The Army MEDEVAC Scandal: Report of Conspiracy
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02 February 2012
An Army officer writes:
The Army is not resisting Dustoff policy change because our leadership honestly believes the current policy is superior, but rather because of AMEDD's [Army Medical Department] protectionist attitude toward "their" Dustoff MEDEVAC helicopters. I'm an active duty infantry officer, and I've been following the Dustoff issue since you first brought attention to it. More importantly, I have a lot of contacts within the Medical Service branch. While we have discussed this issue "around the watercooler" at work, Medical Service officers have been receiving briefings from senior members of their branch about a selectively edited account of SPC Clark's MEDEVAC mission, and what their message should be if anyone asks about it.
My contacts have highlighted that AMEDD's number one priority is protecting their "ownership" of the helicopters in question. They are concerned that removing the Red Cross from AMEDD's birds will result in those helicopters being assigned general purpose tasks, outside of the Medical Service Corp's control. In other words, their top priority is NOT providing the best possible care for our Soldiers and partners, but rather protecting their own fiefdoms. AMEDD is choosing to put Soldiers' lives in danger rather than chance losing "their" birds. Never mind that our sister services, special operations forces and allies are all able to field armed, dedicated CASEVAC/MEDEVAC helicopters! Somehow, despite all the evidence to the contrary, this is still the irrational argument AMEDD is sticking to, and directing its officers to spread. I'm concerned that in the dust-up over policy recommendations, comparisons with Pedro, and rebutting the JCS letter that we may be losing sight of the real obstacle in our path to reform. Sincere thanks for all you do, and keep up the fire!
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Comments
On another note; excellent use of the word “fiefdom”.
Why we tolerate these stupid games from the armed services is a mystery to me. In an era of downsizing, there is no question whom I would hand their pink slips: the politicians, the cubicle warriors, the staff weenies who presume to perpetrate sick policies like this one despite simple common sense proof that their stance is immoral.
Fire 50% of the Pentagon. That will be a good start. Leave the grunts alone. At least the grunts have honor.
Someone ought to be able to discipline any O-6 who diverts dedicated medical aviation assets to some general purpose support mission. Failing the Army's having any discipline, they should just remove the Medical Companies from the Aviation Brigades and make them independent again - but remove the crosses and arm them.
It's a simple problem, and the solution is obvious enough(the Air Force and Marines have already found it)that it could be made between brushing your teeth and putting on your socks. I don't know who has the ultimate authority, but they should be sacked while they wait around for that Powerpoint presentation with the graphs, charts and embossed seals that proves that delayed treatment of injuries is unhealthy.
The moral factor has been employed by the US Armed Forces only as a motivating and team building factor aside from the abstract ethical side of traditional morality. Therefore, US Armed Forces policies are guided by strict economic rules in every aspect. The troops on the ground may exercise their moral principles in combat routine (as they are expected to), but that does not stop their being “economic assets” or “entities functioning as stores of value and over which ownership rights are enforced by institutional units, individually or collectively, and from which economic benefits may be derived by their owners by holding them, or using them, over a period of time (the economic benefits consist of primary incomes derived from the use of the asset and the value, including possible holding gains/losses, that could be realized by disposing of the asset or terminating it)”.
I suppose, that says it all.
It is the Army MSC's who "own" those MEDEVAC helos. They like having those birds, and having control of them VERY much. They will do anything to keep them. They care more about that than anything else. I suspect it was an MSC who wrote that JCS letter that Michael so eloquently dissected and tore apart. You can tell that whoever wrote it knew enough lingo to sound legit, but in reality they don't know what the hell they are talking about, i.e. the obvious confusion the author had of .240 cal weapon vs the M240. They know enough to be dangerous, but that is about all.
Michael, go after the Army MSC's. Not the whole AMEDD, but zero in on the MSC's who control those helos. That is where the incompetence is, and that is where the answer is. If you shine a very bright light there, I'd bet the farm that you will see cockroaches scurry, and those ridiculous red crosses will just magically disappear.
You are completely correct about primum non nocere, I learned that in my first weeks of medical school. But I can tell you, it's not the doctors that are the problem here. The doctors don't care how the patients/casual ties get to them, they, we, just want them in our trauma bays ASAP, how they get to us is irrelevant. And if having a red cross stuck on the front and sides of a blackhawk delays a combat casualty getting to me, then I want that red cross gone. Period.
