Michael's Dispatches 13 Military Pilots Rebuke the Joint Chiefs of Staff

Details Published: Sunday, 29 January 2012 19:48

An overview of harmful Army medical evacuation practices not endorsed by other service branches, and a response to official arguments defending this policy provided by the Joint Chiefs of Staff (JCS) to the House Armed Services Committee (HASC).

30 January 2012

Introduction

Michael Yon is a combat writer, and a former member of the US Army Special Forces. The New York Times noted in 2008 that he’d spent more time embedded with combat units than any other journalist in Iraq, and the reporting on his blog won the Weblog Award in 2005, 2007, and 2008. It is probable that he has also spent more time with combat troops in Afghanistan than any writer, photographer, or journalist of any sort. He is widely respected inside the military and beyond for the quality of his journalism, and his pursuit of the truth alongside US and allied combat personnel in the most dangerous theaters of operation.

On 18 September 2011, Mr. Yon accompanied an element of the US Army’s 1st Infantry Division, the 4-4 Cav, on a nighttime combat operation in Kandahar Province, Afghanistan. During this mission the unit was attacked with an Improvised Explosive Device, deafening one soldier, and amputating both legs and one arm of a second—Specialist Chazray Clark. Specialist Clark was conscious and communicating up until the time he was evacuated.

US and allied forces have two primary helicopter medical evacuation (MEDEVAC) assets in Kandahar: US Army “Dustoff” flights, and US Air Force “Pedro” flights. Unlike Army Dustoff flights, the Pedro flights—as well as British, Dutch, US Marines, Navy, and US Special Operations Command (SOCOM) medical flights—do not bear the Red Cross. The core reasons for this difference involve rapid reaction and maximum flexibility with limited air assets.

While Pedro, SOCOM, and Marine rescue flights can launch and insert quickly due to being armed, US Army Dustoff flights—following Geneva Conventions requirements for bearing the Red Cross—are unarmed, with Army policy requiring armed escort before they are allowed to launch their rescue missions. Consequently, unlike other MEDEVAC/CASEVAC flights, Army Dustoff flights are regularly delayed while they await escort gunships, often from other areas. There is no obligation under the Geneva Conventions to wear the Red Cross.

Specialist Clark and others probably died because of this delay.

During the incident in question, a Dustoff helicopter was approximately three minutes away, parked at Forward Operating Base Pasab. Both Dustoff and Pedro aircrews report being able to be airborne within roughly six minutes of receipt of orders.

However, because there were no Apache gunships available, the Dustoff flight for Specialist Clark was delayed. Official records state that he was delivered to hospital facilities 59 minutes after the MEDEVAC flight was requested by his unit—one minute from falling outside DoD standards, and within the “Golden Hour” from the moment of injury. But the military deceives here. Their fictitious Golden Hour does not begin at the moment of injury, but from the time the 9-line casualty report is received. This deadly deception was revealed in Golden Seconds.

Pedro helicopters also sitting at Kandahar Airfield could have completed this mission in less than 35 minutes. If Pedro or armed Dustoff had been stationed at Pasab, Chazray Clark could have been delivered to the trauma center in roughly 24 minutes.

The official record states that it took 59 minutes to deliver Chazray Clark to the combat support hospital. Video shot by Michael Yon provides conclusive proof that the military has deceived the Congress. Patient delivery took about 66 minutes from the time of injury, and about 65 minutes from the time of first report. There is no argument on this point. This clear deception brings in question all other military statements on this issue.

The death of Specialist Clark attributed to these delays is not an isolated incident.

The purpose of the Red Cross on Dustoff aircraft is to officially designate non-combatant status, granting immunity from hostile fire. Like many 20th Century rules of war, they are simply not recognized by any hostile elements the US is currently in conflict with. Even if they were recognized, the Red Cross is hard to see at night or during limited visibility. Helicopters do get hit with fire at night. For instance, a CH-47 was shot down at night last August, killing all 38 aboard.

According to the Geneva Conventions, "If there is no agreement, belligerents will only be able to use medical aircraft at their own risk and peril."

The reality is that helicopters bearing the Red Cross receive no protections, they are banned from participating in other high-need combat missions, and they have been delayed in their official duties to the point of permitting the deaths of US personnel.

