MEDEVAC/Aeromedical Evacuation

[medic25]

Would anyone have info about the role of PAs during MEDEVAC's or Aeromedical Evacuations within the military? I've heard anecdotally that PAs are at times part of the crew, but have not had much luck finding online resources to confirm it.  

The info I've read about the CCATT's used by the Air Force seemed to be composed of physicians and nurses; are PAs providing care during this phase of care?

[cc56]

When I deployed overseas we had PA's fly with us some times.  We also had the regional MD's fly with us some times.  They were there for help not to direct care.  The regional MD's approved our medical directives before we got in country.  The PA's were told to follow our instructions by the MDs, and the MDs looked to use for direction when needed.  I know some will read this and say no enlisted army flight medic (FM) is going to tell a PA/MD what to do.  We worked as a team, but the FM was primary, the PA/MD secondary when I was in Afghan in 2008-2009.  We trained for the mission, we brought like 95% civilian working paramedics (2 of us were not paramedics).  We trained with pharmacists, resp therapy, critical care docs, ER docs...etc.  The PAs were active duty who worked in the family practice clinic.  Much like in current medicine you don't bring in a dermatologist to run a code, you use an ER doctor.  You don't bring in an ER doctor to do a hysterectomy, you use a GYN surgeon.  Just because you are an MD/PA doesn't mean you are the best at it all.  The same goes for MEDEVAC, you use some one trained in that type of medicine/equipment/environment.   

 

This was for me as a Guard guy in 2008-2009 in a war zone.  When I got back I went to a course called JECC.  It was to train RN's PA"s and others how to take "sick" and post surgical people.  Until recently the Army flight medic was trained to the EMT-B level with a mix of more advanced skills (IV/IO/maybe intubate), and TCCC for trauma.   They were not ready for the post surgical guy who had an Exlap, crainotomy, intubated.....  At best the training was poor if you even knew what to do with these patients.  At the time the Army was piece mealing to improve outcomes.  They have made it better now with the critical care flight medic who is a national registry paramedic.

 

To answer your question I have no idea these days what they are training people to do.  You might have a flight surgeon PA who wants to go on flights.  I don't think there are specific billets for flight PA's in the Army.    I have been out of the FM game since 2013, and out of the active duty game since 2006, so who knows.  This was just my experience.  

 

This is the study that showed Guard MEDEVAC paramedics were doing better than Active duty EMT-B.

https://www.ncbi.nlm.nih.gov/pubmed/23351570

[Joe65D]

CCATT is a 3 person team: physician, nurse, and an RT. Haven't seen PA's used or heard of PA's being considered. The Physician needs quite a bit of critical care experience and it's a pretty competitive gig among physicians, so I don't ever see PA's having a chance. 

[Will352ns]

You also have to understand that you are talking about the missions of 2 different services. CCATT and Aerovac are both USAF.  No PAs involved. These are not point of injury functions, they are to get casualties out of theater after initial stabilization, which is a huge mission that they do well. 

 

USAF does has a small CASEVAC function within SOCOM that uses different platforms (C130's, CV22, ect). This is a point of injury function. There are about 4 PA billets (or there used to be) and they do occasionally fly but the function is mainly performed by SOC IDMTs (my former occupation). 

 

MEDEVAC is Army and they do have PAs with each unit. I'm not sure about conventional units, but I know the SOAR PA's fly with their guys regularly. 

 

As hinted in a previous post, you are limited in your capability by the environment in which you are working. Doc, PA, medic are all going to do the same thing in the back of a cramped space with limited supplies.  Why risk a high dollar asset (Doc, PA) when a medic is going to do the exact same thing?

 

These things considered, Army is the best path to fly if you are a PA. 

[TacMed]

My unit PA flew nearly 200 hours in combat and 300 in training when he was on the conventional side of the house. 

[eamaru16]

USAF experience:

I flew AirEvac for 3 years (2010-2013) as a technician (AET), deployments to Japan, Germany, DC, San Antonio, Scott AFB, and Afghanistan and have 400+ hours of flight time/patient care. My understanding of AirEvac is that we are stabilization care and mode of transportation to get patients to a higher echelon of care. We fly fixed wing opportune aircraft, any asset in the air capable of flying patients not already tasked on a higher priority mission would be tasked to fly an AirEvac mission (C-130, C-17, KC-135, KC-10, C-5, C-21... any fixed wing aircraft the team was trained and qualified on). We mostly fly stable patients but if they were to deteriorate in flight our 5 person team is capable (within the scope of practice) to provide life saving treatment and if necessary call the medical director on the ground at the receiving treatment facility if something out of our scope of practice was necessary. The CCATT teams flight doc, nurse and resp tech were aboard with any predetermined critical patient. They have a broader scope of practice as a team and can handle a wider range of issues. Again, they flew on flights with predetermined critical patients.

