Michael's Dispatches

Slippery Stuff: CASEVAC vs. MEDEVAC


7 December 2011

If you ask ten service members “What is the difference between CASEVAC and MEDEVAC,” you might get six answers.  Five might answer, “I don’t know.”  The other five will surely give five different answers.

I’ve asked dozens and never gotten the same answer twice.  The people I’ve asked include Army Dustoff pilots, Air Force Pedro pilots and crew, and one Marine officer.  I’ve also asked plenty of Generals, Colonels, and senior-ranking enlisted folks.

Bottom line up front: if someone advertises that they know the definition, they don’t.  A single, widely accepted definition does not exist.  Definitions are easy to find in books here and there, but if you poke around enough, you will find that the definitions conflict.

Online dictionaries offer little help.  

According to OxfordDictionaries.com:


•    evacuation of casualties by air.
•    evacuate (a casualty) by air.


•    the evacuation of military or other casualties to hospital in a helicopter or aeroplane:
•    transport (someone) to hospital in a helicopter or aeroplane:

Other dictionaries and military literature render other definitions.  Wikipedia is Wikipedia.

The working definitions of CASEVAC and MEDEVAC are so misleading that you must ask the person using the terms exactly what is meant.  For instance, US Air Force “Pedro” performs CASEVACs.  If you ask a Pedro pilot with hundreds of combat missions behind him, his definitions are likely to be simple:

1)    CASEVAC is armed.
2)    MEDEVAC is unarmed.

The Pedro likely will go on to say that MEDEVACs are protected under the Geneva Conventions and that CASEVACs are not.

I asked an experienced Pedro commander, and got this more granular response:

Well, I don't know that the AF actually has official definitions of either term, but the generally accepted definitions of each among my peers in the AF Rescue community are:

MEDEVAC - evacuation of injured personnel from the battlefield or a low-level care facility to a higher level of care.  In the AF, we generally view this as evacuation from a secured, no-threat landing area where the person is usually "packaged" (had some level of care and/or stabilization).  Sometimes, this can even apply to transport in between FOBs, CASFs, etc.  In fact, it's even called MEDEVAC when a C-17 airlifts people from Bagram to Ramstein.

CASEVAC - is different in that it involves evacuation of injured personnel from the battlefield or the point of their injury, with little or no prior care.  The landing area is not necessarily secured and troops may be actively involved in fighting.  In fact, what really differentiates CASEVAC from MEDEVAC for us is that when conducting CASEVAC we will fight our way in to get the injured person.  Some non-AF people will also add the level of care while en route to their definition - saying there is a higher level of care while en route with a MEDEVAC.  I don't think this really applies with MEDEVAC or CASEVAC on AF [H]H-60s because the PJs are very highly trained medically (in addition to tactically).  All have EMT training and some have up to PA-level training.  In a CASEVAC, they will leave the [H]H-60 to go get the injured person, provide initial medical care (sometimes under fire), bring that person to the helicopter, and treat them on the way home.

If you ask a Dustoff pilot, you’ll get a different answer.  A pilot said to me on the phone that Dustoff are called MEDEVAC because they have medics aboard, and that Pedros are called CASEVAC because they have no medics.  This is false.  Pedros have excellent medics on every flight.  And so by that pilot’s definition, Pedro is MEDEVAC.

Others will say that MEDEVAC aircraft/vehicles are specifically designated for medical evacuations.  Again, this falls flat: Pedros are designated for medical evacuations in Afghanistan, and they are called CASEVAC.  British “Tricky” (call sign for their medical evacuation helicopters) have real doctors aboard, and machine guns.  Army special operations forces often go with real doctors, and always with machine guns.  Their dedicated medical birds don’t wear Red Crosses.  So what are they?  CASEVAC or MEDEVAC?

Marines give another answer.   Let’s don’t even go there.

So I asked a very experienced Army man, and in his wisdom he cut through all the malarkey and put it like this, “You say potAtoe, I say potawtoe.”  He also tells me not to wrestle with pigs when I write something bad about milkooks.  (Few words, simple wisdom.  He’ll probably chastise me via email when he sees that sentence.)

The definitions make no difference, really.  But some people are trying to undermine the message that Dustoff helicopters should go without Red Crosses, and they have hung their greasy hats on the idea that I don’t know the definitions.  In every case, however, the inverse has been true.  I know the many definitions so well that I have mostly avoided the topic to prevent confusion.

Importantly, those people who are undermining the message are trying to leave wounded troops on the battlefield longer.  Many Dustoff and Pedro people, who actually fly these missions, are flooding me with information and encouragement.  All of the Pedro and the majority of Dustoff want the crosses removed from Dustoff helicopters.  Those who are trying to undermine the message are going against the desires of many people who are actually flying these missions today.

