Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XIII: Aeromedical Evacuation
Intra- and Intertheater Medical Evacuation
United States Department of Defense
Intratheater medical evacuation moves patients from one hospital to another within the theater of operations. This includes evacuation between combat zone hospitals, between communication zone (COMMZ) hospitals, or from combat zone hospitals to COMMZ hospitals. Out-country, or intertheater medical evacuation moves patients from hospitals located within the theater of operations to designated casualty-receiving Medical Treatment Facilities (MTFS) located in the Continental United States (CONUS) or in host nations outside the theater. This complex evacuation system consists of two interrelated processes: patient regulation and patient movement. Whereas the medical officer is always responsible for any decision that impacts on the clinical welfare and stability of his patient, the patient administrator and the medical regulating officer (MRO) provide invaluable assistance by communicating up and down the echelons of the combat health care delivery system to facilitate the provision of safe, timely, and efficient movement of casualties. MROs at each echelon function as the gatekeepers and facilitators who achieve an even distribution of cases, assist in minimizing surgical backlogs, maintain an adequate number of available beds for current and anticipated needs, route patients requiring specialized treatment to the proper facilities, and coordinate the smooth, safe retrograde movement of casualties. This system is designed to ensure both the efficient and safe transfer of patients, often over great distances, in such manner that the welfare of the patient is second only to the success of the tactical mission. To achieve these objectives, MROs must maintain current information on the tactical situation, the availability of all types of transportation, the location and capacity of facilities with special capabilities, the current bed status of treatment facilities, surgical backlogs, the number and location of patients by diagnostic category, the location of airfields and seaports, and, most important of all, the individual patient's suitability to withstand evacuation.
Fixed-wing aircraft of the nonmedical variety are utilized to transport personnel and supplies into the theater of operations. After off loading, these same aircraft can be quickly converted and internally reconfigured to accommodate both litter and ambulatory patients. With the exception of aircraft specifically designed to transport patients, most aeromedical evacuation is performed in reconfigured standard military transport aircraft. These aircraft and their medical teams are selected carefully in consideration of the patient's needs. Jet-powered aircraft are capable of rapid patient movement in smooth air at high altitude in pressurized comfort. These movements can be accomplished for short or long-distances as required. Overnight rest stops can be provided along the way, depending upon the patient's clinical status and the distances involved.