Forward aeromedical evacuation: a brief history, lessons learned from the Global War on Terror, and the way forward for US policy.

T USArmy pioneered air evacuation of casualties from the battlefield to a forward operating surgical treatment facility after the advent of the helicopter. This rotary-wing capability was initially used for casualty evacuation (CASEVAC) during the Korean War but evolved to the extent that lifesaving resuscitation was initiated en route by the US Army during the Vietnam War. More recently in Iraq and Afghanistan, medical evacuation (MEDEVAC) by platforms operating under a US and UK joint system has matured to the point where advanced medical capabilities are brought forward to the point of injury (POI). Emerging data from the Afghanistan experience however indicate that clinical and doctrinal gaps exist in US forward aeromedical evacuation (FAME) capability. In this review article, we provide a brief history of military MEDEVAC centered on the evolution of FAME, describe the current FAME platforms in Afghanistan, discuss lessons learned from recent studies examining the performance of the current FAME platforms, and propose the way ahead for FAME in future conflicts.