(1) Lower the seats and secure the vertical support bracket into place.

(2) Place three litters (litter numbers 1 through 3) crosswise on the seats, forward, next to the cab. Secure the litters individually to the seats.

(3) Place two litters (litter numbers 4 and 5) lengthwise on the floor, forward toward the cab, feet first. Secure the litters together and to the vertical seat support.

(4) Place litter number 6 crosswise on the seats near the rear of the vehicle. Slide the litter as far forward as possible. Do not secure the litter at this time.

(5) Place litter number 7 crosswise on the seats as far rearward as possible. Secure the litter to the seats.

(6) Slide litter number 6 rearward next to litter number 7. Secure the litter to the seats.

(7) Raise and secure the tailgate.

(8) The medic rides in the center of the vehicle to monitor the casualties.

b. The combat medic/combat lifesaver rides in the center of the vehicle to monitor the patients.

Aero-medical evacuation is accomplished by both helicopter and fixed-wing aircraft. Dedicated aero-medical

evacuation assets permit en route patient care. This care minimizes further injury to the patient and decreases mortality.

Evacuation by aircraft is considered advantageous for a variety of reasons.

a. The speed with which the patient can be evacuated by air to an MTF ensures the timeliness of treatment, thus contributing to:

Saving lives.

Reducing permanent disability.

Increasing the number of patients returned to duty.

b. The range and speed of aircraft make it possible to evacuate patients by air over relatively long distances in short periods of time. This requires the less frequent displacement of MTFs.

c. Helicopters can move patients quickly over terrain where evacuation by other means would be difficult and perhaps impossible to accomplish. The minimum landing area required for helicopters permits patients to be picked up well forward and delivered to the supporting MTFs.

d. Because of the speed, range, flexibility, and versatility of aeromedical evacuation, patients can be moved directly to the MTF best equipped to deal with their condition.

e. The selectivity in the use of MTFs made possible by aeromedical evacuation procedures permits economy in the use of these facilities. Fewer specialty treatment teams are required because of the capability to rapidly evacuate patients to hospitals with the required specialties. Hospitals are required to move less often, thereby reducing periods of noneffectiveness during movement and reestablishment.

The commander who originates the patient evacuation request is responsible for delivering the patient to the landing site and for loading him aboard the aircraft. The actual loading is supervised by aeromedical evacuation personnel. In airhead operations, patients are normally transported by vehicle or litter bearers to designated points within the perimeter of the airhead where evacuation aircraft may be available.

Helicopters are rotary-wing aircraft capable of horizontal, vertical, lateral, and hovering flight. Their ability to circumvent terrain and obstacles, and the minimum requirements for takeoff and landing enable them to operate from areas inaccessible to fixed-wing aircraft or surface vehicles. The helicopter's capability of flight at relatively slow speeds permits operations during periods of reduced ceiling and visibility. Helicopters are organic to the air ambulance units and aviation units of the division and corps.

Military helicopters are designated by a combination of letters and numbers which are used to identify the basic mission and type: observation helicopter (OH), utility helicopter (UH), and cargo/transport helicopter (CH). The last two classes of helicopters can be used for the air evacuation of litter patients.

a. The UH-60A Blackhawk (Figure 10-22). This helicopter is used as the primary dedicated air ambulance. The normal configuration for aero-medical evacuation provides for four litter patients and one ambulatory patient. The maximum configuration provides for six litter patients and one ambulatory patient, or seven ambulatory patients.

b. The UH-1H/V Iroquois (Figure 10-23). This aircraft also is used as a dedicated air ambulance.

The normal evacuation configuration provides for three litter and four ambulatory patients. The maximum patient configuration provides for six litter patients or nine ambulatory patients.

a. Responsibility. The unit requesting aero-medical evacuation support is responsible for selecting and properly marking the helicopter LZ.

b. Criteria for Landing Sites.

The helicopter LZ and the approach zones to the area should be free of obstructions.

Sufficient space must be provided for the hovering and maneuvering of the helicopter during landing and takeoff. The approach zones should permit the helicopter to land and take off into the prevailing wind whenever possible. It is desirable that landing sites afford helicopter pilots the opportunity to make shallow approaches.

