After more than 60 years, there is still room for improvement when it comes to medical evacuation, suggests Olav Kaarstein, president of NODIN Aviation.

MEDEVAC – bringing doctors to patients, patient to doctor or patient to or between hospitals – is said to have its origins in 1915 when a French modified plane moved Serbian or Albanian patients.

The British performed their first recorded aero med in 1917 with a De Havilland biplane flying a Camel Corps Soldier to hospital in Turkey. At the end of World War II the US Army started developing this life-saving service when establishing tented field hospitals close to the theatre and using helicopters and ambulances to transport wounded soldiers.

In the past four decades, the focus of MEDEVAC has increased as a result of nations being engaged in conflicts far away from their own countries, an increasing number of terrorist actions and large natural catastrophes. With an almost ever-present press transmitting images of people in distress or of the seriously wounded or even deceased into our living rooms, it is vital for nations to have satisfactory routines, procedures and equipment to assure soldiers and citizens that they are able to take care of their own people when wounded abroad, and bring them home for treatment and recovery.

After more than 60 years of developing routines and procedures of MEDEVAC, both within each nation and within coalitions, one would assume that terms and abbreviations, as well as equipment interfaces, are harmonised between nations to assure interoperability, flexibility and cross-training.

A lot has been done in the past 25 years to achieve this. NATO has developed Standards for equipment as well as terminology; several yearly conferences – both military and civilian organised – contribute to the transfer of knowledge and experience between services and nations. Nevertheless, most nations still have huge areas of improvement before perfection. Why?

There is off cause no simple answer to this question, and perfection may never be achieved, but my observations can be summarised by two headings:

  • Medical Routines and Equipment
  • Standardisation and harmonisation between services and nations.

Medical Routines and Equipment

Medical advancement in treatment resulting from experience or from new technology and equipment often causes changes in routines. New threats in the field often result in new products. How can nations assure that such changes do not cause the chain of evacuation to be hampered? Does a nation’s eagerness to use national companies for developing equipment in fact reduce the possibilities of operability between nations? Do initiatives need to be channelled to the central level to assure that local benefit also serves the interest of the total system?

Standardisation and harmonisation between services and nations

While trying to assure interoperability of services as well as national forces, we know that it is impossible to meet all interests. For example, the infantry soldiers want super light, compact stretchers. For the vehicle operator, it is vital that the stretcher fits into the actual stretcher support in the vehicle.

The helicopter or aircraft-operator needs a stretcher approved for aerial evacuation, while the wounded soldier has the best chances of survival and least pain if he is brought throughout the chain of evacuation on the same stretcher. Very often the result is different stretchers in different services, which arguably does not serve the patient.

Can the industry contribute in the process of harmonising, first of all equipment, and assist armed forces in developing and maintaining flexible solutions with high capacity across services and nations?

I am confident they can, as there is a significant level of expertise and knowledge in the industry as well as in the Medical Services. I suggest that this knowledge can catalyse the best solution for the customer and the industry can further improve their services to their customers by:

  • Developing collaboration between companies to extend competence and capacity;
  • Participating in arenas where the customers share their experience in the field;
  • Knowing, understanding and being loyal to applicable standards when designing solutions;
  • Focus on the patient and the medics, not the equipment, when developing innovative design solutions.

What can the customers do to make the suppliers better prepared to develop solutions, products and services that meet the needs of the patients? I would suggest:

  • Improve the arenas where users share their experience in a patient evacuation;
  • Allow and encourage informal discussions between users and industry, enabling the industry to fully understand the need;
  • Describe the issue and/or the need, not the solution. The best solutions may not yet have been invented.

There is a significant effort in many nations to improve their CASEVAC and MEDEVAC capability and if these activities are fairly coordinated the international community will see a huge increase in the total capacity to bring injured people out of disaster areas.


Olav Kaarstein


NODIN Aviation AS

Tel: +47 33 32 79 43


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