It is also worth noting that because Geneva protections were not being afforded to clearly designated US Army Medics, they were ordered to cease wearing the Red Cross-marked armbands and helmets and to start carrying weapons—back in Vietnam. They have not worn them since.

Air Force, SOCOM, Marines, Navy, British and Dutch aircraft have foregone the Red Cross and its legal restrictions, resulting in vastly more flexible MEDEVAC capacity. In addition to being better positioned to save lives, it is notable that these units also maximize the dollar-value to DoD and the US taxpayer by maximizing the utility of the airframes and aircrews involved.

The senseless additional trauma inflicted upon Specialist Clark after the IED by faulty Army MEDEVAC policy was witnessed by Mr. Yon, and in further researching and reporting on the incident, the full scope of the poor judgment involved in these MEDEVAC policies came forth. Many seasoned professionals of all walks, including dozens of aircrew members of different service branches, reached out to him to provide further insight. Dustoff crews, in particular, expressed deep frustration with these policies.

Of additional tremendous concern coming to light is that current Army Dustoff policies actually violate Chapter VI of the 1949 Geneva Conventions, to which the US is a signatory:

“Article 36. Medical aircraft, that is to say, aircraft exclusively employed for the removal of wounded and sick and for the transport of medical personnel and equipment, shall not be attacked, but shall be respected by the belligerents, while flying at heights, times and on routes specifically agreed upon between the belligerents concerned.

They shall bear, clearly marked, the distinctive emblem prescribed in Article 38, together with their national colours on their lower, upper and lateral surfaces. They shall be provided with any other markings or means of identification that may be agreed upon between the belligerents upon the outbreak or during the course of hostilities”

Unless agreed otherwise, flights over enemy or enemy-occupied territory are prohibited.

Medical aircraft shall obey every summons to land. In the event of a landing thus imposed, the aircraft with its occupants may continue its flight after examination, if any.” (Underscore emphasis added)

The reporting of this incident and calls for a change in Army MEDEVAC policy resulted in significant pushback from Army authorities in-theater. Congressional interest and inquiry resulted only in further resistance from military authorities, including at CENTCOM, all the way to the highest levels of Pentagon military leadership—the Secretary of the Army and the office of the Joint Chiefs of Staff.

It is the opinion of Mr. Yon and many of his readers who are subject matter experts, that documentation provided to Members of Congress and the House Armed Services Committee (HASC) regarding Army MEDEVAC policy contains falsehoods and is obfuscatory in nature.

In particular, the office of the Joint Chiefs of Staff provided HASC an unsigned document with neither title page nor date, which was riddled with egregious errors and deceptions. With this document, JCS deceived Congress. While the author is unknown, and may have come from lower commands, the document was provided to HASC by JCS under the color of their authority, without caveat.

The remaining portion of this article addresses this document, and sheds light on the reality on the ground as our troops experience it. Of particular note, thirteen active duty helicopter pilots contributed to this analysis of the JCS document—five Army Dustoff, five Air Force Pedro, and three additional non-Dustoff Army. All have completed at least one tour in Afghanistan, or are there now. Many have also completed combat tours in Iraq. In total, these 13 pilots have roughly 25 combat tours between them, and thousands of missions. More than twenty subject matter experts contributed to this analysis.

A copy of the JCS document is published here. JCS Bogus report to Congress

Commentary and Analysis

The JCS document begins:

“The information below details the circumstances surrounding the event in question as first reported by Michael Yon in his blog titled ‘Red Air’ and followed up by an open letter to Secretary Panetta and President Obama.

After examining the facts and circumstances of this particular incident and compiling data regarding all MEDEVAC/CASEVAC missions in theater, we have found no merit to Mr. Yon's claims that any change in MEDEVAC policy or procedures would provide any improvement in current casualty survival rates.”

Mr. Yon: Both the White House and Pentagon were offered copies of the original, unedited video of the attack in which Specialist Chazray Clark was wounded, described in “RED AIR”, which extended over an hour and included the long delay of the Dustoff arrival. Neither the Pentagon nor the White House accepted the video, nor have they accepted argument from MEDEVAC crews, and aircrews from other services regarding the speed and effectiveness with which they can conduct rescue operations without the Red Cross designation. The edited, public version of the video may be found here.