Definite measurements for LZs cannot be prescribed since they vary with temperature, altitude, wind, terrain, loading conditions, and individual helicopter characteristics. The minimum requirement for light helicopters is a cleared area of 30 meters in diameter with an approach and departure zone clear of obstructions.

c. Removing or Marking Obstructions. Any object (paper, cartons, ponchos, blankets, tentage, or parachutes) likely to be blown about by the wind from the rotor should be removed from the landing area. Obstacles, such as cables, wires, or antennas at or near LZs, which cannot be removed and may not be readily seen by a pilot, must be clearly marked. Red lights are normally used at night to mark all obstacles that cannot be easily eliminated within a LZ. In most combat situations, it is impractical for security reasons to mark the tops of obstacles at the approach and departure ends of a LZ. If obstacles or other hazards cannot be marked, pilots should be advised of existing conditions by radio.

NOTE  In a training situation or at a rear area LZ, red lights should be used whenever possible to mark obstructions.

d. Identifying the Landing Site (Figures 10-24 through 10-28).

(1) When the tactical situation permits, a landing site should be marked with the letter "H" or an inverted "Y"using identification panels or other appropriate marking material. Special care must be taken to secure panels to the ground to prevent them from being blown about by the rotor wash. Firmly driven stakes will secure the panels tautly; rocks piled on the corners are not adequate.

(2) If the tactical situation permits, the wind direction may be indicated by a:

Small wind sock or rag tied to the end of a stick in the vicinity of the LZ.

Man standing at the upwind edge of the site with his back to the wind and his arm extended forward.

Smoke grenades that emit colored smoke as soon as the helicopter is sighted.

Smoke color should be identified by the aircrew and confirmed by ground personnel.

(3) In night operations, the following factors should be considered:

(a) One of the preferred methods to mark a landing site for aircrews using NVGs is to place a light, such as an infrared chemical light, at each of the four corners of the usable LZ. These lights should be colored to distinguish them from other lights which may appear in the vicinity. A particular color can also serve as one element in identifying the LZ. Flare pots or other types of open lights should only be used as a last resort. They usually are blown out by the rotor downwash. Further, they often create a hazardous glare or reflection on the aircraft's windshield. The site can be further identified using a coded signal flash to the pilot from a ground operator. This signal can be given with the directed beam of a signal lamp, flashlight, vehicle lights, or other means. When using open flames, ground personnel should advise the pilot before he lands. Burning material must be secured in such a way that it will not blow over and start a fire in the LZ. Precautions should be taken to ensure that open flames are not placed in a position where the pilot must hover over or be within 3 meters of them. The coded signal is continuously flashed to the pilot until recognition is assured. After recognition, the signal operator, from his position on the upwind side of the LZ, directs the beam of light downwind along the ground to bisect the landing area. The pilot makes his approach for landing in line with the beam of light and toward its source, landing at the center of the marked area. All lights are displayed for only a minimum time before arrival of the helicopter. The lights are turned off immediately after the aircraft lands. Blue and green light sources should only be used as a last resort; the filter on the NVGs may make them difficult to detect.

(b) When standard lighting methods are not possible, pocket-sized white (for day) or amber (for night) strobe lights are excellent means to aid the pilot in identifying the LZ.

(c) During takeoff, only those lights requested by the pilot are displayed; they are turned off immediately after the aircraft's departure.

(4) When the helicopter approaches the LZ, the ground contact team can ask the pilot to turn on his rotating beacon briefly. This enables the ground personnel to identify the aircraft and confirm its position in relation to the LZ (north, south, east, or west). The rotating beacon can be turned off as soon as the ground contact team has located and identified the aircraft. The ground contact team helps the pilot by informing him of his location in relation to the LZ, observing the aircraft's silhouette, and guiding the aircraft toward the LZ. While the aircraft is maneuvering toward the LZ, two-way radio contact is maintained and the type of lighting or signal being displayed is described by the pilot and verified by ground personnel via radio. The signal should be continued until the aircraft touches down in the LZ.

(day).

a. Responsibility for Loading and Securing. The pilot is responsible for ensuring that the litter squad follows the prescribed methods for loading and securing litters and related equipment. The final decision regarding how many patients may be safely loaded rests with the pilot.

b. Safety Measures. When loading and unloading a rotary-wing aircraft, certain precautionary measures must be observed. Litter bearers must present as low a silhouette as possible and must keep clear of the rotors at all times. The helicopter must not be approached until a crew member signals to do so. The litter bearers should approach the aircraft at a 45-degree angle from the front of the helicopter. If the helicopter is on a slope and conditions permit, loading personnel should approach the aircraft from the downhill side. Directions given by the crew must be followed, and litters must be carried parallel to the ground. Smoking is not permitted within 50 feet of the aircraft.

