8 steps to evacuate casualties from combat zones

Technically, aeromedical evacuation has been around since World War I, bringing our wounded back home by way of aircraft. Present day, AE is still a critical component to getting injured troops back to safety.

AE crews, medics, and personnel outside the wire are expertly trained to care for combat-related injuries and conditions. With others’ lives on the line, it’s not surprising that the many-step process of evacuating a casualty of war has been refined to achieve the highest survival rate possible.

1. Triage

The injured are first examined by a medic, corpsman, or any medical personnel available to assess injuries. The medical personnel will continue to attend to the wounded until transportation arrives to transfer them to a higher level of care.

casualty triage

Soldiers conduct simulated casualty triage at Forward Operating Base, Solerno, Kandahar. (U.S. Army photo by Maj. Kamil Sztalkoper)

2. Patient movement

It is of utmost importance to quickly transport the triaged to the nearest hospital or Mobile Air Staging Facility (MASF). The only hardened hospital capable of caring for critical combat-related injuries for a longer period of time is Bagram AB, Afghanistan.

Patient movement

Marines carry their comrade to Huey medevac helicopter. (photo by Stars and Stripes)

The means of transportation for moving a troop to Bagram AB is dependent on where they were injured. If the service member is injured just outside of base, then a Humvee is the obvious choice. If personnel are wounded at a Forward Operating Base, a Huey dust-off mission will be spun up to retrieve casualties.

3. Diagnosis

Once patients are transferred to the hospital, they are stabilized by doctors working in the facility and their diagnosis is entered into a database, called Tra2ces. Tra2ces is relatively new and is one of the sole reasons why the wounded have been tracked so efficiently on their journey from the point of injury to back home with their families.


After patients are successfully entered into the tracking system, the next step is to continue moving back to the States. Tactical Airlift Command and Control (TACC) is responsible for scheduling all planes flying in- and out-of-country.


Lt. Col. John Keagle coordinates a C-17 Globemaster mission to Afghanistan. (U.S. Air Force photo/Capt. Justin Brockhoff)

Depending on the injury, patients are categorized and listed in order of priority. In other words, the most critically wounded will top of the list and will typically be sent home first.


It is the responsibility of the Aeromedical Evacuation Operations Team (AEOT), specifically the admin mission controller, to assign a medical crew to take care of patients in flight. The crews have strict guidelines and must be current in all of their medical training. There is zero tolerance for sandbagging in this career field.

6. AE medical crews

The AE crew consists of three enlisted medical technicians and two flight nurses. The crews are given all patient information and medical equipment needed before mission take-off.

AE Medical Technicians

Master Sgt. Russel Goodwater and Master Sgt. Timothy Starkey assess their checklist for proper protocol during a AE training mission. (photo by Master Sgt. Christian Amezcua)

In the crew, each member has their own task and they work together to guarantee mission success. After all, they are caring for the most precious cargo — their fellow service members.


Before take-off, patients are moved from the hospital to the flight line. The Casualty Air Staging Facility (CASF) could be considered a tent hospital, located on the flight-line, close to the aircraft. Patients will be moved to the CASF in preparation and set up for the flight that will take them one step closer to home.

Aeromedical Evacuation

CASF personnel litter carry a patient from an ambulance bus onto C-17 aircraft at Camp Bastion, Afghanistan. (U.S. Air Force photo/ Master Sergeant Adrian Cadiz)

8. Mission launch

After medical and ground personnel load all patients onto the aircraft, they are flown to Ramstein AFB, Germany, where they can get more in-depth medical care for their injuries. Bagram AB simply does not have the extended-care capability to continually treat critically injured patients.

patient movement

Above, patients have been securely loaded onto a C-17 Loadmaster and await transport to Ramstein AFB.(Photo by Master Sgt. Christian Amezcua)

After a stay at Ramstein, patients are sent back to home base on another AE flight. All the while, AE medical crews are in the air with their patients, providing them with expert care, comfort, and, if needed, a hand to hold.

evacuating casualties

A medical tech holds the hand of a patient during an Aeromedical Evacuation mission transporting patients from Kandahar to Bagram Air Base.(U.S. Air Force Photo by Staff Sgt. Shawn Weismiller)