Evolution of Pararescue Medicine During Operation
Enduring Freedom
By Lt Col Stephen Rush, USAF MC*; Eric Boccio, BS†; Chetan U. Kharod, MD, MPH‡;Jason D'Amore, MD†
MILITARY MEDICINE, Vol. 180, March Supplement 2015
INTRODUCTION
Pararescuemen (PJs) are tactical and technical rescue specialists who also undergo Paramedic certification during their training. In addition, PJs receive further training in military prehospital care, invasive battlefield procedures, and other protocols and techniques emphasized in rescue scenarios. Various aspects of this training regimen are introduced and accomplished in both the Pararescue Schoolhouse as well as subsequent training on reaching home station. Pararescue medical operations include principles of Tactical Combat Casualty Care (TCCC), civilian paramedic medicine, dive medicine, life and limb saving invasive procedures, and wilderness medicine. The maintenance of medical skills is complicated by the need to maintain many other currencies related to mobility, tactical, and technical rescue skills.
Policies and practices are generated and approved by the Pararescue Medical Operations Advisory Board. Internal guidance from board certified physicians in Emergency Medicine, Anesthesiology, and Surgery provide oversight and quality review. In the past few years, attention has focused on the Air Force Trauma Service to develop guidelines and policy as well as the Joint Trauma System in setting policy and guidance.
Working closely with the Trauma Surgeons has allowed U.S. Air Force (USAF) PJs to effectively provide continuity of care from the point of injury to the operating room. In instances where there is a need to develop a new treatment policy in response to a certain locale or mission, the
local flight surgeon is responsible for its development and implementation, which includes the necessary and appropriate training. For example, when packed red blood cells became available in December 2010, a proof of concept was performed in 2013 on the use of fresh frozen plasma.
Oversight of care provided by the PJs is under the license of the assigned flight surgeon. In the absence of a flight surgeon, PJs are directed to practice in accordance with the Pararescue Medical Operations Handbook or the U.S. Special Operations Command Advanced Tactical Paramedic book when conducting military or humanitarian assistance operations.
In addition, in situations where PJs are performing civil operations, they are not only under the license of their medical director (flight surgeon), but also under the guidelines of regional Emergency Medical System (EMS) policies.
The primary and classic mission of PJs is to perform search and rescue to locate, stabilize, and recover downed aircrew in any location and at any time. This mission has expanded to include recovery of isolated personnel on behalf of the Department of Defense in a variety of other settings.
For example, in 2009, a Fragmentation Order was issued to have Air Force Rescue, including PJs, flying on HH-60s and C-130s, and to perform Tactical Evacuation (TACEVAC) in Afghanistan to augment U.S. Army assets performing medical evacuation (MEDEVAC). Several bases were used. A typical alert team included a pair of HH-60s with a Combat
Rescue Officer and 5 PJs between the 2 airframes.
New medical tactics during tactical field care and rotary wing medical operations have emerged from USAF Pararescue participation in TACEVAC in Afghanistan. Collectively, these comprise a portion of Pararescue Medical Operations during Combat Search and Rescue. Building on TCCC, data from this conflict and themes from civilian emergency medicine practice have formed the basis for modernizing PJ medical operations. Although there are several tactical and technical rescue capabilities that distinguish USAF Pararescue from the other 2 platforms operating in Afghanistan, U.S. Army MEDEVAC (DUSTOFF) and the British Medical Emergency Response Teams (MERT), topics discussed herein focus on recent changes to Pararescue medical care regarding tactical field care and evacuation, specifically patient assessment, use of ketamine, approaches to advanced airway management, intraosseous (IO) access, and patient documentation.
If you would like to read the full journal please email Public Affairs at 106RQW.PA@ang.af.mil