History of medical technology and evacuation systems

Medical technology has become critical in the modern healthcare environment given the increase in patient populations and the increased demand for quality, affordable care. Advancements in technology continue to transform nearly every aspect of society including the healthcare field. Innovative technology is considered critical toward improving the delivery and quality of healthcare services. Technology has a long history in the field of healthcare as it is traditionally used in developing medical equipment and enhancing clinical processes. Medical technology is applied in different areas of healthcare including in medical evacuation. Medical evacuation is an important part of healthcare as it is required when a medical issue cannot be effectively and adequately addressed in the current location. This paper examines the history of medical evacuation in relation to technology development and implementation in this area.
Overview of the Concept of Medical Evacuation
Medical evacuation is a process that has traditionally been utilized in the healthcare sector to help address the clinical needs of patients. The term medical evacuation refers to the process of moving a patient from one location to another for a higher standard of care. This process is carried out when the patent’s clinical condition cannot be adequately addressed or treated in the current location. In this case, the patient is moved to a location where he/she can receive quality medical care for the medical condition. According to Reksoprodio et al., medical evacuation is commonly known as MEDEVAC and entails the timely and efficient transfer of casualties to another location for quality care (par, 2). While en route to the new location, patients receive medical care, especially if they are wounded or require urgent care.
In today’s healthcare setting, medical evaluation involves the use of aircraft and other modes of transport for the speedy movement of patients to a location where they can receive a higher standard of care. The increased use of aircraft represents one of the major developments in the area of medical evacuation. Air medical evacuation is usually a complex and challenging process that can be further complicated if the patient is suffering from hazardous infectious or communicable disease (Gibbs et al., p.359). However, air/aerial medical evacuation has improved in recent years because of the ease of air travel, expansion of global commerce, and tourism. Even though these improvements have exposed all regions across the globe to diseases, they have also made it easier to evacuate patients to new locations for a higher standard of care. Medical evacuation is common in situations where there is limited local infrastructure to provide care or in situations where there are potential negative impacts on local healthcare workers. Additionally, medical evacuation is preferred in situations where there is an active war, there are local or national political concerns, or in conflict zones.
History of Aerial Medical Evacuation
Medical evacuation has developed to become an important part of today’s healthcare sector and medical practice. Throughout the history of the healthcare field and practice, patients have always been moved from one location to another because of the need for a higher standard of care. Medical evacuation is particularly common in situations of active war or conflicts, natural disasters or emergencies, and where there is an outbreak. Despite medical evacuation existing for as long as healthcare has existed, aerial medical evacuation initially began in military and paramilitary operations before being incorporated in non-military medical care. The emergence of aerial medical care in military and paramilitary operations and later integration into non-military and emergency medical care is attributable to historical developments in the realm of medical transport. These historical developments paved the way for aerial medical evacuation to become common in non-military and emergency medical care settings.
Early Years of Medical Evacuation
As previously indicated, the history of today’s aerial medical evacuation in emergency medical care can be traced back to aerial medical evacuation in military and paramilitary operations. In essence, the concept of aerial medical evacuation emerged in the military and paramilitary setting before becoming common in the overall healthcare setting. According to Olson, the United States Army pioneered air medical evacuation of casualties from the battlefield following the advent of the helicopter (p.S130). However, medical evacuation started in the first century prior to the advent of the helicopter.
The application and use of medical evacuation can be traced back to the first century when casualties from the battlefield were evacuated to other areas for urgent and high-quality medical attention. During the first century, the Byzantine Empire’s army integrated a system for battlefield casualty evacuation (which is known as CASEVAC) using medics known as Scribones. These medical professionals were located a hundred meters behind the battlefield and were paid a gold piece for every casualty they rescued. However, it was until the 18th Century when records of organized CASEVAC became common. This was during the French Revolution when Baron Dominique-Jean Larrey, Napoleon’s surgeon rode into a battlefield on a horse-drawn carriage to evacuate soldiers. Larrey evacuated injured soldiers from the battlefield to the rear of the combat where they received treatment.
