Medical support and rescue

Do you work to the golden hour?

Not as a blanket promise, because the evidence does not support one. The phrase goes back to R Adams Cowley in the 1970s and was never supported by data of his own. A systematic review by Harmsen and colleagues in the journal Injury (2015) examined twenty studies on the relationship between prehospital time and mortality. Across trauma patients as a whole the review found no consistent relationship. Where speed did matter was in penetrating trauma with unstable circulation and in severe head injury. For everyone else what counted was the type and quality of care given on scene, not transport speed.

What matters more is that in many operating environments an hour to surgical care is not achievable at all. Offshore in a storm, at night across open country, or anywhere the nearest suitable hospital is four hours away, a target figure changes nothing.

So we plan from the real time rather than the desired one. The longer the journey, the more has to be possible on scene, the earlier the decision to move has to fall, and the more precisely it has to be settled who makes it. The concept states the actual time to definitive care, the assumptions behind it, and what follows from that for equipment, qualification and decision points.

What actually covers a deployed medic abroad?

Three things, each checked separately, none of which comes with a job title. Recognition of the qualification in the country of deployment. A named medical direction carrying responsibility for the protocols a non-physician medic works under, and reachable when a decision goes beyond that medic's scope. And professional indemnity, which for work outside the usual scope almost always needs a specific extension.

Where a provider has no medical direction we put one in place. Without it neither the liability nor the insurance usually holds, and prescription drugs cannot lawfully be procured. We work with physician partners in the country concerned.

Carrying controlled drugs across borders is a separate problem. The rules are written for individuals with their own prescription, not for a team holding group stock. We settle that before deployment, not at customs.

Can you just supply us a medic?

We can arrange one, and often do. On its own it rarely helps. What works is the whole chain, meaning the concept, the equipment and supplies, an agreed receiving facility, a route out, and the people who operate it. A medic without that chain is the person who will be blamed for an outcome that was decided before they arrived. So the concept comes first, even when it takes a week.

Our insurer already provides medical evacuation. Why plan it again?

An evacuation policy covers cost and an assistance provider organizes the aircraft. Neither one gets the patient from the platform, the tunnel or the desert site to the airfield. That first leg decides the outcome, and who covers it is regulated very differently from one environment to the next. Offshore it is normally in the contract, with a named helicopter operator and defined weather limits. At sea it usually falls to SAR or the coastguard, a body you do not contract and whose availability depends on the sea area and the situation. On land and on remote projects it is frequently not arranged at all, and that is where the gap opens.

For the second leg, meaning transfer over distance and repatriation, it is worth asking who accredits the operator. CAMTS is the reference in North America and EURAMI the one used across European and international repatriation networks, with separate accreditations for fixed wing, rotary wing and medical escort on scheduled flights. For the first leg off an installation or a vessel these accreditations say much less, because what governs there is the contract with the helicopter operator, the SAR authority for that sea area, and the weather limits.

Can you place a medic inside a close protection team?

Yes, and it is a different role from covering a fixed site. The medic moves with the principal, carries little visible equipment, and must not get in the way of the team's work. TCCC belongs to the trade but falls short as the only training. Someone trained on wound patterns alone stalls when the principal has a heart attack, reacts to something, or has left their regular medication behind. We plan the role broadly enough for that, and draw on civilian, low profile or armored ambulances and their crews depending on the situation.

Do you cover events?

Yes, as concept and command. Event medical cover is a staffing and command problem more than a clinical one: how many crews, positioned where, under whose control, with what route out when 40,000 people are between the casualty and the gate. Alongside that sits coordination with everyone involved, meaning the promoter, the authorities, the ambulance service, fire, police and stewarding, with shared communications that still work when the mobile network is saturated.

Crews are sized against a recognized model that accounts for how far anyone has to walk across the site, not just the headcount. Which model we use and on what assumptions is stated in the concept. The treating crews are local and licensed.