According to JCS:

“Below are definitions that are useful and commonly used when discussing MEDEVAC procedures:

MEDEVAC- Unarmed, specifically designated (Red Cross), US Army UH-60s

CASEVAC- Any evacuation asset other than MEDEVAC (CH-47, UH-1, UH-60, etc.), may be armed or unarmed.

PEDRO- Air Force HH-60 armed with.50 caliber guns on both doors; primary mission is personnel recovery/CSAR; in RC-South, only located at KAF”

Mr. Yon: Pedro units are stationed not only at KAF (Kandahar Airfield), but at Bastion and Bagram as well. (In other Regional Commands.) More importantly, however, while their primary mission might be stated as “personnel recovery/CSAR”, the reality is that they are doing MEDEVAC/CASEVAC daily, and even patient transfers in other areas. Argument has been made that Pedro assets are limited strictly to special operations-types of rescues. This is not the reality of their employment in-theater.

JCS:

“THUNDER- Unit designation for the Army MEDEVACs in RC-South

CHASE- accompanying helicopter, generally "slick" Blackhawk (.240 caliber door weapons, no external tanks/rockets)”

Mr. Yon: No “.240 caliber” weapons exist in the US inventory. This is such a conspicuous error that the author simply cannot have had any experience with combat units. Within a combat unit, this is as glaring as saying, “The Houston Red Sox won the Super Bowl. It was a great soccer match.” Perhaps the author was interpreting this from the M240 machine gun, chambered for the 7.62mm cartridge. Further discrediting the author was a note I received from a Dustoff pilot currently in Afghanistan, stating that most Chase flights in Afghanistan are “MED on MED chase,” and are thus unarmed.

JCS:

“ESCORT- accompanying, full armed helicopter (Apache, Kiowa, Cobra, etc.); specifically not a PEDRO or lightly armed UH-60”

Mr. Yon: This is false—Pedro aircraft do perform escort. Pedros are well armed with two .50 caliber machine guns per aircraft. It is suspected that this duplicitous definition is an attempt to discredit or minimize the policy of other services to provide medical flights that are self-escorted, as Pedro flights are.

JCS:

“Category A (Cat A) - urgent case requiring evacuation within 60 minutes

Category B (Cat B) - evacuation required within 4 hours

Category C (Cat C) - evacuation required within 24 hours

First Up (1st up)- Primary flight asset with responsibility to be first to respond; generally assumed to have 15 minute "run up" time

Second up (2nd up)- Back up flight asset generally responding only after 1" 1 up is unavailable (on mission, mechanical failure, etc)

Run up -The time it takes to prepare an aircraft to fly; generally considered 15 minutes (some aircraft/crew take less time, some take more)”

9 line MEDEVAC Request- 9 lines of information requesting the evacuation (location, number and severity of injuries, condition of landing zone etc...)”

Mr. Yon: The assertion of 15-minute run-up times is inaccurate, and is likely being used to pad “acceptable” time into the delayed response in Specialist Clark’s MEDEVAC, and others. Pedro and Dustoff crews need about six minutes to be airborne. British MERT uses a larger helicopter and brings a surgical team and can take fifteen minutes during daytime, but up to thirty minutes at night.

JCS:

“Summary of events in response to ‘Red Air’.

The Combined Joint Task Force (CJTF) 82 decision matrix on MEDEVAC asset allocation is similar to that of the previous battlespace owner, CJTF-10, in that a dividing line exists whereby those missions falling to the west would be assigned to the MEDEVAC assets based at Forward Operating Base (FOB) Pasab and those falling to the east would be assigned to the assets based at Kandahar Air Field (KAF). While similar decision points exist for the MEDEVAC assets at FOB Sakari Karez, Tarin Kowt, and Wolverine, only the previously described line was relevant as the casualty of reference was between Pasab and KAF. The Patient Evacuation Coordination Cell (PECC) in RC-South has the decision lines plotted to assist with rapid evaluation in assigning the evacuation to the location with the most expedient route to the appropriate military treatment facility (MTF).