a. Interior of the UH-60A Blackhawk. This helicopter, as with the UH-1H/V, has a number of possible seating or cargo configurations. A major difference in preparing the UH-60A to carry litters is that a medical evacuation kit must be installed. This kit consists of a seat/converter assembly unit and a litter support unit. The seat/converter assembly provides for three rear-facing seats which allows the medical attendant and crew chief to monitor patients. The litter support unit consists of a center pedestal which can be rotated 90 degrees about the vertical axis for the loading and unloading of patients. The litter support unit has a capacity of four to six litter patients. The patients can be loaded from either side of the aircraft. Only the upper litter supports in the four-litter configuration can be tilted for loading and unloading patients.

NOTE  When the six-litter modification kit is installed, the center pedestal can no longer be rotated.

If litter patients are not being evacuated, a maximum of six ambulatory patients can be seated on the litter support unit (three on each side). A seventh ambulatory patient can be seated on a troop seat.

NOTE  Only three litters can be loaded when using the internal rescue hoist.

When the medical evacuation kit is installed, a number of cabin configurations are possible. (See Tables 10-3 and 10-4.)

b. Guides for Loading Patients.

(1) Litter patients should be positioned in the helicopter according to the nature of their injuries or condition. Personnel aboard the aircraft supervise the loading and positioning of the patients.

Normally, the helicopter has a crew of four. The crew consists of a pilot in command (PC), copilot (PI), crew chief, and flight medic.

(2) The most seriously injured patients are loaded last on the bottom pans of the litter support unit. However, if it is anticipated that a patient's medical condition may require in-flight emergency medical care (such as cardiopulmonary resuscitation), he should be loaded onto either of the top pans to facilitate access to him.

(3) The structuring of the litter support unit allows patients to receive IV fluids and oxygen in flight. Patients receiving IV fluids can be placed on any of the litter pans, depending on their injuries or condition.

(4) Patients in traction splits should be loaded last and on a bottom pan.

(5) The UH-60A has the capability to be loaded on both sides simultaneously. Patients should be loaded so that upon rotating the litter support, the patient's head will be forward in the cabin. To accomplish this, patients loaded on the left side of the aircraft should be loaded head first and patients loaded on the right side of the aircraft should be loaded feet first (left and right sides are determined from the position of the PC's seat, looking forward). When the six-litter configuration is used, the fifth and sixth litter patients are loaded with the carousel in the fly position. The patients' heads should face toward the front of the aircraft.

c. Installing Litter Pan Supports. Each litter support is attached to the center pedestal by two end pivot shafts and by two T-shaped fittings. These fittings and shafts allow for the removal, interchange, or repositioning of the supports. There are five pivot shaft support holes at both ends on the right and left side of the center console. Behind the holes are support rollers for the pivot shafts. From top to bottom, the top hole is provided for the upper litter in the six-litter configuration. The second hole is for the upper litter support of a four-litter configuration. These end holes line up with a central pivot hole, which accommodates a central pivot shaft on the litter support. Only this litter position allows mid-position pivoting for loading or unloading.

The third hole is for the center litter of the six-litter configuration. The fourth hole is used when installing the litter support as a seat for evacuating ambulatory patients. The fifth hole is used for the lower litter support in the four-litter configuration. The third, fourth, and fifth positions do not provide a tilt function.

(1) Lower litter support installation. Before installing, each center pivot shaft must be retracted and unlocked. The center pivot shaft handle must be secured in the handle retainer. End pivot handles must be in the tilt position.

(a) Engage T-bars on litter support with split retention fittings at the bottom of the pedestal.

(b) Line up the end pivot shafts with holes. Disengage the pivot shaft lever locks and move the end pivot shaft lever toward the pedestal. The pivot shaft is, then, fully inserted into the pivot shaft holes on the pedestal and the handle lock is engaged.

(c) Repeat step (b) for the other end of litter support.

(2) Upper litter support installation. Before installing, each center pivot pin must be unlocked and retracted. The handle is then disengaged from its retainer. The end pivot handles must be in the tilt position.

(a) Tilt the outer edge of litter support slightly down and engage the T-bars into split retention fittings at the second support hole from the top of the pedestal.

(b) Raise the outer edge of the litter support until the support is level.

(c) Insert the end pivot shaft into the pedestal by pulling on the pivot shaft lever lock and moving the lever toward the pedestal until the end pivot shaft engages partway in end pivot support hole.

