In the world of military-speak, it’s called “personnel recovery.” It used to be known as combat search and rescue, or CSAR. However, as conflicts around the world have evolved, there are no longer any clear dividing lines between forces. The basic goal of personnel recovery is “to obtain the release or recovery of captured, missing or isolated United States personnel from uncertain or hostile environments and denied areas.” This could also include foreign personnel at the request of another government. It’s a huge umbrella of events that include man-made and natural disasters, as well as terrorism and war.
In order to train for these events, the U.S. Air Force (USAF) conducts an annual exercise called Angel Thunder. Carried out over thousands of square miles of the Southwestern United States and the Pacific Ocean, this is the biggest, most complex search and rescue exercise in the world. Now in its seventh year, the goal of this two-week exercise is to provide the most realistic, widest range of scenarios that might be faced by USAF rescue units anywhere in the world.
“The goal of Angel Thunder is to set the world standard for personnel recovery training for USAF rescue assets,” explains Brett Hartnett, a retired USAF rescue helicopter pilot who leads the team of contractors who have planned, coordinated and conducted each Angel Thunder exercise. “It includes other U.S. military services, U.S. State Department personnel, international civil and military partners, state and local governmental organizations, and non-governmental organizations (NGOs). We are the only exercise that offers full-spectrum personnel recovery training. So we are a truly unique training venue.”
As word of the exercise has spread, many foreign military units have asked to attend. As many as 16 nations have participated in a past Angel Thunder. In 2014, Sweden, the Netherlands, Germany, France, Colombia, Canada and Great Britain were involved. Over 60 aircraft and about 2,000 personnel were part of this year’s event. Angel Thunder also includes other U.S. military services. The U.S. Army is biggest player with Special Forces and aviation units. The U.S. Navy's Third Fleet is also a big player for maritime scenarios, as well as the U.S. Marines.
“The scenarios are based on real world events and contingencies,” said Hartnett. “We work in a coalition world, so we integrate the other nations just as they would be in a real world event. All the international participants must take an English test and pass with a minimum score to insure adequate communications.”
Each scenario is based on specific learning objectives that have been collected, prioritized and studied. They can also test new techniques, tactics and procedures at Angel Thunder. Scenario control teams, who run each individual event, gather data during each event to evaluate all of the participants. They used to fly every day of the exercise. Now, they having a planning day, a flying day and then another planning day for each major event. The second planning day is used to debrief all the participants and cover the lessons learned. Each day there is flying, a night mission is also executed.
A detailed survey goes to each participant to get their input. All the information is then collated and disseminated. In addition, all the unit commanders get together to discuss each scenario. Each unit commander presents three things that went well and three things that did not.
There is a Ground Rescue Operations Center (GROC) controlling all of the scenarios. It is also built for real-world missions that might occur during the exercise. As a matter of fact, on the first day of Angel Thunder 2014, a rescue mission for two burned sailors located 1,000 miles off the Mexican coast was organized and directed from the GROC.
“We ran two major maritime scenarios this year,” states Hartnett. “One was a contested exercise with a downed pilot in the ocean, with a fully integrated air defense system facing the rescuers. So, there were radar threat emitters which required the use of electronic countermeasures aircraft. This is a new type of scenario and we are still working on procedures. The other scenario involved a freighter that was leased for the exercise, which was taken over by pirates.”
Crews of the individual USAF HH-60G rescue helicopters were mixed from different units. The rescue force as a whole has standardized procedures. This allowed them to see how well these procedures work. In addition, it allows personnel from different units to interact professionally and socially.
“The budget for Angel Thunder is $1.6 million, which is miniscule,” explains Hartnett. “The only way this exercise works is due to networking with many organizations, both military and civilian. We use training areas that we can get for free, such as national park and forest areas, and National Guard training sites. We use a lot of local emergency first responders as players in scenarios involving imaginary host nation civilian responders. They get excellent training in mass casualty incidents and we get free players. We also use Reserve Officer Training Corps cadets to play victims and foreign nationals during scenarios. We also deliver patients to actual hospitals which allows them to exercise their emergency plans. All this at no cost.”