Based on run-up times and distance from the appropriate MTF's, CJTF-82 determined that the MEDEVAC is the only appropriate asset for any Category A casualty found west of the dividing line; Pedro, from KAF, will only be used for the much less urgent Category B (if PEDRO is first up) or Category C (if Thunder is first up). Those casualties to the east of the dividing line will be assigned to MEDEVAC or PEDRO based on which unit is first up and which is second up; the designation of which is alternated each Monday at 1300.”

Mr. Yon: The tone of this passage seems designed to appeal to authority and dazzle with vocabulary, but consistently, Pedro and Dustoff pilots report slow, weak, or poor decision-making processes coming from PECC. Reports indicate this is a major problem with the medical evacuation system in Afghanistan. A common complaint from pilots is that PECC will task aircrews in a way that makes little or no sense, including having a Dustoff or Pedro flight sitting “hot cocked” (ready to go), only to task a unit needing far longer to spin up, such as the excellent but slower British MERT (Medical Emergency Response Team).

Army and Air Force pilots insist the decision on who to send is often tactically senseless. The worst examples involve using Pedro units—possessing the highest and most advanced rescue capability—on routine Cat-B or Cat-C patient transfers. Mr. Yon accompanied such missions with Pedro. It is fairly mindboggling to witness a Pedro flight used for routine medical transfers—it’s the equivalent of using a SWAT team to write parking tickets, being taken out of availability along with the most advanced gear. Pedro HH-60G Pave Hawks are capable of entering very hot Landing Zones on the most dangerous or technically difficult of missions and terrain, on missions that may involve the most severe weather, heavy enemy forces, or require scuba (our vehicles are sometimes blown into rivers), or requirements where the medics may have to climb or parachute to patients. Dustoff cannot perform all Pedro missions, but Pedro can perform all Dustoff missions, and more. Pedro should be reserved for Cat A and very dangerous or technical work. Had this policy been in place for Specialist Clark, he may have lived.

As one Pedro pilot noted: “[This is a] serious problem—our aircraft were never intended to fly as much as they have had to. It is like owning a car with over 400,000 miles that you have to use as a daily driver. Our maintenance folks are killing themselves trying to keep them flying.”

A second Pedro pilot noted: “Pedro is limited in performance due to weight from mission equipment on high altitude missions in hot temps. We have HC-130s [Fixed-wing aircraft] in country and can still do a Jump Mission with the PJs to get medical care to them within the Golden Hour then call a Chinook for extraction. Which the PECC would probably never think of.

This is the critical problem with the entire system. ISAF PECC Qualifications are inadequate for the Medical Evacuation Personnel assigned. They make the recommendations on which asset to use to the officer in charge of the JOC [Joint Operations Center] who then authorizes it. The personnel who fill these positions try hard but are simply not qualified. Many are Non-U.S. Forces and come from other ISAF Nations. The only folks running Medical Evacuations in Afghanistan are American and British. Last time I was there and went to the PECC at Kandahar to see for myself who was making these decisions I was surprised to see for myself that it was a Medical NCO with clinical but no evacuation experience. Medical personnel run system not Personnel Recovery folks. They simply don’t know anything about tactical operations. They spend a lot of time thinking about what is the right thing to do rather than instinctively knowing what to do immediately.

This position should be filled by a Guardian Angel Combat Rescue Officer or Pararescueman, Pedro, Dustoff, or MERT pilot or crewmember that has completed at least one operational tour. We need someone making the recommendations to the officer in charge that actually knows what he is talking about.”

According to the JCS document:

“MEDEVAC's will require an ESCORT if the casualty is in a area designated high risk landing zone, "hot LZ" by the 9 line request. This is accomplished by the PECC alerting the supporting aviation brigade who then scans the airspace to locate the closest appropriate asset able to divert and provide coverage in to the high risk area. In most cases, an appropriate asset is already in the air and can quickly divert to cover the mission; however, if no flying asset is readily available due to mission necessity, an ESCORT will need to be requested from KAF. The latter is the least preferred as it will take more time to scramble the crew and "run up" the aircraft.”

