Naval operational medicine institute

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  Global Patient Movement Requirement Center (GPMRC)
  Scott AFB, IL
  DSN: 576-6161/6162/6262   Com: (618) 256-6161/6162/6262
  
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  Navy Liaison Officer
  DSN: 576-4938/4939   Com: (618) 256-4938/4939
  
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  Theater Patient Movement Requirement Center (TPMRC)
  
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  Europe (UECOM)
  Ramstein Air Base, Kaiserslautern, Germany
  DSN: 480-8040/8041/8042/8043*   Fax 480-8045*
  
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  Pacific (PACOM)
  Yokota, Japan
  DSN: 225-4700*
  

 

DOD Policy

It is DOD policy that the movement of patients of the armed forces, in both peace and war, be accomplished by airlift when airlift is available, when conditions permit and if not medically contraindicated. The policy further states that this mission will be carried out by units specifically assigned that task except when urgent medical requirements dictate otherwise. In that case, any suitable aircraft may be pressed into service.

 

General

Aeromedical evacuations from the field, from aboard ship and from in-garrison facilities are frequently of sufficient urgency that local aircraft assets are used in order to transfer a patient to the nearest available medical facility suitable to that patient's needs. In cases requiring higher levels of care, where immediate danger to life and limb are not urgent considerations or where considerable distances are involved, the Worldwide Aeromedical Evacuation system is used. Or, it may be that urgent cases may require removal from a remote site using local aircraft assets and a link up with the aeromedical evacuation system at some location for further transport. The Navy overseas component commander is responsible for providing aeromedical evacuation over routes solely of interest to the Navy and where the facilities of the Worldwide Aeromedical Evacuation System cannot provide this service. Thus, a burn case requiring evacuation from the middle of the Mediterranean would require use of Navy assets for transportation to some land-based U.S. facility in Sicily or Italy where the patient can then be entered into the worldwide aeromedical evacuation system.

 

Caution

Aeromedical evacuation is a very helpful tool, but DOD policy should not be interpreted as an absolute requirement. You may be called upon for advice or to accompany a medical evacuation requested by a non-flight surgeon medical officer. In some cases, evacuation by air may not be in the best interests of the patient or may cause harm.

One must also bear in mind that an aviator will press a mission further than he otherwise would if he believes lives are at stake, and he must so assume when an aeromedical evacuation is requested. He may, therefore, launch in bad weather or other than ideal circumstances. It is incumbent upon the flight surgeon to evaluate all factors, and if an aeromedical evacuation seems ill advised, to present that opinion to the attending physician and through the medical chain of command if necessary. Clearly, these opinions must be presented in the most diplomatic and informed of methods. When presented with carefully reasoned objectives based on patient interests and safety, most physicians will look at alternative methods of transportation. Entry into the Worldwide Aeromedical Evacuation system is a bit more tightly controlled and run by people who do this every day. That system has a series of checks which prevent such problems.

 

Organization of the Worldwide Aeromedical Evacuation System

9. 
   Medical Regulation (DOD)
   
   The Armed Services Medical Regulating Office (ASMRO) is a tri-service organization which processes requests from medical facilities for evacuation of individuals to facilities able to provide higher levels of care, and then arranges movement to those facilities after having balanced requirements with current capabilities. This office handles cases from overseas and within CONUS during war and peace. Regulation of patients to be transported within the overseas area is not an ASMRO function, but is rather the mission of the Unified Commander of that theater of operations who has a Joint Medical Regulating Office (JMRO) which arranges for movement. There are two JMROs, one located at Frankfurt, Germany for the European theater, and one at Ft. Smith, Hawaii covering the Pacific theater of operations.
   
10. 
    Patient Movement
    
    This is the charter of the U.S. Air Force Military Airlift Command (MAC), 375th Aeromedical Airlift Wing. The 375th has four Aeromedical Evacuation Squadrons (AESs):
    

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  57th AES, Scott AFB, IL - Largely administrative and scheduling.
  
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  1st AES, Pope AFB, NC - The tactical evac squadron in combat situations.
  
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  9th AES, Yokota AFB, Japan.
  
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  2nd AES, Rhein-Main AFB, Germany.
  

