Recent Issues and Advances in Aeromedical Evacuation (MEDEVAC)

Norwegian Helicopter Squadron. It is approximately 20
kilometers from the UN-operated Tuzla Airfield.
1.5 Medical Command and Control
Medical Command and control is limited to the HQ,
UNPROFOR Force Medical Branch and HQ, BH Command
G3MED. The Force Medical Branch has 6 officers (2
physicians, a public health officer, a medical operations/plans
officer, an air evacuation operations/plans officer, and a medical
logistics officer) and 2 NCO clerks. The position for an air
evacuation operations/plans officer was not filled until August
1994. BH Command has a chief medical officer, a medical
operations/plans officer, and an enlisted clerk. The Sector
Headquarters each have a Sector Medical Liaison Officer. This
is a senior medical officer appointed from one of the contingent
medical units in the sector. His role is to advise the sector
commander on medical matters and to assist the Force Medical
Branch in communication with units and implementation of
force medical policies. Since this is an additional duty position,
the role is one of medical planning and cannot be relied upon for
supervision of sector medical operations. The French, United
Kingdom, and Canadian contingents have medical elements
assigned to their contingent headquarters. These personnel are
important points of contact outside of the UN chain of command
for medical planning. Control of all air assets assigned to
UNPROFOR is the responsibility of UNPROFOR Air
Operations which has staff assigned to each major headquarters
and every sector headquarters. The Medical Branch does not
control any intertheater air evacuation assets. Those assets are
contingent nation responsibility.
1.6 UNPROFOR Casualties
Casualties among the UN troops from June 1991 to 15 July 1994
amount to 474 battle injuries and 46 battle deaths. There have
been an additional 594 major non-battle injuries and 53 non-
battle deaths. Casualties have been divided almost equally
between Croatia and Bosnia-Hercegovina. FYROM Command
has not had any battle casualties. Over 1 100 soldiers have been
repatriated for medical reasons.
1.7 Casualty evacuation
Casualties in the UNPAs are evacuated by ground to a battalion
aid station and/or field surgical team. Then they are evacuated
by helicopter or ground ambulance to the US Hospital in Zagreb.
Level 4 care is available from Croatian medical centers in
Zagreb, if needed. The US Hospital serves as an aeromedical
staging facility to repatriate casualties to their home countries.
Serious casualties from accidents in FYROM are evacuated by
helicopter to the Military Hospital in Skopje. From there, they
can be transferred by fixed wing UN transport to the US
Hospital, or they can be directly repatriated to their home
country. Casualties in BH Command are normally transferred
by ground to a field surgical team. From there, they are
evacuated by helicopter to either the Norwegian Hospital or to
Split. At the Split airport they are either transferred directly to
3-3
an intertheater air evacuation aircraft for direct repatriation, or
transferred by UN fixed-wing transport to The US Hospital.
Patients requiring repatriation from the Norwegian Hospital are
transferred to Zagreb or Split by either helicopter or fixed-wing
aircraft. There is no inpatient aeromedical staging facility at
Split. The French Air Force provided one on a temporary basis
during initial enforcement of the heavy weapons exclusion zone
around Sarajevo. Had the airport at Sarajevo become closed for
a prolonged period, the main route of casualty flow from
Sarajevo would have been by ground ambulance to a safe
helicopter staging area and then to Split. An inpatient staging
facility was needed for this contingency to facilitate transfer to
the US Hospital or repatriation. The aeromedical staging facility
was not used and was withdrawn following the crisis. Currently,
French, British, and Spanish clinic teams at Divulje Barracks
provide transport and manpower for transfer of casualties at
Split. Their dispensaries can be used for holding of six to ten
stable patients. A direct aircraft to aircraft transfer at Split
Airport is used for urgent cases. Less urgent cases are unloaded
at Divulje Base and transferred to Split Airport by ambulance.
Humanitarian medical evacuation of refugees in support of
UNHCR is periodically conducted using BH Command air
assets. These evacuations are staged through the Split airport
where the patients are transferred to UNHCR sponsored aircraft
for movement usually to Ancona, Italy. Other UNHCR refugee
flights have been staged from Llubljana, Slovenia.
2. PROBLEMS
2.1 Ground evacuation
Ground evacuation is difficult, often impractical, and sometimes
impossible in this theater because of numerous factors. The
force is widely dispersed. Units are thinly spread over large
areas, often isolated by geographic barriers and warring faction
troops from their main garrisons. The mountainous terrain that
predominates in much of the region imposes severe restrictions
to rapid movement. Rivers and marshes in the plains, coupled
with the destruction of numerous bridges create further natural
barriers. Most of the roads in the conflict area are limited to
small, winding, poorly marked secondary roads that have seen
heavy use and little maintenance during the past three years.
Some main supply routes in Bosnia-Hercegovina are nothing
more than single lane dirt roads. Heavy accumulations of ice
and snow make many routes impassable in the winter. Dense
fog creates a further safety hazard. Casualty evacuation is
impeded by numerous warring faction checkpoints, particularly
when a conflict line must be crossed during the evacuation.
Some routes are closed unpredictably by hostilities or by the
whim of the controlling party. The presence of numerous
unmarked minefields is a further concern. There are no level 2
medical units available to carry out the mission of ground
evacuation and sustaining treatment since the withdrawal of the
British Medical Battalion from the UNPAs in September 1993.
Battalion medical units must be able to evacuate casualties to the
hospitals with their own assets unless they can be evacuated by