THE ROLE OF THE PORTUGUESE AIR FORCE IN CIVIL DEFENCE

Dias J.M.E.

Major General of Portuguese Air Force, Plastic Surgeon, Portugal

SUMMARY. After some general observations about how the Armed Forces may be useful in the event of a fire disaster, the specific role of the Portuguese Air Force is described. Detailed recommendations are made regarding evacuation of burn patients by air.

In the scope of the responsibilities assigned to the Armed Forces by the National Defence Law (art. 24) the Portuguese Air Force has to undertake tasks of a civil nature, in which development in the field of health is included.
This almost constant appeal attains even greater importance in disasters, as is to be expected, considering the high capacity of the Armed Forces to react to the crisis rapidly and to maintain discipline.
Due to incomplete public information it is possible to run the risk of centralizing in the military organization the responsibility for the resolution of one of these disasters in the life of a nation.
Recently, during the Chiado fire, we noticed the expectations created by the possible arrival of a military aircraft, which was considered decisive for the solution of the disaster.
The way in which the Armed Forces participate in rescue operations for the civil population and in the battle against great disasters varies from country to country, reflecting the structure of the society. There are two main groups:

1. countries with centralized power, supported by a strong military force in which the Armed Forces have an important role in the command of the operations, being obliged under the authority of the Government to solve the country's problems;
2. countries with centralized or decentralized power, where the Armed Forces have support functions but will not interfere unless requested by the civil authorities responsible for rescue operations.

The legislation related to the disasters or the plans executed by the legislative authorities must establish a system of command, use, control, intervention and coordination of national resources, both military and civilian, in order to protect the population and prevent damage.
In the case of military budgets, which just cover the task of defence, the reimbursement of the expenses resulting from rescue operations must be paid as a supplement.
In the United Kingdom the general rule is that defence funds must not be used for other purposes. However, the Ministry of Defence has the power to modify this principle whenever human life is in danger.

In Portugal, the National Defence Law (art. 70) places the National Service of Civil Defence, decreed by Law n. 510/80, in the sphere of the Ministry of Home Aftairs in peacetime, and of the Ministry of Defence in wartime.
The coordination between civil and military authorities is made at three different levels: national, regional and local.
At the request of the S.N.P.C. (National Service of Civil Defence) the Armed Forces collaborate in these etTorts and actions, thus fulfilling one of the tasks assigned by the Constitution, that of cooperating in the work of national reconstruction.

Local authorities must be informed about the limitation and risks of air evacuation.
Air evacuation must be authorized only after the evidence of insufficiency of surface means of evacuation. The decision to employ it must never be justified by a single question of preparedness.
Air evacuation can be performed in two different phases from the point of view of application.

1) Primary evacuation (characterized by inaccessibility)

This must obey the same rules as other kinds of evacuation, and in particular:

• time of decision
• time of notification
• time of preparation
• time of reaction
• charts of population concentration in the aftected regions.

In order to transport adequate treatment facilities, operation commanders must be informed of the possibility of burn casualties.

2) Secondary evacuation (characterized by rapidity)
This must be well planned and the aircraft must be carefully equipped.
The following requirements are necessary:

• Complete knowledge and adoption of all techniques of disaster medicine
• Definition of a national plan for the distribution of man-power (doctors, qualified personnel and auxiliary personnel) that will permit the use of all existing means
• Planning for the occupation of extra facilities which will extend the capacity of existing facilities
• Preparation of urgent evacuation plans in wartime
• Establishment of specialized services for injured people in general services.

Secondary evacuation functions between hospital and hospital or between an evacuation centre and a hospital.
Its efficiency depends on the next phase:

• The quality of the hospitalization
• The main characteristic of the hospital plan for assistance is the capacity of activating the emergency services, i.e. the plan for small disasters is enlarged by a larger mobilization of personnel and equipment.

Specific alterations are rarely necessary:

• This implies that every organization and every hospital must establish its own disaster plan and get appropriate experience from this situation, and also establish adequate coordination with other departments in relation to the solution of the problem

Air evacuation is a specific military health service task.
This has been clearly demonstrated in wartime. During World War 11 aeromedical transport of 1.4 million patients was very successful, with only 46 deaths ocurring during transport.
The first modern reports of airlifting casualties are from 1870 during the siege of Paris, when injured soldiers were airlifted from the battle-field in hot-air balloons.
The Korean war, the Vietnam conflict and more recently the British campaign in the South Atlantic reveal once again the importance of air evacuation but also the high incidence of burns (14%) and the effectiveness of air transport.
In our colonial war in Africa, in approximately 2000 air evacuations we had the same rate of burn casualties, totally supported by the Air Force.
This means that the Air Force is especially prepared for air evacuation.
For these reasons, and also because of the need to train personnel, participation in civil defence must be stimulated in peacetime.
In Portugal in recent years we have responded well to civil demands, as mentioned above.
We employ different types of aircraft depending on the weather and time conditions, landing facilities, the number of patients and the three different (continent and insular) regions, as follows:
In the Azores:

• Aviocar and helicopter SA 330. Hours of flight - 256 hours.

In the Madeira Islands:

• Aviocar.

On the Continent:

• Aviocar, Cessna, C-130, SA-330 and Alouette. Hours of flight: 1987 - 793.00 hours 1988 - 633.30 hours 1989 - 583.00 hours.

Only in the Azores is evacuation entirely (in clinic and in flight) the responsibility of the Air Force. It is performed under Air Force clinical supervision from the different islands (Flores, Corvo, S. Jorge, Graciosa, Pico, Faial and Sta Maria), to the main hospital centres of S. Miguel and Terceira.
On the Continent, clinical supervision during flight depends on the civil health service which requests the Air Transport. A certain number of rules must be respected regarding the bums:

1. Complete information about patient conditions using the Field Medical Card adopted in the NATO countries
2. Direct contact between referring and receiving physicians answering the following questions: 1) Sex, age, weight and height 2) Nature of the agent 3) Extent and depth 4) Special areas burned, limbs 5) Respiratory involvement 6) Other injuries 7) Clinical history, allergies, illnesses 8) Level of consciousness 9) Urinary output 10) Amount of fluid already given. Other medications 11) Pathological findings 12) Religion
3. Creation of a team responsible for emergency medicine
4. Preparatory proceedings: 1) Stabilization of humoral conditions 2) Control of life-threatening -haemorrhage from associated injuries 3) Placement of various types of catheters 4) Establishment of respiratory stability with tracheal intubation if necessary

5) Escharotomy in circumferential full-thickness burns of the extremities
6) Use of ultrasonic Doppler flow meters
7) Control of cardiac arrhythmias prior to movement
8) Placement of thoracotomy tube in pneumothorax
9) Gastric decompression
10) A supply of humidified air is essential during long flights
11) Monitorization of blood pressure and cardiac frequency
12) Local treatment with chemotherapeutic agent to prevent desiccation and to limit microbial proliferation during transfer.

Until we reach the point when the entire clinical assistance for bums during flight is placed under the responsibility of highly specialized teams, these rules will help to lead to a very low mortality rate during air transport.
But we must not forget that better than any other solution is the prevention by all means of the possibilities of fire disaster.

RÉSUMÉ. Après des considérations d'ordre général à propos de l'emploi des Forces Armées en cas de désastre d'incendie, l'Auteur décrit le rôle spécifique de l'Aviation portugaise et propose des recommandations détaillées pour l'évacuation par avion des brûlés.