEDEVAC assets, a whole host of factors I'm guessing.
> 
> I should probably stop thinking about that damn country, but here we are.


Burn casualties went in-theater to Landstuhl, through Turkey, and then to Texas, after stabilized. Probably not helpful but it's before coffee.


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## Devildoc (Dec 19, 2022)

It depends on the nature of the casualty; the 'criticality'.  The army had combat support hospitals and the navy had fleet surgical hospitals (think upgraded MASH), the real sick went to role 3 (NATO designation) at Bagram or Kandahar.  Role 3 is basically a for-real multidisciplinary high-level hospital.

Of course there were echelons of care along the way...FOB --> FRSS/STP (Navy/Marine, not sure what the Army's unit is called...Forward Surgical Team?) --> CSH/FSH --> role 3 --> Germany.


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## amlove21 (Dec 19, 2022)

@AWP 

Yeah, pretty much what everyone here said. Basically, the Army was the lead component (with the British) for MEDEVAC throughout the nation. Before the FRAGO MOD 4 was dropped, we (AF Rescue) shared the pie because there were just too many missions to go around. 

So, from a tactical standpoint- someone gets injured. 9 line hits wherever the medevac/British MRT/AF PJs are. Back in those days they were calling them "Alpha, Bravo, and Charlie", but in the actual terminology those were URGENT SURGICAL/URGENT, PRIORITY, and ROUTINE patients. Alpha's were essentially immediate launch, Bravo's were within 8 hours, Charlie's you had 24 hours. They did this weird thing where they would call things "Tactical Alpha's" for a bit too. If a team went on target and some dude rolled his ankle or took a casualty that would affect the mission, they'd call MEDEVAC to take that dude off target. They weren't actually an URGENT/URG SURG, but they were slowing the team down, so they'd have to go. Those were always suuuuuuper sporty, for whatever reason. 

There was *sort of* a system for which platform got which patient between DUSTOFF, PEDRO and MRT- but it was ran by medical nerds and pilots and to be honest, they didn't do a great job. Every deployment I had, it seemed like I was fighting some J3 type that would send us to go on a patient transfer and send the MRT 47's into a hot LZ... it happened way, way too many times and I don't want to murder anyone today, so I am just gonna move past it. Some days it was just "next up", but some missions it was plainly apparent that shit was about to get sporty, so they'd send us. We had a great relationship with the MRT, and the architecture considered the MRT a "flying role 2", or an FST-like entity because their docs could do invasive surgery on the 47, so sometimes a patient would obviously need surgery on the bird, but it was too hot, so the PJ team would get on with the Brits. 

As far as "where did everyone go", it was pretty well covered above. There were a metric shit ton of FOBs around, and they all had some level of care they could provide. So lots of times it would be "medevac this dude off target, stabilize them enough for further transport, get them to BAF ASAP, further stabilize, then out to Germany and back stateside. 

Obviously, when you were out of BAF, everything was a smash and grab job to get back to BAF. If you were at Kandahar or Bastion or J-Bad or whatever, you'd have to figure out how bad the patient was, who could fix them and where to take them. Neuro and burns were only at BAF for a while, I wanna say the whole time. 

It got a little wonky when it was a partner force; out of BAF/Bastion, you'd basically take them to their own hospital, like Lashkargah. This was always weird because MED ROE was restrictive in who we could pick up, where we could take them, etc. We had to take people we *knew* weren't gonna make it unless they went to BAF, but they were Afghani, so you basically landed at Lash and wished them luck. Americans also *NEVER* went in the hospital for security reasons. The docs or nurses or whoever they were would come out with a gurney, sometimes a rickety ass wheelbarrow, take your patient with absolutely zero handover, and then we would bounce.


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## AWP (Dec 19, 2022)

@amlove21 you get that stupid-ass emoji but your post warrants more than a Like, but goddamn...anyway.

Part of me is fascinated by processes and I've read about how patient care evolved over the GWOT. Leaps and bounds, generational, even evolutionary shifts in patient care. With war, that's the best lemonade you can make some days. I'm curious how the process went from "IED and a bunch of fucked up dudes" for example to Landstuhl.

On a personal level, and I guess what made me think about this, was one of those little memories broke off like an acid flashback. I remember FOB Salerno and how when I left the pax terminal there was a "back road" which took me behind the FST/ CSH/ whatever hospital existed there. I remember walking that road to the end and then hanging a right for a LOOOOOONNNGGGGG walk to my radio site. Anyway, more than once I walked past the hospital and just had a dark thought: how many people died right inside that tent 50 feet from where I stood?