Bottom line: If someone says they know the definition of CASEVAC/MEDEVAC, they don’t.

For more information, please read:

FOOL’S GOLD Troops’ Blood
Marked For Destruction
US Army violating Geneva Conventions

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  • This commment is unpublished.
    Kirk Kraemer · 8 years ago
    I think one of the big differences is that the Air Force birds are more like CSAR aircraft (Combat Search and Rescue). I don't think an Army Dustoff would perform that mission. Its kinda like an apple and an orange.
  • This commment is unpublished.
    TrT · 8 years ago
    My own opinion, based utterly on ignorance, would be similar to that of the Pedro Commander.
    Although I'd say prior medical treatment isnt really relevent.

    All helicopter evacs in Afghanistan are likely to involve shooting, so should be casevacs, be thay kidney failure at a FoB or IED injuries.

    A helicopter evac after an accident at a fireing range in Germany is unlikely to involve any shooting.
  • This commment is unpublished.
    okiquit · 8 years ago
    They're all heroes to me, especially the 436th Medical Detachment crews who flew our medevacs in Quang Nam.
  • This commment is unpublished.
    Dan · 8 years ago
    Having worked in combat developments at the AMEDD C&S we generally used the following accepted definitions:
    MEDEVAC - use of "dedicated" platforms (ambulances, aircraft, etc) to move the sick and injured - with assigned crews with organic medical equipment.
    CASEVAC was normally referred to "lift of opportunity" (much like the Marines used to rely upon) - might or might not have organic medical personnel and equipment.

    Mike - definitions are like you say - variable - your points regarding the Red Crosses and the weapons are truly the central issue regardless of what we call it - movement of sick and injured MUST have several things - medics, equipment, protection, and be dedicated to that mission - meaning that those platforms CAN NOT be used for other missions - that is really the crux of the issue that the Army Medical Department has with removing the Red Crossed - we know that the Aviation Battalion commanders will soon be using them for other missions.
  • This commment is unpublished.
    peter · 8 years ago
    Whoa--doctors on helos!! I am not sure about that unless they are going to do surgery. I read years ago the Israelis' would put doctors with the troops on the font line, but after losiing so many in combat, they decided to use more highly trained para medics.. A doctor takes 4 years of college, followed by four year of medical school, followed to 7 years of post medical school training. A thoroughly trained trauma paramedic takes 2 years. I hope the Brits re-evaluate that policy!! Otherwise, a great explanation on the nitty gritty details of various air ambulances!
  • This commment is unpublished.
    Fullgrin · 8 years ago
    In Army references and NATO STANAGS, the term MEDEVAC is defined as a dedicated platform with assigned medical personnel to treat enroute. The evacuation mission is their primary function. CASEVAC is any other available assets that can evacuate wounded. CASEVAC may or may not have assigned medical personnel, but the primary mission of the platform is not medical in nature. By these definitions, the Pedro USAF and British Tricky assets are operating as CASEVAC, as neither platform as the sole mission of MEDEVAC as their primary function. The Pedro's will tell you that their primary function is CSAR, despite the fact that the CASEVAC mission takes 95% of their focus in their current mission set. Tricky are also used for other non-MEDEVAC roles as well. The only mission for DUSTOFF is MEDEVAC.

    I also agree that if able, Aviation Commanders would use the aircraft for other roles as they are short the required number of platforms to accomplish huge number of assigned missions.
    • This commment is unpublished.
      Epador · 8 years ago
      I would agree strongly with Fullgrin, MikeM et al and add that the Pedros and CSAR mission of RESCUE SQUADRONS, their C-130's and HH-60's, became trumped years ago in the various sand and mud boxes where they took missions that should have been handled by others assets, like a CCAT team, simply because they trained and worked to respond quickly to needs that the pure medical boondocracy of the military could not wrap its collective neurons around to design a functional and responsive system.
      • This commment is unpublished.
        Epador · 8 years ago
        Doc's rarely fly on the Blackhawk on combat missions mainly due to the high risk and high value, but also because there really isn't much room there to do much but get in the way of all the tactical folks there - but do on the C-130 where there is more room.
        SOCOM operations are, uhm, [probably] a bit different, but I won't say how.
        The USCG will fly docs on some evacs, depending upon availability and mission, but their Rescue Swimmers often end up being the medics until the bird hits some form of civilization. Been there and done that too.
  • This commment is unpublished.
    MikeM · 8 years ago
    I did a tour in Afghanistan as a Battle NCO in an aviation Battalion and routinely handled launching/prioritizing MEDEVAC's. We also often kicked missions toward the Pedro's and visa-versa. We always considered both our Med guys and the Pedro's to be "MEDEVAC" because like Michael said, there's good med guys/gals on both platforms.