Mr. Yon: This entire passage would be made largely irrelevant were Dustoff MEDEVACs armed. In all but the most extreme cases—where Pedro units would be best tasked—Dustoffs simply would not need escort if they had their own weapons. Pedro is armed and requires no additional escort. Escort requirements cause delays, and further stress already stretched rotary assets.

JCS:

“The incident in question involved a casualty at approximately 0450 on 18 September 2011 in the TF Spartan AOR in RC-South. Since the near entirety of TF Spartan's battlespace is west of the dividing line, the appropriate aircraft for any CAT A casualty in this AO is a MEDEVAC. In this case, because the western LZ was considered high-risk the MEDEVAC required an armed escort. Because none of the airborne assets were able to leave their mission to provide coverage an AH-64 was requested from KAF. The crew was scrambled and the aircraft was "run up" and launched toward Pasab; the MEDEVAC from Pasab then joined the ESCORT in the air as it approached the objective.

Timeline:

a. 04:50 – 9-line request placed by unit in field

b. 04:52 – Time of PECC authorization (and begin tasking for ESCORT)

c. 05:24 – Wheels up for MEDEVAC from Pasab

d. 05:37 – Wheels down for MEDEVAC at Casualty

e. 05:39 – Wheels up with Casualty

f. 05:49 – Wheels down at MTF (KAF)”

Mr. Yon: Had the Dustoff stationed at Pasab been armed, the seven-minute run-up time and roughly three minute flight time from Pasab to the Landing Zone (LZ), plus a combat-realistic 2 – 3 minute loading time, would have meant Specialist Clark would have been airborne to the Combat Support Hospital at Kandahar Airfield within fifteen minutes of his unit calling in the 9-line request.

Instead, roughly half an hour was wasted in waiting for an escort, along with additional minutes in linking up with the AH-64 escort.

According to JCS:

“The only stated time goal for MEDEVAC is the 60 minute "golden hour" from time of 9- line request to wheels down at the MTF. This mission was documented at 59 minutes. The 60 minutes is derived from a combination of assuming it takes 15 minutes to "run up" the aircraft, 40 minutes to fly from the base-point of injury-MTF, and 5 minutes for casualty load time; however, this breakdown is only based on estimates and there is no rule that each specific subset must be met.”

Mr. Yon: This passage is a stunning argument for mediocrity, and shamelessly uses poor policy to provide cover for poor decision-making. Given the circumstances and available assets, Specialist Clark should have been at the hospital within half an hour, maximum. This letter argues a fictitious 59-minute timeline, in addition to ignoring the minutes it took Specialist Clark’s leadership to determine, in the dark in a combat environment, the nature of the blast and casualties, and to call in the proper information in the required 9-line format.

JCS:

“The extenuating circumstances in this case were the need for an ESCORT and the atypical situation where an ESCORT capable of diverting from its current mission could not be found. This circumstance delayed the MEDEVAC from departing Pasab and required an AH-64 ESCORT to be alerted from KAF. While it would appear that 32 minutes from the PECC notification to wheels up for the MEDEVAC is excessive, the delay was due to the need to confirm that none of the ESCORTs in the air were able to leave their present mission and then to notify an AH-64 crew to move out to their aircraft, run it up, and fly to meet the MEDEVAC.

Mr. Yon's allegation is that the PEDRO would have been more appropriate in this situation. There is no substantiating evidence for this claim. In hindsight, it might have been possible to transport this casualty to the MTF more quickly if the PEDRO would have been launched at the exact time of notification for this mission but that would only have been possible with the foreknowledge of no available local ESCORT.”

Mr. Yon: The mendacity (or ignorance) of this argument is made clear by this Pedro pilot: “Does not make sense. Why would there be no operational knowledge of which tactical assets were available for tasking? Pedro was either first up or second up. If Dustoff was first up but had no escort, immediately send the second up, Pedro. Pedro goes either way. [This is a] leadership failure— there is a system in place, and they should know which assets are available. I knew when I was in Command of the Pedros who else was available besides us; there is no excuse for this.”

JCS:

“However, once the time had been taken to ascertain no active local ESCORTs were available, turning to the KAF-based PEDROs would not have decreased the mission time as the AH-64 and PEDRO would have similar preparation and flight times due to distance from the casualty.”

