title: Audit of the effectiveness of command and control arrangements for medical evacuation of seriously ill or injured casualties in southern Afghanistan 2007.
abstract: OBJECTIVE
  The effectiveness of the command and control of medical evacuation by helicopter (MEDEVAC) of casualties sustained in southern Afghanistan each month from 1 May to 31 July 2007 was audited. In this period 762 casualties of all categories were evacuated to International Security Assistance Force (ISAF) field hospital facilities under the direction of Operations and medical staff of NATO Regional Command (South) (RC-S). The criterion for the audit was the time taken from notification in the RC-S Combined Joint Operations Centre (CJOC) until the helicopter landed ("Wheels Down") at the destination field hospital's helicopter landing site. The standard to be met was 90 minutes for all "9-liner" Category A (URGENT) and Category B (URGENT - surgical) cases (in hospital within 2 hours of wounding) allowing for time from injury to first notification in the CJOC, and time from landing to transfer to the Emergency Department (30 minutes together) at the designated destination hospital. Those that did not meet this target were assessed in order to review their outcome and to identify means for improving performance.
  
  
  RESULTS
  Analysis of evacuation times for all missions each month from May to July revealed that three quarters of A and B category missions met the 90 minute target. No adverse outcome resulted from those which did not meet this target, reasons for which included distance (more than 30 minutes flying time each way), delay in securing a hostile landing site, delay in obtaining sufficient information, incorrect categorization of the casualty's priority, and on one occasion, an overmatch of assets available at that time. No casualties died who were recoverable. Comparison with data from the two previous RC-S rotations (prior to 1 May 07) showed an improvement in mean response time, but little change in median response on the rotation of RC-S staff on 1 May 07. The major change that had occurred on this rotation was to move the medical operations staff into the CJOC. The convergence of median and mean at this time indicates a reduction in "outliers", providing evidence that collocation of medical and operations staff improves incident response and should be the "default setting" in deployed tactical formation headquarters.
  
  
  CONCLUSIONS
  Regular audit of MEDEVAC response should be routine for Medical Operations staff, in order to ensure the optimal casualty care pathway from point of wounding to field hospital.
authors.affiliation: Headquarters 1st (UK) Armoured Division, British Forces Post Office 15. robin.cordell180@mod.uk
authors.forename: R F
authors.initials: RF
authors.lastname: Cordell
authors.forename: M S
authors.initials: MS
authors.lastname: Cooney
authors.forename: D
authors.initials: D
authors.lastname: Beijer
mesh_terms: D000346:Afghanistan; D017732:Air Ambulances / Q000706:statistics & numerical data*; D019992:Databases as Topic; D006801:Humans; D008485:Medical Audit; D008887:Military Medicine / Q000592:standards / Q000706:statistics & numerical data*; D008889:Military Personnel; D010360:Patient Transfer / Q000592:standards / Q000706:statistics & numerical data*; D013997:Time Factors; D014218:Triage / Q000379:methods / Q000592:standards; D006113:United Kingdom; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*