The flight surgeon elects to medevac a patient. The nearest U.S. medical facility does not have the capability to handle the case but does have a large airport available. The flight surgeon prepares the patient for transport while the staging medical facility contacts the ASMRO (JMRO in European and Pacific theaters) with the request for movement of the patient. ASMRO (or JMRO) matches the patients requirements with the capabilities of higher level facilities for that day and then contacts the cognizant AES for movement to the final destination. Each case is regulated individually except during wartime, when large numbers of casualties may dictate regulation and transport on the basis of injury categories such as neurology injury, orthopedics, burn or other.

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  C-130 used by 1st AES primarily in the tactical role. 74 litters, 94 ambulatory.
  
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  C-9A Nightingale (specific configuration). 30 litters (40 wartime) 40 ambulatory.
  
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  C-141 (multi-purpose configuration). 103 litters, 168 ambulatory.
  

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  2flight nurses.
  
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  3 aeromedical evacuation technicians.
  
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  May be augmented as required.
  

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  1A - Severe psychiatric
  

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  1B - Intermediate psychiatric
  

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  1C - Moderate psychiatric
  

 

Class 2 (Litter)

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  2A - Immobile
  

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  2B - Mobile
  

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  3A - Non psych, non substance abuse going for treatment.
  
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  3B - Recovered patients returning home.
  
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  3C - Drug/substance abuse patients going for treatment
  

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  4A - Infant/child under 3 in bassinett/car seat
  
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  4B - Recovered infant/child requiring seat
  
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  4C - Infant in incubator
  
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  4D - Under 3 on a litter
  
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  4E - Outpatient under 3
  

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  5A - Ambulatory, non psych/substance abuse going for treatment.
  
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  5B - Ambulatory, psych/substance abuse going for treatment.
  
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  5C - Psychiatric outpatient going for treatment/evaluations.
  
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  5D - On litter for comfort/safety going for treatment.
  
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  5E - Returning on litter for comfort/safety.
  
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  5F - All other returning outpatients.
  

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  6A - Medical attendant
  
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  6B - Non-medical attendant
  

Indication - to save life/limb/eyesight or prevent complications of serious illness.

Requires - Doctor to doctor referral.

*Validation by surgeon at Wing or designated overseas flight surgeon.

2. Priority - move within 24 hrs

Requires - Doctor to doctor referral.

Routine flight.

GPMRC locates a bed for the patient.

4. Special - Inflight care exceeds usual capabilities

Requires special equipment/teams/expertise/limit stops/RON.

5. 
   DD form 602 - (Patient evacuation tag) Legible, with primary and secondary diagnoses, orders and treatments.
   
6. 
   Narrative summary.
   
7. 
   Patient x-rays, records.
   
8. 
   Medications: CONUS Travel - 3 day supply, Overseas Travel - 5 day supply.
   
9. 
   Special Diets.
   
10. 
    IV fluids, supplies, etc.
    

 

Special considerations:

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  Originating M.D. is responsible for care until patient reaches destination hospital.
  
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  Medical crew may request flight surgeon evaluation.
  
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  Death in flight. 
  
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  Do not resuscitate orders (DNR).
  

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  Cardiac --10 days post MI, 5 days complication free.
  
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  Anemia -- Hb/Hct 8.5/30 -- May need continuous 0_2.
  
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  Chest tubes -- HeimlichValve -- XR to assure lung expansion.
  
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  Infectious Disease -- Usually not accepted -- Special precautions -- Isolation is possible.
  
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  Immobilized Jaw --Aspiration protection --Quick release mechanism (Rubber retaining bands with scissors attached to the patient).
  
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  Tracheotomy -- Change 24-48 hrs prior to flight.
  
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  C-SpineFracture -- Stryker frame -- Collins traction.
  
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  Pregnancy -- OB records.  Medical officer with labor patient or if on Ritodrine.
  
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  TB -- New: on litter with mask.  Over 2 wks: chemotherapy no precautions.
  
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  Casts -- Dry 48- 72 hrs.  Bi-Valve all casts.
  
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  Post-op -- 5 days post major surgery, and must be stable.
  

SSIC's are designed to meet the needs of the entire Navy Department for a single standard subject scheme to be used for classifying (numbering), arranging and filing, and referencing various types of Navy and Marine Corps documents by subject matter. This is required on all Navy and Marine Corps letters, instructional forms and other official documents.

