The forward support medical
company plays a vital role in the manning task by providing division-
and unit-level health service support to all units operating in
the supported brigade area on an area basis. As shown in Figure 9-1, the company consists of a company headquarters, treatment
platoon, and ambulance platoon.
The company performs the following
Treatment of patients with
minor diseases and illnesses, triage of mass casualties, initial
resuscitation and stabilization, advanced trauma management, and
preparation for further evacuation of patients incapable of returning
Ground evacuation for patients
from battalion aid stations and designated collection points.
Emergency dental care.
Emergency medical resupply
to units in the brigade area.
Medical laboratory and radiology
services commensurate with division-level treatment.
Outpatient consultation services
for patients referred from unit-level MTFs.
Patient holding for up to
40 patients able to return to duty within 72 hours.
Coordination with the UMT
for required religious support.
The modular medical system
standardizes all medical treatment subunits within the division.
Modules are duplicated at different levels of health care to allow
the medical managers to rapidly tailor, augment, or Medics provide
support to the platoons reinforce medical units where the need
is and companies of the battalions. most critical. So if the FSB
medical company cannot handle the work load in the brigade sector,
additional modules may be sent forward from the MSB or corps.
The system is oriented to patient acquisition, emergency medical
treatment, initial resuscitation, patient holding, returning soldiers
to duty, and patient evacuation. The five modules are --
Combat medic. The
combat medic is the first person in the health services support
chain who makes medically substantiated decisions based on formal
training. The combat medic is organic to medical platoons and
sections of combat and combat support battalions.
Ambulance squad. This
squad, which can split into two teams, evacuates patients and
provides care en route.
Treatment squad. This
squad provides ATM to battlefield casualties. ATM is emergency
care designed to resuscitate and stabilize patients for evacuation
or to treat and return to duty. Squads are organic to medical
platoons of maneuver battalions and to FSB medical companies.
When not engaged in ATM, these squads provide routine sick call
on an area basis.
Area support squad. The
area support squad provides emergency dental care and basic medical
laboratory and X-ray diagnostic support. The squad is colocated
with a treatment team and patient-holding squad. The three form
an area support section. This section provides medical support
on an area basis.
This squad can hold
and provide minimal care for up to 40 patients who will return
to duty within 72 hours. The squad is organic to the FSB and MSB
Only four phases of medical
treatment are normally performed in the brigade area. These four-self-aid/buddy-aid,
advanced first aid, EMT, and ATM-are collectively referred to
as far forward medical care. This care maximizes return to duty
of soldiers at the lowest possible level. It also provides stabilization
and care for injured soldiers not expected to return to duty and
allows for their rapid evacuation.
Self-aid/buddy-aid is the
lifesaving care given to an ill, injured, or wounded person by
a nonmedical soldier. All soldiers are expected to know the lifesaving
measures discussed in FM 21-11.
Advanced first aid is performed
by the combat lifesaver. The combat lifesaver is a member of a
combat, CS, or CSS unit who is not a medic but has received medical
training beyond basic first aid. This function is an additional
duty for the soldier.
Emergency medical treatment
involves medically substantiated decisions based on medical MOS-specific
training. It is provided by the combat medic or EMT NCO. It includes
emergency lifesaving measures, management of the airway, control
of bleeding, and administration of intravenous fluids and medicinal
ATM requires a higher degree
of medical skill and judgment. It is performed at both the unit
and division level by physicians assisted by physician assistants
and EMT NCOs. ATM involves use of intravenous fluids and antibiotics,
preservation of the airway by insertion of a breathing tube, and
the application of more secure splints and bandages. This phase
also involves laboratory and X-ray capabilities; a wide range
of drugs, equipment, supplies, and intravenous fluids (including
expander blood products); and a patient-holding capability.
Early medical intervention
and sorting, and continuing evaluation of patients are necessary
to minimize mortality and morbidity. Forward medical support is
critical to meet this need. Forward support is provided by medical
company treatment elements working at battalion aid stations,
reinforcing treatment capabilities before expected casualty-generating
operations. It includes the positioning of tracked ambulances
with battalion combat trains to maintain contact with the BAS
during movement. Also, it involves establishing predetermined
ambulance exchange points to reduce ambulance turnaround time
and fuel consumption of tracked ambulances.
