Recent Issues and Advances in Aeromedical Evacuation (MEDEVAC)

for loading litter casualties. A second Yak-40 is available, but it
is not equipped with a cargo door. An Antonov-26 turboprop
transport carries 39 passengers on center-facing seats. 8 floor-
loaded litters and 19 ambulatory casualties can be carried by
folding up one row of seats. A rear cargo ramp facilitates
loading. Two IL-76 jet transports are used for cargo and
passenger transport. They can carry 79 seated passengers or 20
floor-loaded litters and 35 ambulatory casualties. The rear cargo
ramp facilitates loading.
Intertheater air evacuation is performed by contingent aircraft
or commercial air carriers. Contingent owned aircraft consist of
dedicated air evacuation aircraft or opportune logistics and troop
transports augmented with medical equipment and crews.
Repatriation to countries not operating such aircraft is conducted
using commercial airlines. A commercial Swiss air ambulance
is available to the UN with approval by the UN Medical Director
for special cases. France, Great Britain, Spain, Canada, and
USA are among countries that have the capability to send
aircraft on an urgent basis to evacuate casualties from theater.
2.3 Air Movement Restrictions
Air movement restrictions adversely affect the timeliness and
safety of MEDEVAC missions. Overflight of conflict areas is
limited to strict air corridors and a defined schedule established
by negotiation. Variations are allowed only by special
clearance.
~ Deviation of more than a few kilometers or a few minutes can
result in the warring parties firing on UN aircraft. Despite
adherence to air corridors, many of the UN aircraft have
sustained minor battle damage from ground fire. Helicopter
I landing sites are limited to designated helipads at established
camps. Most of these are poorly marked and not lighted.
2.4 Weather
Poor weather and lack of all-weather flying instrumentation and
air trafic control systems affect the ability to complete
MEDEVAC missions. There are no navigational aids in the
conflict area. Aircraft rely on LORAN and global positioning
system for navigation and have to perform visual approaches.
Low ceilings and fog combined with mountainous terrain create
a hazardous flying environment and preclude flying in some
areas.
2.5 Operational Factors
Numerous operational factors impact the effectiveness of
MEDEVAC in UNPROFOR.
Request procedures: Request procedures for an emergency
MEDEVAC mission are complicated. The request is relayed by
medical personnel through their battalion HQ and then through
the Sector HQ to either UNPROFOR Air Operations or BH
Command Air Operations. The flying unit is tasked by Air
Operations and a clearance initiated with the warring factions.
Clearances have to be approved for each party that will be
overflown. The clearance process can take from one to three
hours.
3-5
Communications: There is no capability for direct
communications between MEDEVAC aircraft and ground
medical units. Because of limited radio networks, all
communications must go through the battalion to the Sector Air
Liaison Officer.
Forward basing: There is no forward maintenance capability
for helicopters. Contracts do not provide for forward basing of
contract crews. Prepositioning of helicopters is limited to
daytime only and does not include medical crews.
Fiscal concerns: Fiscal limitations beyond the control of the
UNPROFOR Force Commander limit the availability and
prepositioning of dedicated helicopters for MEDEVAC.
Military helicopters in BH Command are limited to 25 flight
hours each per month. This effectively precludes their use for
training exercises. Contracts do not have provisions for the
additional costs of maintenance and billeting associated with
forward basing. Addition of more and better equipped contract
helicopters is difficult to achieve under the current limitations.
Language: Language barriers tend to complicate the request
procedure for MEDEVAC sorties. Although English is the
official UNPROFOR language, not all medical contingents have
personnel who can speak English fluently. Nonmedical
interpreters have to be used by some battalions to translate and
forward requests. Many of the staff officers forwarding and
receiving requests speak English as a second language. This
sometimes results in delays and incomplete information being
received.
Training: The level of training varies widely among the
contingents. Some medical contingents have no experience with
helicopter MEDEVAC. Training has to be conducted with all
contingents on UNPROFOR procedures. Some contingents who
have not sustained casualties lack a sense of urgency to prepare
for the worst case. Helicopter ground safety is a special concem.
There has sometimes been a reluctance by Air Operations to
dedicate their limited flight hours to MEDEVAC training
exercises with field units.
Sustained operations: The UNPROFOR MEDEVAC system
functions adequately for small numbers of casualties, but it
remains untested by a true mass casualty scenario. The level of
medical manpower and equipment is probably the limiting
factor. There are not enough medical crews to fully man the
existing aircraft without stripping battalion aid stations, field
surgical teams, and the hospitals of manpower and equipment.
Response to multiple incidents simultaneously or a sustained
mass casualty scenario might overwhelm the medical resources
of UNPROFOR.