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AJ Eke. Army Helicopter Casualty Evacuations in Belize in 1995 And

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AJ Eke. Army Helicopter Casualty Evacuations in Belize in 1995 And J R Army Med Corps: first published as 10.1136/jramc-143-02-04 on 1 June 1997. Downloaded from J R Army Med Corps 1997; 143: 93-96 Army Helicopter Casualty Evacuations in Belize in 1995 and 1996 Maj AJ Eke MS, SS, DIH, MFOM, DAvMed, RAMC* Senior Specialist in Aviation Medicine Aviation Branch, Headquarters Land Command, Airfield Camp, Netheravon, Salisbury, Wilts, SP4 9SF. SUMMARY: Since the withdrawal of Royal Air Force Puma helicopters from Belize in 1994, the role of casualty evacuation (CASEVAC) of British military personnel, Belizean citizens and foreign nationals throughout the country, has passed to 25 Flight Army Air Corps, currently equipped with Gazelle helicopters. Details of casualty evacuations during 1995 and 1996 have been collated and analysed in order to provide information on casualty types, and the locations from which casualties have been evacuated, during this 2 year period. The data so obtained might be used to ensure the future provision of an appropriately equipped CASEVAC helicopter, or to highlight common causes of significant morbidity in British troops deployed to Belize. Background City may exceed 12 hours, and night-time travel is Belize is. a developing country to the east of Guatemala particularly hazardous. and south of Mexico in Central America, approximately the Helicopters have a number of uses in casualty care: size of Wales, and with a total population of some 216,000 improvement of response time where casualties are in (Fig 1). The country's topography can be divided into 4 remote areas; earlier delivery of advanced medicalguest. Protected by copyright. main regions: a northern flat plain, with some cultivated intervention; increased speed in transportation of the areas and other areas covered in dense scrub and trees; a casualty; direct delivery to the most appropriate specialist central mountain range, with steep sided hills covered in centre; and interhospital transfers (1). It is now well­ dense secondary jungle; a more undulating southern region, recognised that the prognosis for injured casualties is also covered in secondary jungle; and a low coastal plain worsened by delay in receiving advanced medical care. For covered in mangrove swamp. There are, in addition, severely injured patients, the mortality rate has been hundreds of small islands, or cayes, strung along the observed to increase by 300% for every 30 minutes' delay longest barrier reef in the western hemisphere. in treatment, and the use of helicopters for rapid evacuation The climate of Belize is tropical, hot and humid. Daytime of casualties in conflict has been given as the most likely temperatures range from 25 to 35°C during the year, cause of the progressive reduction in casualty mortality remaining high throughout the night in the lower-lying rates (2). areas but falling to 4°C in the mountains. Relative humidity Transportation of casualties by helicopter is, however, is consistently in the high 90%s. The rainy season is associated with a number of disadvantages. The between June and January, although tropical storms environment inside the aircraft is extremely noisy, produce heavy rainfall throughout the year, and the rendering communication difficult and preventing use ofhttp://militaryhealth.bmj.com/ hurricane season occurs between July and November. techniques such as auscultation in flight. There is The Belizean economy is based mainly on agriculture, considerable vibration, which makes delicate manual tasks especially on sugar cane and citrus fruits, although tourism even more difficult, and can exacerbate both pain and is becoming increasingly important with growing haemorrhage. Dependent on the type of helicopter in use, recognition of the natural assets of the unspoilt interior of there may be limitations on space available, with patient the country, and the beauty of the cayes and reef. At present care being hindered in small aircraft with cramped cabin the majority of tourists originate from the United States. spaces. There will also be a limit to the amount of The Belizean population is divided so that approximately equipment and/or attendants which may be carried, as half live in the 7 major cities, with the remainder in a many helicopters operate close to maximum weight limits. number of smaller towns, and small isolated settlements in In addition, there are constraints on the operation of remote areas. Hospitals are located in Belize City, helicopters in poor weather conditions. Helicopters do not on September 29, 2021 by Belmopan, Punta Gorda, Orange Walk, and Dangriga, have an all-weather capability. although only the former has facilities to deal with Until late 1994, a helicopter Search and Rescue and significant trauma or surgical, medical or obstetric casualty evacuation service was provided to British and emergencies. Transport communication between the Belizean Military personnel, Belizean civilians (including centres of population is improving, but remains very poor the Belize Defence Force or BDF) and foreign nationals by western standards. The majority of the lengths of the 4 (predominantly tourists but also including British nationals national highways is unmetalled, with frequent potholing, on Operation Raleigh, and staff of the British High and impassable flooding after tropical storms. Road travel Commission) by the Pumas of 1653 Squadron, Royal Air times between the more distant major centres and Belize Force. 