While a detailed breakdown of the scenarios is beyond the scope if this article, EMS World was allowed to observe one of the more complex events that encompassed the full range of assets available to the USAF rescue forces. It was a mass casualty incident involving approximately 50 victims of a terrorist bombing in a remote village in a mythical foreign country. USAF medical forces arrived by ground vehicle convoy, set up security, and began triage and treatment. Rescue helicopters of the USAF and French Air Force evacuated to patients to a secure airport. Here, other USAF medical personnel received the patients, continued medical care and loaded them into large fixed-wing transport planes that had been converted into air ambulances. The patients were them flown to more sophisticated care.
Medical care for the victims began with the arrival of USAF pararescuemen. These are highly trained special forces whose primary job is to rescue downed pilots behind enemy lines. They are trained in infantry combat, parachute jumping, scuba diving, mountain climbing and are nationally registered paramedics. The National Geographic Channel featured their experiences in Afghanistan in the series “Inside Combat Rescue.”
The pararescuemen can be inserted and extracted by either of two specialized aircraft. The HH-60G Pave Hawk is a version of the twin-engine Blackhawk helicopter fitted with machine guns, armor plating and specialized electronics. It is capable of refueling in mid-air to extend its range. The other aircraft is the HC-130 four-engine turboprop. This long-range aircraft can be used to refuel the Pave Hawk helicopters and insert pararescuemen by parachute at distances helicopters can’t reach. The aircraft can also be used to fly ahead of the helicopter to find the exact location of victims. In addition, the interior can be converted into an air ambulance.
After triage and initial care, the victims were flown by helicopter to a secure airfield with more sophisticated care. This airfield can be as austere as a section of dirt road or a fully functioning metropolitan airport. USAF personnel called combat controllers can parachute into the austere sites to see if it is secure and check the condition of the surface to make sure the large transports can safely land and takeoff. They are also certified Federal Aviation Administration air traffic controllers who can direct the activities of incoming and departing aircraft.
If the airfield needs to be in operation for several days, a USAF Contingency Response Wing may be used. These units bring with them all the assets needed to keep a busy international airport in operation. This includes air traffic control , aircraft refueling, establishing aircraft maintenance areas, passenger and cargo facilities, security troops, and anything else needed to keep the aircraft flowing smoothly in and out of the airport. These units are often used for catastrophic disasters such as earthquakes and hurricanes that destroy normal airport infrastructure.
Once the patients arrived at the airport, the helicopter crews turned them over to the USAF’s 187th Aeromedical Evacuation Squadron (AES) of the Wyoming Air National Guard. The basic job of an AES is to care for the patients in the cabin of the large transports during the flight to definitive care. Several USAF aircraft have been designed to be quickly converted from cargo or passenger service into an air ambulance. These kits allow litters to be stacked up to three patients high. Special pallet loads of medical equipment are loaded with oxygen, suction, monitors and other equipment that can be powered by the aircraft electrical system. Personnel in an AES include physicians, nurses, respiratory therapists and other medical technicians.
For severely ill or injured patients, a Critical Care Air Transport Team, or CCATT, may be used. These self-contained small teams are made up of physicians, nurses and medical technicians with specialized training and equipment. They can care for several critical patients during the long hours it may take to reach a destination with definitive care. These teams have been used extensively during the wars in Iraq and Afghanistan. They have also been used in large natural disasters such as Hurricane Katrina and the earthquake in Haiti.
In addition to complex scenarios, Angel Thunder also provided the opportunity for individual training for both aircrews and medical personnel. A Tactical Combat Casualty Care (TCCC) refresher class was held for medics from the U.S. Secret Service, FBI, Drug Enforcement Administration, USAF, and the militaries of Sweden, France, Colombia and Denmark. It was taught by civilian flight paramedics and physicians, most with past military medicine experience. It began with skill stations such as IV placement and advance airway maneuvers. A class on canine care for military working dogs included IV access, airway management and pain med administration.
The class quickly moved on to scenario-based training, with night and low light level situations, combat evacuations, care under simulated gunfire, and unknown active shooters in a village setting with good guys and bad guys. Both human patient simulators, including pediatric models, and live patients were used.
“This is the only place where national policy on personnel recovery is exercised,” says Hartnett. “As far as the future goes, it looks like we are going to survive as an exercise. With all the budget cuts, we weren’t sure. We try to learn and grow as well as present scenarios that reflect the conditions found around the world. The threats and situations in the real world change from year to year, and Angel Thunder has evolved with these conditions. It is the best personnel recovery training anywhere.”
Barry D. Smith is ground CQI coordinator for the Regional Emergency Medical Services Authority (REMSA) in Reno, NV. Contact him at firstname.lastname@example.org.