Mr. Yon: Again, the entirety of this argument would be irrelevant were the Red Cross removed, and Army MEDEVAC flights made by armed helicopters. Mission time would have been less than half of what it was. Critically, changing this policy also keeps those AH-64 Apaches on-station, on the combat missions they’re intended for, and protecting ground units.

JCS:

“If it is alleged that waiting for an armed ESCORT is an excessive delay it must be considered that to date, there have been only five escorted MEDEVACs that have encountered surface to air fire resulting in degraded operations, two of which were PEDRO helicopters.”

Mr. Yon: In light of the many counterfactual statements above, these numbers should be looked at with suspicion, especially considering that medical flights are not all qualitatively equal. It should be kept in mind that in August 2011, an ESCORTED helicopter was shot down during a combat operation, with 38 people being lost, including 22 Navy SEALs. This JCS red herring is discussed in detail in “Golden Seconds” . Importantly, Pedro units are far more frequently sent into far more dangerous situations than are Dustoff. Per capita, Pedro takes more fire.

JCS:

“Based on all the facts regarding this incident it is ISAF's contention that the MEDEVAC assets were properly managed according to well established protocol. Based on the information provided, the timeline appears reasonable for the conditions on the ground. The well established PECC procedures appear to have been followed and the casualty arrived at the MTF within the established 60 minute goal in spite of being injured at a high risk location requiring an ESCORT aircraft.”

Mr. Yon: Medical professionals know that the Golden Hour starts ticking at the moment of injury, and adding in the requirements of assessment and reporting for Specialist Clark’s unit, the overall time was well over the “Golden Hour.” Importantly, we were taking no ground fire on the LZ. A more courageous and sensible decision by PECC would have been to launch Dustoff and let the pilot and ground commander decide on whether to complete extraction, or to wait for escort. Pedro and Dustoff pilots complain that PECC tends to be risk averse to the point that troops die.

A pilot with a tour in Iraq and a recent tour in Afghanistan was livid with the JCS document: “This ‘Golden Hour’ thing is, as you have pointed out, a flawed way of thinking about it. Why not make it a ‘Golden Half Hour,’ or a ‘Golden as soon as possible’? It is just a statistical construct. Each wounded American soldier must be looked at and cared for individually in terms of what is best for them. In most cases, that means getting them there fast. It makes a big difference. Believe me, if the leadership had their own sons in harm’s way as I have [his son is also a combat veteran], they would think much differently, and become totally committed as I have to fly as many as possible to the hospital as fast as possible.”

JCS:

“Theater-wide MEDEVAC Statistics

For the period May to Oct 11 there were 1209 Coalition Forces (ISAF and USFOR-A) CAT A missions of which 95 CAT A missions were Out of Standard (OOS), meaning they exceeded the 60 minute Golden Hour planning factor. This equates to 7.86% of CAT A MEDEVAC missions that were OOS. There are several factors that can cause a mission to become OOS, including weather, mechanical, distance, enemy situation and waiting for air weapons team (AWT). Of the 95 OOS CAT A missions from May-Oct 11, seven were categorized as being a result of waiting for an AWT and none of these seven OOS missions had a clinical impact on the casualty.”

Mr. Yon: Considering Specialist Clark was alert and talking up until the point of being evacuated, but succumbed shortly thereafter, it’s fairly outrageous to read a claim that says nobody experienced “clinical impact” from these delays. This short timeframe and the attempt at wielding statistics to cover poor policy and judgment only adds to this outrage. Essentially, this document argues for a Military Golden Hour to be treated as a “pass all.” By self-scoring, if no more than 59 minutes of the debatable Golden Hour are used, they get a 100%. How many more wounded veterans would have died if evacuations were delayed by an additional forty minutes? According to iCasualties.org, 46,542 US troops (not to mention contractors and allies) have been wounded in Iraq and Afghanistan. If an additional 40 minutes were added to each before they reached a hospital, how many more would have died? One percent? Two percent? That’s anywhere from 465 – 931 additional dead.

“The overall trend line for OOS missions is decreasing over time. In 2010, 11.8% of the total CAT A missions were OOS compared to 7.86% OOS from year to date.