1653 Squadron was based at Airport Camp, some 20 * now Consultant in Aviation Medicine J R Army Med Corps: first published as 10.1136/jramc-143-02-04 on 1 June 1997. Downloaded from 94 Helicopter Casualty Evacuations in Belize minutes by road from Belize City. The Puma is a medium Table 1. Support Helicopter with a crew of 3, and a seated passenger British Military CASEVACs 1995/6 by cause. capacity of 14. In addition, the Puma can be fitted with a Actiden~ Assaull Heal Biles' Diving Med Surg Obstetric Food winch which is clearly invaluable in operations over dense Slings Poisoning jungle terrain. The Puma support was withdrawn with 1995 43 0 14 4 0 8 0 0 8 departure of the RAF contingent from Belize in 1994. At 1996 19 0 11 3 0 4 4 0 1 this time the role of providing a 24 hour casualty evacuation Total 62 0 25 7 0 12 4 0 9 service! for the entire country was passed to 25 FIight, Table 2. Army Air Corps who are currently equipped with Gazelle Belizian National CASEVACs 1995/6 by cause. helicopters. The Gazelle is a small light reconnaissance Actiden~ Assaull Heal Bilesl Diving Med Surg Obstelric Food helicopter, with a crew of one or 2 pilots, and further Slings Poisoning seating for 2 to 3 passengers. If a lying casualty is to be 1995 7 1 2 0 1 1 4 4 3 carried, the left-hand front seat and flying controls are 1996 9 4 0 1 0 5 2 5 0 removed, and a Bofors Splint stretcher must be used in Total 16 5 2 1 1 6 6 9 3 order to fit the casualty's feet into the small rear baggage Table 3. space. This leaves room only for a single seated attendant Foreign National CASEVACs 1995/6 by cause. in the rear, who has restricted access to the patient in flight. For night CASEVACs of a lying casualty, single-pilot Night AccideD~ Assaull Heal Bilesl Diving Med Surg Ob~etric Food Slings Poisoning Vision Goggle (NVG) flight must be carried out. This is a 1995 3 2 0 1 2 2 2 0 1 risky procedure which is not generally authorised for Army 1996 5 0 0 2 0 3 1 0 0 Aviation operations. There is no facility for winching from Total 8 2 0 3 2 5 3 0 1 the Gazelle, so for jungle evacuations either the patient must be transported through the jungle to a cleared area, or guest. Protected by copyright. a new landing site area cut laboriously from the jungle at The predominant causes for evacuation of British the pick-up point. military personnel were injury resulting from accidents (62 Despite the apparent constraints on carriage of casualties in total over the 2 year period, representing 52%), and heat in the Gazelle, 25 FIt AAC have been regularly, and illness (25 casualties over 2 years, or 21 %)(Table 1). The successfully, tasked with CASEVAC since the departure of most common categories for Belizean casualties were 1653 Squadron in 1994. This paper analyses the details of accidents (16, or 32%), and obstetric emergencies (9, or helicopter CASEVACs carried out by 25 FIt AAC during 18%) (Table 2). Foreign nationals were also most likely to 1995 and 1996. require CASEVAC following accidents (8, or 33%), with medical problems (5, or 21%) as the second commonest Results cause (Table 3). Scrutiny of the causative factors in more During 1995 and 1996 a total of 192 casualties were detail reveals that over the 2 year period, 18 of the British evacuated by the Gazelles of 25 FIt AAC. These have been military casualties were evacuated for eye injuries caused broken down into population groups (British by tree sap, released whilst cutting jungle foliage. A military/dependants, Belizean nationals, and foreign number of these were injured after cutting a jungle landing nationals including British civilians), into diagnostic site for evacuation of a colleague. http://militaryhealth.bmj.com/ groups, and according to location from which the Most British military casualties were evacuated from evacuation took place (jungle, mountains, cayes or towns). jungle locations (89, or 75%), or mountain sites (18, or Records for 1995 show that 77 British military, 23 l5%)(Table 4). Belizean nationals were most likely to Belizeans, and 13 foreign national casualties were require evacuation from towns (21, or 43%) or jungle evacuated, totalling 113 persons. For 24 of these, part or all locations (18, or 37%) (Table 5).
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