Decline of Dustoff: A Symptom

27 June 2013

2011-09-18 010716ccFinal1000pxMY2011

http://vimeo.com/31609732

More people are waking up to smell the bitter tea.  Our Army helicopter medical evacuation system, called “Dustoff,” is broken. People are dying because of it.  I have written about this many times.

And now retired Dustoff pilot Brigadier General Patrick Brady has weighed in with his article “Decline of Dustoff: Medal of Honor Huey pilot bemoans today’s medical air-evacuation process.”

Among other Dustoff policy failures, the idea that Dustoff should remain unarmed while flying with red crosses is ridiculous. During the last sizable wars we have fought -- Vietnam, Iraq, Iraq again, Afghanistan -- we have always enjoyed air superiority and we had hospitals close to the action.

In Afghanistan, commanders made it mandatory that unarmed Dustoff have top cover, often in the form of Apache helicopters.  This policy has caused lethal delays and stretched our already straining assets.

By contrast, Air Force Pedro rescue uses organic machine guns and do not wait for cover.  In Afghanistan, there was a dirty little secret.  Pedro was sent on most of the most dangerous missions in RC-South.

I made the video above during a combat mission in Kandahar Province.  The wounded Soldier was Chazray Clark.  We shared a tent.  Chazray died after a long wait after stepping on a bomb.  The Apache top cover was slow and commanders would not release the unarmed Dustoff to come without top cover.  The excellent Dustoff people would have flown the mission alone, as they often did in Vietnam.

In fact, I learned that this crew asked to be released to come alone.  They were sitting on FOB Pasab, with rotors turning in the dark, just minutes away from the two patients.  At the same time, two Air Force Pedro crews down at Kandahar Airfield were sitting in their two birds begging for release.  Dustoff and Pedro were denied.

Dustoff would get the mission only when the Apache arrived.  I learned that the Pedro folks became quite angry that they were not released to pickup Chazray, and the Dustoff people were in a similar mood.

There was more to it than just the two casualties, including Chazray, now a triple amputee, bleeding, in great pain, waiting for the very late Dustoff – Pedro could have already taken him: Every minute we wasted on the landing zone, the enemy had time to dial in their mortars while we were without cover.  The Taliban in that area have very powerful recoilless rifles, and of course machine guns and RPGs.  And so every minute that Dustoff was delayed, not only could the enemy get us in the open, but he could get into position to hit the Dustoff.  Speed is crucial for every reason.  We were giving the Taliban time to set up ambushes.

We were lucky that the enemy did not react quickly enough.  But that was only luck.  There were just a few skirmishes later that day with no more casualties on our side.  The next day we lost another to a bomb, this one an Afghan Soldier.  He was dead on the spot, so his body was carried out with no need for Dustoff.

And so even in stone aged Afghanistan, Dustoff policy was costing us.  But now imagine a war with a real adversary, where the skies are contested, and where enemy on the ground has shoulder fired surface to air missiles.  Remember, we armed the Mujahidin in Afghanistan with SAMs, and they promptly began reducing the size of the Soviet helicopter fleet.

We have been fighting the Flintstones in Afghanistan.  When we go up against people with money and more sophistication, a high cover Apache will just get shot down.

Due to sequester, the US military is being gutted.  The Air Force has 33 squadrons sitting on the ground because they cannot afford to fly.  Seven more squadrons have severely cut their hours.  Most of the aircraft we have are getting old.

In the Army, helicopter pilots have had training curtailed and cancelled, such as high altitude training.  This is incredible.  The Marines are looking at cutting 8,000 troops next year.  The Army is looking at cutting 80,000, and some smart people believe that is not enough.

Likewise the Navy is taking hits.  We could go on for pages about what is being slashed.  Just recently, people would argue on my website that to say these things was to cry wolf, that sequester is not a big deal.  This is a huge deal.  The military is being crippled.

Meanwhile, the Army insists that it is smarter to burn money and watch troops die due to silly Dustoff policy that requires more helicopters to do a worse job.  The decline of Dustoff, and the silliness that surrounds this red cross and machine gun issue, is just a symptom of a larger cancer, and a sip of our bitter tea.

Red Air

Comments   

+2 # RE: Decline of Dustoff: A SymptomTime to stay home 2013-06-27 16:02
You have two issues here which I don't believe you should mix together.

The Dustoff policy *is* insane, as you have well documented, for all the obvious reasons. The best course of action IMO is to kill it all together - the only way I know to eliminate these sort of bad command structures - and let the Pedros have sole responsibility for Medevac in theater.

