Smoky Mountain Rescue

As two park rangers care for a hiker attacked by a bear in the Great Smoky Mountains National Park, the patient continues to lose blood. They pack the wounds and treat the patient for shock and hypothermia. It is at least a nine-mile hike to the closest road, and there isn’t enough manpower to carry the patient out. They’d called for a helicopter when they first received the call of a hiker in distress at 10:15 p.m., but the darkness had long since fallen before they’d begun their search. They are sweating bullets, keeping the patient alive as best they can, when they finally hear the chop of the approaching rotors and the pilot making radio contact…

This is becoming more of a regular occurrence in the Smokies and surrounding Cherokee National Forest. The MEDEVAC (Medical Evacuation) Tennessee Army National Guard unit, out of Joint Base McGhee-Tyson, has been used more often since the unit was reassigned to the base in 2016.

Critical Care Flight Paramedic SFC Tracy A. Banta says the most significant advantage of the military medevac units compared to civilian aeromedical programs is the hoist and FLIR (Forward Looking Infrared) system. The aircraft and helmet-mounted systems allow the pilot and crew members to see in darkness and poor weather conditions.

The hoist is a considerable asset in search and rescue missions where there is no place for a helicopter to land. Banta says the 290-foot rescue hoist cable is typically used with the “civilian strop” (a horse collar with a thong strap to keep a person from falling through should they let go with their arms). They also have a two-person rescue basket and jungle penetrator.

Military Capabilities

Banta reiterates they train for war, including medevac, search, and rescue as their primary mission. The medical personnel are enlisted health care providers who are highly trained. Many work their full-time jobs as paramedics on civilian aircraft or ground ambulances. Their critical care flight paramedics are flight paramedic (FP-C) credentialed by the International Board of Specialty Certifications.

The US Army’s Blackhawks also have more all-weather capability and power than traditional civilian aircraft. This is very important with their primary mission, which is much different from their civilian counterparts, who routinely provide medical care on the ground and in the air. The military model is “grab and go,” with very little medical care offered on-site. The Blackhawks travel 150 miles per hour (top speed of 222 mph) and can quickly have a patient at a trauma center.

One issue that can arise is the helipad. Not all Level 1 trauma centers can accommodate a large aircraft like the Blackhawk, and they are forced to use an alternate landing site. The unit based at McGhee Tyson most often transports patients to the University of Tennessee Medical Center at Knoxville, which has a large pad that can accommodate them. Banta says they once delivered a patient to Fort Sanders in Knoxville. The pilot set the wheels on the pad and kept the rest of the helicopter in hover while they offloaded.

Unit Organization and Oversight

The unit was redesigned in September 2002 from CECAT Medical to the 146th Medical Company (Army Aviation). They were deployed to Fort Benning in 2003-2004. In September 2006, they were redesignated to Detachment 1, Company C 2-104th Aviation Regiment. In September 2010, they were redesignated to Detachment 1 Company C 1-169th Aviation Regiment. They were deployed to Afghanistan from February to December 2011.

During the 2015 Army Restructuring Initiative, Tennessee moved away from the OH-58D and moved the MEDEVAC back to Knoxville in 2016. Detachment 1 Company C 1-169th Aviation Regiment was redesignated to Detachment 1 Company C 1-171st Aviation Regiment and added Detachment 1 Company C 2-135 Aviation Regiment and Detachment 1 Company G 1-111 Aviation Regiment. For operational control and pooling of resources, they became Task Force MEDEVAC—“Task Force Smokey.” However, they all operate independently on paper.

The Tennessee Army National Guard MEDEVAC units operate out of Joint Base McGhee Tyson with the Tennessee Air National Guard’s 134th Air Refueling Wing. The National Guard assets are a shining example of the state’s commitment to providing its citizens with the highest levels of emergency medical care. The unit’s ability to rapidly respond to emergencies and transport critically injured or ill individuals to medical facilities has saved countless lives.

According to SFC Banta, Army Aviation personnel drill double that of regular guard units to meet flying hour requirements. They drill two weekends per month and one month during the year. This is in addition to their regular jobs, as they are not full-time employees of the Guard.

