An Updated Review of Improvised Ground Evacuation Platforms for Austere Special Operations Casualty Transport

In 2018, the Expeditionary Resuscitative Surgical Team 3 (ERST-3) published a retrospective review on the ground casualty evacuation (CASEVAC) options available to a Special Operations Forces (SOF) unit in the Horn of Africa. Seventeen months following their deployment, ERST-7 provided an update on the improvised ground evacuation platforms in the same area of operations and what has and has not worked based on combat experience and new literature.

This publication is an update to a retrospective review of various modes of ground transportation used by ERST-7 during their deployment with Special Operations Command Africa from July 2020 to January 2021. The authors excluded all hand-carried litter and air evacuation platforms. The authors discuss litter setup, necessary modifications, litter capacity, strengths and weaknesses, and any recommendations for a Mine-Resistant Ambush Protected (MRAP) vehicle, a full-size pickup truck, and a mid-size pickup truck based on their use during the ERST-7 deployment. The authors also used previous literature to support their recommendations.

The SOF unit to which ERST-7 was assigned still uses two of the four platforms included in the original study. The authors recommend continued use of the MRAP for patient extraction with a solely widthwise patient configuration, weather-proofing the open beds of MRAPs, and outfitting all MRAPs for Tactical Combat Casualty Care (TCCC) if the CASEVAC-designated MRAP is disabled. The pickup trucks functioned well for expedient CASEVAC under non-hostile conditions. However, they should be a last resort for CASEVAC outside friendly-controlled areas due to inadequate cover and concealment for patients and medical personnel providing enroute care.

Vehicles of opportunity available to SOF personnel are constantly changing. Continuous evaluation of local platforms is crucial, especially for partner force personnel who may not have access to dedicated air and ground MEDEVAC platforms. The authors recommend baseline readiness training on CASEVAC scenarios for those units traveling to areas without MEDEVAC assets.