The sequester is an entirely different animal. Good people can make *strong* arguments about the amount of waste they see (i.e., a lot), the way the congress critters on both sides of the aisle use Defense spending as a Corporate Welfare and jobs program (they do), and whether the American Empire is *vastly* overextended (it is). There are bad guys out there but tell me why we need to be the army that is larger than the next 12 countries' armies combined? The simple answer is we don't.

We keep being a little too eager to get involved in overseas adventures while our real adversaries like the Chinese and Russians devote far less to defense spending and more to their domestic economies. There's a new foreign policy we should try, called "mind our own business". We have way too many wasteful programs like the F-22 and F-35. It's time to stay home for a change - can we please stay out of a war for at least one presidential term? - and sink some of that money into repairing bridges and infrastructures instead of nation building overseas.
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-1 # RE: Decline of Dustoff: A SymptomDustoff 2013-07-01 19:19
How you went from Congress and oversea adventures to the problems of Dustoff is beyond me. :-x
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# RE: Decline of Dustoff: A SymptomTime to stay home 2013-07-01 23:16
Mike brings up Dustoff problems, which we all mostly agree with. He also brought up the sequester in the same article, in the last four paragraphs. He ties them together in the first sentence of the last paragraph.

My point was that these are separate issues. The sequester cuts the army - and I and many others believe it is overdue. It is a false choice to say if we don't restore money cut by the sequester that we will watch people die in Dustoff situations. No, we will watch Dustoff continue to harm us because it is a stupid policy, independent of the sequester. And it can be changed independent of the sequester.

If you can grasp that, it is not beyond you.
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+6 # IsolationismFred Smith 2013-06-27 16:54
In this world, we have two "near-peers", Russia and China, that would like nothing better than to see us roll up our overseas capabilities and hunker down behind our borders. Impossible. We have economic and other interests that will require an ability to protect them, particularly foreign trade. Writer should review history 1918-1941 and contemplate how long it would take for us to spin-up defunct capabilities. As for the F-22 and F-35 "wasteful programs", both of our "near-peers" are building 5th generation fighters to further their international designs-once they achieve air dominance, we will not be able to change the game and will suffer the inevitable consequences.
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+3 # Dustoff is deadRic Walters 2013-06-27 17:29
Killing off the dustoff concept is way past due. No one can seriously expect any modern enemy to "play fair" and not shoot at medics. Arm all of them up to Pedro standards.

Time to Stay Home is off base, though, when he calls for the Pedros to have all the medevac/casevac missions. There are not enough, and never will be enough, Air Force PJs to handle that load. There are only something like 600 AF wide. The selection process can't and won't be watered down (not even for the girls) to fill enough slots to provide a theater-wide, or world-wide capability. PJs are not only medics, they're SpecOps warfighters. Their pipeline is around 2 - 2.5 years from accession to first assignment. We need them to be able to concentrate on what they're supposed to do, which is behind-enemy-li nes rescue and recovery. Let's make sure that every military medic is trained to at least National Registry Paramedic standards, and they're given the support they need by their respective Medical Corps, arm the Dustoff birds so they can fight their way in and out when needed, and get back on track to being the most feared military on earth.
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+2 # RE: Dustoff is deadTime to stay home 2013-06-27 17:59
Ric, we are in full agreement that Dustoff should be eliminated. We may disagree on which way it gets done faster, but we are 99% agreed on the rest. The easy solution is to arm, repaint, and be done with it. That is apparently too hard to do. My suggestion is only a brainstorm that assumes the latter (the common sense approach can't prevail) and tries another way to kill the bad command structure beast. We both are after the end state: whatever bird comes to the rescue, it is armed and launches the minute it gets the call.
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+2 # WriterMichael Yon Author 2013-06-27 20:10
Ric Walters -- quick note. Pedro has less than 100 birds, too. I think about 97 but it has been awhile since I checked. They would need many hundreds more just for a start, and actually they have a different, far more complex mission. Dustoff is quick haul. Pedro is ready to go very deep into enemy territory. The Army does need organic MEDEVAC but needs to do a better job with it.
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# RE: Dustoff is deadDustoff 2013-07-01 19:21
As a former dustoff medic. I'm with ya Ric.
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+5 # RE: Decline of Dustoff: A SymptomTime to stay home 2013-06-27 17:49
You are missing the point altogether. We need current technology fighter jets. What we don't need is F22 and F35 "programs" that bleed us dry. The waste is almost institutionally baked in at every step of procurement. The decision to test and build the F-35 at the *same* time was a political move to get federal funding flowing to congressional districts before actual performance of the weapon system was shown. Worse, their is over dependence on simulation instead of tried and true engineering principles like breadboarding and rapid prototyping that rely on field testing in real conditions.