(d) Turn the center pivot shaft lock handle counterclockwise until it is horizontal.

(e) Push the center pivot shaft toward the pedestal until the shaft is fully inserted into the center pivot shaft hole. The opposite end of the litter support should be raised or lowered to align the center shaft on the support with the center hole on the pedestal.

(f) Turn the center pivot lock lever clockwise to the horizontal position.

(g) Repeat step (c) above for the other end of the litter support. Now slide both end pivot shafts in fully by moving the pivot lever lock handle to the engaged position.

(3) Upper litter support relocation for six-litter configuration.

(a) Remove the litter support from the second support hole from the top of the pedestal.

The removal of the litter support is the reverse of its installation. Before relocation, each center pivot pin must be locked and the handles must be secured in the handle retainer.

(b) Line up the end pivot shafts with the top support holes. Then fully insert and engage the handle lock.

(c) Repeat steps (a) and (b) above for other end of litter support.

(4) Middle litter support installation for six-litter configuration.

(a) Remove the litter support from the fifth (bottom) support hole. The removal of the litter support is the reverse of its installation.

(b) Align the end pivot shafts with third support hole from the top of the pedestal to relocate it. Then fully insert and engage handle lock.

(c) Repeat steps (a) and (b) above for other end of litter support.

(5) Bottom litter support installation for six-litter configuration. To complete the six-litter configuration, the modification kit is required. The kit consists of a tube assembly and a restraint assembly for each side.

(a) Insert the restraint assembly using the plate quick disconnect fittings into the proper quick attachment fittings on the cargo floor. Pull up on the restraint assembly to check for secure installation.

(b) Attach tube assembly longitudinally to the proper tie down restraint rings on the cargo floor. Ensure that the restraint rings are properly secured to the bracket tube support with the attached pin (Figure 10-29).

(c) Repeat steps (a) and (b) above for the other end of the litter support.

(6) Litter support installation for ambulatory patient seating.

(a) Prepare supports as in c(1) above.

(b) Engage the T-bar on the litter pan with the split retention brackets below the support tilt stop brackets.

(c) Position the litter support at the second from the bottom litter support end pivot hole on the pedestal.

(d) Line up the end pivot shafts with the holes. Disengage pivot shaft lever lock and move pivot shaft lever toward the pedestal. Fully insert the pivot shaft into pivot shaft hole on the pedestal and engage handle lock.

(e) Repeat step (c) for the other end of litter support.

(7) Storage of litter pans.

(a) Lower stowage brackets to the horizontal position and insert the retaining pin through stowage bracket into pedestal.

WARNING

(b) Place the litter pan in the stowed position against the center pedestal.

(c) Secure the litter pan to the center pedestal by routing the opposite web strap around the upper portion of the litter pan handle. Secure the metal clasp to the metal ring.

NOTE  The use of the opposite strap reduces excess movement of litter pan.

(d) Use opposite web strap to secure the upper side of the litter pan handle as described in step (c) above, while the same side web strap is used to secure the bottom side of the stored litter pan handle.

(e) Remove the stowed litter pans by reversing steps (a)ó(d) above.

d. Loading of Upper Litters. For ease of loading, the upper litter pans may be tilted. Upper litter pans are supported by a center pivot shaft and two end pivot shafts, one at each end of the litter pan. To tilt the upper support for the loading and unloading of litter patients, the center shaft remains locked to the pedestal and the end shafts are disengaged for support pivoting.

NOTE  This system was designed to pivot about the center shaft allowing either end to be tilted downward. Although the supports may be pivoted at either end, more effort is required when a loaded litter is installed.

e. Loading and Securing Patients.

(1) In loading four litter patients with a four-man litter squad, the litters are loaded from the top to bottom. The sequence for loading litters from one side of the aircraft with the carousel turned is upper right, upper left, lower right, and then lower left. To load litters from both sides of the aircraft simultaneously, the sequence is upper then lower (Figure 10-30).

(a) The litter support unit is rotated 90 degrees clockwise to receive the litter patients.

The flight crew lowers the top pan to accept the litter and stands by to assist. This is accomplished as the litter squad approaches the aircraft.

(b) The litter squad moves into the semi-overhead carry, lifting the litter just high enough for the litter stirrups of one end to slide onto the litter pan. The litter squad slides the litter forward.

