The Challenge of Combat Search and Rescue for Colombian National Army Aviation

By: MAJ Cesar Rolon Villamizar & MAJ Andrés Fernández Osorio, National Army of Colombia

The soldier, above all other people, prays for peace, for he must suffer and bear the deepest wounds and scars of war.
——Douglas MacArthur (1880–1964), General, U.S. Army

Since the mid-1960s, the Republic of Colombia has suffered from an internal armed conflict against Marxist-Leninist narco-guerrillas, violent drug cartels, illegal armed groups, and criminal bands, most of whom support themselves through the production and trafficking of narcotics.1 This situation profoundly affected the stability of the country; more specifically, foreign investment dropped, international confidence in the country reached unfavorable levels, and several social and economic problems reached the boiling point. Nevertheless, despite the colossal tasks of the war against terrorism, drug trafficking, and a static economy, during the past decade the Colombian government has made steady progress through an ambitious and innovative approach that Time Magazine called "The Colombian Comeback: From nearly failed state to emerging global player—in less than a decade."2

An important part of this strategy relies on the Armed Forces of Colombia. Despite the risks they faced, Colombia's armed forces have established a more stable security environment so that citizens can live in peace and the government's programs can achieve their desired goals. Regrettably, the conflicts have exacted a terrible toll on armed forces personnel and civilians, many of whom have been wounded or killed by the terrorists. The Colombian National Army Aviation, eager to save the lives of all victims, including those of wounded terrorists, and to enhance national disaster relief and humanitarian assistance, created the Combat Search and Rescue Unit (CSRU) in 1997 as a decisive response to the needs of the country within the field of human life and human rights protection.

This article describes the Colombian National Army Aviation's system—called the Casualty Evacuation and Rescue Organization (CERO)—which was designed to save the lives of Colombian military personnel, civilians, and adversaries wounded in conflict zones. It explains the importance of the CSRU and the rationale behind its mission, and explores the common misunderstanding that confuses search and rescue with the function of personnel recovery. Finally, this article discusses the required doctrinal concepts that should be enforced to achieve both true interoperability among the military services and the maximum protection of human lives.

Background

During the past decade, the Colombian government and Ministry of National Defense designed three strategic policies designed to bring an end to Colombia's ongoing civil conflict, as well as guarantee economic and social development programs throughout the country. The Democratic Security Policy (2002–2005), the Policy for the Consolidation of Democratic Security (2006–2009), and the Comprehensive Security and Defense Policy for Prosperity (2010–2014), backed by the United States–Colombia joint initiative "Plan Colombia," maximized the Colombian armed forces' capabilities and reduced terrorism, kidnaping, and drug-trafficking levels.

Along with the enhancement of interoperability among the armed services3 and the acquisition of new equipment, these policies progressively increased the numbers of Colombian armed forces personnel; enhanced professionalism among the officers, NCOs, and soldiers; and improved the forces' ability to fight terrorism and drug cartels across the country (see figure 1).4 These changes were accomplished in compliance with human rights and international humanitarian law. The enhanced capabilities of the services, specifically within the areas of aviation, intelligence, and SOF, boosted the number of successful military operations and subsequently citizens' levels of security and confidence. This increased security served to bolster new economic and social programs and foreign financial investment.

Better planned and professionally executed military operations have positively affected the morale of troops as the number of armed forces personnel killed in action has decreased significantly (see figure 2).6 Unfortunately, enhanced military operations have also impelled the weakened terrorist groups to use prohibited weapons, such as land mines and IEDs, in a desperate effort to hinder the operational effectiveness of the military. As a result, the numbers of those wounded in action during the same period notably increased (see figure 3).7 Recent studies have shown that Colombia, with an unfortunate average of 811 land-mine and IED victims per year (almost 39 percent of whom are civilians), has one of the highest per capita casualty rates in the world.8

Besides the casualties inflicted by IEDs and gunshots, a wide variety of tropical diseases such as leishmaniasis, malaria, dengue, and several other common pathologies demands a permanent tactical health care system with a high level of readiness to ensure the survivability of the more than 400,000 armed forces personnel permanently deployed across the country's 1.1 million square kilometers. All of these challenges, combined with the extremely difficult geographical and meteorological conditions of the country, from dense tropical jungle to mountain ranges reaching 6,000 meters high, create a complex environment for the armed forces' operations tempo.9 This situation forced the services to permanently revise their own policies, systems, and procedures in order to ensure that they could execute an appropriate medical evacuation of casualties within the "golden hour" of maximum survival.10

The 2008 Colombian Ministry of National Defense's Directive No. 001, Definition of Public Forces' Tasks, and the 2009 Colombian Military Forces General Headquarters' Directive No. 003, Military Forces' Roles and Tasks, assigned responsibility to the Army, Navy (and Marines), and Police for casualty evacuation (CASEVAC) and medical evacuation (MEDEVAC) missions at the tactical level; similarly, the Air Force was made responsible for such missions at the operational and strategic levels.11 Each service functions within a joint operations structure, but independently undertakes and supports its own operations guided by its own doctrine, regulations, and policies. This structure has permitted the creation and implementation of tailored tactics, techniques, and procedures (TTPs) suited to the requirements of the respective service.