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  SSIC's provide for a convenient numerical classification outline consisting of 14 major numerical series.
      (1) May be broken into primary, secondary, and tertiary subjects.
      (2) A number to be assigned to any and all subject matters.
  
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  Correspondence files are always in SSIC order. This is universal among Navy and Marine Corps.
  
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  Correspondence files are always renewed at the beginning of each new calendar year.
  
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  Classified Documents will always have their SSIC numbers prefixed by a certain number of zeroes.
  a. Confidential documents' SSIC numbers are prefixed by 1 zero (I.E., CO1530)
  b. Secret documents' SSIC numbers are prefixed by 2 zeros (I.E., S001530)
  c. Top secret documents' SSIC numbers are prefixed by 3 zeros (I.E., TS0001530)
  

The 14 major subject groups are designated by either a 4 or 5 digit number:

Includes subjects relating solely to the administration of military personnel. Civilian personnel subjects are included in the 12000 series. General personnel subjects relating to both civilian and military personnel are included in the 5000 series.

Includes subjects relating to general communication matters and to communication systems and equipment.

Includes subjects relating to such matters as operational plans, fleetoperations, operational training and readiness, warfare techniques, operational intelligence, research and development, geophysical and hydrographic support.

Includes subjects relating to the logistical support of the Navy and Marine Corps, including procurement, supply control, property redistribution and disposal, travel and transportation, maintenance, construction and conversion, production and mobilization planning, and foreign military assistance.

Includes subjects relating to the administration, organization, and management of the Department of the Navy , including general personnel matters concerning both civilian and military personnel, records management programs, security, external and internal relations, audiovisual management, law and legal matters, office services, office automation, and publication and printing matters.

Includes subjects relating to medical matters such as physical fitness, general medicine, special or preventive medicine, dentistry, medical equipment and supplies.

Includes subjects relating to the financial administration of the Department of the Navy, including budgeting, disbursing, accounting, auditing, contract auditing, industrial and other special financing matters, and statistical reporting.

Includes subjects relating to all types of ordnance material and weapons, including ammunition and explosives, guided missiles of all types, nuclear weapons, fire control and optics, combat vehicles, underwater ordnance materials, and miscellaneous ordnance equipment.

Includes subjects relating to such matters as the design and characteristics of ships, and to ships material and equipment.

Includes subjects relating to general categories of materials not included in the specialized material groups. It includes audiovisual/graphic arts/photographic/television/video equipment and accessories, general machinery and tools, personnel (materials), and miscellaneous categories.

Includes subjects relating to ashore structures and facilities, fleet facilities, transportation facilities, heavy equipment, utilities and services, and other similar subjects.

Includes subjects relating solely to the administration of civilian personnel. Military personnel subjects are included in the 1000 series. General personnel subjects relating to both civilian and military personnel are included in the 5000 series.

Includes subjects relating to aeronautical and astronautical material, including parts, accessories, and instruments; special devices; armament; aerological equipment, weapons systems, types of aircraft; and astronautic vehicles.

Includes subjects relating solely to administration and mission of the Coast Guard. NOT TO BE USED BY NAVY OR MARINE CORPS ACTIVITIES.

When looking for a specific instruction, you should use NAVPUBINST 5215.1 (Consolidated Subject Index). This publication includes: The Alphabetical Listing, Numerical Listing, Cancellation Listing, and the DOD Implementation Listing. A listing of instructions issued by Washington, DC Headquarters Organizations is issued twice each year. This numerically indexed, subject-categorized compilation will aid in identifying active naval instructions applicable to addressee's programs or subject matter interests.

 

Navy Disease Vector Ecology and Control Center

 

Navy Environmental Health Center

 

Armed Forces Medical Intelligence Command (AFMIC)

Com:  (301) 619-7511 DSN:  343-7511

 

BUPERS

 

BUMED

 

Research & Development Command

R&D (CODE 026)       DSN:  295-0287

 

United States Air Force School of Aviation Medicine (USAFSAM)

 

United States Air Force Aeromedical Research Lab (USAFAMRL)

 

United States Army School of Aviation Medicine (USASAM)

 

Available Lines of Communication for ALSS Problems