The flight crew member guides and assists the litter squad, until the litter stirrups of both ends are secured on the pan. The litter squad departs as the flight crew member raises the pan back to its upright position and secures it. The flight crew member fastens the litter straps attached to the litter support assembly.

(c) After the first litter is loaded, the squad leaves the aircraft as a team to obtain another litter patient. The second, third, and fourth litters are loaded in the same manner, except that the bottom pans are not tilted to receive patients.

(d) After having loaded four litter patients, the litter support unit is rotated 90 degrees counterclockwise and locked in the in-flight position. The cargo doors must be closed for flight.

(2) The loading of six litter patients requires the repositioning of the litter support prior to loading. The loading procedure remains the same as the four-litter configuration except for the following:

(a) The top litter support no longer tilts. This necessitates overhead loading and may require additional assistance.

(b) After four litters are loaded, the pedestal must be rotated back to the locked position. The restraint and tube assembly modification kit is then installed. The last two litters are side loaded between the restraints, with the patients' heads toward the front of the aircraft. They are secured.

(3) When the aircraft is to receive a mixed load of litter and ambulatory patients, one top pan of the litter support is removed and repositioned just above the bottom pan on the same side. The aircraft can now accommodate two or three litter and four ambulatory patients (Figure 10-31).

(a) The litter support unit is rotated clockwise to receive the litter patients, except for the third litter in the six-litter configuration. The litters are loaded as described in paragraph e(1) above.

Upon loading and securing the litter patients, the litter support unit is rotated counterclockwise to the in-flight position. The third litter is then loaded when the six-litter configuration is used.

(b) Ambulatory patients are escorted to the aircraft by ground personnel. They are assisted into their seats and secured with the seat belts attached to the litter support unit.

(c) The cargo doors are now closed for flight.

WARNING

f. Unloading Patients. The aircraft is unloaded in the reverse order of the loading procedure.

The pans are normally unloaded bottom pan first, then top, to ensure that the most seriously injured patients are unloaded first.

a. Interior of the UH-1H/V Iroquois. This helicopter has several litter and seating configurations.

A change, to meet operational requirements, can be made from one configuration to another within a few minutes. Facilities for carrying a tier of three litters loaded lengthwise in the aircraft are located on each side of the helicopter cargo compartment (Figure 10-32). This gives the helicopter a maximum litter capacity of six or a total of nine ambulatory patients. This configuration is normally used in rear areas to move large numbers of stable patients. The normal configuration for the aircraft is three litter patients loaded crosswise and four ambulatory patients. The maximum load the helicopter can lift must be considered. This load capacity varies with the altitude and temperature. The pilot advises the personnel on the ground of his load capacity.

b. Guides for Loading Patients. Patients are normally loaded from the top tier down to the bottom tier, with the most seriously injured loaded last.

(1) Litter patients should be positioned in the helicopter according to the nature of their injuries or condition. Personnel aboard the helicopter supervise the loading of the aircraft.

(2) The most seriously injured patients are placed in the bottom litter tiers to permit in-flight care.

(3) Litter patients receiving IV fluids should not be positioned on the top row of litter tiers but should be placed as low as possible in the litter rack.

(4) Patients in Hare traction splints with splint supports and footrests must be loaded last and placed directly on the floor of the helicopter.

c. Loading and Securing Patients.

(1) In loading six litter patients with a four-man litter squad, the litters are loaded from both sides of the aircraft and from top to bottom. Figures 10-33 and 10-34 illustrate procedures for loading the right side. Figure 10-35 illustrates procedures for loading the left side.

(2) When the helicopter is equipped for mixed loading (Figures 10-36 through 10-38), three litters are loaded crosswise and four ambulatory patients are loaded in the side seats.

(a) When loading from the left, the litter squad moves to the side of the helicopter with the litter perpendicular to the cargo compartment; then the squad moves into a litter post carry. Bearers numbers 1 and 3 give their litter handles to the crew members who place the handles in the litter support brackets on the far side of the aircraft. Bearers numbers 2 and 4 secure the foot of the litter.

(b) After the first litter is loaded, the squad leaves the helicopter to obtain another litter patient. The second and third litters are loaded in the same way as the first one. After the three litter patients are loaded, the ambulatory patients are taken to the aircraft and directed to their seats.

d. Unloading Patients. The aircraft is unloaded in the reverse order of loading. The tiers are unloaded from bottom to top on one side and then on the other side. At the unloading command, the litter squad moves to the helicopter and the bearers take their proper places at the litter. The squad then performs its duties in the reverse order of loading.