FM 8-10-6 MEDICAL EVACUATION IN A THEATER OF OPERATIONS TACTICS, TECHNIQUES, AND PROCEDURES HEADQUARTERS, DEPARTMENT OF THE ARMY DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. *FM 8-10-6 FIELD MANUAL HEADQUARTERS No. 8-10-6 DEPARTMENT OF THE ARMY WASHINGTON, DC, 14 APRIL 2000 MEDICAL EVACUATION IN A THEATER OF OPERATIONS TACTICS, TECHNIQUES, AND PROCEDURES TABLE OF CONTENTS Page PREFACE ......................................................................................................... xi CHAPTER 1. INTRODUCTION TO THE COMBAT HEALTH SUPPORT SYSTEM AND MEDICAL EVACUATION .............................. 1-1 1-1. General ................................................................................. 1-1 1-2. Threat................................................................................... 1-1 1-3. Medical Threat and Medical Intelligence ......................................... 1-2 1-4. Medical Evacuation Versus Casualty Evacuation ............................... 1-3 1-5. Theater Evacuation Policy........................................................... 1-4 1-6. Factors Determining the Evacuation Policy ...................................... 1-6 1-7. Impact of Evacuation Policy on Combat Health Support Requirements..... 1-6 1-8. Adjustments to the Evacuation Policy............................................. 1-7 1-9. Planning for Combat Health Support.............................................. 1-7 1-10. Echelons of Medical Care........................................................... 1-8 1-11. Principles of Combat Health Support Operations ............................... 1-10 1-12. Army Medical Department Battlefield Rules..................................... 1-11 1-13. Mandated Medical Evacuation Support ........................................... 1-12 CHAPTER 2. ECHELONS I AND II MEDICAL EVACUATION......................... 2-1 2-1. General ................................................................................. 2-1 2-2. Echelon I (Unit Level) Medical Evacuation...................................... 2-1 2-3. Echelon II Medical Evacuation in the Division.................................. 2-4 2-4. Echelons I and II Medical Evacuation in the Corps............................. 2-5 CHAPTER 3. CORPS AND ECHELONS ABOVE CORPS MEDICAL EVACUATION UNITS ........................................................ 3-1 Section I. Medical Evacuation Battalion..................................................... 3-1 3-1. General ................................................................................. 3-1 3-2. Assignment............................................................................. 3-1 DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. *This publication supersedes FM 8-10-6, 31 October 1991. i FM 8-10-6 Page 3-3. Mission and Capabilities.......................................................... 3-1 3-4. Organization and Functions ...................................................... 3-2 Section II. Medical Company, Ground Ambulance..................................... 3-5 3-5. General............................................................................... 3-5 3-6. Assignment.......................................................................... 3-5 3-7. Mission, Capabilities, and Limitations ......................................... 3-5 3-8. Organization and Functions ...................................................... 3-6 Section III. Medical Company, Air Ambulance........................................... 3-8 3-9. General............................................................................... 3-8 3-10. Assignment.......................................................................... 3-8 3-11. Mission and Capabilities.......................................................... 3-8 3-12. Organization and Functions ...................................................... 3-9 CHAPTER 4. THE MEDICAL EVACUATION SYSTEM................................ 4-1 4-1. General............................................................................... 4-1 4-2. Medical Evacuation................................................................ 4-2 4-3. Basic Considerations in Medical Evacuation Operations.................... 4-4 4-4. Property Exchange and Patient Movement Items............................. 4-12 4-5. Medical Evacuation Tools ........................................................ 4-12 4-6. Medical Evacuation Support for Combat Forces in the Offense and Defense...................................................................... 4-15 4-7. Medical Evacuation Support for Choices of Maneuver and Enabling Operations........................................................................ 4-20 4-8. Medical Evacuation Support in Stability Operations......................... 4-23 4-9. Medical Evacuation Support in Support Operations ......................... 4-25 4-10. Medical Evacuation of Enemy Prisoners of War ............................. 4-26 4-11. Evacuation and Disposition of Remains........................................ 4-27 4-12. Aeromedical Evacuation Operations............................................ 4-27 4-13. Evacuation of Military Working Dogs ......................................... 4-29 CHAPTER 5. MEDICAL EVACUATION IN SPECIFIC ENVIRONMENTS........ 5-1 5-1. General............................................................................... 5-1 5-2. Mountain Operations .............................................................. 5-1 5-3. Jungle Operations .................................................................. 5-5 5-4. Desert Operations.................................................................. 5-7 5-5. Extreme Cold Weather Operations.............................................. 5-15 5-6. Medical Evacuation in a Nuclear, Biological, or Chemical Environment ..................................................................... 