    We called something "CASEVAC" when we used a rather unusual platform for the evacuation of a wounded.

    -During an Air Assault, somebody is wounded. One of the assaulting birds (Blackhawk or Chinook) would take them back because they're already there and therefor it's the quickest means.

    There are many other good examples that I don't know I should discuss in open source as I don't want to share some good tactics still in use(I'll stay away from gray areas on OPSEC).

    My bottom line: Define them how you want, that's what we called them... Not that it made a difference to us.
  • This commment is unpublished.
    Brad · 8 years ago
    I usually agree with you Michael, but there are established definitions of MEDEVAC and CASEVAC in both Army Doctrine and the Comittee on TCCC (Tactical Combat Casualty Care). The fact that most running around do not understand that is the problem. I will not repeat them as MikeM, Fulgrin and Dan
    have already given them.

    The understanding is also counfounded by the fact that the terms MEDEVAC and CASEVAC in the USAF mean completely different things because they not only move patients around in theater (CASEVAC), they move them globally (MEDEVAC). That is why your PEDROS are called CASEVAC even though they would meet the Army definition of MEDEVAC. It makes sense if you understand there is a difference in service terminology.
  • This commment is unpublished.
    Pat · 8 years ago
    I'm Navy but I agree with the Air Force definitions. I was mob'd to Landstuhl in '10/'11 and we certainly used the word CASEVAC. We didn't use MEDEVAC either but it logically fits with transporting stabilized patients from theater hospitals to Landstuhl (Ramstein) for more definitive care prior to sending them stateside.
  • This commment is unpublished.
    Michael Yon author · 8 years ago


    That's the whole point. :)

    • This commment is unpublished.
      Matt · 8 years ago
      Why doesn't the military just change the definititions to suit their needs.

      CASEVAC could stand for "Combat Air Space Evacuation"

      MEDEVAC could stand for "medical evacuation non combat"

      That way you could send in the armed birds for a Casevac and the unarmed for the Medevac? Seems simple to me, but then again, I am not in the military, only a supporter at home.
  • This commment is unpublished.
    Michael Yon Author · 8 years ago
    The point of this exercise has been made again in the comments. Different people have different definitions of CASEVAC/MEDEVAC. The working definitions in the field vary dramatically.

    At the end of the day this is about removing the Red Crosses from Dustoff helicopters. It's not about definitions or Geneva Conventions. The Army has stated in writing that they are following Geneva Conventions. If they are to be taken at face value, they also are breaking the GC. If they take the position that GC does not apply, then why are we still pushing Dustoff into combat sporting Red Crosses and no guns?

    All roads lead to removing the Red Crosses. All roads other than the internal political power struggle over control of the Dustoff birds.
  • This commment is unpublished.
    Dan · 8 years ago
    Mike - you are right about the point - however, I'm not sure you fully recognize the impact of removing the red crosses. From my vantage point, the Aviation Branch commanders would then be able to use these aircraft for any other mission - and, just like when the 57th Med Det first went to Vietnam in the early 60's - they would be used for other missions - woe unto the GSAB commander who rapes his DUSTOFF unit for another mission leaving it unavailable to conduct an urgent medevac. AND that is exactly what would happen - DUSTOFF MUST BE READY AT ALL TIMES - WE DO NOT PLAN OUR MISSIONS - THE ENEMY DOES! JUST ensure we have gun cover and we'll be there - it's all about the "Systems" in place - and it's not about how you define the task with a label.
  • This commment is unpublished.
    Fullgrin · 8 years ago
    I agree 100% with Dan in that removing the crosses would allow the overzelous Aviation Commander to use platforms that are meant to fill the MEDEVAC role for other purposes when he cannot meet all his mission needs. Removing the crosses would place the masses at risk by allowing commanders to use "acceptable risk" as a method when they want to reduce the number of aircraft dedicated to MEDEVAC standby. The only reason we don't get tasked to fly VIPs, transport equipment, fly Air Assault mission, or execute Ring Routes is beause we have those red crosses permanantly affixed to the aircraft.

