Soldiers encounter various hazards in theatres of operations, and whether they sustain combat wounds or other injuries, every minute of excellent medical care they can receive is integral to their recovery. However, the infrastructure of hospitals in crisis regions or countries with less advanced technology is often not adequate for this purpose. And it is then that medical evacuation via air transport may be required.

The tool for the job

For cases such as these, the capabilities of the A400M have been significantly upgraded. Apart from the capability of refueling other aircraft in the air and performing the protected transport of material and personnel to other countries and crisis regions, the heavyweight plane is now also capable of flying seriously injured soldiers out of those countries and crisis regions.

Following several field trials of the medevac equipment of the German Air Force and Medical Service, the A400M’s operational suitability test was completed successfully last year. On 1 August 2018, the assumption of full operational capability was reported and since then, the A400M has been employed in eight rescue missions.

The responsibility for the co-ordination of evacuation flights rests with the European Air Transport Command (EATC) located in Eindhoven; EATC’s main task is the co-ordination and operational command and control of air transport and air-to-air refueling assets and the repatriation of injured and wounded service members from theatres of operation and crisis regions. This multinational co-operation saves a lot of resources for the member states of Germany, France, Spain, Italy, Luxembourg, the Netherlands and Belgium.

A global operation

When it comes to carrying out a medical evacuation flight, the EATC will first alert the Bundeswehr Medical Service, which provides the medical personnel for the flight. At the same time, German Air Force Headquarters and Air Transport Wing 62 in Wunstorf will be alerted. After this, the aircraft will be prepared for the mission.

For such flights, the aircraft’s cargo compartment will be adapted and equipped in such a way that intensive medical care can be provided for up to six people during the flight to Germany (or other countries of the alliance). The reconfiguration of the cargo compartment will be performed by medical equipment technicians of the air wing, while the Medical Service will ensure the presence of personnel sufficiently trained and qualified for intensive care on medevac missions.

The mobile intensive care modules raise medical standards in the aircraft to the same level of intensive care units found in hospitals, containing nearly all the supplies that are typically required to provide immediate care to patients. In addition, large quantities of equipment and medication are stored in supply boxes stowed in the cargo compartment. The medical equipment used is state-of-the-art, and consequently, errors or faults caused by technical failure occur far less frequently. In combination with highly professional medical personnel, errors that occur during rescue or aid flights can be reduced to an absolute minimum.

The medical equipment that must be retrofitted into the aircraft comprises 2.8 tons of material. The drawers of the mobile intensive care modules are filled with medical instrumentation and medication, and a further 18 transport boxes will be added to this.

It takes three to four people about four hours to retrofit the aircraft with all the required equipment, after which time the A400M is mission ready.

While the process is ongoing, the assigned medical personnel will arrive. These personnel are on permanent standby in a weekly rotation. The so-called ‘notice to move’, i.e. the maximum period from alerting to aircraft take-off, is 12 hours.

Thanks to its self-protection equipment and air-to-air refueling capability, the A400M can be deployed all over the world, as well as in crisis regions.

Qualification of technicians and medical personnel

Before the A400M can take off on its mission, the medical crew must be familiarised with the aircraft and the medical equipment. This includes the aircraft’s special features, such as the emergency oxygen supply, several emergency procedures, and the position and opening-up of escape doors, which is a process that requires a lot of practice. The rope ladder structure in the tail area, which is used in case of emergency, is another challenge for the crew’s co-ordination and suitability for high altitudes. The Air Force Center of Aerospace Medicine conducts the A400M complementary module of the training of medical personnel in medevac assignments in co-operation with Air Transport Wing 62 in Wunstorf.

During this training course, the crew members learn how to correctly load and unload material and fill supply boxes with the necessary medication and medical aids

During this training course, the crew members learn how to correctly load and unload material and fill supply boxes with the necessary medication and medical aids. They also learn where and how all of the equipment is stowed, where the connections for all of the devices are located and where to find the escape doors.

The demands placed on the personnel rise in line with the increasing number of highly sophisticated devices placed onboard. Those demands include performance capacity, concentration, stress, teamwork or safety awareness, and are summarised under the generic term of ‘human factors’.

Human factors and the crew

A consequence of the increased demands on the one hand, despite the equipment working better and better on the other hand, is a current fault frequency in the medical field of approximately 70 to 80 per cent, which is ascribed to human failure. In order to prevent those faults, the personnel’s non-technical skills are trained and improved upon within the framework of crew resource management training.

During the training course, the A400M cargo compartment is loaded with medical equipment and occupied by medical personnel; the students work in several teams in the six mobile intensive care modules installed. Personnel receive training on how to handle the specific features of the aircraft both on the ground and during flights, thus ensuring that the correct action will be taken in the instance of an emergency. The medical personnel are flexible in how they work together, depending on the nature of injuries and the number of patients.

During medevac flights, the minimum crew comprises a medical director, whose responsibilities are similar to those of a chief physician in a hospital; the director’s ‘right and left hand’, the medical crew chief, who is responsible for organisational matters, including food and accommodation for the crew; and the medical equipment technician, another key crew member who checks the function of all the equipment before the flight and is also responsible for monitoring it during the flight.

There is also an anaesthetist and an anaesthesia nurse on board who permanently care for the patients’ conditions and monitor their state of anesthesia. The final members that make up the minimum crew are two paramedics and independent medics who treat emergency patients autonomously and assist the physicians in performing their tasks.

From the ‘old lady’ to the ‘jack-of-all-trades’

The changeover in air transportation from the Transall C-160, the ‘old lady’ of the Air Force, to the Airbus A400M, began five years ago. After nearly 1,200,000 flight hours and more than 40 years, nearly all of the Air Force’s 90 Transall aircraft retired. The last remaining Transall aircraft are stationed at Air Transport Wing 63 in Hohn, Northern Germany, and they will soon join their sister aircraft in retirement in about two years. Following this, the A400M will be totally responsible for the entire Bundeswehr air transport mission profile. The heavyweight aircraft can fly about 6,400 kilometers without the need for a stopover, which means non-stop point-to-point flights to all current German theatres of operations.

The heavyweight aircraft can fly about 6,400 kilometers without the need for a stopover, which means non-stop point-to-point flights to all current German theatres of operations

The flying range is increased by the A400M’s air-to-air refueling capability, but conversely, the A400M is capable of refueling other aircraft during the flight as well.

The A400M’s new features are remarkable in comparison to the Transall. The A400M is about 10 metres longer, about three metres higher, and capable of transporting more than 40 tons of additional payload. Furthermore, the new transport aircraft is equipped with four – instead of two – engines. In conclusion, it can be said that the A400M flies twice as far, twice as fast and loads three times as much cargo as the Transall.

With its various capabilities, the A400M is the most advanced aircraft of the German Air Force and its medical equipment is state-of-the-art. The A400M, in medevac configuration, makes the soldiers’ journey home from crisis regions faster and safer. Because, when man and technology work together, patients will have the best treatment possible in air transportation.