Not yet reviewed by Pith; the record is open.

The transfer of patients between two aircraft using an underway watercraft increases medical evacuation reach and flexibility in maritime environments. The selection of any one of multiple underway watercraft for patient exchange is complicated by participating aircraft utilization history and a participating watercraft position and velocity. The selection problem is modeled as a semi-Markov decision process with an action space including both fixed land and moving watercraft exchange points. Monte Carlo tree search with root parallelization is used to select optimal exchange points and determine aircraft dispatch times. Model parameters are varied in simulation to identify representative scenarios where watercraft exchange points reduce incident response times. We find that an optimal policy with watercraft exchange points outperforms an optimal policy without watercraft exchange points and a greedy policy by 35% and 40%, respectively. In partnership with the United States Army, we deploy for the first time the watercraft exchange point by executing a mock patient transfer with a manikin between two HH-60M medical evacuation helicopters and an underway Army Logistic Support Vessel south of the Hawaiian island of Oahu. Both helicopters were dispatched in accordance with our optimized decision strategy.