This chapter discusses battalion casualty evacuation operations. Casualty evacuation requires extensive plans, preparation, battlefield initiative, and coordination. The effectiveness of casualty evacuation influences the unit's morale and combat effectiveness.
Large numbers of unexpected casualties and casualties in unexpected locations can hinder or defeat an attack. Commanders and medical platoon leaders must plan beyond their immediate tactical objectives. Medical support must be positioned so the commander can exploit the opportunities created by tactical success. The BAS must mutually support companies; however, as with any battlefield system, its positioning should weight the main effort. Evacuation assets should be task organized and allocated by projected casualties.
The S1 is the coordinating staff officer most concerned with casualty evacuation. As such, he is an integral war gamer during the IPB process. This allows him to analyze the tactical plan and terrain and to identify areas of anticipated casualty density. The BAS should be located as far forward as METT-T allows. The BAS must have enough medical supplies to treat the highest number of expected casualties. Casualty collection points should be predesignated and routinely planned. Ambulance exchange points (AXP) should be used. Extra casualty evacuation and treatment support should be planned for and requested from the forward support medical company. The medical support matrix should be integrated with the tactical overlay. Table F-1 shows an example format for a medical support matrix. If deviation from the matrix occurs, the BAS location must be known at all times. The BAS should remain on location as long as practical. Extra medical supplies can be issued to maneuver elements to help them treat casualties.
a. Offense. BAS mobility must be maintained. During offensive operations, BAS can travel with the combat trains or with the last maneuver company in the order of movement. This way the BAS can obtain aid in the event of a breakdown or navigational help.
b. Defense. The depth and dispersion of the defense creates important time and distance considerations. In a nonlinear defense, enemy and friendly units intermingle, especially in poor visibility. MSRs and routes between positions might be interdicted. Tactical and logistical vehicles should be used as needed for patient evacuation, as this does not adversely affect their mission. For example, empty ammunition trucks can backhaul casualties. Also, damaged vehicles can be towed to the BSA and used to carry casualties. A platoon can be tasked to "follow and provide casualty evacuation support" to the main effort.
Casualty evacuation is a team effort. It is the responsibility of all soldiers-not just the medics. This includes combat lifesavers, infantry squad leaders, staff officers, the medical platoon leader, and the battalion commander. The primary duty of a combat lifesaver is the mission. Treatment of casualties is secondary. Appropriate ground and air evacuation techniques should be used based on METT-T and on patient categories of precedence (URGENT, PRIORITY, and ROUTINE).
F-4. FOLLOW-AND-SUPPORT CONCEPT
Use of a "jump" aid station by the medical platoon can be effective. In anticipating surge requirements, the medical platoon leader should forward deploy, or jump, part of the BAS. The distance is determined mostly by the operation (offensive or defensive) and by the enemy threat. The senior enlisted medic should accompany the forward aid station to provide medical advice and expertise. This "follow and support" concept simplifies triage forward, which in turn improves the rate at which casualties are treated in the main aid station. To prevent ambulances and aid stations from being positioned accidentally at risk from enemy action, "jump" aid stations must be properly controlled. Planned checkpoints that are possible aid station locations must be designated along the MSR. They should be included in the operation overlay in the OPORD. The jump aid station follows the lead maneuver units; as one of these maneuver units comes into contact, the jump aid station should move to the nearest checkpoint and prepare to treat casualties. As the jump aid station moves into position, the administrative/logistical net should be used to inform units of its location. Medical leaders must be proactive and push forward. Ambulance drivers must have mounted land navigation skills to allow them to move over unfamiliar terrain at night. This makes finding CCPs, aid stations, and AXPs easier. Some wounded soldiers require limited treatment only and can be returned to duty at once. While they wait to rejoin their units, these soldiers can carry litters, freeing medics for patient care. They can also help guard the perimeter, act as ground guides, handle patient administration, or work mess duty.
Redundant communications are important to timely casualty evacuation. In the BAS, they monitor the battalion command net. If message traffic indicates units in contact and casualties, the jump aid station moves forward IAW a predetermined plan and begins treating patients. This works faster than if the jump aid station waits for a message. It also provides a backup in case the administrative/logistical net is jammed.
F-6. MAINTENANCE AND CASUALTY EVACUATION
Collocating maintenance and medical assets is useful for evacuating casualties. Maintenance soldiers should be cross trained as combat lifesavers and should know how to extract casualties from combat vehicles. They should any appropriate medical supplies such as litters and IV units. Vehicles evacuated to the rear for repair can also carry casualties.
F-7. COLOR-CODED TRIAGE SYSTEM
This system involves the use of color-coded signs during daylight hours and color-coded chemical lights at night. The signs are placed in front of the appropriate treatment areas. Any color combination can be used. For example, red can be used for expectant, blue for immediate, and green for minimal. When casualties arrive, a DA Form 1380 is marked for each with the appropriate color. The litter team then takes the casualty to the treatment area for that color code. Litter bearers are seldom medics; this method helps get the patients treated faster. The color codes used should not conflict with other tactical signals. (AR 140-185, Chapter 3, provides instructions on how to complete DA Form 1380.)
F-8. SPECIALTY PLATOONS
Members of specialty platoons are not authorized medics. Scouts often operate forward of the FEBA; mortars operate up to 1,500 meters behind the FEBA. These distances from the companies (which have medics) can inhibit timely casualty evacuation. This situation may also apply to other dispersed elements such as ADA and GSR teams. To offset this problem, thorough coordination with maneuver units near the dispersed unit is required. Maneuver units can help the scouts by evacuating casualties from forward of the FEBA to preplanned CCPs in the company zone or sector. Battalions must maximize combat lifesaver training for mortar and scout platoons.
F-9. LOCATION OF CASUALTIES
Locating casualties during and after a battle can be a time-consuming and difficult task, especially at night or in dense woods. Whatever the signal used, it must conform with the unit TACSOP and not conflict with other signals. Several techniques to facilitate patient locating follow:
a. Vehicles carrying critically wounded personnel can be identified by a red flag during daylight and a red chemiluminescent light at night. This tells medics which vehicle they should go to first.
b. Fallen casualties can be marked with visible or infrared chemiluminescent lights or glint tape. These can be located at night by medics using the infrared source on night vision goggles.
F-10. EVACUATION TECHNIQUES
The rapidly employable lightweight litter, referred to as the SKEDS litter, is designed to be used as a rescue system in most types of terrain, including mountains, jungle, waterborne, and on snow or ice (Figure F-1).
a. The SKEDS litter is made of durable plastic. It can be rolled and carried in a camouflage case. The basic litter weighs 16 pounds complete with carrying case, straps, snap link, and a 30-foot kernmantle rope. Other optional items, such as the spine immobilize and flotation system, increase the weight to 32 pounds.
b. The SKEDS litter enables a single soldier to pull a casualty over most types of terrain; a field-expedient poncho litter requires two soldiers or more. Up to four soldiers can use hand loops to carry a SKEDS litter containing a seriously injured casualty across difficult terrain.
c. The SKEDS can be used to move equipment, ammunition, or other heavy loads to and from DZs, LZs, and objective areas in addition to its medical use.
d. The litter is listed in the GSA Federal Supply Schedule, March 1989, FSC Group 42, Part I, Section B, Special Item Number 465-10, Emergency Stretchers, Brand SKEDCO Incorporated, page 8.
Leaders must retain common sense and attention to safety considerations despite their concern for casualties. Ambulance drivers or soldiers working around MEDEVAC helicopters must keep the risks in balance.
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