TACTICAL EVACUATION CARE

Triage principles in this CPG should be heavily emphasized to support efficient use of CASEVAC and MEDEVAC resources. Role 1 to Role 3 evacuation priority should be based on trauma in combined injury casualties. Retriage for evacuation priority is crucial. If a casualty starts exhibiting signs and symptoms of significant exposure, the provider may need to change the triage category depending on evacuation capability, time to surgery and other “non-clinical” risk assessments by the triage person in charge. Evacuation out of theater for those with exposures likely to cause Acute Radiation Syndrome are described below. Additional guidance on evacuation operations in contaminated environments can be found in JP3-11. The decision to use ground and air transport platforms to transport contaminated casualties lies with Commanders after calculating acceptable risk, informed by medical personnel with expertise in this area. Risks include but are not limited to:

- contaminated casualty or retained radioactive material.
- cumulative exposure to transport and medical crew while transiting the contaminated environment.
- cross contamination of the transportation platform.

Although aircraft can safely fly through fallout (ATP 3-05.11) and the risk of ingestion and inhalation is small with PPE, rotor wash from helicopters can disrupt/spread settling radiological dust particles, liquids, and solids and can increase risk. Ground personnel and aircraft crews conducting CASEVAC/MEDEVAC operations should use PPE guidelines in this CPG if the aircraft is picking up patients in a Warm Zone. The use of protective masks (military or Level C) may provide some protection initially, but the canister or filters of the masks can accumulate radiological particles during prolonged use.

When preparing to execute a CASEVAC/MEDEVAC for a radiation casualty, medical providers should account for ensuring decontamination, isolating immunocompromised patients, and access to an appropriate receiving medical facility. Those who still have embedded shrapnel may require shielding. Portable shielding devices such as lead rolls are not currently issued as common equipment and unlikely to be necessary. Not all patients require shielding, only patients with retained radioactive material which is highly unlikely. The shielding device only needs to be large enough to cover the radioactive hazard, not the whole patient.