It never ceases to astound me that the self-proclaimed experts are so ignorant of the basic terms and definitions and too lazy to find the definitions they wish to elaborate on. In recent months, that has been one self-published journalist on a crusade to remove MedEvac markings from DustOff helicopters. He has recently proclaimed that the definitions of CasEvac and MedEvac are just too murky to figure out, for him, and hence beyond the comprehension of his readers, the Generals, and politicians he's trying to convince. Previously, he couldn't figure out what "Arab" means.
So what does the Army say is the difference?
a. Medical Evacuation. MEDEVAC is defined in FM 8-10-6as the timely, efficient movement and en route care by medical personnel of the wounded, injured, and ill persons, from the battlefield and other locations to MTFs (medical treatment facilities). The term MEDEVAC refers to both ground and air assets. Divisions are equipped with both ground and air MEDEVAC assets.
b. Casualty Evacuation. CASEVAC is defined as movement of casualties to initial treatment facilities and movement of casualties to MTFs in the combat zone. It does not include en route care by medical personnel and implies that nonmedical assets (UH-60s or CH-47s) are being used to move casualties. CASEVAC should only be used when the unit has a large number of casualties (exceeding the ability of the MEDEVAC aircraft to carry) or MEDEVAC is not available.
c. Casualty Evacuation Support for Operations. Use of CASEVAC aircraft for combat operations will be determined by the force commander. He should always request the use of MEDEVAC aircraft first. If current MEDEVAC support is insufficient to meet his requirements for evacuation of casualties, he should request CASEVAC support from the aviation brigade. If necessary, requests to use utility helicopters for CASEVAC operations will be made through the division G3. MEDEVAC aircraft that are DS to a division will receive their missions through the DMOC. The DMOC is responsible for airspace control measures and mission planning for MEDEVAC assets. .... In either case, the ground commander requesting CASEVAC support must understand that CASEVAC support provides transportation for casualties and does not provide any care en route to the treatment facility.
But what about those armed PJ/Pedro CSAR helicopters? They have dedicated medical personnel and machine guns. CSAR is COMBAT Search and Rescue. Their primary mission is to find and extract personnel shot down and/or on the run from enemy forces. Their secondary mission is to provide medical treatment after their primary mission is done. Historically, the CSAR mission was an Army Special Forces mission, but when the Air Force decided to get in the Special Operations community, because it has a bunch of pilots that could get shot down, they were given this mission. Their tactics to do so began with the manuals Army Special Forces had developed on it in Viet Nam.
Since there aren't a lot of pilots getting shot down in Afghanistan, the PJ's stand ready to use their skills in other capacities, and do a hell of a job at it, but Medical Evacuation is not their primary mission. They're good at en route medical treatment, but they are designed to go in fighting, and forcibly extract distressed Troops. It is a very special mission. And there remain many medical extraction missions that are better served by dedicating more space and weight to purely medical purposes than to use it for offensive weapons.
Why would you want to have two different terms for something with the same general goal? Well, the goal is to get the wounded to a Medical Facility as quickly as possible. Fortunately, the Army knew this question would arise and explained it in FM 8-10-6:
a. General. During air assault operations, the AATF staff and aviation battalion plan for the use of lifting aircraft to backhaul casualties from the LZ. Additionally, the force commander plans for MEDEVAC aircraft to support his operations. However, flowing MEDEVAC aircraft in during the air assault may become difficult and conflict with the ongoing operation. In this case, the AATFC and AMC will plan for CASEVAC operations by the assaulting aircraft. On air assaults with multiple lifts, the AATF plans for using the lifting aircraft to pick up casualties during successive lifts. On single lift air assaults, aircraft are designated to remain on standby for CASEVAC operations. These aircraft will normally stand by at a central location, most likely the PZ, FARP, or established holding area.
Clearly, it is better to have dedicated MedEvac personnel than to have CasEvac backups, but is there any "protection" offered these birds? CasEvac is a backup plan to get the wounded out to medical treatment, even though it's not a dedicated medical bird, but what of the MedEvac birds?
According to the Geneva Conventions, dedicated medical personnel and equipment (including hospitals, ambulances, air ambulances, doctors, and medics) are non-combatants and attacks on them are the equivalent of attacking civilians, i.e. war crimes. Even if captured, medical personnel are considered "protected" and not Prisoners of War. According to the Geneva Conventions, they are to be allowed free rein to do their medical duties, even in a POW camp.
