Unfortunately, in today’s military, the chances of using a 9 line MEDEVAC format in combat are high and many operational personnel are not receiving the training required to call it into medical personnel correctly. If a MEDEVAC is improperly requested, the patient may not receive medical care promptly, possibly resulting in catastrophic consequences.

All personnel, civilian or military should be trained to calmly and collectively call in a 9 Line MEDEVAC under stress. Additionally, training should include stressful scenarios where personnel, from privates to senior officers, practice calling in MEDEVACS to training cadre.

When calling in a MEDEVAC, there are several steps that the individual must take to ensure the 9 Line is properly called in and dispatched units are given the necessary information required to reach the patient’s location.

How To Call in a 9 Line MEDEVAC
A U.S. Army crew chief with the 2-501st General Support Aviation Battalion (GSAB), 1st Armored Division, based in Ft. Bliss, Texas, peeks slightly out of a HH-60M MEDEVAC, making sure it is safe to land below during Guardian Response 18 at Muscatatuck Urban Training Center, Ind., April 20, 2018. (Photo by Staff Sgt. Christopher Sofia)

What is a MEDEVAC?

MEDEVAC is an emergency medical evacuation. A medical evacuation (MEDEVAC) can be performed during wartime, a natural disaster, or in specific instances where a medical evacuation is required after vehicle accidents or manmade situations such as active shooters or terrorist attacks.

The 9 Line MEDEVAC is a field triage process to identify the most critical patients so that they get priority care and transportation.  Others are transported in order of injury type and severity according to the 9 Line MEDEVAC request.

What Is The Difference Between CASEVAC and MEDEVAC?

The primary difference between CASEVAC and MEDEVAC is that the CASEVAC option relies on non-dedicated medical personnel such as the closest available unit or a QRF response team. The MEDEVAC option uses a dedicated team of medical professionals that are on standby to respond via land, sea, or air to the incident. Units such as Air Force PJs are a perfect example of a MEDEVAC response.

Preparation Steps to Calling in a 9 Line MEDEVAC

Step 1: Return fire/render the scene safe

Before attempting to call in a 9 Line MEDEVAC the scene must be rendered safe. Personnel should not reduce the overall efficacy of the force’s firepower to call in a 9Line. If the unit under fire reduces the overall aggression and violence of action against the enemy force it could result in a greater loss of personnel. At all costs, the firefight must be won before moving towards rendering aid to the wounded.

Step 2: Care Under Fire

Once fire superiority has been established medical personnel can begin care under fire. In this step, medical personnel and medically trained operators can start to tend to life-threatening wounds while maintaining security.

Step 3: Determine the number of patients by type

This is not only valuable information to have when calling in the 9line but it will also allow medical personnel to accurately triage patients based on their medical condition and chances of living. In this step critically wounded personnel is identified and consolidated in the event, there is limited space on incoming MEDEVAC platforms.

Step 4: Contact MEDEVAC channel

While ensuring the scene safe is important, getting the MEDEVAC out is also critical. MEDEVAC units will have varied response times but giving them notification of the situation as soon as possible will help reduce their time to the station. If the operating element has a BFT, this should be hit as quickly as possible to let supporting units know of the emergency taking place. Again, operating personnel should practice radioing for help as part of their response to an attack.

Step 5: Using 9 Line MEDEVAC format to call in MEDEVAC

The first five lines are most important when calling in a MEDEVAC, the other four can be relayed when birds are in the air. Ensure you have a safe LZ for the landing party.

No matter what the situation on the ground the radio operator should remain calm and collected at all costs. Personnel calling in a MEDEVAC while in a state of panic may relay incorrect information or speak in a manner that is incomprehensible over the radio.

Remember, responding units will not come any faster if the RTO is calling the 9 Line in a sensitive manner. To ensure the 9Line is called in properly the Operator should consider writing down the information to ensure all pertinent information is passed.

What are the 9 Lines of MEDEVAC?

Line 1: Location and Pickup Site

This is given in an MGRS 6 to 8 digit grid

Line 2: Frequency and call sign at the pickup site

This is the frequency and callsign that you will be talking to the incoming MEDEVAC aircraft on. In most cases, this is a predetermined, non-encrypted channel that is set-aside for MEDEVAC. If possible write this on all 9Line cards before the mission.

Line 3: Number of patients by precedence

A- Urgent (surgical)- i.e. requires the in-flight surgeon to perform surgery while en route to the hospital. B- Urgent (non-surgical)- the i.e. patient has an arterial bleed that can be stabilized until arriving at the hospital. C- Priority- i.e. injuries that are not immediately life-threatening but could become fatal eventually. D- Routine- i.e. patient requires regular medical care, but the unit cannot transport them by their means. E- Convenience- i.e. nonlife-threatening care provided to personnel in a combat zone.

Line 4: Special Equipment required

A- None B- Hoist C- Extraction Equipment- i.e. jungle penetrator D- Ventilation

Line 5: Number of Patients by type

A- Litter- cannot walk on their own B- Ambulatory- able to self-move to MEDEVAC platform

Line 6: Security of Pickup area

N- No enemy troops in area P- Possible enemy troops in area (approach with caution) E- Enemy troops in area (approach with caution) X-Enemy troops in area (armed escort required)

Line 7: Method of Marking at the pickup site

(important: always ensure marking equipment is available to the marking personnel. If you are going to throw purple smoke, ensure you have purple smoke on hand) A- Panels- i.e. VF-17 panel B- Pyrotechnical equipment- i.e. pen flare, red star cluster C- Smoke Signal- (provide smoke color) D- None E- Other- i.e. IR flash or beacon.

Line 8: Patient Nationality and Status

A- US Military B- US Civilian C- Non-US Military D- Non-US Citizen E- EPW

Line 9: NBC Contamination

A- Nuclear B- Biological C- Chemical *During peacetime provide terrain of pickup site

Once in the air, the operator will relay the final four lines in the same manner given. It’s always important to remain calm on the radio and ALWAYS have a 9 Line MEDEVAC on hand.

Once in the air, the operator will relay the final four lines in the same manner provided. Remember, training to send in a 9 Line is necessary for all personnel on the ground. You never know when YOU may be calling in a MEDEVAC and you never want to wait until the situation takes place to figure out that you are unable to call it incorrectly. A simple way to keep a 9 Line on you at all times is to carry the RE Factor Tactical 9 Line MEDEVAC format which is available on our website. Made in the USA of tough marine-grade vinyl,  they are precisely cut to fit on the back of a PRC-148 radio or the buttstock of a rifle.

M.I.S.T. Report

The M.I.S.T. Report has recently been incorporated into the 9 Line MEDEVAC format and traditionally comes after the 9 Line Format.

The M.I.S.T. Report stands for:

M – Mechanism of injury (mine, GSW, RPG, RTA, etc. given)

I – Type of Injury (found and or suspected)

S – Signs (pulse rate, blood pressure, respiratory rate)

T – Treatment is given (morphine, tourniquet, etc.Example) A/C – adult/child (include age if known)

In Conclusion

The 9 line MEDEVAC format can vary based on the operational element. Most use the U.S. military 9 line MEDEVAC format while others use NATO 9 Line or internally generated 9 Lines with the unique information required for supporting units.

All leadership and medical personnel should get with local MEDEVAC elements to ensure they have proper radio frequencies and 9Line formats readily available.

Also, every person on the ground should have a 9 Line MEDEVAC card on his or her person at all times. This can be a card placed in an IFAK, on a radio, or kept in a pocket.

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