Medical%20Evacuation%20Network%20Project

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Medical Evacuation Network Project

• LT McMullen
• LT Dunham

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Presentation Medical Evacuation

• Background Information
• Helmand Province Graph / Network
• Analysis
• Questions

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Medical Evaculation

• 500AD Byzantine Empires Army was first to
  employ a organized medical evacuation.
• By 1800 most armies had some medical evacuation
  capability.
• Almost every conceivable mode of transportation
  has served to evacuate wounded from the
  battlefield.

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Medical Evacuation

• Today US military doctrine employs a combination
  of ground, rotary and fixed wing transport.
• In southern Afghanistan, urgent patient transport
  relies almost entirely on a robust aeromedical
  evacuation network.

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Golden Hour

• Golden Hour in emergency medicine refers to the
  span of time immediately after a traumatic injury
  of a soldier and the time medical intervention
  offers the greatest chance of survival.

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Levels of Care

• Intra Theater Medical Care
• Level 1
• Care is administered at/close to POI and includes
  self or buddy aid, emergency lifesaving measures.
• Level 2
• Care includes basic resuscitation, limited
  surgical capability, basic transfusion services,
  limited ancillary services.
• Level 3
• The highest level of care in an operational
  theater and has all the capabilities of a medical
  treatment facility (MTF) in the States.

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Purpose

• Initial Intent (week 1 of the course)
• Model an aeromedical medevac network in Helmand
  Province.
• Assess the robustness of the network with two
  medical evacuation platforms transporting
  multiple patients.
• Assess design impact of providing critical care
  capabilities onboard current platform and
  extending golden hour

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Purpose

• Revised Intent (week 9 of the course)
• Model a notional aero medical evacuation network
  in Helmand Province Afghanistan.
• Test the networks ability capacities evacuate
  patients on demand.
• Optimize placement of Military Treatment
  Facilities (MTFs).

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Purpose

• Measures of Effectiveness
• The ability to transport patients throughout the
  entire medevac network in under 60 minutes
  (binary).

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Helmand Province
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Medical Evacuation Helicopters

• SH-60
• Max Speed 145 knots
• Capacity 4 litter patients
• MH-4E Chinook (British)
• Max Speed 154 knots
• Capacity 1-2 patients
• Helicopter Assumptions
• 115 miles per hours (patient load/unload time,
  threat, etc).
• Only SH-60s where employed.
• Each SH-60 had a chase bird
• Capacity 2 litter patients

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Inaccessible Air Spaces

• Dust/Sand Storms
• Among natures most violent and unpredictable
  phenomena.
• High winds, unleashing turbulent, suffocating
  cloud of sand
• Reduced visibility
• Can travel at more
• than 75 miles per hour

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Inaccessible Air Spaces

• Surface Air Missiles (SAMs) Rocket Fire
• "The US helicopter was shot down by the Taliban
  as it was taking off," "It was hit by a rocket
  fired by the insurgents."

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Assumptions

• Interdiction Model
• Level 2 MTFs have capacity
• of 2 patients
• Level 3 MTF has an infinite
• capacity
• Forward Operating Bases
• (FOBs) and MTFs are
• co-located
• SH60s have a capacity
• of 2 litter patients
• Only considered immediate
• or urgent evacuations

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Assumptions

• Design Model
• Probability (weights)
• assigned for casualty
• evacuation for each POI
• Iterative process
• One patient evacuation
• demand at each node

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Helmand Network Model Topology
(0,8,0)
(Cost, 8,0)
(0,max bed capacity,0)
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Primal Setup
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Dual Setup Arc Attacks
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Interdiction 1-2 Patient _at_ each POC

• Optimal Inaccessibility
• 24 inaccessible air spaces
• Example
• 7 POI locations are
• unreachable

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Interdication 3-4 Patients _at_ each POI

• 10 in-accessible air spaces
• Example
• 2 patients from POI make
• it to L2 MTF South,
• However 1-2 patients
• are unable to travel to
• L3 MTF due to
• inaccessible air space

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Interdiction 3-4 Patients _at_ each POI

• 27 in-accessible air
• spaces
• Outcome
• 10 POI locations lose 1-2
• patients
• 7 POI locations are
• unreachable

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Analysis
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Analysis
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Design-Optimal Placement of 2 MTFs

• Realistic Causality Distribution

• Constant Distribution

• 64 of POIs are reachable in under 60 minutes

• 89.5 (weighted) of POIs are reachable in under
  60 minutes

reachable in over 60 minute
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Design-Optimal Placement of 3 MTFs

• Realistic Causality Distribution

• Constant Distribution

• 90.625 of POIs are reachable in under 60 minutes

• 90.48 (weighted) of POIs are reachable in under
  60 minutes

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Design-Optimal Placement of 4 MTFs

• Realistic Causality Distribution

• Constant Distribution

• 93.55 of POIs are reachable in under 60 minutes

• 95.23 (weighted) POIs are reachable in under 60
  minutes

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Design Analysis

• Optimal placement of MTFs under constant
  distribution increases our ability to reach
  patients in under 60 minutes.
• Original Placement of 4 MTFs 87.1
• New Placement of 3 MTFs 90.625
• New Placement of 4 MTFs 93.55
• Optimal placement of MTFs under realistic
  causality distribution increases our ability to
  reach patients in under 60 minutes.
• New Placement of 3 MTFs 90.48
• New Placement of 4 MTFs 95.23

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Conclusions

• Current MTF placement is very close to the
  optimal position suggested by our model.
• Interdiction is probably not the best model for
  this network.
• If interdiction model was desired one that models
  weather would be more appropriate.

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Conclusions

• Network should be reevaluated as the battle space
  evolves.
• Political and historical factors will be
  considered in facility placement by decision
  makers.
• Combined or Joint Operations adds more complexity
  (more medevac platforms types, country caveat
  constraints, medical rules of eligibility, etc.)

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Questions

• Questions?