The Army is the tip of the spear of the Colombian military forces' groundbased strategy, as well as the service with the largest number of troops and rates of wounded and killed in action. The Army therefore required a precise system that would guarantee its troops' lives, as well as those of the civilian population and injured adversaries. No "off-the-shelf " approach was suitable; it was necessary to take into account a broad spectrum of factors, including the reality and projection of the conflict, the lessons learned, and the means available. After a comprehensive analysis by the CSRU of the Colombian National Army Aviation, an effective solution was designed to provide the best support to the troops: the CERO ("zero" in English) system.

The National Army of Colombia's Personnel Evacuation System

The National Army of Colombia is the largest service of the Colombian Armed Forces and is responsible, along with the Marines, for ground military operations against domestic or foreign threats. It is organized around eight territorial divisions and one special division: the Air Assault Aviation Division (DAVAA). DAVAA is a one-of-a-kind military unit of combined arms that encompasses the Army's Special Forces Brigade, the Special Counternarcotics Brigade, and the National Army Aviation, which operates the largest fleet of helicopters in the Colombian Armed Forces.

DAVAA is responsible not only for planning, executing, and coordinating special operations and counternarcotics raids but also for providing aviation support to the eight divisions, through Mobility and Maneuver Army Aviation Battalions attached to each division, and tactical evacuation (TACEVAC) for its own troops, wounded adversaries, and civilians. TACEVAC is a comprehensive task designed by the National Army Aviation, and defined as a tactical mission performed by DAVAA's CSRU, usually within a threat environment, using nondedicated, armed, and unmarked (no emblems of the International Red Cross are displayed) aerial, land, or maritime platforms to locate, evacuate, and provide pre-hospital care to wounded or injured individuals from the point of injury to the nearest medical facility.

TACEVAC is one of the most sensitive aviation missions performed by DAVAA; the Army's ethos implies a moral commitment to armed forces personnel and their families that ensures maximum effort to protect lives. Still, the wide range of high-risk tasks assigned to the National Army of Colombia—such as the fights against terrorism and drug cartels, the liberation of kidnapped personnel, the protection of national infrastructure, and the humanitarian land mine and IED clearance programs—assures a high rate of wounded and killed in action to be supported by DAVAA's CSRU.

The Combat Search and Rescue Unit

The CSRU is the Special Operations Aviation unit responsible for the planning, coordination, and execution of TACEVAC aviation missions. Created in 1997, it has performed more than 12,000 missions and has saved more than 9,000 lives, setting an unprecedented level of response to the needs of the Colombian armed forces within the field of human rights protection. For the National Army of Colombia, combat search and rescue (CSAR) is an indispensable element of military operations implied within the Army's responsibilities. CSAR is a military occupational specialty within the Colombian National Army Aviation's operations specialty, and CSAR operators are Special Operations Forces who form part of an Army aircrew. CSRU has five operational companies: Alpha, Bravo, Charlie, Delta, and Echo. Each operational company consists of search and rescue operational teams (SROTs) that specialize in different search and rescue missions: SROT-A specializes in jungle operations; SROT-B in mountainous terrain; SROT-C in water rescue; SROT-D in urban terrain; and SROT-E specializes in extrication equipment.

All CSRU troops are fully combat-experienced personnel drafted from the Army's SOF units; once chosen, they are required to pass CSRU's selection process and complete a three-month Military Rescuer course. This selection and training process guarantees that CSRU will accomplish its missions, for four reasons. First, CSRU personnel are completely capable of executing missions under fire and behind adversary lines due to their previous training and combat experience in SOF units—it has been shown repeatedly that combat training is not a replacement for combat experience. Casualties usually occur within a combat situation in high-risk surroundings; SROTs are fully competent to rescue wounded personnel under fire, fighting their way in or out as necessary to evacuate the injured. When performing civil or military search and rescue, contingencies such as bad weather, mechanical failure, or tactical considerations may impede the evacuation of the wounded from the field; in this case, SROTs can easily be attached to ground units, taking care of the casualties without being an obstacle or a risk for the combat personnel in the field.