During my DC deployment in 2011, I flew with a Flight Nurse who, in the civilian world, was a PA. It is certainly an uncommon occurrence but I believe if the need is great enough and you are very clearly able to demonstrate your clinical knowledge and differentiate between a PA and Flight Nurse scope of practice you would be able to fly as a flight nurse. However, as Will352ns mentioned, why limit yourself to a career where you do not get to apply your PA knowledge and skills fully?

Hopefully, one day in the near future, our fellow political PA advocates will be able to show the world that a PA is capable of performing the duties of a USAF Flight Doc and we can lend a hand where the need is greatest.

[LT_Oneal_PAC]

The Navy has a flight surgeon residency for PAs. The same one that MDs go to.

[dphy83]

I feel bad (but only a little) for resurrecting this 2 year old thread, but what, if any, reserve or NG units would best afford a PA to fly. Fairly determined to join one of the part time branches as a PA, but just trying to ensure I join the one I'd enjoy the most. I'm prior enlisted in the infantry, so I'm partial to being as close to the front as possible if ever deployed. 

[bovineplane]

General support aviation BN or GSAB. Generally they are made up of uh-60s and ch-47s. As an aeromedical PA you are required to fly a set amount of hours per semi-annual period. Gsab is made up of a lift company of uh-60s, medevac company and a Chinook company. There are more flight qualified personnel in a gsab than any other Army unit. 

I can't speak Nationwide but Nevada has a national guard GSAB split between the Vegas and Reno area. 

If you are not an aeromedical PA you would need the state to pay for and send you to the class. It is 42 days at fort Rucker, Al. Bring your golf clubs. If you can't swim I wouldn't go. You are required to pass dunker training or overwater survival training.

It doesn't require Olympic level swimming but if you are deathly afraid of being 5 point harnessed to a seat while a Sim cockpit is dropped into and spun upside down in 20 feet of water requiring you to get out while blindfolded and wearing flight gear. . . Then you might not want to go. 

We only had one PA nearly die so it wasn't terrible. Nobody got chest compressions

Edited January 31, 2020 by bovineplane

[dphy83]

8 hours ago, bovineplane said:

General support aviation BN or GSAB. Generally they are made up of uh-60s and ch-47s. As an aeromedical PA you are required to fly a set amount of hours per semi-annual period. Gsab is made up of a lift company of uh-60s, medevac company and a Chinook company. There are more flight qualified personnel in a gsab than any other Army unit. 

I can't speak Nationwide but Nevada has a national guard GSAB split between the Vegas and Reno area. 

If you are not an aeromedical PA you would need the state to pay for and send you to the class. It is 42 days at fort Rucker, Al. Bring your golf clubs. If you can't swim I wouldn't go. You are required to pass dunker training or overwater survival training.

It doesn't require Olympic level swimming but if you are deathly afraid of being 5 point harnessed to a seat while a Sim cockpit is dropped into and spun upside down in 20 feet of water requiring you to get out while blindfolded and wearing flight gear. . . Then you might not want to go. 

We only had one PA nearly die so it wasn't terrible. Nobody got chest compressions

While not a super strong swimmer, I'm stubborn enough to try and see how I fair. I passed the silly (ground) Army combat water survival test so there's hope. I guess what I am wanting to know is there any role for in flight medical care for PAs in the Reserve or NG? I looked into the GSABs that you mentioned and I see they contain the MEDEVAC components, but are those in flight medical personnel enlisted medics? Or is what I'm wanting a pipedream and the Army just isnt going to risk sending out a PA/medical officer on MEDEVAC missions? 

Edited January 31, 2020 by dphy83

[bovineplane]

On 1/31/2020 at 5:17 AM, dphy83 said:

While not a super strong swimmer, I'm stubborn enough to try and see how I fair. I passed the silly (ground) Army combat water survival test so there's hope. I guess what I am wanting to know is there any role for in flight medical care for PAs in the Reserve or NG? I looked into the GSABs that you mentioned and I see they contain the MEDEVAC components, but are those in flight medical personnel enlisted medics? Or is what I'm wanting a pipedream and the Army just isnt going to risk sending out a PA/medical officer on MEDEVAC missions? 

If you aren't medevac, you are casevac. I know that doesn't sound drastically different but it is. I have seen units put casevac on Chinooks but again, those are in GSABs. If you are looking for a medical role on an aircraft in the army, join a gsab. 

Another course you can look at is JECC. Joint enroute critical care. Again, medevac. Not Casevac. Casevac is any non standard platform, ground or air, used to move casualties. Medevac is a dedicated platform for casualty movement.