    Don't be misled by others that the Red Crosses are what keeps the powers that be from launching into hot LZs. Other Blackhawk and Chinook QRF helicopters are also prohibited from launching into a high risk area or hot LZs without gunship escort as well, even when they have door guns.
  • This commment is unpublished.
    Fullgrin · 8 years ago
    The real issue at hand isn't the red crosses or lack of door guns, it is the shortage of gunships. Even if the Army aircraft had the same weaponry at Pedro, the risk mitigation and misison approval system that the Army Aviation commanders use would prohibit Army aircraft from entering a high risk area without gunship support on site with them.
  • This commment is unpublished.
    Simonferrer · 8 years ago
    The part of this whole mess that I don't understand is why the Army is making such an overzealous deal out of Geneva Convention compliance in the Afghan conflict in the first place. To the best of my knowledge, no previous royal, democratic, or communist governmental regime in Afghanistan, least of all the Taliban, signed or agreed by treaty to abide by the Geneva Accords, which releases us from any moral obligation to observe them when fighting a non-unified, non-uniformed enemy like the Taliban or HIG. For that matter [please correct me if I'm wrong here] the United States didn't sign the accords either. We aren't even fighting a declared war here, rather a counterinsurgency, to which the Geneva convention does not apply. It seems to me that the brass are using the Geneva convention as an excuse to hide the fact that they let soldiers die or lie untreated because of blind compliance to an outdated beaurocratic rule. "Don't rock the boat" has led to "Cover your ass".
  • This commment is unpublished.
    Tony Kaiser · 8 years ago
    ...with removing the Red Cross, then Big Army should establish clearly and unequivocally that Air Ambulance Company birds are to be used as MEDEVAC assets and ONLY as such, and hold GSAB etc. commanders accountable for misuse.

    If it's just a problem with the use of Christian symbols, ICRC now has a neutral symbol called the "Red Crystal" (aka "Red Diamond") that is already recognized by U.S. law.
  • This commment is unpublished.
    Brandon · 8 years ago
    Speaking as Marine officer who spent 20 months in Iraq with the Marine Aircraft Wing TACC, I'd like to think I have the straight scoop. MEDEVAC was always Army birds with medics, no guns, and always had an escort. CASEVAC was pretty much any helo which might require an escort, depending on the threat level. Any medics were provided by the ground unit, if at all. Short version, MEDEVAC was going to the hospital in an ambulance, CASEVAC was going in a taxi.
  • This commment is unpublished.
    Keith · 8 years ago
    The official definitions as laid out in Tactical Combat Casualty Care come from the Joint publication 1-02
  • This commment is unpublished.
    shah · 8 years ago
  • This commment is unpublished.
    Leo · 8 years ago
    In the civilian world- MEDEVAC= a patient or surgical transfer that is planned.
    - CASEVAC= an emergency

    In the Army- MEDEVAC= ANY MEDical EVACuation, it can be anything
    - CASEVAC= The same thing BUT- there are more than one type of 9 Liner, including a 9 line "CAS" for Close Air Support. That's why an 9 Liner for wounded is Called a MEDEVAC, so that there is no confusion on broken comms trying start up helo gunships when Casualties need to be moved. Sounds implausible but those confusions can happen.

    In short anything prefaced with "CAS"= Close Air Support
    Anything prefaced with "MED"= Wounded Personnel
  • This commment is unpublished.
    Ron Rogers · 7 years ago
    What I have learned so far:

    1) The Red Cross is to prevent Army Aviation Unit commanders from misusing medical helicopters - even though these helicopters are packed with medical monitors, etc.
    2) NCOs with direct experience are able to answer these questions more clearly and concisely than those of us who are officers - except for one Marine officer.
    3) These definitions do not matter. Medical Aviation Companies should be left alone, except for support by Aviation Brigades to which they are now subordinate.
    4) Regardless of cost, helicopters evacuating the wounded need to be armed because the enemies we face no longer afford Geneva protections to them.
    5) There should be no difference between the armament carried by SOF, AF, Army, and Marine helicopters evacuating wounded personnel. All are taking the same risks and are saving the same US and Allied troops.

    If we focused on the narrow mission of getting our troops to the right level of care ASAP, we wouldn't be debating definitions, crosses, and armament. If there were more helicopters in theater, we would have fewer problems. Why aren't they there?
  • This commment is unpublished.
    Av8tor366 · 6 years ago
    Okay, being the Army Aviator extraordinaire that i am, here is the real deal:
    Medevac: Helicopter plucks you out from the field to the nearest aid station. Helo has a big red cross so it don't get shot at.
    Casevac: Airplane takes you from the aid station/nearest airfield to a bigger and better hospital.
    Difference is medevac takes you out of the field when you get hit, you ge stabilized, then casevac takes you to better care and better looking nurses.
  • This commment is unpublished.
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  • This commment is unpublished.
    Lawrence · 1 years ago
    This has been an issue within my unit for a while. I was constantly getting bumped down the list for primary medical evacuation on missions. Finally talked to the joint leadership. They said “it is because you are casevac and we need medevac.” “We need medical capability on the bird.” I was lost. My team is made up of a Doctor and a critical care/FPC paramedic with advanced equipment. We are casevac because we can use any vechicle/bird for ops. That’s how the SOF medics move patients. We have all been dealing with it for years. It gets worst during joint missions.

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