medical company to the nearest 44th Medical Brigade treatment facility capable of providing necessary and immediate treatment. Contrary to the classical concept of evacuation, this may have been a surgical hospital, field hospital, evacuation hospital (all Echelon/Role III) or field army level clearing company (Echelon/Role II). Medical group Medical Regulating Officers (MROs) located at group headquarters or group forward command posts had the primary responsibility for control of this phase and the primary means of evacuation was usually "Dustoff." Phase III involved movement of patients to in-country treatment facilities to provide further definitive care, in-country convalescence, or an even distribution of patient workloads. Patients in this category usually had an expected length of hospitalization of less than 30 days. The initial responsibility for Phase III began with the medical group MRO. If evacuation to hospitals of another medical group was required, a request was submitted to the brigade MRO. At that point, the brigade MRO assumed responsibility for Phase III and distributed patient workload to hospitals capable of completing required treatment. The primary means of evacuation was provided by U.S. Air Force fixed-wing aircraft, with "Dustoff" providing some assistance. Phase IV included evacuation to out of country to United States Pacific Command (PACOM) or continental United States (CONUS) treatment facilities for extended definitive treatment or convalescence in excess of thirty days. Phase IV was the complete responsibility of the Brigade MRO and a change in procedure for out-of-country evacuations was initiated in November 1967. Although the change was referred to as a "new" system, there were no new concepts initiated because the "new" system was existing Army doctrine. It had not, however, previously been applied to aeromedical evacuation in Vietnam. Prior to the change, patients identified by medical officers for out-of-country evacuation were moved from hospitals to the near­est U.S. Air Force casualty staging facility. There, the patients were regulated through the Far East Joint Medical Regulating Office (FEJMRO) and the PACOM or CONUS destination hospital was obtained and recorded. Brigade and group MROs received an "after the fact" report of the number of patients evacuated out of country. Major disadvantages included: Lack of control of out-of-country evacuation by the brigade MRO Hospitals were not aware of where patients were being transferred, which made follow-up of patients virtually impossible Casualty staging facilities were completing and closing out clinical records since destination hospitals were not available at the time patients were