Recent Issues and Advances in Aeromedical Evacuation (MEDEVAC)

crew members in Italy who were required
for active flying only sporadically, two or
three days a month. Further, the deployed
ALCE Commander required a change to
his terms of reference (TO&) to enable
him to divert his aircraft from UNHCR
duty to the purely Canadian mission of an
airevac. Command involvement in TORS
will occur much earlier in the process in
future.
Understanding leads to acceptance. Once
the ALCE Commander became accustomed
to the airevac role, he was intent on
keeping his medical crew nearby. When a
crew was obliged to bring a patient all the
way back to Canada, the ALCE
Commander immediately agitated for the
retum of "his nurse''. When a second
ALCE was established in Nairobi under
emergency conditions, the medical crew
was an integral part of the response from
the outset.
TERMS OF REFERENCE
When first tasked, the stated mission for
our medical crews was tenuous at best.
Without references for the deployment of
airevac crews, the first nurse to join the
ALCE was not well versed in her role, and
not understood by the ALCE staff who had
never had to consider the medical crew as
part of the team before. She was quite
literally required to write the medical terms
of reference, which were then modified at
will by her successors. While this was part
of the initial challenge of the job, it also
created unnecessary uncertainty and stress
as each team was required to explain the
"do's and donW of their job to aircrew
who were unfamiliar with the continual
deployment of medical crew. It was a
learning experience for all concerned, and
til crews began to rotate through for
tour did the medical crew truly
become a part of the team.
The first four months, when the mission
was simply to provide airevac support to
the ground troops in BosnidCroatia, were
quite sedentary - only two missions a
month were flown to the European
destination of Landstule US Army Medical
Centre in Ramstein Germany. However,
when the team began flying wounded
refugees and their families out of the
theatre of war, the terms of reference
changed again.
2-3
An understanding of our role was now
required from all agencies, including not
only our own aircrews but the UNHCR in
Geneva and Ancona, the Red Cross in
Sarajevo and Italy, and the medical
facilities on the ground in Sarajevo. The
medical crew was required to respond to
the imperatives of airevac in a war zone,
under fire or in imminent danger. While
tactical principles are taught on the initial
airevac course, this was the very first time
that these concepts had been implemented,
requiring decisions on such basic concepts
as getting off the aircraft to take report on
patients in a quieter environment - if you
did, you were quite likely to be left behind,
since the aircraft commander, in the
interest of his aircraft's safety, was intent
on a 5-8 minute turnaround time.
Other changes occurred as well. The
strictly airevac role of the meQcal
personnel was immediately expanded to
include doing sick call for the four nations
of aircrew stationed at Ancona Liaison
with the local medical establishment was
critical to this expanded role. Further,
Critical Incident Stress reactions were not
uncommon during the first few months of
the mission, and it became the nursek
responsibility to give a pre-deployment
briefing to all personnel prior to leaving