Second, CSRU personnel entirely understand the relevant doctrine, the missions, the tactical situation, and the requirements of the troops because they previously were in the field as members of the units they now support. There is often an additional moral commitment involved, because the SROT's members are generally rescuing and supporting friends and former comrades.

CSRU's primary responsibility is to provide CSAR and TACEVAC coverage for Army operations; its secondary responsibility is to provide humanitarian relief and assistance along with the National Unit for Disaster Risk Management, military and civil search and rescue in coordination with the Colombian Special Administrative Unit of Civil Aeronautics, and Non-Conventional Assisted Recovery.

Third, CSRU personnel, as part of the National Army Aviation, are completely familiar with the available aerial platforms and relevant regulations, thus creating a supportive environment for every mission. All SROTs' equipment and TTPs fully comply with National Army Aviation flight regulations. In addition to receiving medical training in basic life support and other necessary medical evacuation protocols, SROT members will act as hoist operators and load masters where needed. Fourth, CSRU personnel take responsibility for the entire chain of evacuation procedures: they rescue the casualties from the field, receive and process the diagnostics and treatment plans given to them by the ground unit's medics, provide tactical combat casualty care during transport to the medical facility, provide full information on each case to the receiving medical personnel, track the patient's recovery, and integrally assess the whole process for lessons to be learned. In sum, CSRU ensures the survivability of the troops through a trusted chain of tactical health responders.

The CERO System

The CERO system is a comprehensive strategy designed by CSRU personnel, which aims to reduce to zero the mortality rate of wounded or injured individuals, including troops, civilians, and adversary personnel. It strives to fully report, locate, support, recover, and reintegrate individuals through the maximization of DAVAA's capabilities, and thus provide the National Army of Colombia with the most effective solution for TACEVAC missions. The CERO system is the result of a DOTMLPF12 assessment that included quantitative methods, comparative analysis, and common sense about the actual and projected scenario of a conflict; the doctrine, resources, and personnel available to fight; the lessons learned; and the approaches used by other countries' armed forces.

A complete statistical analysis, using a primary dataset collected over the years by the CSRU along with official reports produced by the Colombian Ministry of National Defense, provided useful insights that supported the theoretical framework suggested by the CSRU's CERO system. The four primary findings are as follows.

First, seriously wounded or injured patients are most likely to die during the pre-hospital period of care,13 at the point where they were injured, or during transport to medical facilities. Despite the reduction in numbers of Armed Forces personnel killed in action during the past decade, the number of urgent and priority TACEVACs requiring medical assistance by SROTs has increased (see figure 4). The statistical significance of this factor (R² = 0.6658) underscores the importance of providing medical assistance before and during TACEVAC missions, especially when handling urgent and priority patients. CSRU's statistical analysis demonstrated that patient mortality usually decreases when TACEVACs are performed with SROTs that can provide specialized medical assistance, versus general transport performed without health care.

A 2011 survey by the U.S. Defense Health Board drew similar conclusions when analyzing tactical evacuation care improvements within the U.S. Department of Defense: "A retrospective cohort study … demonstrated that mortality was significantly lower when evacuation was performed by a U.S. Army National Guard Air Ambulance unit with formally trained CCFPs (critical care flight paramedics) compared to standard military air ambulance units, staffed with EMT-Bs (emergency medical technician-basics)."14

Second, the urgent and priority patients' survivability could be maximized by providing them with proper basic life support (BLS) and pre-hospital trauma life support (PHTLS) in situ, to stabilize and prepare them for transportation to a medical facility, rather than relying solely on access to scarce dedicated medical transportation platforms. Indeed, in Colombia, due to the scarcity of dedicated MEDEVAC platforms, the evacuation time has often been prolonged far beyond the golden hour. Frequently, the chain of command underestimates the importance of BLS and PHTLS, which provide patients with essential medical care prior to evacuation; this evacuation-dependent approach has been proven wrong by many successful strategies—such as the Ranger Casualty Response System—that have strengthened the medical skills of SOF troops and thus reduced their levels of mortality.15 Furthermore, a 2001 survey published by the U.S. Army Medical Department established that "transport from an injury scene to an intermediate level hospital for the purpose of ‘stabilization' prior to transport to a trauma center produced a delay in definitive surgical intervention that was, on average, 6 times (196 minutes) longer that the time it would have taken to have directly transported the patient to the trauma center (34 minutes)."16 Through SROTs, the CSRU ensures wounded personnel and their chain of command a high level of patient survivability despite the platform or means of evacuation used.