In the last six months, there have been a total of 57 surface to air fire events involving MEDEVAC aircraft. Of the 57, none resulted in aircraft being shot down. Five resulted in hits which degraded operations, including one British ‘Tricky’ CH-47, two US Army ‘Dustoff'HH-60s, and two US Air Force ‘Pedro’ HH-60s.”

Mr. Yon: Is this for the entirety of Afghanistan, or just Regional Command South? Importantly, the JCS admit here that the Red Crosses do not stop the enemy from shooting at Dustoff. We’ve seen too many faulty numbers and statements in the JCS document. None of the numbers can be trusted.

JCS:

“Summary

The MEDEVAC circumstances surrounding the specific incident highlighted in Michael Yon's ‘Red Air’ did not contribute to the untimely death of a brave Soldier who suffered a triple amputation due to an IED strike. Removing Red Cross from Army ‘Dustoff' helicopters will not improve the exceptional MEDEVAC capability already in place. Not only is there a policy implication with making such a decision but more importantly an operational impact which actually may degrade current MEDEVAC capability.”

Mr. Yon: This note from a former Ranger and Green Beret, who is also a combat veteran, clarifies the obfuscation: "Not one point that they have made in their letter supports the above contentions. They have written a letter and included arguments and made points, but not for the ‘conclusions’ above. It is as though the Chiefs wrote a different letter and then omitted all discussion of the Red Cross, not to mention ‘policy implications’ (and what does that mean?), not to mention their reference to ‘an operational impact.’ The Chiefs have not explained their nebulous ‘policy implications’ or their reference to potential ‘degraded capabilities’ or their reference to ‘operational impact,’ whatever that actually means. More artful public affairs sleight of hand. The Chiefs obviously think that we are stupid."

JCS:

“The primary mission of Pedro helicopters are for Personnel Recovery and Combat Search and Rescue. Pedro's in the Afghanistan theater are routinely integrated into the MEDEVAC rotation to maintain crew and medic proficiency. Because of advanced avionics and other organic armament and weaponry, the Pedro is rated as being able to only carry two litters at a time, compared to the Army Dustoff which is rated as being able to carry four litters at a time. The extreme altitude and often unpredictable weather conditions in Afghanistan make the weight of a helicopter a critical planning factor in being able to conduct flight operations.

Mr. Yon: A Dustoff pilot currently in Afghanistan disagrees. JCS states that four litters can go, but according to the Dustoff pilot, the Dustoff can carry four litters only “if carousel litter carriers are installed, in which case we would be power limited because the stupid things weigh over 500 pounds and make it impossible to work on any part of a casualty but their head or feet. We don’t use carousels in Afghanistan. We strap litters to the floor, and three will fit but two will be ignored.

The Dustoff pilot says two patients will be ignored. Experienced combat medics will say that no matter how great the medic, he or she cannot work on three Cat A patients simultaneously. Dustoff carries one medic and so more than a single Cat A will just be strapped down for the flight.

A flight of one Dustoff and one Apache can treat just one Cat A patient.

By comparison, Pedro escorts Pedro. Each of the two Pedro HH-60G Pave Hawks carries two or three pararescue “PJ”s. (Often a total of five PJs between the two birds.) And so a normal flight of two Pedro Pave Hawks can work five Cat A patients. (There is some nuance depending on types of wounds, etc.)

As medics, PJs are well trained. They also receive rigorous combat training and can parachute to patients, mountaineer, and scuba dive, all of which can be needed in Afghanistan. PJs are trained to fight. In the case that a Special Forces (Green Beret) team medic is wounded in Afghanistan, at least one Pedro unit planned to leave a PJ or two behind to cover for the team while another medic could be found. When patients are trapped in twisted wreckage of armored vehicles, PJs have gear and training to cut into the vehicles. PJs are something of mixture (for argument’s sake) between Rangers and highly trained medical personnel. And so with a Dustoff flight, you get one medic whose mission often must wait for launch authority. Pedro brings four .50 caliber machineguns with dedicated gunners, along with five commandos (PJs) who can get off the birds. Dustoff is an air ambulance: Pedro is more of a special operations force.