In mass casualty situations,
the principle behind medical management changes from treating
the worst cases first to providing the greatest good to the greatest
number. At no time is the abandonment of a single patient contemplated.
The categorization and scope of treatment are based on clinically
sound criteria on what can be done to save the lives of as many
casualties as possible. As each patient moves from one treatment
station to another (battalion aid station to division clearing
station), his condition is continually evaluated. Once medical
assets are no longer overwhelmed by the number of casualties,
treating the worst first again becomes the overriding principle.
Control of the medical company
assets is retained by the medical company commander. Medical resources
are limited. Therefore, the medical company commander must be
able to employ medical elements to respond to the brigade commander's
plans in a timely manner.
The company headquarters provides
command and control for the company and other medical units that
may be attached. It provides unit-level administration, general
supply, and NBC operations and communications support. It also
provides supply point distribution of class VIII items for the
brigade. Unit supply operations are discussed in FM 10-14, unit
maintenance in FM 43-5, and unit GRREG functions in FM 10-63-1.
Unit biomedical maintenance is provided by the division medical
supply office of the MSB medical company. C3 considerations for
the headquarters are covered in Chapters 3 and 4. The headquarters
may be organized into command, supply, operations and communications,
dining facility, and maintenance elements.
The medical company commander
also serves as the brigade surgeon. As such, he must keep the
brigade commander informed on the medical aspects of brigade operations
and the health of the command. He should regularly attend brigade
staff meetings to provide this input and to obtain information
to facilitate medical planning. Specific duties in this area include
Assure implementation of the
health service section of the division SOP.
Determine the allocation of
medical resources within the brigade.
Supervise technical training
of medical personnel and the combat lifesaver program in the brigade
Determine procedures, techniques,
and limitations in the conduct of routine medical care, EMT, and
Monitor and coordinate requests
for aeromedical evacuation from supported units.
Ensure implementation of automated
Inform the division surgeon
on the brigade's medical support situation.
Monitor the health of the
command and advise the commander on measures to counter disease
and injury threats.
Assume operational control
of augmentation medical units when directed.
Exercise technical supervision
of subordinate battalion surgeons.
Advise physician's assistants
of artillery and engineer battalions as required.
Assume technical supervision
of physician assistants organic to subordinate units in the absence
of their assigned physicians.
Provide the medical estimate
and medical threat input for inclusion in the commander's estimate.
The treatment platoon operates the division clearing station in the BSA and provides assets to reinforce supported unit medical elements. Platoon elements receive, triage, treat, and determine disposition of patients. The platoon consists of a platoon headquarters, an area support section, and a treatment section.
The platoon headquarters is
the command and control element of the platoon. It determines
and directs the disposition of patients and coordinates their
further evacuation with the ambulance platoon.
The area support section operates
the division clearing station. It consists of an area support
treatment squad, an area support squad, and a patient-holding
squad. These elements operate as a single medical unit and are
not normally used to reinforce or reconstitute other units. The
area support treatment squad is the base treatment element of
the clearing station. The squad consists of two teams which provide
troop clinic services, trauma treatment, and tailgate medical
support. When the clearing station moves, one of the treatment
teams along with elements of the holding squad serves as a jump
element. They set up the new clearing station while remaining
elements close out operations at the old site. The area support
squad consists of the dental and diagnostic support elements of
the clearing station. The patient-holding squad operates a 40-bed
facility for patients awaiting evacuation and patients expected
to be returned to duty within 72 hours. A temporary surgical capability
can be given the clearing station by augmenting the area support
section with a surgical detachment from corps assets.
The treatment section consists
of two treatment squads. Each squad employs treatment vehicles
with medical equipment sets-two trauma sets and two general sick
call sets. These squads provide troop clinic services, trauma
treatment, and tailgate medical support. This section is oriented
toward augmenting or reinforcing supported units medical elements
and alleviating mass casualty situations. Each squad may be split
into two treatment teams.
The ambulance platoon performs
ground evacuation from battalion aid stations and designated collection
points to the BSA clearing station. The platoon has a platoon
headquarters and five ambulance squads. The headquarters provides
command and control and plans for the employment of the platoon.
