Aeromedical Evacuation Control Centre
Besides the operational “Planning”, “Tasking” and “Mission Controlling Branch”, a fourth essential part of the EATC’s Operational Division is the Aeromedical Evacuation Control Centre (AECC).
This centre, staffed by Aeromedical Evacuation specialists (5 flight surgeons and 3 flight medics) coming from the different EATC Participating Nations (PNs), is responsible for the coordination and supervision of the medical evacuation of soldiers from anywhere in the world to their home country, or to a safe place where better medical care is available. This type of evacuation is called Strategic Aeromedical Evacuation (StratAE).
In 2014, the EATC AECC managed the transport of 1126 patients. Patients have been repatriated from 68 countries all over the world, proving that StratAE is a worldwide mission.
More cross-nationality is the future goal
One of the major goals of AECC is to provide synergistic effects by repatriating patients in cross-national flights, meaning that a patient is transported by another nation’s aircraft (e.g. a Belgian patient on a French aircraft).
A good example of a cross-national mission occurred in March 2014: A French navy soldier with a sprain of his left knee was repatriated on board of a German A-310 from Dakar back to Cologne. He was escorted by a medical team consisting of a German paramedic and a French flight nurse. Later that day the patient had an additional flight with a French C-235 bringing him back to Paris.
Another good example of a cross-national mission took place in July 2014:
A Dutch corporal had an appendectomy in the French Role 2 in Gao, Mali. He was brought to Bamako with an intratheatre flight. From there he was flown to Brussels with a Belgium ERJ-135 on a stretcher and escorted by a Belgium medic and a Dutch flight nurse. Further repatriation back to the Netherlands was done by a Dutch ambulance.
AECC aims at cross-nationality
The EATC AECC also coordinates evacuations of patients from non-EATC nations:
In March and September 2014, the MedEvac version of German Airbus A310 MRTT (located at the Special Air Mission Wing MoD in Cologne) took off towards Kiev (Ukraine), where injured Ukrainian soldiers had been gathered from several hospitals in order to bring them to Germany to relieve the Ukrainian health care system and to provide additional high-standard medical care. On the way from Kiev to Germany, the Airbus made stops in Berlin and Hamburg before finally reaching Cologne again. These stops were necessary to distribute the patients among nearly all German military hospitals. During the second mission in September, some of the patients were flown from Berlin to Stuttgart with a German MedEvac C-160 on the same day to facilitate the patient distribution and to avoid the excess of allowed crew duty time. In order to execute cross-national StratAE missions the medical personnel has to be trained and certified on the different nations’ aircraft to comply with national and multinational regulations. With the introduction of new courses to train AE personnel on other nations’ MedEvac aircraft and equipment the opportunity for cross-national training and qualification was established.
In 2013 AECC was able to increase the percentage of cross-national Strategic AE from ongoing missions as new operational areas with single Strategic AE hubs (e.g. Bamako) created the opportunity for significant enhancements. This increased number of cross-national flights was obtained by mainly utilizing already preplanned routine flights.
Due to significant changes in the areas of operations (e.g. France is no longer using Bamako as hub) and the end of the ISAF-mission, the percentage of cross-national Strategic AE has slightly decreased in 2014. Nevertheless - as proven by the examples below - cross-national Strategic AE is still one of the key goals of AECC.
The following two cross-national Strategic AE missions were performed with dedicated aircraft in full AE configuration.
1. On 25 May 2014 a German Airbus A-310 in full AE configuration took off from Cologne in the afternoon in order to pick up 3 French and 3 German casualties in Djibouti after a suicide bomber attack. The patients were escorted by a German medical team consisting of 10 medical personnel: A flight surgeon functioning as Medical director (MD), a non-commissioned officer (NCO) as Medical crew chief (MCC), a Medical Equipment engineer, an anesthesiology team and four flight medics. All patients were brought to Cologne. Then these French patients were flown back to Paris with a Falcon 900 escorted by a French flight nurse and the German patients were distributed to different hospitals in the surroundings for urgent surgery.
2. On 10 December 2014 the German MedEvac A-310 took off from Cologne again for a flight to Bamako. The German medical team was augmented with a Belgian Flight Surgeon, a flight nurse and 3 medics. Due to a delay in receiving diplomatic clearances and according to crew duty regulations, a remain over night (RON) in Bamako was necessary. The next morning the Belgian soldier was brought to Bamako from Koulikoro via a 2 hour lasting road transport. Finally the patient was enplaned on the MedEvac A310 on a litter and repatriated back to Brussels on that same day.
Both recently performed missions demonstrate the gain in flexibility and efficiency achieved by this cross-national cooperation. Besides, mutual trust and confidence is increased in the involved medical personnel and responsible military commands.
In order to provide the best possible medical care to patients, the EATC AECC can task several assets from the different PNs. Depending on the type of injury or disease, a PTU (patient transport unit equipped with monitoring, respirator, medication etc. for intensive care) or a basic stretcher can be used for the evacuation.
PTUs are available in the Belgian Embraer ERJ-135 and ERJ-145, or the German Airbus A310, A319, A340 and C-160 Transall. Belgium just acquired 2 pallet-based PTUs to be used on C-130 and future A400M. PTUs (LSTAT, Life Support for Trauma and Transport) are also available in the Spanish CASA 295, C130 and B707.
Basic stretchers can be installed in the Belgian, Dutch and French C130, the Belgian A321, the French and German Airbus A310, and the German and French Transall C-160 as well as in the French Casa CN-235. They can also be installed in the Spanish CASA 295, C130 and B707.
Besides the medical equipment, the appropriately trained and qualified medical personnel escorting the patient is essential for a successful AE mission. Tailored to the mission, this personnel has to be assembled by AECC. Keeping in mind the aims of cross nationality in AE, AECC supports the process of standardization of common basic principles for training and education within the EATC partner nations.
Therefore it is important to provide adequate lessons learned of conducted AE missions to several boards dealing with the improvement of AE.
In the last months, since the outbreak of the so far largest Ebola epidemic in the world, there have been a lot of considerations about the transportation of passengers / patients out of EBOLA affected areas. Right now, AECC has no highly infectious patient transportation capability under its operational control (OPCON). Nevertheless, Italy and Spain, as new member nations of EATC, do have such capabilities and offered them to be used on request. Germany and France are developing such capabilities as well, but further developments have to be awaited, particularly in the certification process, before potentially offering this capability to other EATC partners.
The EATC has the capability to advance in all areas of European Air Transport and especially in the field of Aeromedical Evacuation. With the accession of new EATC partner nations and the gathering of additional AE capacities, the need for functional work on common concepts and doctrines has increased. Besides the already well established procedures and excellent performance in the operational area of controlling European AE missions, AECC is ready to be more involved in the development of common standards for cross-national AE and interoperability. Nowhere else in Europe are as many AE specialists from different countries working together as a team on a daily basis as in AECC. This may lead to the midterm aim of a Centre of Excellence for AE within the EATC.
Service for the patients
AECC has access to a MedEvac fleet that is capable of managing nearly every emergency situation all over the world.
In the meantime, some of the aircraft used by AECC for MedEvac purposes are undergoing a - more or less - steady changing process: e.g. the aging C-160 Transall will be replaced in the future by the A400M, featuring more range, capacity and velocity.
Other aircrafts like the German Airbus A310MRTT remain “state of the art” in Strategic Aeromedical Evacuation and will stay in service for at least another decade.
Picture by Airbus