Pedro pilots dismiss the weight argument. As one highly experienced Pedro pilot noted: “…I've had three litters back there…and if the survivors can sit up (ambulatory) you can quite literally pile them in. I haven't limited the aircraft yet over there. The considerations are patient care, time en route, aircraft performance (do I have the power to take off) and the ground threat…if I don't take the survivor now does he have the time to wait for the next trip? As a Flight Lead, I'll weigh all available info, and lean on the Pararescue Team Lead to determine how many. If it’s a mass casualty event, we'll triage the survivors and take the Cat A’s first and return for the B’s and C’s and lastly the Heroes [KIA]. But yesterday here at [training] I put 9 people in the back of one aircraft, and 9 in another, total of 18 bodies in two aircraft. They were all ambulatory and the ground threat was high so comfort went out the window. It was about getting their asses out.”

JCS:

“Arming a Dustoff helicopter, whose primary mission is MEDEVAC, would require approximately an extra 600 lbs. This is based on two door gunners, 200 lbs each; two .50 cal machine guns, 841bs each; plus conservatively estimating 100 lbs of ammunition. This extra weight would have a severe impact on lift capability and also limit the ability to evacuate four litters vs. two. This trade-off of lift to armament is unacceptable and would result in severely degrading MEDEVAC operations.

Mr. Yon: Combat experienced Dustoff and Pedro pilots address this:

Dustoff pilot: “The weight argument is crap. My platoon flies UH-60A+ aircraft (Alpha slicks with Lima model engines) chased by UH-60L with [M-240 machine guns] mounted. Our chase birds outweigh us by about 1000lbs. The HH-60L and M models weigh significantly more but still much less than the Pedros' birds.”

Pedro pilot: “Remember that arming 2 x Dustoff helicopters means no chase aircraft and allows you to use both aircraft as evacuation platforms. You have a greater capability not less.”

Dustoff pilot: “…The notion that 600 extra pounds would exclude us from carrying 4 litter patients is wrong. We have a ‘PPC’ (performance planning card) that we use to tell us exactly how much we can carry…I can guarantee the Lima and Alpha+ models can handle that no problem...in RC S/SW. In east and north the altitude starts to get much higher so I can't speak for that region as we do not fly there. Second carrying 4 Cat A litter patients would most likely mean there was a mass casualty, of which my unit has responded to at least [stricken for anonymity] and to my knowledge they were all local nationals …Apart from that my medics generally put one Cat A on board because they can only efficiently work on ONE patient at a time, especially in the Clark case, with a triple amputation that medic has his hands full. That's not to say we leave anybody behind but the most critical are treated first. Which is why we spread the patient load. The example of 4 Cat A just sounds like deflection when the real point of all of this is not to increase patient capacity but to get the wounded off the battlefield in the quickest manner possible. If need be we can take as many patients as will fit inside, but as one of my medics told me, it comes down to who he thinks has a chance as to who gets treated on the flight as the majority of our flights are less than 30 min. Like I said above if one aircraft HAS to take 4 litters there have already been calls made and at least three more hawks will be en route.”

Pedro Pilot: “The DUSTOFF aircraft I escorted as a Pedro [were faster than] me; they were much lighter than I was and had a large power reserve that I did not possess because of my extra weight in armaments. That being said, the Pedros record on being able to still execute the CASEVAC goes without question.”

Mr. Yon: These pilots find no merit in the weight argument.

JCS:

“In conclusion, the MEDEVAC system currently in place is truly a success story. This level of capability has never been delivered before and demonstrates the degree of commitment that is expended in supporting our US, NATO, ISAF and Afghan forces. While it is not a perfect system it is truly unprecedented and we should ensure any changes to the system is carefully examined and only done after a thorough evaluation in order to ensure our service members receive only the best care available.”

Former Ranger and Green Beret: “I am really tired of the Chiefs [congratulating] themselves over a ‘level of capability that has never been delivered before.’ So what? [They] send the best men in the nation to war, who go willingly, who volunteer. They deserve the best. They are not receiving the best now, and worse, they are not receiving the best now due to bureaucracy and parochialism and the egotistical protection of fiefdoms. The JCS should be ashamed of themselves.”