Third, assigning dedicated aerial TACEVAC platforms is not a recommended solution for the National Army of Colombia because it reduces the availability of multipurpose aircraft that are used for a wide range of missions; furthermore, it is not a fiscally responsible solution because the funding required to procure the necessary dedicated aircraft is needed in other crucial areas. In order to ascertain the quantity of dedicated aircraft needed to meet the TACEVAC requirements of the National Army of Colombia, it is feasible to use the U.S. Army Table of Organization and Equipment and associated policies.17 The rules that allocate U.S. Army air ambulances established that each Army division should contain one aviation brigade with 12 aircraft. In the case of the National Army of Colombia, this would mean a total of 108 aircraft (9 × 12), a number far beyond the reach of the service. Alternatively, CSRU's CERO system uses all of the aerial, land, or maritime multipurpose non-dedicated armed platforms available to the National Army of Colombia and deployed across the country, adapting them for TACEVAC missions with modular medical packages and SROTs, thus guaranteeing a rapid response to save lives.18 This approach has been successfully proven by the U.S. Joint Special Operations Task Force, which in 2003 incorporated the concept of multipurpose aircraft fitted with "modular medical packages that would allow for the rapid transition of an armored, armed rotary wing aircraft, not dedicated to TACEVAC missions, into a temporary designated CASEVAC transport vehicle."19

Fourth, an appropriate evacuation decision-making chain of command is needed to guarantee the effectiveness of the whole tactical care system. The worst possible case is to have multiple commands—sometimes from different services—each with different criteria, located in different areas, remotely handling a TACEVAC mission; unfortunately such missions have sometimes occurred. The CERO system maintains that the only way to ensure adequate medical coverage is through the centralization of the TACEVAC mission requirements by the corresponding Mobility and Maneuver Army Aviation Battalion assigned to the jurisdiction, which, in conjunction with SROTs, plans and executes the mission based on a METT-TC20 matrix and risk assessment. The CERO system's goal is to coordinate the resources available to ensure a 60-minute time frame for TACEVACs, in correspondence with the standard mandated by the U.S. Secretary of Defense.

Rescue Missions: Different Approaches, Common Conclusions

Even though diverse doctrine and terminology are used by the different services of the armed forces, several common conclusions should be drawn to ensure true interoperability among them, especially in the area of TACEVAC missions, to avoid possible interference with each other's mission and the loss of human lives. First, despite the many names given by the services to rescue missions, all the names refer to the same objective: to save lives. Combat search and rescue, personnel recovery, tactical recovery of aircraft and personnel, and non-conventional assisted recovery, for example, are all terms used by each service to describe how the same mission is executed based on the service's own doctrine. The mission must be understood as the rescue of victims (one's own troops, the civilian population, or adversary personnel), and this fact should not be confused by the names used within the services.

Since the mid-2000s, the term personnel recovery (PR) has been commonly used by armed forces globally to describe the sum of military, diplomatic, and civil efforts to execute the recovery and reintegration of isolated personnel;21 personnel recovery, however, includes a wide range of methods that require an extremely high degree of combat experience, means, and capabilities. It is a common mistake to assume that military units responsible for CASEVAC, MEDEVAC, and TACEVAC missions are capable of performing PR missions. Consequently, senior military commanders and decision-making officers should carefully consider the inconvenience of giving military units without full PR capabilities such designations and related responsibilities. In the specific case of the National Army of Colombia, DAVAA is fully capable of performing all PR methods because it integrates the SOF units and a CSAR unit for the full range of rescue missions.

Second, a key factor that guarantees coherent interoperability among the services is a unified activity that allows each service to plan and execute its own operations and missions with total independence within its responsibilities. Interoperability is not only the joint execution of operations in a common scenario but also the understanding of other services' missions and requirements, as well as tailoring effective and appropriate options collectively to accomplish a final objective. Third, forces specifically trained for rescues are responsible for accomplishing the mission; therefore, the selection process, training, and TTPs should be adjusted to meet the requirements of the services, with the emphasis on the survivability of the troops and nothing else.

The CSRU's CERO system described in this article is a reliable, combat-proven system for TACEVAC missions. CERO has continually confirmed its efficiency and value in Colombia's ongoing internal conflicts. The CSRU, as part of the Air Assault Aviation Division, will always strive for the modernization of policies, procedures, technology, and coordination with other services or government agencies, to provide our troops with the best possible guarantee for their lives.

