Gulf War Aeromedical Evacuation

375th Medical Squadron personnel off-load medical equipment from one of the 37th Airlift Wing C-9A Nightingale aircraft during a training exercise at the Headquarters Air Mobility Command, Scott AFB, IL, 29 September 1993
375th Medical Squadron personnel off-load medical equipment from one of the 37th Airlift Wing C-9A Nightingale aircraft during a training exercise at the Headquarters Air Mobility Command, Scott AFB, IL, 29 September 1993.

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Aeromedical Evacuation after Vietnam

Subsequent to the conclusion of the Vietnam War, Aeromedical Evacuation (AE) supported a variety of contingency and humanitarian operations over the next two decades. The more notable ones included Operation Homecoming (the return of US prisoners of war from Vietnam), return of the 52 American hostages held in Iran for over 400 days, evacuation of casualties from the bombing of the US Embassy and Marine Corps barracks in Beirut, and evacuation of 167 casualties from Grenada. Officially designated mobile aeromedical staging facilities (MASF) were in the AE inventory and available when Operation Urgent Fury in Grenada took place in October 1983 but were not used.

AE proved to be a key factor in the overall success of Operation Just Cause in December 1989. During that short but violent conflict to oust Panamanian dictator Manuel Noriega, wounded American soldiers, sailors, airmen, and marines received care at the joint casualty collection point (JCCP) at Howard AB, Panama. The JCCP, which included both conventional and special-operations assets, combined surgical and mobile aeromedical-staging capability into one element by employing MASFs for the first time. The JCCP treated 276 patients, stabilizing and evacuating 257 to military hospitals in San Antonio, Texas, on nine AE missions (using eight C-141s and one C-130). Four of the nine missions (which evacuated 192 casualties) took place during the extremely intense first 24 hours of the operation. The overall survivability rate for American service members treated at the JCCP during the operation was 99.3 percent (276 total casualties treated; only two died from their wounds). Furthermore, no deaths occurred during AE missions.

Aeromedical Evacuation during Desert Shield / Desert Storm

Marines are being loaded onto a C-141B Starlifter aircraft for Aeromedical Evacuation from Al-Jubayl Air Base in southern Bahrain to Germany for treatment of wounds received during Operation Desert Storm, 4 February 1991
Marines are being loaded onto a C-141B Starlifter aircraft for Aeromedical Evacuation from Al-Jubayl Air Base in southern Bahrain to Germany for treatment of wounds received during Operation Desert Storm, 4 February 1991.

The next challenge for AE came in response to Iraq’s invasion of Kuwait in August 1990. During the weeks preceding the start of Operation Desert Storm, United States Central Command predicted that as many as 15,000 Americans would be wounded in the early stages of the allied invasion to reclaim Kuwait. With the help of aeromedical elements from the Air Force and medical units from the Army, Navy, and Air Force, a coordinated, multitheater chain of evacuation was created to evacuate potential casualties.

The overall Air Force Medical Service deployment in Desert Shield was much faster than in the Vietnam War, even though 175 more hospital beds deployed (925 versus 750). Air transportable clinics and hospitals were the key to rapid mobility. The clinics deployed immediately with their flying squadrons. The first squadron medical elements and air transportable clinics left the United States on 8 August 1990, just one day after the first fighter aircraft deployments. The first ATHs left on 11 August from Shaw, MacDill and Langley Air Force Bases.

The Air Force AE system, totaling over 1,950 personnel, included 19 AE liaison teams, 12 MASFs, 99 tactical AE crews, 46 strategic AE crews, and 22 flight surgeons, as well as support and command and control elements. The plan was to use medically configured C-130s for dedicated evacuation flights within the Persian Gulf, followed by a combination of dedicated and retrograde C-141s evacuating the most seriously wounded to Europe and CONUS.

The mobilization and deployment of Air Reserve Component (ARC) forces were essential to the evacuation plan due to extremely high patient movement planning factors of up to 6,000 per day. ARC accounted for almost 97 percent of the total AE forces, serving in a multitude of AE elements that created an elaborate evacuation chain stretching from Southwest Asia to the CONUS. The planning factors for AE, predicated on a six-week rather than six-day air war were very high. Predictions averaged over 1,000 intratheater patient movements per day, and intertheater AE movements were predicted to average an additional 900 patients per day.

In Germany and England, several contingency hospitals and smaller tactical fighter wing hospitals were already in place. The Air Force contingency hospitals, containing from 500 to 1,500 beds, were "turnkey" facilities fully equipped and calibrated, needing only professional staff deployed from CONUS to begin operations. By early February 1991, these hospitals were ready for full operation.

Most Air Force planners did not anticipate that the air and ground fighting during Desert Storm would hardly tax the medical system. In the event, coalition casualties were so light that the staff at Air Force contingency hospitals in Europe, like many of their counterparts in the Arabian Peninsula, practiced very little combat medicine. From August 1990 to March 1991, disease and nonbattle injuries accounted for most of the patients evacuated from Southwest Asia to Europe during Desert Shield / Desert Storm. An aggressive preventive-medicine campaign was implemented, proving very effective in minimizing losses to disease. Orthopedic and sports injuries accounted for about 43 percent of the evacuees from the combat theater.

During Desert Shield / Desert Storm, several significant issues arose to challenge the AE forces, including the lack of Kevlar protective equipment for many of the Guard and Reserve personnel; the need for contingency training for the ground AE elements as well as a more streamlined, coordinated process for patient regulating; and review of interface points with the AE system. Nonetheless, the mission involved the largest deployed AE force in history, totaling over 12,632 patients evacuated on 671 AE flights with no in-flight deaths—a complete success.

Aircraft used for Aeromedical Evacuation during the Gulf War

The aircraft used for AE during Desert Shield / Desert Storm included:

  • C-9A Nightingale
  • C-130 Hercules
  • C-141 Starlifter

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