Remember, the AMEDD is composed of 4 corps of officers: Medical (the doctors), Dental, Nurse, and Medical Service (admin/support) . It is the Medical Service Corps types who control the MEDEVAC helos. Not the doctors, or nurses, or dentists. I believe the key to getting rid of the red crosses, which I and anyone else who really cares about kids like Chazaray Clark, wholeheartedly support, lies in zeroing in, and shining light on the actual individuals who control those MEDEVAC Blackhawks. And those people have Medical Service Corps on the lapels of their Class A uniforms.
thanks for responding. Thanks for your service. Sounds like you're a
doctor too, but in the "trenches" as it were. My main concern is those
doctors who have risen to the ranks for Administrative Zealots, and have
forgot they came from the trenches. They will be very hard, vis a vie,
resistant to change, unless you can show them it is harming patient care!
yours,
A. Peter Troedson, MD
Take a look at the command structure for AMEDD and tell me who is the advocate for the MEDEVAC mission? Is it the dermatologist? The immunologist? Or is it one of these specialists:
Pediatrician
Sociology/Health Administration
Family practice
Veterinarian
Artillery Officer
The new Surgeon General does have a background as a Clinical Trauma Nurse Specialist, and the Command Sergeant Major was a Medical NCO/Combat Medic. But if you go back over a decade you'll see that MEDEVAC has never risen to the top of senior command despite 10 years of continuous war.
Who speaks for the wounded on the battlefield awaiting rescue? Who presses for continuous improvement in MEDEVAC? Yes, there are people within the organizational structure of AMEDD who do a great job in researching advances - but what BG or MG owns that mission?
The medical specialties in my comment above are the actual specialties of the AMEDD senior command team.
Not only will it affect ownership it will affect what funding they will receive. Follow the money trail.
The MEDEVAC assets were turned over to the Combat Aviation Brigades (CAB) years ago. But the pilots and crews are still the responsibility of AMEDD (e.g. AMEDD trains them and maintains different MOSs for pilots and medics than comparable roles in the CAB)
Remove the red crosses and put guns on the MEDEVAC birds. Simultaneously, the Army should include in the CAB command evaluation process performance measures for timely and effective MEDEVAC missions during the period under review. If the CAB thinks he can snag some armed MEDEVAC copters for air assault roles fine. But if his Charlie Company of MEDEVAC copters fails to meet a new, tougher timeline for rescues then the CAB CO gets screwed in his performance evaluation. If a CAB commander wants to roll the dice when it comes to saving the wounded, then let him bet his career on it because he is already betting people's lives on it.
Since the Army is the sole source provider of MEDEVAC per DoD doctrine have the JCS approve the performance guidelines.
In AMEDD's defense, while they may be misguided, they're not utterly evil. The concern of "losing control of their assets" is a valid one, at least to some degree. If the red crosses are removed, then it is only a matter of time before the MEDEVAC aircraft start being used for other purposes (I know, it's not supposed to happen, but it will). Then we run the risk of having Soldiers die because all the MEDEVAC helicopters are busy ferrying DVs around the theater. The only solution I can see is to remove the red crosses AND remove the MEDEVAC assets from the CAB.
That way they cannot be diverted to other missions as others here have suggested.
You may well be right, I don't believe that anyone truly wants to do something that they know is hurting our troops. But I also believe that people working within bureaucracies can and do lose sight of the big picture. And I believe that they can lose perspective to such a degree that they start doing things that would appear to an outside observer to be really stupid. But in their minds, its perfectly justifiable and defensible. And it certainly appears that to me that is what is going on here.
There's just no excuse for not making every effort possible, and I mean every single one, to get a wounded troop to as high an echelon of care as soon as possible. To my way of perhaps simplistically thinking, that is the big picture. Everything else is fluff.
The idea of the "golden hour" is a great teaching tool, and sounds good, but there is nothing magic about 60 min. The reality is the sooner a trauma patient gets to an operating room, the better. Period. I read someone say elsewhere on this site that it should be the "golden as soon as possible", and that is really true. Minutes, seconds count. Hiding behind an arbitrary 60 min cutoff might be bureaucraticall y defensible, but morally it is not.
I've seen that video of Chazaray on a stretcher, holding his head up, looking around, and asking for pain medicine. That is huge, it has enormous implications. That means his blood pressure was high enough at the time to be supplying his brain with enough 02 to be functioning basically normally. He was likely entirely "savable" at that point in time. How long had it been since the IED went off? And how much longer after he did that did it take for him to get loaded on the bird?
That young man, in that situation, at that time, to me, is the big picture. Anything that impeded his earliest possible evacuation should be ruthlessly dealt with.
Now is the time for our elected Representatives to force the US Army to make the changes necessary to get the job done and done correctly.
To hell with their worry over assets assigned to their command. They are obstructionist and all responsible for the death of untold numbers of our soldiers. That is criminal and should result in a Court Martial under UCMJ!
If names cannot be named with confidence, then nominating the most likely candidates may be in order. Anyone so nominated is then welcome to speak to their own actions.
I think you are right on the money. Individual people are making these decisions, hiding within the bureaucracy. I'd be willing to bet that it's not just one name, but it is few enough to count on one or maybe two hands. Locate, identify, and then prosecute those targets. As publicly as possible.
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