NATO STANDARD

AAMedP-1.20

RECOMMENDED MEDICAL
EQUIPMENT FOR AEROMEDICAL
EVACUATIONS
Edition A Version 1

JULY 2018

NORTH ATLANTIC TREATY ORGANIZATION

ALLIED AEROMEDICAL PUBLICATION

Published by the
NATO STANDARDIZATION OFFICE (NSO)
© NATO/OTAN
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RESERVED FOR NATIONAL LETTER OF PROMULGATION

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RECORD OF RESERVATIONS

CHAPTER RECORD OF RESERVATION BY NATIONS

Note: The reservations listed on this page include only those that were recorded at time of
promulgation and may not be complete. Refer to the NATO Standardization Document
Database for the complete list of existing reservations.

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RECORD OF SPECIFIC RESERVATIONS

[nation] [detail of reservation]

Note: The reservations listed on this page include only those that were recorded at time of
promulgation and may not be complete. Refer to the NATO Standardization Document
Database for the complete list of existing reservations.

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TABLE OF CONTENTS
CHAPTER 1 INTRODUCTION ........................................................................... 1-1
1.1. AIM ............................................................................................................... 1-1
CHAPTER 2 FORWARD AEROMEDICAL EVACUATION................................. 2-1
2.1. DEFINITION ................................................................................................. 2-1
2.2. GOALS OF IN-FLIGHT MEDICAL TEAM ..................................................... 2-1
2.3. SPECIFICS ................................................................................................... 2-1
2.4. RECOMMENDED MEDICAL EQUIPMENT .................................................. 2-1
CHAPTER 3 TACTICAL AEROMEDICAL EVACUATION .................................. 3-1
3.1. DEFINITION ................................................................................................. 3-1
3.2. SPECIFICS ................................................................................................... 3-1
3.3. RECOMMENDED MEDICAL EQUIPMENT .................................................. 3-1
CHAPTER 4 STRATEGIC AEROMEDICAL EVACUATION ............................... 4-1
4.1. DEFINITION ................................................................................................. 4-1
4.2. SPECIFICS ................................................................................................... 4-1
4.3. RECOMMENDED MEDICAL EQUIPMENT .................................................. 4-1
4.4. SPECIFIC DEVICES..................................................................................... 4-1

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CHAPTER 1 INTRODUCTION

1.1. AIM

1. The aim of this standard is to establish qualitative guidelines with respect to the
medical materials required to ensure that Aeromedical Evacuation (AE) of casualties
can be performed securely, from a medical and an aeronautical standpoint, during
forward, tactical or strategic AE.

2. The medical state of the patient has to be managed with the best possible level
of care and according to the most up-to-date medical practice.

3. Medical equipment will be chosen taking the specific constraints of the

aeronautical environment into account. All equipment for AE must be airworthy, and
has to be certified for the aircraft. It will be used on, according to the aircraft’s
certification standards and by the pertaining aviation authority.

4. AE may be delivered to a single patient or multiple casualties and the spectrum

of disease/injury may range from minor to the critically ill. As a general rule, the
composition of the medical team and the necessary equipment will be tailored to the
patient’s physical and psychological needs. In addition, the team and the equipment
will be constrained by the size of the airframe particularly in the forward area.

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CHAPTER 2 FORWARD AEROMEDICAL EVACUATION

2.1. DEFINITION

Forward AE (FwdAE) is defined as the phase of medical evacuation that provides airlift
for patients under medical supervision between the point of injury or illness and the
first Medical Treatment Facility within the area of operations.

2.2. GOALS OF IN-FLIGHT MEDICAL TEAM are to provide care in accordance

with the Catastrophic Bleeding, Airway, Breathing, Circulation (CABC) principles, to
perform appropriate handling and immobilization, to manage pain, infection and
nursing care during the flight.

2.3. SPECIFICS

FwdAE is mostly accomplished with a helicopter. The mission is usually to save life,
limb or eye-sight and fulfilled in a complex environment. Due to low available space,
noise and vibrations, patient monitoring is difficult. On-board medical equipment, in-
flight technical procedures and medical supervision are limited. Chosen medical
equipment must be compatible with the available space and weight allowed for the
mission. Electrical equipment has usually to be powered with batteries. The patient
has to be prepared for the flight on the ground as much as possible.

2.4. RECOMMENDED MEDICAL EQUIPMENT for forward AE include, but are

not limited to:

2.4.1. Hemorrhage control:

- Tourniquets,
- Wound packs
- Hemostatic bandages, agents and devices

2.4.2. Airway and Breathing:

- Bag Valve Mask

- Manual, pneumatic or electric ventilator
- Portable oxygen apparatus
- Oxygen delivery system, oxygen rebreathing bags
- Airway management equipment (naso/oropharyngeal airways,
supraglottic airway devices, laryngoscope handle and blades,
endotracheal tubes, surgical airway equipment)

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- Suction device and suction catheters.

