Medical Evacuation Network Project

1. Medical Evacuation Network Project LT McMullen LT Dunham

2. Presentation: Medical Evacuation • Background Information • Helmand Province Graph / Network • Analysis • Questions

3. Medical Evaculation • ~500AD Byzantine Empire’s Army was first to employ a organized medical evacuation. • By 1800 most armies had some medical evacuation capability. • Almost every conceivable mode of transportation has served to evacuate wounded from the battlefield.

4. Medical Evacuation • Today US military doctrine employs a combination of ground, rotary and fixed wing transport. • In southern Afghanistan, urgent patient transport relies almost entirely on a robust aeromedical evacuation network. Update 7 June 2007

5. Golden Hour • “Golden Hour” in emergency medicine refers to the span of time immediately after a traumatic injury of a soldier and the time medical intervention offers the greatest chance of survival.

6. Levels of Care Intra Theater Medical Care • Level 1 • Care is administered at/close to POI and includes self or buddy aid, emergency lifesaving measures. • Level 2 • Care includes basic resuscitation, limited surgical capability, basic transfusion services, limited ancillary services. • Level 3 • The highest level of care in an operational theater and has all the capabilities of a medical treatment facility (MTF) in the States.

7. Purpose Initial Intent (week 1 of the course) • Model an aeromedical medevac network in Helmand Province. • Assess the robustness of the network with two medical evacuation platforms transporting multiple patients. • Assess design impact of providing critical care capabilities onboard current platform and extending “golden hour”

8. Purpose Revised Intent (week 9 of the course) • Model a notional aero medical evacuation network in Helmand Province Afghanistan. • Test the network’s ability capacities evacuate patients on demand. • Optimize placement of Military Treatment Facilities (MTFs).

9. Purpose Measures of Effectiveness • The ability to transport patients throughout the entire medevac network in under 60 minutes (binary).

10. Helmand Province Update 7 June 2007

11. Medical Evacuation Helicopters • SH-60 • Max Speed ~145 knots • Capacity 4 litter patients • MH-4E Chinook (British) • Max Speed 154 knots • Capacity 1-2 patients • Helicopter Assumptions: • 115 miles per hours (patient load/unload time, threat, etc). • Only SH-60s where employed. • Each SH-60 had a chase bird • Capacity 2 litter patients

12. Inaccessible Air Spaces • Dust/Sand Storms • Among natures most violent and unpredictable phenomena. • High winds, unleashing turbulent, suffocating cloud of sand • Reduced visibility • Can travel at more than 75 miles per hour

13. Inaccessible Air Spaces • Surface Air Missiles (SAMs) & Rocket Fire • "The US helicopter was shot down by the Taliban as it was taking off," … "It was hit by a rocket fired by the insurgents."

14. Assumptions • Interdiction Model: • Level 2 MTFs have capacity of 2 patients • Level 3 MTF has an infinite capacity • Forward Operating Bases (FOBs) and MTFs are co-located • SH60s have a capacity of 2litter patients • Only considered immediate or urgent evacuations

15. Assumptions • Design Model: • Probability (weights) assigned for casualty evacuation for each POI • Iterative process • One patient evacuation demand at each node

16. Helmand Network Model Topology Start (0,∞,0) Empty FOB (Cost, ∞,0) FOB FOB (0,∞,0) (0,1,1) Full (0,max bed capacity,0) End Update 7 June 2007

17. Primal Setup Update 7 June 2007

18. Dual Setup & Arc Attacks Update 7 June 2007

19. Interdiction: 1-2 Patient @ each POC • Optimal Inaccessibility • 24 inaccessible air spaces • Example: • 7 POI locations are unreachable

20. Interdication 3-4 Patients @ each POI • 10 in-accessible air spaces • Example: • 2 patients from POI make it to L2 MTF South, • However 1-2 patients are unable to travel to L3 MTF due to inaccessible air space

21. Interdiction 3-4 Patients @ each POI • 27 in-accessible air spaces • Outcome: • 10 POI locations lose 1-2 patients • 7 POI locations are unreachable

22. Analysis

23. Analysis Update 7 June 2007

24. Design-Optimal Placement of 2 MTFs Constant Distribution: Realistic Causality Distribution: 89.5% (weighted) of POIs are reachable in under 60 minutes • 64% of POIs are reachable in under 60 minutes reachable in over 60 minute

25. Design-Optimal Placement of 3 MTFs Constant Distribution: Realistic Causality Distribution: 90.48% (weighted) of POIs are reachable in under 60 minutes • 90.625% of POIs are reachable in under 60 minutes

26. Design-Optimal Placement of 4 MTFs Constant Distribution: Realistic Causality Distribution: 95.23% (weighted) POIs are reachable in under 60 minutes • 93.55% of POIs are reachable in under 60 minutes

27. Design Analysis • Optimal placement of MTFs under constant distribution increases our ability to reach patients in under 60 minutes. • Original Placement of 4 MTFs: 87.1% • New Placement of 3 MTFs: 90.625% • New Placement of 4 MTFs: 93.55% • Optimal placement of MTFs under realistic causality distribution increases our ability to reach patients in under 60 minutes. • New Placement of 3 MTFs: 90.48% • New Placement of 4 MTFs: 95.23%

28. Conclusions • Current MTF placement is very close to the optimal position suggested by our model. • Interdiction is probably not the best model for this network. • If interdiction model was desired one that models weather would be more appropriate. Update 7 June 2007

29. Conclusions • Network should be reevaluated as the battle space evolves. • Political and historical factors will be considered in facility placement by decision makers. • Combined or Joint Operations adds more complexity (more medevac platforms types, country caveat constraints, medical rules of eligibility, etc.) Update 7 June 2007

30. Questions • Questions?