So, if we know (and we do) that dedicated medical assets have a better likelihood of saving lives than the untreated care but quickest transport to those assets, then it is also clear that MedEvac is better for the patient than CasEvac. What then are the trade-offs of exchanging the Red Cross for a machine gun? Well, it would immediately remove the protections of the medical assets of the Geneva Conventions, but what would it gain? The (legal) ability to attack the enemy while evacuating friendly wounded.
There is finite amount of lift (i.e. weight) for a helicopter. There is a finite amount of space. A litter takes up more space than does a seated passenger. A medic need room to move around that patient, to work. A gunner needs room to work as well, and he and his gun also take up available weight. The more weight you put on an aircraft, the slower it flies. Every pound you put on needs to have a mission oriented purpose.
But the enemy doesn't respect the Geneva Conventions. To compensate for this the Army sends attack helicopters as escort to DustOff, but would it be better to just arm MedEvacs? It would take up precious lift and room to do so, weight and space unavailable to the medics to do their jobs. And even the best guns the military had to offer would be less than dedicated gunships protecting their flanks while they were on the ground doing medical tasks.
In other words, if we want to best care for Our Wounded, we need to dedicate as much weight and space to the medics that will care for them. And if we want to best protect those MedEvacs, we need to send in gunships for their flanks. But if those MedEvacs are already busy, we need to get Our Wounded to care as quickly as possible, and that means any bird in the area, even without the medics.
What must they do to be legally protected from enemy attack?
(1) Display the distinctive flag of the Geneva Conventions (red cross on a white background) over the unit/facility and in other places on the unit/facility as necessary to adequately identify it. (The other emblem recognized by terms of the Geneva Conventions is the red crescent. Emblems not recognized by the Geneva Conventions but used by other countries, such as the red shield of David by Israel, should also be respected.)
(2) Mark with the distinctive Geneva emblem (red cross on a white background).
(3) The GWS protects from attack any medical vehicle appropriately marked and exclusively employed for the evacuation of the sick and wounded or for the transport of medical personnel and equipment. The GWS prohibits the use of medical vehicles marked with the distinctive emblems for transporting non-medical troops and equipment.
Protected personnel are:
(1) Authorized to be armed with only individual small arms. (Army Regulation 71-32 provides the doctrine that governs what types of small arms medical personnel are authorized [limited to pistols or rifles, or authorized substitutes].) These small arms may only be used for defensive purposes. The presence of machine guns, grenade launchers, booby traps, hand grenades, light antitank weapons, or mines in or around a medical unit would seriously jeopardize its entitlement to protected status under the GWS.
CASEVAC Aircraft : UH-1Hs, UH-60s or CH-47s which are configured with litters and/or jump seats in order to provide evacuation of casualties when standard MEDEVAC aircraft are committed or unavailable.
MEDEVAC aircraft: UH-1Vs/UH-60As designed, equipped, and staffed to perform standard medical evacuation.
MEDEVAC pad: The pickup and landing zone established by the FSMC for use by MEDEVAC/CASEVAC aircraft in the conduct of aerial casualty evacuation missions to and from the FSMC. This MEDEVAC pad is marked in standard fashion with a red cross for daytime and landing lights for nighttime operations. This pad must be easily identifiable for pilots conducting both daytime and nighttime casualty evacuation operations and distinguishable from landing pads utilized for logistical resupply operations, troop pickup/landing, etc.Medical evacuation: Process of moving patients from point of injury (POI) or illness to a medical treatment facility (MTF) XVIII Airborne Corps, US Army.
ALL photos courtesy of SSG Brian Cowdrey, DustOff Medic, RIP.
See also: A Soldier's Perspective by CJ Grisham on the topic.
The Dustoff Mission at Bagram, Blackhawks loaded to the gills with medical equipment to save lives:
The US Air Force Combat Search & Rescue, "PJ's," or "Pedros," loaded with weapons, and enough medical equipment to stabilize a patient until they get to the hospital:
For the wounded, the most important thing is getting to medical care, as quickly as possible. Both Dustoff and the Pedros can do that. Getting care in the air, on the way to the hospital is best effected by the extra medical equipment aboard an Army MedEvac, but the Pedros will also use everything in their aircraft and all their skills, to keep the wounded alive.
Each has their place. Pedros have a primary mission of rescuing downed pilots and DustOff has a primary mission of saving the lives of the Wounded. Neither are slouches. Whether a Pedro or DustOff picks you up on the battlefield, your chances of survival have just gone up. But they are not the same and are not interchangeable.
Bouhammer Weighs In
BlackFive Weighs In
Assoluta Tranquillita Boils it down, and links to the sources, those that have been on the battlefield.
Stumble It!
