Thanks to the introduction of the NHIndustries NH-90 medium utility helicopter, the Italian Army’s Aviation Division has revolutionised its approach to medevac and combat search and rescue (SAR) operations. The NH-90 has now become the main helicopter type for these special missions, replacing the older Agusta-Bell AB-412 and AB-205.

The larger interior cabin of the NH-90 allows crews to work easily on the patient, with enough space to perform tracheal intubation. Thanks to this capability, the Army has changed its operational philosophy.

With the older aircraft, in an operational theatre like Afghanistan, the first approach would have been to ‘stay and play’ – medical staff tried to do as much as possible on the ground before boarding the aircraft with the patient. For example, performing intubation and venous-drainage access on the ground, since space onboard helicopters available at that time was limited. This approach, of course, increased the team’s exposure to enemy fire.

With the NH-90, the Army has been able to move away from 'stay and play' to 'scoop and run', where the patient is evacuated from the scene as quickly as possible. A combination of the old and new procedures is now 'scoop and play' – to quickly evacuate the patient and work on them at the same.

CSAR procedures have been compared to a Formula One pit stop where each member of the team has a specific action to perform. Everyone has their sphere of expertise, which partly overlap. The doctor knows that they will have to deal with the management of the airway, a nurse undertakes the venous access, while another nurse monitors the patient’s vitals. The rescue is carried out in a 'horizontal' manner, wherein everyone knows what to do about the injured person, without waiting for instructions from the team leader.

For medevac/rescue missions, the Italian Army has chosen to equip its NH-90 with STARMED’s Patient Transport Modular System (PTS). The PTS, which contains medical equipment and the patient, is adaptable to any system or vehicle that is compliant with NATO standard, whether on the land, at sea or in the air. Where it is not possible to land, crew descend from the helicopter in the hover – fast roping and rappelling are used to put a team on the ground quickly; the hydraulic rescue hoist is used to land and recover personnel and a stretcher. All require specific training for their use.

The NH-90 is a multi-role machine and in Italian Army use it comes equipped with a dedicated hydraulic hoist system capable of performing a whole range of activities, not simply rescue. The hoist for the NH-90 has been designed and produced by the German company Vincorion/Jenoptik Advanced Systems GmbH.

Images © Dino Marcellino