I have no idea why Salerno popped into my brain which led to remembering other things. I was sober at least, so...yay? I guess all of us as we grow older will have those moments and we'll either push them back into the box or come on here and ask questions. For that, I'm grateful for those who have, or will, answer.

FWIW, a different way for drip irrigating my garden popped to the front of my grey matter the other day, so it isn't all...this shit.


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## Devildoc (Dec 19, 2022)

amlove21 said:


> There was *sort of* a system for which platform got which patient between DUSTOFF, PEDRO and MRT- but it was ran by medical nerds and pilots and to be honest, they didn't do a great job. Every deployment I had, it seemed like I was fighting some J3 type that would send us to go on a patient transfer and send the MRT 47's into a hot LZ... it happened way, way too many times and I don't want to murder anyone today, so I am just gonna move past it. Some days it was just "next up", but some missions it was plainly apparent that shit was about to get sporty, so they'd send us. We had a great relationship with the MRT, and the architecture considered the MRT a "flying role 2", or an FST-like entity because their docs could do invasive surgery on the 47, so sometimes a patient would obviously need surgery on the bird, but it was too hot, so the PJ team would get on with the Brits.



The navy only relatively recently formalized enroute care, I want to say about 2010 +/-.  Before then it was "hey corpsman, hey nurse, there's the helo, get on it."  The helo might be navy, Marine, or army (I don't recall and AF), and we may or may not have had any training for that specific platform.  But even then the quality of care differed from what the army provided because our SOPs/TTPs were different.  That became joint and more formalized even more recently.

That's not even touching on the misuse of capabilities and the lack of education: we, you (PJs), AF CCATT, we not all the same.  None of us were better/worse, just all very different in SOP/TTP and capability.


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## Devildoc (Dec 19, 2022)

AWP said:


> Part of me is fascinated by processes and I've read about how patient care evolved over the GWOT. *Leaps and bounds, generational, even evolutionary shifts in patient care. *



No truer words.


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## amlove21 (Dec 19, 2022)

Devildoc said:


> The navy only relatively recently formalized enroute care, I want to say about 2010 +/-.  Before then it was "hey corpsman, hey nurse, there's the helo, get on it."  The helo might be navy, Marine, or army (I don't recall and AF), and we may or may not have had any training for that specific platform.  But even then the quality of care differed from what the army provided because our SOPs/TTPs were different.  That became joint and more formalized even more recently.
> 
> That's not even touching on the misuse of capabilities and the lack of education: we, you (PJs), AF CCATT, we not all the same.  None of us were better/worse, just all very different in SOP/TTP and capability.


Yeah there was often confusionan and people couldn't figure it out. I spent a lot of brain power trying to get people to understand what we were and what we provided- and I did that every single deployment. 


AWP said:


> @amlove21 you get that stupid-ass emoji but your post warrants more than a Like, but goddamn...anyway.
> 
> On a personal level, and I guess what made me think about this, was one of those little memories broke off like an acid flashback. I remember FOB Salerno and how when I left the pax terminal there was a "back road" which took me behind the FST/ CSH/ whatever hospital existed there. I remember walking that road to the end and then hanging a right for a LOOOOOONNNGGGGG walk to my radio site. Anyway, more than once I walked past the hospital and just had a dark thought: how many people died right inside that tent 50 feet from where I stood?
> 
> I have no idea why Salerno popped into my brain which led to remembering other things. I was sober at least, so...yay? I guess all of us as we grow older will have those moments and we'll either push them back into the box or come on here and ask questions. For that, I'm grateful for those who have, or will, answer.


Yeah man- I have a lot of those thoughts. We would take shit tons of incoming at BAF when I was there last, and they finally got "lucky" enought to actually hit some contractors right next to our building. We treated those three dudes in the concrete bunkers and they lived, so that was dope. But one of them wasn't super great. 

Anyway, that bunker was right by the back door to our building, it was the main entrance. Walking by that bunker every day going about my mundane tasks was a super weird juxtaposition to the ghosts of that scene- blood, carbon, med rucks, litters, all of us working hard to cheat death. 

We responded to a chow hall (it was the contractor chow hall- you know the one, you were there at that time) that also took incoming and it was a true mass casualty; months later, we happened to be at the range on that side of base and we stopped in to grab food. It was really, really weird.


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## Gunz (Dec 19, 2022)

AWP said:


> I should probably stop thinking about that damn country, but here we are.