5-17 5-7. Naval Operations................................................................... 5-19 5-8. Airborne and Air Assault Operations........................................... 5-21 5-9. Army Special Operations Forces ................................................ 5-22 ii FM 8-10-6 Page 5-10. Military Operations on Urbanized Terrain .................................... 5-22 5-11. Cross-Forward Line of Own Troops Operations ............................. 5-36 5-12. Combat Search and Rescue Operations ........................................ 5-38 5-13. Minefield Operations .............................................................. 5-38 CHAPTER 6. MEDICAL REGULATING 6-1. General............................................................................... 6-1 6-2. Purposes of Medical Regulating................................................. 6-1 6-3. Medical Regulating Terminology ............................................... 6-1 6-4. Medical Regulating from the Division.......................................... 6-4 6-5. Medical Regulating Within the Combat Zone................................. 6-6 6-6. Medical Regulating from the Combat Zone to Echelons Above Corps... 6-7 6-7. Medical Regulating Within Echelons Above Corps.......................... 6-8 6-8. Intertheater Medical Regulating ................................................. 6-8 6-9. Mobile Aeromedical Staging Facility........................................... 6-9 6-10. Limitations of the United States Air Force Theater Aeromedical Evacuation System.............................................................. 6-10 6-11. Originating Medical Facility(cid:146)s Responsibilities ............................... 6-10 6-12. Medical Regulating for Army Special Operations Forces................... 6-11 CHAPTER 7. EVACUATION REQUEST PROCEDURES 7-1. General............................................................................... 7-1 7-2. Unit Evacuation Plan .............................................................. 7-1 7-3. Determination to Request Medical Evacuation and Assignment of Medical Evacuation Precedence .......................................... 7-1 7-4. Unit Responsibilities in Evacuation ............................................. 7-2 7-5. Types of Medical Evacuation Request Formats and Procedures........... 7-3 7-6. Collection of Medical Evacuation Information................................ 7-3 7-7. Preparation of the Medical Evacuation Request .............................. 7-4 7-8. Transmission of the Request ..................................................... 7-4 7-9. Relaying Requests.................................................................. 7-6 CHAPTER 8. MANUAL EVACUATION 8-1. General............................................................................... 8-1 8-2. Casualty Handling ................................................................. 8-1 8-3. General Rules for Bearers ........................................................ 8-2 8-4. Manual Carries ..................................................................... 8-2 8-5. Casualty Positioning............................................................... 8-3 8-6. Categories of Manual Carries.................................................... 8-4 8-7. Special Manual Evacuation Techniques........................................ 8-25 iii FM 8-10-6 Page 8-8. Evacuation from the Bradley Infantry Fighting Vehicle..................... 8-35 8-9. Minefield Extraction............................................................... 8-39 8-10. Rules for Surviving Minefields and Acquiring Casualties .................. 8-42 CHAPTER 9. LITTER EVACUATION ....................................................... 9-1 9-1. General............................................................................... 9-1 9-2. Types of Litters..................................................................... 9-1 9-3. Dressed Litter....................................................................... 9-9 9-4. Using Patient Securing Straps.................................................... 9-12 9-5. General Rules for Litter Bearers ................................................ 9-12 9-6. Use of Spine Boards and the Kendricks Extrication Device................ 9-13 9-7. Travois............................................................................... 9-18 9-8. Packsaddle Litter................................................................... 9-19 9-9. Litter Evacuation in Mountain Operations..................................... 9-20 9-10. Techniques for Litter Evacuation in Mountain Operations.................. 9-20 9-11. Types of Litters for Mountain Operations ..................................... 9-20 9-12. Methods of Litter Evacuation in Mountain Operations...................... 9-21 9-13. Horizontal Hauling Line .......................................................... 9-25 CHAPTER 10. EVACUATION PLATFORMS................................................ 10-1 Section I. Army Ground Ambulances..................................................... 10-1 10-1. General............................................................................... 10-1 10-2. Ground Ambulances............................................................... 10-1 10-3. Ambulance Driver ................................................................. 10-2 10-4. Medical Aidman.................................................................... 10-3 10-5. Ambulance Loading and Unloading ............................................ 10-3 10-6. Truck, Ambulances, 4x4, Utility, M996 and M997 ......................... 10-4 10-7. Truck, Ambulance, 1 1/4 Ton, 4x4, M1010.................................. 10-15 10-8. Truck, Ambulance, 1 1/4 Ton, 6x6, M792 ................................... 