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by CPT Anthony Armstrong, Aviation Observer Controller, JRTC

Forward support MEDEVAC team (FSMT) leaders consistently fail to effectively employ their aircraft at the Joint Readiness Training Center (JRTC). This is not surprising, since there is no doctrinal literature that explains how to employ the FSMT. Some generalizations about employment are found in FM 8-10-6, Medical Evacuation in a Theater of Operations, Tactics, Techniques, and Procedures. But now as that leader stands in Cortina as part of a brigade combat team.he is the expert. The leader knows garrison coverage at Home Station well (24-hour coverage - each aircraft covers an 8-hour shift), so that is what he reverts to on the training battlefield. The result is a coverage plan that is not flexible, time driven, and fosters a lack of operational awareness. This article provides some insight on how to employ the FSMT on an event-driven battlefield.

The FSMT leader is a primary medical planner in the brigade combat team. When the service support annex of the operations order reads, "MEDEVAC will provide 24-hour coverage," it is the FSMT leader's responsibility (he is the expert). The FSMT leader must be involved in continuous medical planning 24 to 48 hours out with other key medical planners -- the medical company commander, brigade S-1, combat health support officer, and the brigade surgeon. The key elements needed to develop and execute a FSMT coverage plan based on events on the battlefield are battle tracking, situational awareness, casualty estimates, and a thorough understanding of fighter management, as well as duty days and environmental relative factors (ERF).

Battle Tracking and Situational Awareness

The FSMT leader must be an integral member of the staff he is assigned to in order to participate in all levels of planning and to maintain situational awareness of the battlefield. Early involvement in the Military Decision-Making Process (MDMP) allows the FSMT leader to understand both the mission of the maneuver elements and the commander's intent. It also allows for medical planning to be integrated into the mission instead of being reactive to the mission.

The tactical operations center (TOC) provides communications assets for the FSMT. Current MEDEVAC TOE does not provide the FSMT with communications equipment - the FSMT is completely reliant on the unit to which it is attached. Too often, MEDEVAC sections set up their own command posts (CPs) and operate in a vacuum. Units that operate independently from their own CPs are completely reactive and consistently lose aircraft and personnel to the enemy. Unresponsive support results in higher died-of-wounds (DOW) rates. It is imperative to synchronize information with other staff sections and monitor communication nets (intelligence, fire support, flight operations, command, medical). The TOC provides the capability to flight follow with aircrews and provide them with tactical updates. If a unit can send a MEDEVAC liaison (LNO), this continuous staff interaction is better served by the LNO, freeing up the FSMT leader to lead his section.

Casualty Estimates

The brigade S-1 and surgeon develop a casualty estimate for each operation. The goal is to maximize the utilization of lift assets to "do the most good for the most amount of soldiers." The medical company commander uses the casualty estimate to develop a plan for allocating the evacuation and casualty treatment assets. The FSMT leader must understand the ground evacuation plan and its limitations before supplementing the plan with air assets. When he knows when events are going to take place, the approximate number of casualties to expect, and the ground evacuation plan, he can develop a coverage plan.

EXAMPLE: How many casualties can be moved each hour with the MEDEVAC UH60 liter (L) configuration (4L or 6L)? Keep in mind loading and unloading time, flight time between pickup and landing areas, and deviations for refueling.

  • Can we move the estimated number of casualties?
  • Do we need additional tactical airlift (CASEVAC)?
  • Consider OPCON of CASEVAC assets to the FSMT leader.

Fighter Management

A thorough understanding of the unit's SOP on fighter management is essential. Fighter management is a combat multiplier when used effectively. Often SOPs leave a great deal of room for self-interpretation.

  • Make sure the SOP is very specific so that soldiers understand it.
  • Keep garrison MEDEVAC coverage out of the TACSOP. Garrison coverage does not apply in a tactical scenario.

The most common misunderstandings are duty day (start, stop and reset times) and environmental relative factors (ERF) for flight time. When units block out periods of time for a MEDEVAC crew to cover (i.e., 24:00 to 12:00), they often do not consider how the environmental relative factors affect the coverage window. Often the crews will "ERF out," creating a gap in coverage. This gap in coverage becomes critical if the situation requires medical evacuation at an inopportune time.

  • Make sure the aviation battalion task force commander knows the MEDEVAC cycles. This allows him to augment with CASEVAC aircraft. The planning example illustrates an effective technique for managing actual flight times tied to events.
  • Remember to plan in time, before actual flight and post flight, for mission preparation, briefs, and debriefs. Consider the aircrew's circadian rhythm. The duty day window allows flexibility within the window to shift actual flight times.
  • Try not to shift a crew's duty day more than four hours either side of their established rhythm.
  • Determine who has waiver or extension authority before deploying. Proper fighter management coupled with risk management will ensure the FSMT can provide continuous support for extended periods.

The following assumptions affect the planning example:

  • The FSMT deploys to the JRTC as part of a brigade combat team.
  • There is no general support or area support aircraft to supplement the FSMT. One UH60 non-standard and one CH47 are under the operational control of the FSMT leader for CASEVAC.
  • There are two major events/missions in the 24-hour example.
  • A battalion assault resulting in 56 casualties.
  • A company raid producing approximately 31 casualties.
  • The duty day for the aircrews is 12 hours with the following ERFs: 5 hours of goggles, 6 hours day/night combination, and 8 hours day.
  • The MEDEVAC aircraft have a 4-litter configuration and the CH47 has a 24-litter configuration with medical personnel onboard to provide en route care.
  • Average time for patient upload and download, en route times, and refuel equals one hour. MEDEVAC crew number 2 is given a one-hour duty day extension to debrief. Sunrise is at 06:00 and sunset is at 18:00.

End Result

The FSMT leader provides real-time information to his aircrews as he tracks the battle with other staff members. The aircrews receive thorough briefings for pre- and post-flight. The FSMT leader effectively coordinates deviations to the plan and makes adjustments as necessary. His understanding of casualty estimates and fighter management provide for overlapping coverage, the capability of moving 32-litter casualties an hour for both missions, and continuous air evacuation capability for 24 hours. During peak casualty times, there are two MEDEVAC aircraft available for the most critical patients. Understanding how to employ a FSMT effectively and coordinating a comprehensive coverage plan based on events on the battlefield will preserve the fighting strength of the brigade combat team.

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