Prior to this, battlefield casualties were largely considered liabilities to the war effort and were left for dead with little-to-no medical attention or medical care. There was minimal interest in medical evacuation during this period because of various factors, especially the state of medical treatment. Medical care during this period provided no hope for treatment or cure, which made it difficult for any war casualty to survive or recovery from injuries sustained on the battlefield. Additionally, wounded soldiers were largely viewed as hindrances to the progression of the war and future operations of the Army (Lam, p.19-1). Medical evacuation also received minimal attention during this period because it would imply removing other combatants from the battlefield to provide their transport. Consequently, the ability to move patients from the battlefield to another location for medical treatment/care developed more slowly during the 18th Century in comparison to other medical capabilities. Evacuation was not regarded as a medical responsibility since healthcare professionals at the time treated those who could get to their facilities on their own or were brought by others.
A significant turning point in the history of medical evacuation occurred in 1862 during the Civil War. Dr. Jonathan Letterman established a medical evacuation system involving the use of military ambulance for the US Army. The development of automobiles during this period played a critical role in the establishment of this system and changed the history and practice of medical evacuation. Letterman’s development of an ambulance system for CASEVAC for the U.S. Army was seemingly influenced by Larrey’s work. As medical capabilities enhanced, Larrey realized that most wounded soldiers died from the need of help and as a result, designed the Flying Ambulance. The Flying Ambulance was a light wagon used to carry surgeons to the casualties instead of vice-versa. Larrey successfully developed and equipped three divisions of ambulances. These divisions were equipped with evacuation vehicles, medical equipment, and trained personnel.
Letterman’s development of an ambulance system for the US Army during the Civil War a significant turning point in the practice of medical evacuation. Following Larrey’s work, most Armies across the globe had established some form of evacuation system by the mid-1800s. However, Letterman’s work paved the way for the emergence of much better military ambulance systems for CASEVAC since it was influenced by the advent of new technologies. In this case, Letterman capitalized on the advent of new technologies that enabled safe movement without compromising the overall war initiative. Moreover, he capitalized on the increasing social activism that advocated for medical care for wounded soldiers to design a system that would change the history of medical evacuation. From this period until the mid-20th Century, several forms of ground ambulances were used to evacuate casualties from the battlefield to locations where they could receive medical care/treatment.
Aerial Medical Evacuation in Military and Paramilitary Operations
Organized evaluation of wounded soldiers from the battlefield for medical treatment/care became more common in the late 19th Century. This was influenced by various factors including improvements in the capabilities of military medicine and the emergence of new technologies in the transportation sector. As a result of these emerging trends, military commanders started to realize the unique advantages of evacuation of wounded soldiers for medical care and the benefits of establishing an organized medical evacuation system. Improvements in medical capabilities enhanced the belief that wounded soldiers would receive much better care and increased the survival rates of casualties dramatically.
Aerial medical evacuation was brought to public attention during the Vietnam war where it was massively used. However, aerial medical evacuation was not a new concept prior to the Vietnam War since it has a long history of trial and error as well as success and failure (Vanderburg, p.6). Aerial medical evacuation emerged around the same time as the concept of fixed-wing aircraft flight. In essence, developments in the field of air travel through the introduction of fixed-wing aircraft flight influenced the emergence of the aerial medical evacuation before World War I. The idea of aerial medical evacuation emerged shortly after the first airplane was flown by the Wright Brothers. Following the first successful flight, two US Army medical officers, Lieutenant A.L. Rhodes and Captain George H.R. Gosman designed an aircraft for transporting patients. These two medical officers used their own financial resources to create and flew the first-ever air ambulance across the globe at Fort Barrancas, Florida, in 1910. However, this first aircraft crashed after flying 500 yards at an altitude of 100 ft. This relatively unsuccessful event acted as the beginning of developments in this area and further trial and error as well as success and failure.
The first case of a successfully accomplished CASEVAC using air ambulance took place during the First World War. This isolated case at the time, occurred when the French used a fixed-wing craft to evacuate wounded Serbian soldiers retreating from Albania. The Korean War highlighted the significance of a helicopter for CASEVAC. Even though helicopters designed by the Korean Army for CASEVAC had many shortcomings and unsuitable for medical evacuation, the experience demonstrated the need for armies to establish a permanent organization dedicated to this objective.