About the Author(s):
MAJ Cesar Rolon Villamizar is the commanding officer of the Combat Search and Rescue Unit of the National Army of Colombia.
MAJ Andrés Fernández Osorio is an active officer in the National Army of Colombia. He is currently studying in the International Masters in Economy, State, and Society program at University College London.


NOTES:

1. This article is a tribute to the sacrifice of the personnel of the Armed Forces of Colombia, who fight with an enormous faith in the cause, and to the courage, sacrifice, and honor of the soldiers of the Colombian National Army Aviation's CSRU, who will leave no one behind.

2. Tim Padgett and John Otis, "The Colombian Comeback," Time Magazine, 23 Apr 2012.

3. The Armed Forces of Colombia comprise the Army, Navy (including Marines), Air Force, and Police.

4. Ministry of National Defense, Logros de la Política Integral de Seguridad y Defensa para la Prosperidad–PISDP, September 2013 (in Spanish): http://www.mindefensa. gov.co/irj/portal/Mindefensa?NavigationTarget=navurl://f1047445615b9c3543fcf8c4e0b4e4be

5. All figures were created by the authors using Colombian Ministry of Defense data.

6. Ministry of National Defense, Logros de la Política Integral de Seguridad y Defensa.

7. Ibid.

8. Presidential Program for an Integral Action against Mines, "Who We Are," August 2013: http://www.accioncontraminas.gov.co/Programa

9. Headquarters, Department of the Army, Army Personnel Recovery, Field Manual 3-50.1 (Washington, D.C.: HQ, Dept. of the Army, November 2011), 1–2: http://armypubs.army.mil/doctrine/DR_pubs/dr_a/pdf/fm3_50x1.pdf

10. The golden hour, or golden time, is a widely accepted description of the 60-minute period within which a patient with a traumatic injury has to receive proper medical treatment; after this period, life chances are seriously threatened by further complications and involve lesser probabilities of recovery.

11. Colombian Military Forces General Headquarters, Military Forces' Roles and Tasks, Directive No. 003, 2009, Annex E, 78.

12. Doctrine, organization, training, materiel, leadership and education, personnel, and facilities (DOTMLPF) is a comprehensive evaluation system that encompasses doctrine, organization, training, maintenance, leadership, personnel, and facilities.

13. Kyle N. Remick et al., "Transforming US Army Trauma Care: An Evidence-Based Review of the Trauma Literature," U.S. Army Medical Department Journal, July/September 2010: http://cdm15290.contentdm.oclc.org/cdm/singleitem/collection/p15290coll3/id/1148/rec/8

14. U.S. Defense Health Board, Tactical Evacuation Care Improvements within the Department of Defense, 2011-03 (Falls Church, Va.: U.S. Defense Health Board, 2011), 4: http://www. health.mil/Libraries/110808_TCCC_Course_Materials/0765- DHB-Memo-110614-TACEVAC.pdf

15. U.S. Central Command Pre-Hospital Trauma Care Assessment Team, Saving Lives on the Battlefield: A Joint Trauma System Review of Pre-Hospital Trauma Care in Combined Joint Operating Area–Afghanistan (CJOA-A) (Washington, D.C.: U.S. Central Command Pre-Hospital Trauma Care Assessment Team, 30 January 2013): http://rdcr.org/wp-content/uploads/2013/02/CENTCOM-Prehospital-Final-Report-130130.pdf

16. Robert T. Gerhardt et al., "US Army MEDEVAC in the New Millennium: A Medical Perspective," The United States Army Medical Department Journal, July–September 2000: 38: http:// www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA381068

17. L. Fulton, P. McMurry, and B. Kerr, "A Monte Carlo Simulation of Air Ambulance Requirements during Major Combat Operations," Military Medicine 174, no. 6, 2009: 610–614.

18. The standard policy for tactical evacuation (TACEVAC) missions of the Colombian National Army Aviation is the use of armed, unmarked (no emblems of the International Red Cross are used), multipurpose helicopters, fitted with modular medical packages manned by SROTs.

19. U.S. Defense Health Board, Tactical Evacuation Care Improvements within the Department of Defense, 6.

20. METT-TC stands for mission, enemy, time, terrain, troops, and civilians.

21. United States Joint Chiefs of Staff, Personnel Recovery, Joint Publication JP 3-50 (Washington, D.C.: Joint Chiefs of Staff, 2011), ix: http://usacac.army.mil/CAC2/doctrine/CDM%20 resources/manuals/jps/jp3_50.pdf

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