It coordinates support with the medical platoons of the supported
maneuver battalions, plans ambulance routes, and establishes AXPs
for ground and air ambulances as required. Each squad splits into
two ambulance teams and provides evacuation from forward areas.
Planning for medical operations
within the brigade area is done by the medical company commander/brigade
surgeon and support operations section of the FSB in coordination
with the medical operations center. In addition, the company XO
(the field medical assistant) is the principal assistant to the
company commander on the tactical employment of the company assets.
A sample medical company layout is shown in Figure 9-2. The basic
considerations which influence the employment of medical assets
within the brigade are --
The brigade commander's plan.
- The anticipated patient load.
- Expected areas of casualty density.
- Medical treatment and evacuation resources available.
Medical planners use these
factors to forecast the anticipated evacuation requirements in
the main battle area and adjacent sectors. Having a single manager
of health service support in an area of operations, enables shifting
scarce medical resources. The medical company commander must
also ensure that the medical annex of the OPLAN includes --
Procedures to handle and treat chemical casualties and
provision for chemical protective shelter systems and decontamination
Provision for surgical augmentation.
Provision for A2C2 for supporting
air ambulances and for road clearances and MSR priorities for
Augmentation of medical support
assets for contingency operations, This may include ground and
air evacuation assets, modular trauma treatment squads/teams,
and combat stress control augmentation.
Provision for medical representation
on casualty damage assessment elements.
Immediate deployment of available
treatment and evacuation elements in direct support of the affected
force for triage and evacuation.
On-call designated MSB medical
assets to reinforce the forward medical company so it can continue
to support forces not affected.
On-call available corps medical
assets to be provided to stabilize the situation.
- Division and brigade SOPs for the use of nonmedical vehicles and aircraft to alleviate Level II medical evacuation backlog.
Several Geneva Conventions
affect medical operations in the brigade sector. Sick, injured,
and wounded prisoners are treated and evacuated through normal
channels. However, they are physically segregated from US and
allied patients. EPW patients are evacuated from the combat zone
as soon as possible. Only those who run a greater health risk
by being evacuated may be temporarily kept in the combat zone.
Civilians wounded or sick as a result of military operations are
treated and transferred to civil facilities when required. Properly
identified personnel performing medical duties in medical units
are protected under the Geneva Convention. Details are in DA Pamphlet
27-1 and FM 27-10.
The medical company, in coordination
with the medical operations center and the FSB S2/S3, must also
develop a combat lifesaver program for FSB personnel. Training
is most critical for elements which will be deployed separately
such as MSTs, contact teams, and truck drivers. However, the program
should cover all elements of the FSB.
The division clearing station
in the BSA is principally operated by the medical company treatment
platoon. In addition, a team from the MSB medical company preventive
medicine section and a behavioral science NCO from the MSB company
mental health section may augment the capability of the BSA clearing
station. Also operating at the clearing station are any elements
of the FSMC treatment section not
deployed forward. During static situations, ambulance teams may
also be stationed at the clearing station and provide routine
sick call runs and emergency standby support to units operating
in and around the BSA.
The clearing station maintains
its integrity at all times. Considerations for positioning this
MTF within the BSA are given in Chapter 5. Figure 9-3 shows a
sample clearing station layout in a field environment.
The functions performed at
the clearing station are those discussed for the area support
section of the treatment platoon. Seriously ill or wounded patients
arriving at the station are given necessary treatment and stabilized
for movement. Patients with minor injuries and illnesses are treated
within the capability of the attending medical and dental officers.
These patients are held for continued treatment or observation
for up to 72 hours; evacuated to the appropriate MTF for further
treatment, evaluation, or disposition; or treated and immediately
returned to duty. Resupply of personal equipment for return-to-duty
soldiers is addressed in Chapter 7. Other functions of the clearing
station include --
Providing consultation and
clinical laboratory and X-ray diagnostics for unit physicians
and physician assistants.
Recording all patients seen
or treated at the clearing station and notifying the brigade S1.
Verifying the information
contained on the field medical card of all patients received at
Monitoring casualties when
necessary for radiological contamination before medical treatment.
Details are in FM 8-9 and TM 8-215.
Ensuring NBC casualties are
properly handled according to the guidance in Appendix B.