The Vietnam War marked the other major turning point in the history of aerial medical evacuation. This War brought attention to aerial medical evacuation as aircraft were massively used to evacuate wounded soldiers from the battlefield to other locations for medical treatment and care. The massive use of aerial medical evacuation during the Vietnam War was pioneered by the US Army. US Army Air Corps pioneered air evacuation of wounded soldiers from the battlefield when they used C-47s and C-54s aircraft to execute an Air Ambulance squadron in the 1940s (Bedi par, 2). Despite being largely successful at moving patients speedily, it was characterized by some in-flight challenges.
During the Vietnam War, the 57th Medical Detachment of the US Army arrived in Vietnam aboard the Bell UH-1 helicopter in 1962. The helicopter, which was a replacement of the H-13 in 1955, carried patient litters in-board and delivered en route care. This helicopter was a reflection of developments in the field of transportation, particularly the aviation industry. It marked some improvements in the design of aircrafts such as enhanced flight crew and better speed and endurance. Given its improved capabilities, en route care in this helicopter included surgical airway establishment, application of first aid, intravenously administered fluid resuscitation, and morphine administration for pain. The improved capabilities of the aircraft resulted in its use for aerial medical evacuation during the Vietnam War. Some of the initiatives that reflected the increased use of aerial medical evacuation during the War include PEDRO and DUSTOFF units (Olson et al., p.2).
The success of the use of aircraft medical evacuation during the Vietnam War paved the way for its eventual use in the non-military and emergency medical care settings. After this War, MEDEVAC units were deployed numerous times in support of Desert Storm and Shield in Iraq, Operation Just Cause in Panama, and Operation Urgent Fury in Grenada. While combat operations in each of these conflicts ended quickly, wounded soldiers were transported by MEDEVAC units.
Aerial Medical Evacuation in Non-military and Emergency Medical Care
Aerial medical evacuation in the non-military and emergency care settings can be traced back to the use of aircraft evacuation in military and paramilitary operations. Following the successful application of aerial medical evacuation in the military, state and local governments in the United States sought to leverage this success. These governments leveraged the success of this initiative in the military world to start looking at how helicopters can be used in civilian emergency medical service systems (Olson et al., p.3).
The use of aerial medical evacuation in non-military and emergency medical care occurred after the Vietnam War. This practice was partly influenced by the success of aircraft evacuation during the war and the evolution of the emergency medical services system in the U.S. between 1960 and 1973 (Shah, p.414). During this period, a more organized and structured emergency medical services system was developed in the U.S. and influenced by several historical, medical, and social factors. The development and use of aerial medical evacuation in these settings were largely influenced by lessons learned during the Civil War and the Vietnam War. As the aviation industry continued to develop, aircraft were increasingly used in the healthcare sector for medical evacuation during this period.
A significant point in the use of aerial medical evacuation in non-military medical settings occurred in 1962 when U.S. medical authorities recognized the urgency of transferring trauma patients to well-equipped hospitals for treatment (Air Ambulance and Commercial Medical Escort Services par, 9). As a result, the National Academy of Science issued a policy paper that encouraged public healthcare facilities to embrace the use of medical air ambulance flights to help car crash victims and other critically ill patients. The policy paper influenced the creation of a contemporary nationwide emergency medical response system in the country. Over the past few decades, air ambulances have become integral parts of this system as helicopters are commonly used for emergency medical transports and medical evacuation.
In conclusion, aerial medical evacuation is an important part of today’s emergency medical services. However, the history of aerial medical evacuation can be traced back to the early days of medical evacuation in military and paramilitary operations. As evident in this discussion, aerial medical evacuation has a long history that dates backs to the first century and characterized by trial and error, successes and failures, and eventual success.
Works Cited
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Vanderburg, Kathleen. “Aeromedical Evacuation: A Historical Perspective.” Aeromedical Evacuation, 2003, pp. 6–12., doi: https://doi.org/10.1007/0-387-22699-0_2.