10-15 10-9. Buses (Ambulances) ............................................................... 10-17 10-10. Carrier, Personnel, Full Tracked, Armored, M113, T113E2.............. 10-19 Section II. Nonmedical Vehicles Used for Casualty Evacuation or Medical Evacuation ...................................................................... 10-20 10-11. General............................................................................... 10-20 10-12. Casualty Transport and Patient Evacuation in a Mass Casualty Situation .......................................................................... 10-20 10-13. Truck, Cargo/Troop Carrier, 11/ , 4x4, M998 (Four-Man 4 Configuration)................................................................... 10-24 10-14. Truck, Cargo/Troop Carrier, 11/ Ton, 4x4, M998 (Two-Man 4 Configuration)................................................................... 10-25 iv FM 8-10-6 Page 10-15. Truck, Cargo, 5 Ton, 6x6, Wide Bed, and Truck, Cargo, 21/ Ton, 2 6x6, Wide Bed .................................................................. 10-26 10-16. Heavy Expanded, Mobility Tactical Truck, 8x8, Cargo, M977 ........... 10-27 10-17. Semi-Trailer, Cargo, 221/ Ton, M871 ........................................ 10-28 2 10-18. Truck, Cargo, Medium Tactical Vehicle, Long Wheelbase, 5 Ton, M-1085 ........................................................................... 10-29 10-19. Truck, Cargo, Medium Tactical Vehicle, Light Vehicle Air Drop/ Air Delivery, 5 Ton, M-1093 ................................................ 10-30 10-20. Truck Cargo, Light Medium Tactical Vehicle, Light Vehicle Air Drop/Air Delivery, 21/ Ton, M-1081 ...................................... 10-32 2 Section III. Evacuation by Medical Air Ambulances .................................... 10-33 10-21. General............................................................................... 10-33 10-22. Advantages of Aeromedical Evacuation........................................ 10-33 10-23. Responsibilities for Loading...................................................... 10-34 10-24. Army Air Ambulances ............................................................ 10-34 10-25. Helicopter Landing Sites.......................................................... 10-35 10-26. Loading Patients Aboard Rotary-Wing Aircraft .............................. 10-41 10-27. Loading Patients Aboard the UH-60A Blackhawk ........................... 10-41 10-28. Loading Patients Aboard the UH-1H/V Iroquois............................. 10-49 Section IV. United States Army Nonmedical Aircraft................................... 10-54 10-29. General............................................................................... 10-54 10-30. Army Fixed-Wing Aircraft....................................................... 10-54 10-31. U-21/C-12 Aircraft ................................................................ 10-55 10-32. Loading Patients Aboard Army Fixed-Wing Aircraft........................ 10-55 10-33. The CH-47 (Chinook)............................................................. 10-56 10-34. Loading Patients Aboard the CH-47 (Chinook)............................... 10-56 Section V. United States Air Force Aircraft.............................................. 10-58 10-35. General............................................................................... 10-58 10-36. Types of Air Force Transport Aircraft and Units ............................ 10-58 10-37. Aeromedical Evacuation Civil Reserve Air Fleet Aircraft.................. 10-59 10-38. Preparing Aircraft to Receive Patients ......................................... 10-60 10-39. Developing the Loading Plan .................................................... 10-60 10-40. Documentation Required.......................................................... 10-61 10-41. Patient Assessment Information ................................................. 10-62 APPENDIX A. EFFECTS OF GENEVA CONVENTIONS ON MEDICAL EVACUATION ................................................................ A-1 A-1. General............................................................................... A-1 A-2. Distinctive Markings and Camouflage of Medical Facilities and Evacuation Platforms........................................................... A-1 A-3. Medical Aircraft.................................................................... A-2 A-4. Self-Defense and Defense of Patients........................................... A-2 v FM 8-10-6 Page A-5. Enemy Prisoners of War.......................................................... A-3 A-6. Compliance with the Geneva Conventions..................................... A-3 APPENDIX B. MEDICAL EVACUATION ESTIMATE AND PLAN ................... B-1 Section I. Medical Evacuation Estimate .................................................. B-1 B-1. General............................................................................... B-1 B-2. Sample Format for the Medical Evacuation Estimate of the Situation.... B-1 Section II. Medical Evacuation Annex to the Combat Health Support Plan...... B-12 B-3. General............................................................................... B-12 B-4. Sample Format for the Medical Evacuation Annex to the Combat Health Support Plan ............................................................ B-12 APPENDIX C. USE OF DD FORM 1380, US FIELD MEDICAL CARD SAMPLE FORMAT .......................................................... C-1 C-1. General............................................................................... C-1 C-2. Use of the US Field Medical Card.............................................. C-1 C-3. Preparation of the Field Medical Card ......................................... C-2 C-4. Disposition of Field Medical Cards............................................. C-3 C-5. Field Medical Record Jacket..................................................... C-3 APPENDIX D. MEDICAL REENGINEERING INITIATIVE MEDICAL EVACUATION UNITS ...................................................... D-1 D-1. General............................................................................... D-1 D-2. Headquarters and Headquarters Detachment, Medical Evacuation Battalion .......................................................................... D-1 D-3. Medical Company, Air Ambulance............................................. D-2 D-4. Medical Company, Ground Ambulance........................................ D-3 APPENDIX E. USE OF THE HIGH PERFORMANCE HOIST IN MEDICAL EVACUATION OPERATIONS........................................... E-1 Section I. Crew Responsibilities ............................................................ E-1 E-1. General............................................................................... E-1 E-2. Primary Crew Responsibilities................................................... E-1 Section II. Intercrew Communications..................................................... E-2 E-3. General............................................................................... E-2 E-4. Intercrew Communications....................................................... E-2 Section III. Employment........................................................................ E-4 E-5. General............................................................................... E-4 E-6. Hoist Rescue Operational Phases................................................ E-4 vi FM 8-10-6 Page Section IV. Environmental Factors .......................................................... E-5 E-7. General............................................................................... E-5 E-8. Water Recovery Operations...................................................... E-5 E-9. Land Operations.................................................................... E-7 E-10. Night Recovery Operations....................................................... E-8 Section V. Inert Patient Recoveries......................................................... E-9 E-11. General............................................................................... E-9 E-12. Procedural Guidance .............................................................. E-9 Section VI. Meteorological and Terrain Factor........................................... E-10 E-13. General............................................................................... E-10 E-14. Performance Planning............................................................. E-10 E-15. Mountain Operations .............................................................. E-10 E-16. Jungle Operations .................................................................. E-11 E-17. Extreme Cold Weather Operations.............................................. E-12 Section VII. Safety and Emergency Procedures for Hoist Missions................... E-14 E-18. General............................................................................... E-14 E-19. Safety Factors....................................................................... E-14 E-20. Emergency Procedures............................................................ E-20 E-21. Tactical Considerations ........................................................... E-21 Section VIII. Forest Penetrator ................................................................. E-21 E-22. General............................................................................... E-21 E-23. Configuration of the Forest Penetrator ......................................... E-22 E-24. Application.......................................................................... E-22 E-25. Employment of the Forest Penetrator........................................... E-22 Section IX. SKED Rescue System............................................................ E-25 E-26. General............................................................................... E-25 E-27. Configuration ....................................................................... E-25 E-28. Operation of the SKED Litter.................................................... E-26 E-29. Maintenance of the SKED Litter ................................................ E-30 Section X. Rescue (Stokes) Litter............................................................ E-31 E-30. General............................................................................... E-31 E-31. Configuration ....................................................................... E-31 E-32. Function ............................................................................. E-31 E-33. Maintenance......................................................................... E-34 Section XI. Poleless Semirigid Litter ........................................................ E-34 E-34. General............................................................................... E-34 E-35. Employment of the Poleless Semirigid Litter ................................. E-34 E-36. Function ............................................................................. E-35 E-37. Maintenance......................................................................... E-36 Section XII. Survivor(cid:146)s Sling (Horse Collar) and Cable Weight Cover............... E-36 E-38. General............................................................................... E-36 E-39. Configuration ....................................................................... E-36 E-40. Function ............................................................................. E-37 vii FM 8-10-6 Page E-41. Maintenance......................................................................... E-37 E-42. Modifications ....................................................................... E-38 Section XIII. Hoisting Vest....................................................................... E-38 E-43. General............................................................................... E-38 E-44. Configuration ....................................................................... E-38 E-45. Employment of the Hoisting Vest ............................................... E-39 E-46. Maintenance of the Hoisting Vest............................................... E-41 APPENDIX F. THE USE OF SMOKE AND OBSCURANTS IN MEDICAL EVACUATION OPERATIONS............................................ F-1 F-1. General............................................................................... F-1 F-2. Employment of Smoke and Obscurants ........................................ F-1 F-3. Geneva Conventions and the Use of Smoke and Obscurants in Medical Evacuation Operations .............................................. F-2 F-4. Use of Smoke in Aeromedical Evacuation and Hoist Rescue Operations........................................................................ F-3 F-5. Employment of Smoke in Ground Medical Evacuation Operations ....... F-4 APPENDIX G. TACTICAL STANDING OPERATING PROCEDURE................. G-1 G-1. General............................................................................... G-1 G-2. Purpose of the Tactical Standing Operating Procedure...................... G-1 G-3. Format for the Tactical Standing Operating Procedure...................... G-1 G-4. Sample Tactical Standing Operating Procedure (Sections).................. G-2 G-5. Sample Tactical Standing Operating Procedure (Annexes) ................. G-3 APPENDIX H. PATIENT REGULATING FORMS SAMPLE FORMAT .............. H-1 Section I. Use of DD Form 600, Patient(cid:146)s Baggage Tag............................... H-1 H-1. General............................................................................... H-1 H-2. Preparation of DD Form 600 .................................................... H-1 H-3. Receipt for Checked Baggage.................................................... H-1 H-4. Disposition of DD Form 600..................................................... H-1 Section II. Use of DD Form 601, Patient Evacuation Manifest....................... H-3 H-5. General............................................................................... H-3 H-6. Preparation of DD Form 601 .................................................... H-3 H-7. Disposition of DD Form 601..................................................... H-5 Section III. Use of DD Form 602, Patient Evacuation Tag............................. H-5 H-8. General............................................................................... H-5 H-9. Preparation of DD Form 602 .................................................... H-5 H-10. Continued Use of DD Form 602 ................................................ H-6 H-11. Disposition of DD Form 602..................................................... H-6 viii FM 8-10-6 Page APPENDIX I. SAMPLE FORMAT FOR MEDICAL EVACUATION MISSION COMPLETION RECORD .................................................. I-1 APPENDIX J. PROCEDURES FOR LITTER EVACUATION TRAINING........... J-1 J-1. General............................................................................... J-1 J-2. Basic Guides for Training Litter Bearers ...................................... J-1 J-3. Litter Commands................................................................... J-1 J-4. Formation for Instruction......................................................... J-2 J-5. Procedures to Procure, Ground, Open, Close, and Return the Litter..... J-2 J-6. Procedures for Loading a Patient onto a Litter ............................... J-6 J-7. Procedures for Carrying a Loaded Litter ...................................... J-15 J-8. Procedures for Surmounting Obstacles......................................... J-21 APPENDIX K. SELECTION OF PATIENTS FOR AEROMEDICAL EVACUATION AND PATIENT CLASSIFICATION CODES AND PRECEDENCE.............................................. K-1 K-1. General............................................................................... K-1 K-2. Selection of Patients for Aeromedical Evacuation............................ K-1 K-3. Briefing of Patients Prior to Aeromedical Evacuation....................... K-3 K-4. International Standardization Agreement Codes .............................. K-3 K-5. International Standardization Evacuation Precedence........................ K-3 K-6. Patient Classification .............................................................. K-5 K-7. United States Air Force Evacuation Precedence.............................. K-5 APPENDIX L. RISK MANAGEMENT ......................................................... L-1 L-1. General............................................................................... L-1 L-2. Types of Risks...................................................................... L-1 L-3. Hazards .............................................................................. L-1 L-4. Risk Management Steps........................................................... L-1 L-5. Risk Management Principles..................................................... L-3 L-6. Risk Assessment.................................................................... L-3 L-7. Factors to Consider in Risk Assessment ....................................... L-6 APPENDIX M. MULTINATIONAL OPERATIONS ......................................... M-1 M-1. General............................................................................... M-1 M-2. Alliances and Coalitions .......................................................... M-1 M-3. Command Structure of Multinational Forces.................................. M-1 M-4. Rationalization, Standardization, and Interoperability....................... M-3 ix