The flaws in the way these platforms are created and procured are well documented. They will be studied by business schools now and in the future as textbook examples of how not to procure.

There are so many sites to refer to about the waste it's hard to pick just one or two. Here's one, "The Jet that Ate the Pentagon", from the same place Mike references above:
http://www.foreignpolicy.com/articles/2012/04/26/the_jet_that_ate_the_pentagon

Lest you are tempted to kneejerk call me a libtard just because I don't think throwing money at the military solves everything, here's another from the red side of the line.
http://www.conservativedailynews.com/2013/03/time-to-cancel-the-f-35/

I'll borrow your snarky phrase, Fred: "Writer should review history", i.e., *recent* history, specifically of procurement in this post 9/11 decade where the default approach has been to throw money at the military. Our blood and treasure has to be spent wisely, prudently, and with a initial default value of "restraint".
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+4 # Doctrinein_awe 2013-06-27 18:57
Two issues for me are:
(1) the way the DOD has assigned ownership of MEDEVAC to the Army, and the Army's incompetence in upgrading the skills of the air and ground medics despite decades of internal and external pleas to do so. This includes insane procurement policies that resulted in hundreds of millions being spent on next generation MEDEVAC helicopters with less capability to reach high altitude positions and non-combat MEDEVAC helicopters that are limited to 30 minutes flight time in temps over 80 degrees due to flight control equipment heat stress shutdowns and cabin temps exceeding limits for pilots. Expensive retrofits of cooling equipment that was stripped out in the initial orders.

(2) I'm not an expert, but it seems to me that most of our war fighting plans assume air superiority. Our current fleet of air superiority fighters are long in the tooth and vulnerable to new generation adversary fighters. The cancellation of the F-22 program and substituting a non-air superiority fighter/ground attack aircraft for it is nuts. It is like saying we can't afford a new generation hunter/killer sub so we'll substitute for it with more frigates. Yes, both can ply the seas, but their capabilities and missions are vastly different. Do we expect that China and Russia will not try to exploit the gaps in our capabilities?

Regarding how the enemy sees out medics and MEDEVAC assets. In today's OC Register: "Some of the first casualties in an infantry battalion are often corpsmen, said Navy Captain Greg Jone, a surgeon with the 1st Mariner Expeditionary Force. At times they are targeted by the enemy. We know this is true in Afghanistan."
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+1 # TrueMichael Yon author 2013-06-27 20:27
You have studied this topic in detail and can see many issues that are not apparent to most. I did not mention the new Dustoff birds as that is going down yet another rabbit hole. You know what I mean.
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-1 # RE: Decline of Dustoff: A SymptomwoodNfish 2013-06-27 18:42
"Due to sequester, the US military is being gutted."

That is a load of bull puckey, Michael. The sequester cuts are insignificant to amount of tax money the military receives. The military is so fat with money that in the Pentagon even the assistants have assistants. The military wastes billions of dollars every year. It has plenty of money, but is playing a political game while our soldiers die. F them and F this government!
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+6 # Real ProblemsJoseph C Humphrey 2013-06-27 19:50
Does anyone we're fighting recently follow the Geneva convention or these "gentlemen's" rules of war? Yet we insist on affording those rights to people who don't even qualify for them. It's time to wake up and realize the enemy fights dirty and it's a WAR! As for the cuts, I'm sure we can all agree that there's money wasted all over our federal entities, but I for one would rather it be wasted for our men and women dying in a foreign country to protect our freedom than on someone ruining our country then spending a $100,000,000 on a vacation!!! How bout we make smart cuts with sequestration and pull our head out of our ass as a country and pay attention to the real world...