The preventive medicine team
attached from the division preventive medicine section of the
MSB ensures that preventive medicine measures are implemented
to protect against food-, water-, and vector-borne diseases and
environmental injuries (such as heat and cold injuries). Specifically,
the team --
Performs environmental health
surveys and inspections.
Monitors water production
and distribution within the brigade area.
Investigates incidents of
food-borne, water-borne, insect-borne, zoonotic, and other communicable
Helps train unit field sanitation
The representative from the division
mental health section of the MSB functions as the brigade combat
stress control coordinator. He is normally attached to the FSB
medical company and operates from the BSA clearing station. He
advises the brigade surgeon on mental health considerations. He
keeps abreast of the tactical situation and plans for battle fatigue/neuro-psychiatric
care when maneuver units are pulled back for rest and recuperation.
He assists in patient triage and ensures BF/NP patients are handled
properly. Normal treatment follows these guidelines:
Mild cases are given a brief
respite of 1 to 6 hours of comfort and reassurance and are returned
to their units.
Moderate cases maybe assigned
work at a logistics facility in the BSA for 1 to 2 days. During
this time, however, they must be under medical supervision, and
the medical company remains responsible for such services as feeding
the patients. Moderate cases may also be held at the holding facility
if space is available.
Severe cases may be held in
the clearing station holding facility for up to 72 hours if behavior
is not too disruptive. The CSCC provides guidance to clearing
station personnel on treating BF/NP patients. Treatment consists
of sleep, hydration, quality food, hygiene, general health measures,
and restoration of confidence. It also includes soldierly work
details and individual counseling. Medication is prescribed by
the attending physician only to briefly aid in sleep or to control
disruptive behavior. The CSCC also helps the attending physician
to coordinate RTD of patients fit to perform normal duties.
Severe cases beyond the ability
of the clearing station to manage are evacuated to the DSA clearing
station as conditions permit. Physical restraints are used during
transport when necessary. The physician, in coordination with
the CSCC, may evacuate the patient directly to a corps facility
only if long-term care is required. In such cases, the patient's
field medical card should be annotated to reflect a psychiatric
Evacuation from the BASS is
normally provided by the FSMC ambulance platoon and a forward
air ambulance team of the supporting corps air ambulance company.
These assets also support other units in the brigade area on an
area basis. Typically, one team from the ambulance platoon is
field sited at each BAS. The other ambulances of the platoon are
located at AXPs, designated collection points, or at the clearing
station. Within the BSA, units are responsible for getting wounded,
injured, and sick soldiers requiring treatment to the clearing
An air ambulance team of the
corps air ambulance company is normally field sited at the BSA.
Administrative and logistics responsibilities, discipline, internal
organization, and training are the responsibility of the parent
air ambulance company. The team leader should be involved with
the tactical planning process enough to ensure appropriate employment
of the air evacuation assets and to obtain the required airspace
management information. He coordinates aviation support requirements
and airspace C2 matters with the brigade S3 (air). When air superiority
exists, the team evacuates urgent patients from forward sites
in the brigade area to the BSA clearing station. The treatment
platoon sets up and marks the helicopter landing zone at the forward
triage site. The support operations section and brigade surgeon
plan the air evacuation routes to and from the forward triage
site with the air ambulance team leader.
If medical company evacuation
assets are overwhelmed, additional assets may be requested from
the MSB medical company or the corps through the medical operations
center of the DISCOM. Another alternative is the use of nonmedical
air or ground transportation assets. This support is normally
coordinated by the company XO with the FSB support operations
section. Whenever possible, these assets are augmented with medical
personnel and supplies to provide en route care.
When necessary to keep tracked
ambulances from having to spend too much time evacuating patients
to the BSA, an ambulance shuttle system may beset up between the
clearing station and BASS. Such a system uses ambulance exchange
points. AXPs are positions where patients are exchanged from one
ambulance to another. They are normally preplanned and moved often.
Using AXPs allows ambulances to return to their supporting positions
more rapidly. This is desirable since the crews are more familiar
with the roads and the tactical situation near their bases of
Another form of ambulance
shuttle system involves the use of ambulance loading points and
relay points. In this type of system, ambulances are stationed
at loading points ready to receive patients. Ambulances are also
stationed at relay points ready to replace ambulances leaving
loading points to evacuate patients. Control points may also
be required at crossroads or junctions to direct empty ambulances
from relay points to loading points.
