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I am a Physician's Assistant assigned to a Paladin unit, 2-3 FA, in Germany. I have some true CASEVAC concerns related to the current MTOE of the Paladin units. From my perspective, it is apparent that we are not keeping doctrine up with the advancements of the Field Artillery. When technology of the war machine calls for more soldiers to move farther forward on the battlefield, the doctrine of combat casualty support for those soldiers should also change.

The Field Artillery has progressed a long way in a short period of time. The days of the Field Artillery sitting on some far backside of a hill, for hours at a time, throwing hot steel into the enemy, are gone. The days of cumbersome equipment and targeting circles has been replaced by technology. The goose egg has been wiped out and replaced by vast terrain. The command and control of the individual artillery pieces is not over an area of a few hundred meters, but over several kilometers. Spread out and hide, move often, and you may survive.

The Field Artillery fights the counter-battery. They lay down minefields to turn the enemy into kill zones or halt their advance for the "Queen of Battle." They take out tanks and enemy artillery to reduce and degrade the enemy to a force that can be reckoned with and then create a smoke screen so the enemy doesn't see where the Queen is until it is too late. The Field Artillery is a vital link in the superior Army that we have today to destroy, degrade, and achieve victory against our enemy.

A gunny is a vital survival aspect of each platoon, constantly searching for new terrain forward in the battlefield, into which the smoke and platoon leaders can move their section chief. The smoke and platoon leaders are constantly in command of a killing machine that surpasses all other predecessors.

With the fielding of the Paladin, the Field Artillery has progressed past its survivability capacity in terms of combat casualty support. The battery commander, platoon leader, smoke or gunny cannot be expected to provide the needed lifesaving and evacuation assets when they are engulfed in the movement of the battery and platoons while still firing hot steel to suppress or destroy the enemy. The 1st Sergeant, although a vital link, has only two medics and no evacuation capability at the battery level, other than his vehicle, which may or may not be suitable for non-conventional evacuation of small numbers of wounded soldiers. The answer is not as simple as an MTOE change. If commanders are truly concerned about the survivability of the soldier while maintaining combat power, changes must come from the top. Battalion and battery commanders can only utilize what they are given.

I am impressed with the soldiers and the machines they command in my Paladin unit. When my unit fielded the Paladin, I educated myself so I could best support and save the lives of those soldiers. I quickly became aware of the limitations of support provided to those soldiers, and to me. Everything I learned, I passed on to my leaders. I told the executive officer, "Sir, I cannot support this battalion with the assets that are at my disposal and expect to have soldiers survive when wounded." I very bluntly told him that his soldiers will die, no matter how hard we worked, if we did not increase our capability within the battalion to evacuate and treat the soldiers on the battlefield and do this as far forward as possible. He agreed that we are inadequate in this aspect of survival.

My battalion has one conventional evacuation vehicle: an M997, four-litter ambulance. My aid station is a tent and equipment that we carry around in a 5-ton truck. I have 12 very well-trained medics and myself. Although we are an effective team, spread throughout the battlefield, we are not enough. When I bring this issue up to brigade support elements, they insist that we have the ability to evacuate. "Use the vehicles within the platoon is the usual answer." If we use these vehicles, we take away from the combat power, maneuverability or command of the platoon. Taking away from the effectiveness of the battery or platoon equals more soldiers on the battlefield who die from the Field Artillery not being able to suppress or destroy the enemy. We have a very serious mentality: Every round that the Field Artillery sends downrange must count for something to the fighting infantry and armor units. If not, they die. I have changed and configured my assets that I have, to do the best with less, but our best is not good enough.

Each battery needs at its disposal a treatment and evacuation asset. This can best be performed by the use of two to three medics with a M113 track vehicle or a M997 wheeled vehicle. My mobility is essential for carrying the treatment capability that I can provide as far forward as possible. This can be performed by three to four medics in a treatment area, one M577 tracked vehicle, one M998 ¼-ton truck for movement and extra evacuation and a 5-ton truck for medical and chemical supplies.

The leaders above the battalion level must recognize the increased ability that the Field Artillery has, and the associated increased support they need. If they do not recognize the need, and do not give us the support assets required, the survivability of the Field Artillery on the battlefield is in great jeopardy. If the "King of Battle" dies, so does the Queen.