The Army will be training hundreds of new medics in enhanced skills to treat wounded servicemembers during the flight from the battlefield to field hospital, when the most severely injured have a better chance of surviving with an experienced paramedic aboard.
The tentative plan is to train 1,200 critical-care flight paramedics at a cost of $53 million, with the first of them deployed next year, says Col. Bob Mitchell, aviation consultant to the Army surgeon general.
"(This) is a quantum leap forward for how we've done business so far," says Lt. Col. Bob Mabry, an emergency medicine and pre-hospital care specialist, and an architect of the plan.
The need for the new specialists became clear when the vast distances for airlifting casualties in Afghanistan complicated care for troops suffering multiple amputations, severe blood loss, brain damage and internal injuries, Mabry says. Massive bleeding and organ failure make it difficult for surgeons to save these casualties.
A new Army study shows that severely injured troops and Afghan civilians transported by Army National Guard units whose medics were also civilian flight paramedics had a 66% higher survival rate than casualties carried by standard Army medical evacuation units.
Civilian flight paramedics are the highly trained medical professionals found on emergency air helicopters, also known as medevacs.
In Afghanistan, medical flights are usually staffed by medics with basic lifesaving training only.
The Army has placed critical-care nurses on flights between medical facilities, but not on flights from the battlefield.
Mitchell says a dozen of these nurses are now in Afghanistan.
The current survival rate for wounded troops, at more than 95%, has never been better, military data show.
However, most of the remaining 5% die before reaching surgeons.
"We want to enhance the skills of our medics at the critical time between the point of injury and getting them back to the hospital," says Brig. Gen. Richard Thomas, an assistant surgeon general. "Our (survival) numbers are good. But that's a vulnerable period in there."
Training for medics would increase from four weeks to six to eight months, Mitchell says. Trainees would learn ways of delivering oxygen to patients in cases of severe brain injury, injecting drugs that temporarily paralyze and sedate so a breathing tube can be inserted and a ventilator used during flight.
Monitoring ventilation pressure during altitude changes also would be crucial, says Mabry, who served as a special operations medic during the "Black Hawk Down" battle in Somalia in 1993 before becoming a doctor.
The new paramedics also would be skilled at providing transfusions and drugs to stem blood loss, he says.
Without the new skills used on severe casualties fresh from battle, massive blood loss and the shock and organ failure that follow create problems surgeons can't fix, Mabry says.
"You get to a point where (damage) is irreversible," he says. "We can't get you back."