You’ll never stop thinking about it. You’ll be thinking about it until the day you die, and not a day will pass without some iota of memory flashing through your head, however fleeting.

That’s the small part of us that never comes home.


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## Muppet (Dec 24, 2022)

AWP said:


> @amlove21 you get that stupid-ass emoji but your post warrants more than a Like, but goddamn...anyway.
> 
> Part of me is fascinated by processes and I've read about how patient care evolved over the GWOT. Leaps and bounds, generational, even evolutionary shifts in patient care. With war, that's the best lemonade you can make some days. I'm curious how the process went from "IED and a bunch of fucked up dudes" for example to Landstuhl.
> 
> ...



Brother, I routinely think about the past days at Bragg and Saudi right after the Khobar bombing when we went after for region security with the boys. I hated the Army fuck fuck games but loved my time as a line doc, miss that, it molded me to what I am as a paramedic today, but, I'll never feel like I did then with who I was with then, the shit we saw then (not "combat" but weird shit in a fucking shithole country with assholes that hated you).


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## Muppet (Dec 24, 2022)

Gunz said:


> You’ll never stop thinking about it. You’ll be thinking about it until the day you die, and not a day will pass without some iota of memory flashing through your head, however fleeting.
> 
> That’s the small part of us that never comes home.



That last line is seriously deep brother. For Nam vets, both my parents, pops a line doc with 101st, ma was a nurse at China Beach. Dad told me some stories, ma, never, ever talked about it and cried sometimes.

My grandfather was a line doc during DDay. I'm told he had a very hard time for decades.

I never saw combat, the mid and late 90s but spent time in a region of the middle east, during the Haaj (pilgrimage to Mecca), when every dick face that wanted to do dirt in country was there, saw some weird shit in and around AL Khobar/Daharan, still think of it at times.

To add, when shit it fan, a few things went on, we sent our guys to MODA, a Saudi Airforce hospital, then, they went to landstul.


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## Teufel (Dec 26, 2022)

I was lucky to avoid medevac out of Afghanistan so I can’t comment on how that process works past the BAS. I did my initial triage in Abu Ghraib the first time I was wounded, which was really different since there were detainees intermixed with coalition wounded at some points.


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## Gunz (Dec 26, 2022)

I  watched all the episodes of Inside Combat Rescue and recently rewatched the series. Just amazing what the PJs can do in the back of a 60. I got loaded into a Huey with two other WIAs and the only crewman was a door gunner. We couldn’t have gotten an aspirin.


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## Devildoc (Dec 26, 2022)

Gunz said:


> I  watched all the episodes of Inside Combat Rescue and recently rewatched the series. Just amazing what the PJs can do in the back of a 60. I got loaded into a Huey with two other WIAs and the only crewman was a door gunner. We couldn’t have gotten an aspirin.



I think @amlove21 talked about the series on here before, but my remembering might be faulty.  It was entertaining but I recall it showed some normal (i.e., regular CASEVAC/dust-off) stuff and not a whole lot of PJ-centric stuff.  I'd love to see a show about some of their more technical, high-speed rescues.  They sure had one or a million.

RE: about being in-country, I remember smells, sounds.  It's weird I can not think about it at all, then one smell is all it takes.  Then I think about it obsessively for a couple days then life takes over again.


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## Gunz (Dec 26, 2022)

I joked about aspirin. Doc had given me a shot of morphine before the dust-offs landed so the 20 minute flight to Danang was not bad. The Huey doors were open, the rotor wash felt cooler than the humidity on the ground.

Inside Combat Rescue impressed me greatly, especially the episode where these young NCO PJs performed a successful tracheotomy in the helo. Unbelievable.


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## amlove21 (Dec 28, 2022)

Devildoc said:


> I think @amlove21 talked about the series on here before, but my remembering might be faulty.  *It was entertaining but I recall it showed some normal (i.e., regular CASEVAC/dust-off) stuff and not a whole lot of PJ-centric stuff.*  I'd love to see a show about some of their more technical, high-speed rescues.  They sure had one or a million.
> 
> RE: about being in-country, I remember smells, sounds.  It's weird I can not think about it at all, then one smell is all it takes.  Then I think about it obsessively for a couple days then life takes over again.


Yeah, they focused pretty heavily on the MEDEVAC mission set and nothing else. At the time, the teams just wanted to get into the fight- and we did that, for sure. Looking back, I don't know if the price we paid (individually and as a career field) was worth it. MEDEVAC killed more PJs than gunfights did.


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