SPC HUMPHREY US ARMY INFANTRY 02-06
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# Fighting "Fair"Robbie 2013-07-13 17:32
If I remember my US history well enough, wasn't one of the reasons we won the Revolutionary War because we chose to, according the Brits, not fight fair? Instead of standing straight up in Red Coats for all to see we broke the "rules of war". How sad we have become so tied up in fighting fair that we have become the modern equivalent of British in
Revolutionary times, and we all know who won that war!
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+2 # When I have your woundedJeff B 2013-07-14 07:22
The decline of Dustoff has nothing to do with the crews or their equipment. It has everything to do with it now falling under an Aviation Commander instead of the MSC like it was originally intended. We are now exposed to the systemic risk aversion within the Army leadership structure. From the halls of the Pentagon down to the Battle Captains in the TOC (who are sometimes just LTs), everybody is focused on their career risk perception and not on the mission or the soldier in the field. Would I like to be armed? As a former scout pilot the answer is Hell yea! Has not being armed or flying a red cross ever stopped me or anyone on my medevac team from landing in a hot LZ? Nope, but the chain of command monitoring the battlespace from an air conditioned TOC over 50 miles away has. The medevac aircrews in Vietnam did not have these same challenges and they succeeded in ways beyond anyones imagination. They also only had to worry about the enemy and the weather, as if that wasnt enough. As a current medevac pilot, I not only have to worry about those threats, I also have to worry about my own COC punishing me for not having their tacit approval to simply do my job. This reality has forced us to get creative with our sit stats.....but then there is always that damned UAV overhead! Of course to a man, no one on my team will leave another soldier on the ground, providing we are allowed to launch in the first place. The simple and only real necessary fix to Dustoff is to take it away from the Aviation Commanders and make it its own entity again.
On a final note about Pedro, yea I know you guys have your sexy TV show but.......lets not forget that the real designation is CSAR. As someone already mentioned, we currently own the battlespace. In potential future theaters we may not. If/when that time comes and you are out actually performing CSAR, Dustoff will still be flying for the wounded.
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# HooeyAndrew B. 2013-09-22 05:09
Having flown DUSTOFF over three tours to RC-Sourth, Southwest, and West, I know that our crews never failed to land when allowed by higher levels of authority to launch. On two occasions, Pedro (then called Habu, launched and refused to land for SF WIA in RC-S due to heavy dust on a moonless night. Guess who was called to complete the mission? DUSTOFF. The problem isn't DUSTOFF, it's the powers that be who choose which asset to send for the wounded. The problem in my last tour was the Patient Evacuation Coordination Center, called PECC. The PECC in RC-SW were British and they wanted to send only the British MERT crews for critical patients. This was hotly contested by both DUSTOFF and Pedro leaders. The PECC and British doctors went as far as to say that an additional 20 minute wait by a critical patient was acceptable to have MERT arrive rather than the Pedro or DUSTOFF crews. Made no sense. The unit I flew for rescued around 2700 patients in 9 months, about half of which were urgent patients. In the same 9 months, Pedro flew less than 300 missions. Someone explain the disparity? Our aircraft were shot up something like 8 times, but we never refused a mission. Our CO would actively argue with the PECC, and at times our aviation Brigade to launch us when time was absolutely critical, even when very little was known about the area. He wanted to leave decisions to the pilots in the aircraft because we had better situational awareness that anyone 50-100 miles away. He also flew missions as a regular pilot so he knew how missions were constantly scrutinized by the wrong people. Where Pedro and MERT were grounded due to low visibility, we would often fly to get the patient. We also moved crews and helicopters to within 7 miles of the worst area in the region while the other assets were 30 miles away and in doing so, we reduced the high death rate of the Marines we were supporting.
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# Apples to OrangesMichael Yon author 2013-09-22 05:46
Andrew,

Thank you for the thoughtful comment. Much of this I have heard in person, seen in person, or have read comments about.

The PECC fights over launch authority and who to launch are well known within the medevac (meaning here Dustoff, Pedro, MERT) community who deployed to Afghanistan. Others have said that the launch authority often came from someone who was neither a pilot nor medical professional.

That aside, on the relative number of Pedro vs. Dustoff missions, your comment indicates that favoritism often comes into play on who to launch. Having been eyewitness, I concur with your comment, as do others from the community.

But there is an apples to oranges comparison here, too. You mentioned that during some period Dustoff flew 2,700 missions and Pedro flew 300. I cannot attest to the numbers but I do know that Dustoff had far, far more birds in Afghanistan than Pedro. There are less than 100 Pedro HH-60s in the entire US inventory. (Down to about 93, I think, but not sure.) Dustoff probably had well over a hundred birds just in Afghanistan. There are fewer Pedro birds and so naturally they will fly fewer total missions.

As for who will go where, some places/times Dustoff was not allowed to fly and all missions went to Pedro due to ground fire hazards, such as an area near the ring road not far from KAF.

One of the places with the highest threat that I ever saw was Sangin over in Helmand. I saw Pedro practically daily, but never Dustoff, despite that Dustoff flies faster and could have been there sooner from Bastion. It was all about the guns. Pedro has them, Dustoff does not.
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