CG Rotary-Wing MEDEVAC Considerations

Medical evacuations conducted by Coast Guard helicopters are fundamentally different from those performed by civilian air ambulances or dedicated military MEDEVAC platforms. Coast Guard helicopters are not configured solely for providing in-flight medical care, and unlike most other services, the Coast Guard almost always hoists the patient—often from austere, remote, or high-risk environments. Additionally, unless it is coordinated with an external agency to bring a higher-level provider aboard, the only onboard medical care is typically performed by a rescue swimmer. Rescue swimmers are EMTs trained in basic life support and trauma care and equipped with limited medical gear. These differences introduce unique patient risks and require careful assessment. For each case, responders must evaluate the benefit to the patient of healthcare at the destination and weigh it against the inherent dangers of the mission, including hoisting risks and limitations of care en route. This list of considerations is designed to support informed, risk-balanced decision-making to optimize patient outcome. 

Decision to launch 

Medical considerations 

• General patient information. 
  • Age/gender/level of ambulation/size (large frame) /method of injury/vitals/medication/IV/additional pertinent info. 
• Care being provided.  
  • Care patient receiving in their current location (cruise ship, M/V, F/V, S/V, community hospital, clinic). 
  • Provider (MD, PA, NP, RN, EMT). 
  • Facility capabilities and limitations.  
• Care needed at destination. 
  • Facilities available to provide the care that is needed. 
• Time to care. 
  • First window and the negative consequences if this window is not met. 
  • Next window(s) and consequences. 
  • Non-maritime – reason commercial services turn down the mission. 
    • Darkness/ceilings/visibility/winds/runway conditions/crew mission time. 
    • Reason(s) ground transportation is not a viable option. 
    • Probability that commercial services will be available within the time to care window. 
• Care en route. 
  • In flight restrictions.  
  • En route care needed. 
    • Is basic EMT care sufficient.  
    • Does an additional rescue swimmer improve capability. 
    • Can necessary care be provided by embarking on scene medical provider. 
    • Do we need to launch with providers (physician, nurse, paramedic). 
    • Is special equipment necessary.  
    • Does the medical team (Flight Surgeon/on scene provider) understand the transport risk (level of care and time en route). 

• Additional passengers (e.g., next of kin for a minor). 

Aviation considerations  

• Environment. 
  • Distance offshore/ceilings/vis/icing/winds/seas/illumes (darkness). 
• Offshore Escort. 
  • Fixed wing or second rotary wing asset. 
• Crew. 
  • Time of day/fatigue, experience, recency, etc. 
• Helicopter. 
  • Range, mission degraders, inspections. 
• Miscellaneous. 
  • Vessel closure rates with land/port, vessel stability, hoist area/obstacles, boat/surface MEDEVAC alternative. 

Considerations after launch decision prior to departing 

Cabin configuration 

• Bring gear (e.g., extra litter/extra trail lines and weight bags/blankets/air wedge/special medical equipment for care provider). 
• Leave gear (e.g., pump). 
• Seats (add/remove), seat waiver. 

Comms with vessel  

• Command Center to ship means of communication. 
• Helo to ship frequencies. 
• Hoist brief. 
  • Command Center (radio or SAT phone). 
  • Offshore escort asset.  

Route considerations 

• Weather.  
  • Ceilings, visibility, icing, convection, turbulence/wind, seas – trends. 
• Time of day. 
  • Sunset/sunrise. 
• Fuel. 
  • Options/margin.  
• Time. 
  • Patient care/air station resources. 
• Flight plan. 
  • IFR/VFR. 

Hoist sequence considerations – Deployment, triage, packaging, movement of patient, order of recovery (provider, NOK, patient, swimmer), gear (litter, basket, SADPU, bare hook), trail line use (remains on deck throughout sequence, recovered between evolutions, detached and left on deck). 

Patient delivery reconsiderations after assessment  

• Communicate ETA changes and changes in patient condition. 
• Communicate potential contingency plans (e.g., wing to wing transfer to an air ambulance due to a fuel stop or care considerations, change in hospital due to fuel, weather, or patient condition, etc.).