Equipment and Personnel

Task Force Smokey trains for search and rescue medical evacuation in times of war. The unit can provide emergency medical transport for patients with various medical conditions, including trauma, cardiac, and respiratory emergencies. They are equipped with a Med-Kit interior, which includes:

• litters
• SKEDCO
• Jungle Penetrator
• rescue strops
• attachment points for a neonatal isolette
• pediatric care kit
• burn kit
• splints & traction splints
• oxygen
• ventilator
• suction
• long spine board
• Oregon spine splint
• advanced airway kit
• IV solutions and warming unit
• hypothermia kits
• EKG monitor/defibrillator
• drug box
• aid bags

They also have a 660-gallon water bucket that can be attached to the bottom of the aircraft to fight wildfires and carry firefighting backpack units and crash rescue equipment. The aircraft are staffed with a pilot, co-pilot, crew chief, and two flight paramedics. They have the room and horsepower, allowing them to carry more than a typical civilian aeromedical helicopter and take more wounded.

Missions and Mobilization

The MEDEVAC unit has a long and proud history of providing emergency medical transport services to the citizens of Tennessee. Since its activation in 1995, the unit has been deployed multiple times to support various operations, including peacekeeping missions in Kosovo and combat operations in Afghanistan. Their dedication to serving their fellow citizens has earned them numerous awards and commendations. They have been mobilized to support Hurricanes Floyd, Gustav, Irma, Ivan, Maria, Matthew, and Katrina. They were also deployed to the Great Smoky Mountains National Park wildfires in 2016 and the Kentucky floods in 2022. The unit has provided hundreds of rescues throughout its history.

Getting the military to send a MEDEVAC helicopter isn’t as quick as dialing 9-1-1 for an ambulance and sending a regional aeromedical unit. There are chains of command and control that must be followed.

In Tennessee, the request has to be made from a civilian or local government agency to the local emergency management agency (EMA). Local EMA passes the request to the State Emergency Operations Center. The state watchpoint officer contacts the joint operations center, which reaches the State Aviation Officer and Army Aviation Support Facility Commander. The request then flows to the Army Aviation Support Facility (AASF) Operations Officer and Facility Flight Operations.

For a mission to be approved, it either has to be federal or able to be written off as a training mission in most instances. Responses can be as quick as 30 minutes if a request occurs while the unit is staffed during the drill period or during business hours of the AASF#2. Other missions may require waits of 1-2 hours as personnel are called in for service. As a Tennessee National Guard asset, the unit is not staffed with full-time employees like their civilian counterparts.

The trial program enabling some medics to administer blood products to wounded soldiers began in Afghanistan. The “Vampire” trial had two MEDEVAC companies in Task Force Hammerhead participating. One was Company C, 1st Battalion, 169th Aviation Regiment, Army National Guard. Captain Nathaniel Bastian says, “Specifically, we implemented a new blood transfusion process for critically injured patients on MEDEVAC aircraft. Gaining this blood product transfusion capability aboard MEDEVAC aircraft was a force-multiplier in terms of increasing the probability of patient survivability because it expanded the en-route medical treatment tool kit for our flight medics.” SFC Tracy Banta, UH-60 Standardization Instructor at McGhee Tyson, says Task Force Smokey is implementing the blood program and is ironing out the details.

A Special Breed

While the Sikorsky UH-60 Blackhawks are a great recruiting tool and often steal the show, the people are the tangible asset. Banta says the civilian benefit is mainly in the form of their outreach programs. Task Force Smokey is an NAEMT training site that conducts classes throughout the area and state. “Training is a third of the job for flight personnel,” according to Banta. They teach EMT classes. Their personnel also help teach ACLS, PALS, CPR, and other courses to help keep their credentials up—helping other training centers.

Not all medical personnel are flight paramedics when they come to them. Banta says some paramedics join and get accepted into the program. Still, some join the Guard and receive their training there. They are sent to school for EMT, EMT-P, and critical care flight paramedic as part of their advanced individual training.

Not everyone works out. Just as with civilian EMS, some get into the job and then realize they don’t like it or don’t have the time required. However, they do have a high success rate with training—Banta says they have a 90% first-time pass rate at Fort Sam Houston in Texas’s critical care flight paramedic training program.

Not all personnel interested in Army aviation want to fly. Still, they all have the same training and drill commitment as the flight crews. Banta says it takes a special breed, and they are always looking for people interested in flight operations. Recruits are welcome; they need them all, whether they want to be a pilot, mechanic, in operations, ground crew member, crew chief, or flight paramedic.

While interviewing SFC Banta in his office, I was lucky to meet "Maverick" as he walked through the building. He wasn’t as tall as I imagined, but he wagged his tail and was very friendly. The support dog regularly comes to Banta’s office for a bite of cheese when he enters the building.

John M. Dabbs is a consultant and investigator for the Northeast Tennessee Regional Health Office and a frequent contributor to EMS World.