Medical supplies, equipment,
and repair parts are provided through medical logistics channels.
Unit- and division-level medical elements carry a 5-day stockage
of medical supplies. During combat operations, the medical section/platoon
and the FSB medical company receive preconfigured medical supply
packages pushed forward from the division medical supply office.
Push resupply operations will continue until the situation stabilizes.
At that time, if METT-T permits, line-item requests will begin.
Resupply requests are sent through the class VIII supply point
at the FSMC. Items will be issued from supply point stocks if
available. If a request cannot be filled at the supply point,
it is passed to the DMSO. Truckload delivery for one unit may
be delivered directly by division transportation assets. The normal
method of moving class VIII supplies forward is by ambulance backhaul.
This is preferred since it maximizes use of transportation assets
and because Geneva Convention markings of ambulances afford some
protection from attacking aircraft.
The basic characteristics
of medical support in offensive operations are --
As areas of casualty density
move forward, the routes of evacuation lengthen, requiring forward
movement of medical assets.
Heaviest patient loads occur
during disruption of enemy main defenses, at terrain or tactical
barriers, and during assaults on final objectives.
Medical elements of the brigade
and FSB treat indigenous and displaced persons that become sick
or wounded as a result of military operations. In coordination
with the division G5, these people are moved to civilian treatment
facilities immediately after being treated.
- The main attack normally receives the greatest medical support.
Two basic problems confront
the medical company in the offense. First, contact with the supported
units must be continuous. Also, the mobility of treatment elements
must be maintained. Contact is maintained through evacuation elements
operating within and between the unit-level facilities and the
clearing station. Treatment elements should be minimally staffed
consistent with the patient work load, and patients must be evacuated
as promptly as possible. Therefore, available ambulance assets
are positioned forward.
Treatment elements are issued maximum allowable loads of medical supplies before the start of the attack. From the clearing station, supplies move forward via ambulances in response to informal requests from supported medical elements and through exchange of medical equipment received from aid stations.
In fast-moving situations,
patient collection points are predesignated along the axis of
advance. The points operated by FSMC assets also provide units
lacking organic medical support with areas for patient disposition
in high mobility situations.
Medical support of defensive
operations is more difficult than in the offense. Casualty rates
are lower, but forward acquisition is complicated by enemy action
and the initial direction of maneuver to the rear. Increased casualties
among medical personnel will reduce treatment and evacuation capabilities.
Heaviest casualties, including those produced by enemy artillery
and NBC weapons, may be expected during the initial enemy attack
and in the counterattack. The enemy attack may disrupt ground
and air communication routes and delay evacuation of patients
to and from aid stations.
The probability of enemy penetration
requires locating treatment elements farther to the rear than
in the offense. However, their locations must not interfere with
the maneuver of reserve forces.
The depth and dispersion of
the mobile defense create significant time and distance problems
in evacuation support to security and fixing forces. Security
forces may be forced to withdraw while simultaneously carrying
their patients to the rear.
Medical support in retrograde operations varies widely. However, certain factors should always be considered:
Time available for medical
operations is likely to decrease. The brigade surgeon must evaluate
the company's capability to collect, treat, and evacuate patients.
Patient evacuation will be
complicated by movement of troops and materiel on evacuation routes
and by enemy disruption of C3. Plans for evacuation in such conditions
should be included in tactical SOPs. Mobility of the clearing
station may be increased by evacuating patients directly from
the BASS to corps MTFs whenever possible.
Sorting of patients becomes
more critical. Proper sorting and rapid evacuation lessen the
need for establishing complete clearing stations.
When patient loads exceed
the means to move them, the brigade commander must decide whether
to leave patients behind. The brigade surgeon assists in such
decisions. Medical personnel and supplies must be left with patients
who cannot be evacuated.
Medical company assets displace
by echelon and hold patients for the shortest possible time. Locations
of successive positions must be planned in advance. Initial locations
are further to the rear than in other types of operations. For
continuity of support, the next rearward locations are operational
before the forward MTFs are closed.
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