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EMSWORLD.com | MARCH 2015 47 Patient being loaded into a Dustoff helicopter at a forward operating base in Afghanistan. U.S. Army T he clattering of helicopter blades cuts through the humid air in a steamy jungle clearing behind enemy lines. On board an injured soldier lies on a stretcher with an IV dripping plasma into his arm. The pilot increases the pitch on the rotor blades and the helicopter rises on its slow journey to a U.S. Army hospital. This scene took place not in Vietnam but in Burma during World War II in 1945. It was one of the first times a helicopter was used to evacuate a wounded soldier from the battlefield. Twenty years later, similar scenes occurred thousands of times during the Vietnam War. By then, dedicated U.S. Army air ambu- lance units, using the call sign Dustoff, had been established with the sole job of getting wounded soldiers to surgical hospitals as soon as possible. Almost 900,000 patients were transported by these units by the time U.S. involvement in the war ended. Since then, Dustoff units have accompanied U.S. troops in every major conflict. The success of their operations in Vietnam became the catalyst for the birth of the civilian air ambulance industry in the 1980s. Army Flight Medic Training While civilian air ambulances use highly trained nurses and para- medics, training for U.S. Army flight medics consisted of a NREMT EMT-Basic course with IV administration and advanced airway training. In addition, f light medics took Advanced Cardiac Life Support (ACLS), Pediatric Education for Prehospital Professionals (PEPP) and Prehospital Trauma Life Support (PHTLS). When a unit returns to the U.S. after a tour of combat, they do an after action review (AAR) that lists positive and negative perfor - mance. AARs for medical units began to reflect the lack of critical care skills of the flight medics when treating and transporting very sick and severely injured patients. However, without definitive data, the Army would not act on this anecdotal evidence. Nothing was changed until one particular unit served in Afghanistan. About two-thirds of all U.S. Army air ambulance units are in the Army National Guard or Reserve. Many of the flight medics in these units work as civilian paramedics for fire departments and ambulance services. In 2009, C Company, 1st Battalion of the 168th Aviation Regiment (C-1/168) was deployed to Afghanistan. It was an Army National Guard air ambulance unit with 12 UH-60 Black Hawk helicopters from California and Nevada, augmented with an additional three Black Hawks and crews from the Wyoming National Guard. Almost all of the flight medics were experienced civilian paramedics. "Our unit developed its own set of protocols for the flight medics while we were being mobilized to go to Afghanistan," explains Steve Park, a former Army flight medic who deployed with C-1/168. At the time, Park was also a paramedic with the Regional EMS Authority in Reno, NV. Today he is a firefighter-paramedic with the North Lake Tahoe Fire Protection District in Nevada. "Our noncommissioned-officer-in-charge (NCOIC) of the flight medics, Rob Walters, a paramedic with the Sacramento (CA) Metro- politan Fire Department, developed them. They were pretty aggres- sive, with things like RSI and Solu-Medrol for head injuries. Once in country, they had to be approved by the brigade flight surgeon who was in charge of all the flight medics. She was reluctant to allow this level of care, but Walters presented her with all of our certifications to show we could do this. We wanted to provide this level of care to our patients. We kept on saying that if every person in our home towns deserved paramedic-level care, our soldiers deserved that same level of care. We had to fight for it, and they finally gave us a trial period with our protocols. Once their staff saw what we were capable of, they allowed us to use our own protocols.