Cover: Personnel Recovery in the AFRICOM Area of Responsibility

Personnel Recovery in the AFRICOM Area of Responsibility

Cost-Effective Options for Improvement

Published Aug 27, 2019

by Christopher A. Mouton, Edward W. Chan, Adam R. Grissom, John P. Godges, Badreddine Ahtchi, Brian Dougherty


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Research Question

  1. What are the most cost-effective options for improving medical rescue capabilities in U.S. Africa Command's area of responsibility?

The mission of rescuing injured personnel in Africa is uniquely challenging for a variety of reasons, including the limited scale yet widely distributed nature of U.S. Africa Command's (AFRICOM's) operations and the uncertain security conditions in much of the continent. This report identifies the most cost-effective options for improving rescue capabilities in AFRICOM's area of responsibility (AOR).

The researchers built a rescue model that accounts for seven factors: the costs of new rescue capabilities, the current and projected locations of medical treatment facilities in AFRICOM's AOR, the current and projected locations of deployed aircraft in Africa, the existing locations of airfields in Africa, the locations and numbers of U.S. personnel in Africa, the survival rates of injured personnel as a function of time and of medical care received, and the trends in injury occurrences in combat theaters. In addition to charting the optimal rescue paths out of Africa, the model calculates the marginal cost-effectiveness (in terms of survival rates) of investing in four separate rescue assets at various basing locations while instituting shorter aircraft alert times. The findings suggest that there is a very strong synergy to be gained from combining mobile surgical teams with shorter aircraft alert times. Under all sets of conditions considered, additional surgical teams are always initially preferred to additional aircraft. The researchers recommend that AFRICOM request additional mobile surgical teams and decrease aircraft alert times as much as possible.

Key Findings

Cost-effective rescue options

  • There is a very strong synergy to be gained from combining mobile damage control (DCS) surgery teams (those that can travel to the patient) with shorter aircraft alert times (e.g., being able to launch a recovery within one hour of notice rather than the current three).
  • These synergies increase rapidly with decreasing alert times below one hour. Compared with a notional alert time of three hours, an alert time of 15 minutes would be more than twice as beneficial as an alert time of one hour. The expected survival rate would rise 1.5 percentage points, going from three hours' notice to one hour's notice and 3.4 percent going from three hours' notice to 15 minutes' notice.
  • Under all sets of conditions considered, additional DCS teams are always initially preferred to additional aircraft.


  • Coordinate with DCS providers (Air Combat Command, Air Force Special Operations Command, Air Mobility Command, Army Medical Department, Navy Bureau of Medicine, and others) to ensure that mobile DCS teams can move surgical capabilities to patients during rescue missions.
  • Decrease the alert times of dedicated rescue aircraft to one hour.
  • Explore the feasibility of decreasing the alert times to less than one hour. The times can vary by location and can be adjusted, based on the estimated risk to force. The rescue aircraft and DCS teams can also be forward-staged to support high-risk activities in high-intensity zones of operation. These are just some of the options that can be explored.

This research was sponsored by David Thiede of AFRICOM and conducted within the Acquisition and Technology Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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