- Large bore needle for needle chest decompression (min 8cm-3.25inch)

2.4.3. Circulation:

- Intravascular and intra-osseous access equipment

- Intravenous solution in soft pouches: replacement fluid (e.g. Ringer
Lactate or normal saline solution), osmotherapy fluid
- Fluid infusion pressure device
- Defibrillator (Automated (AED), semi-automated or manual)

2.4.4. Medical examination and monitoring:

- Single use examination gloves

- Waterless hand cleanser
- Strong scissors
- Stethoscope
- Vital signs monitoring to include: pulse, blood pressure, pulse oxymeter
- Surgical masks
- Individual lamp
- Waste collection bags, containers including sharps containers

2.4.5 Medication as indicated by patient’s clinical condition and team

competencies.

2.4.6 Handling and immobilization equipment:

- Stretcher (NATO standard litter, with restraint straps)

- Spine immobilization equipment (cervical collars, backboard)
- Upper and lower limbs immobilization equipment, traction splint
- Patient warming/cooling equipment

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CHAPTER 3 TACTICAL AEROMEDICAL EVACUATION

3.1. DEFINITION

Tactical Aeromedical Evacuation (TacAE) is defined as the phase of medical

evacuation that provides air transport for patients under medical supervision between
medical treatment facilities within the area of operations.

3.2. SPECIFICS

TacAE is usually accomplished with a fixed-wing tactical asset, able to land on short
and basic airways, and/or by using a rotary-wing asset. Flight times are expected to
be longer than for FwdAEs; the available space and permissible weight may be,
enabling a higher level of en route care and treatment with more sophisticated medical
equipment.

3.3. RECOMMENDED MEDICAL EQUIPMENT for TacAE includes all the

FwdAE equipment and is augmented with:

3.3.1. Airways and breathing:

- Consider backup resources as appropriate (number of patients, flight

time, space, device malfunction, disposables etc)
- Additional airway management equipment (chest drainage
equipment).
- End tidal CO2 detection capability
- Electrical continuous suction device
- Nebulizer

3.3.2. Circulation:

- Consider backup resources as appropriate (number of patients, flight

time, space, device malfunction, disposables etc)
- Electric infusion pumps
- Supplies for central venous access
- Volume expansion fluids (and blood/blood products if indicated by
the mission)

3.3.3. Medical examination and monitoring:

- Portable, battery-operated monitor/defibrillator with tape write-

out/recorder, defribrillator pads, ECG leads
- Glucometer or blood glucose measuring device with reagent strips
- Thermometer
- Otoscope

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3.3.4. Injectable drugs, as indicated by patient’s clinical condition and team

competencies

3.3.5. Nursing supplies:

- Local antiseptics
- Dressing supplies
- Absorbent pads
- Disposable hand towels
- Waterproof pads / incontinence pads
- Comfort items : e.g. urinal, basin, diapers, ear covers, pillows,
blankets
- Urinary catheters, urine bags
- Temperature management equipment
- Feeding adjuncts : disposable goblets, straws
- Nasogastric tubes
- Sterile cloths and sheets for burnt patients
- Disinfectant solution for cleaning equipment

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CHAPTER 4 STRATEGIC AEROMEDICAL EVACUATION

4.1. DEFINITION

Strategic Aeromedical Evacuation (StratAE) is defined as the phase of medical

evacuation that provides air transport for patients from medical treatment facilities
within the area of operations to medical treatment facilities outside the area of
operations, or additional AE between medical treatment facilities outside the area of
operations.

4.2. SPECIFICS

StratAEs are realized using fixed-wings assets, usually commercial-like assets, but can
also be performed with tactical aircrafts. The assets must offer a long-range capability.
StratAE missions are often long duration flights. These assets usually also allow
several patients to be flown out of the theater at the same time, some of them
potentially being critically ill. Available space and allowed weight for medical equipment
are usually not a constraining issue. In many cases, the aircraft produces electrical
power and oxygen, thus saving batteries and oxygen bottles. Once certified, the most
updated and sophisticated medical equipment can be used on board.

4.3. RECOMMENDED MEDICAL EQUIPMENT for StratAE includes all the

above, plus:

- Point of care testing e.g. for hemoglobin/hematocrit, lactate, glucose

blood gas, electrolytes,
- Ultrasonography
- Spare batteries

4.4. SPECIFIC DEVICES

Some patients could imply specific devices, often with presence of specialized medical
team (with their own equipment) such as:

- Invasive pressure monitoring,

- Intracerebral pressure monitoring
- Ultrasound imaging device
- Pressure sores fighting paddings.
- Negative pressure wound therapy
- Fiber optic bronchoscopy

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