Military

Combat health support planning is one of the most difficult and important elements of the brigade military decision-making process (MDMP). The medical plan, when properly created and synchronized to the rhythm of the brigade’s scheme of maneuver, serves as a powerful tool for economically evacuating casualties from the battlefield. A flexible, aggressive, anticipatory medical plan provides the fighting soldier a strong sense of faith, enhancing his will to fight and defeat the enemy on the battlefield. While the execution of the medical plan depends on the actions of many, the quality of the plan depends upon a few key individuals: the brigade surgeon, support operations officer, the medical planner (if available), the medical company commander, the brigade CSM, and the brigade S1. A successful combat health support plan must consider the combat health support planning integration into the brigade MDMP, casualty estimates, asset acquisition and utilization (ambulance exchange points, air integration, and nonstandard ground vehicles), unit dynamics and training, and, finally, leader positioning on the battlefield.

The medical company leadership, especially the company commander and the company first sergeant, must be competent as well as technically and tactically proficient. The medical company commander is unique in his capacity when compared to the supply company commander or the maintenance company commander. He is required to be a part of the brigade MDMP, and his command and control responsibilities are far greater because of the dispersion of his assets on the battlefield. The medical plan often relies on additional assets, such as nonstandard air and ground evacuation vehicles, from other units. Because of these additional requirements, it is imperative that the medical company commander be aggressive in taking part in the MDMP so as to facilitate the proper allocation of the additional assets. Commanders who are not aggressive in their approach to MDMP never see the required assets making it into the brigade operations order.

In order for a medical company commander to economically resource his medical plan, he must work with the brigade S1 to develop a casualty estimate based on the brigade scheme of maneuver. The casualty estimate is the primary tool used to predict when and where casualties are going to occur during the battle. This estimate, once developed and refined, serves as a base from which the medical company commander can request additional support from the brigade. Because the nonstandard vehicles and nonstandard air assets are sought after resources, the estimate strengthens the medical company commander’s place on the order of merit list for receiving the additional support. If the estimate is not synchronized with the brigade scheme of maneuver and is not based on the arbitration done by the brigade as to where the casualties are predicted to occur, it simply loses its effectiveness. In total, the estimate not only provides the medical company commander a basis for requesting additional support, but it also assists in the process of deciding where medical assets are to be arrayed on the battlefield, such as the ambulance exchange points (AXPs).

Ambulance exchange points, along with the battalion aid stations (BAS), primarily function as the first line of defense for the medical community. The AXP, according to FM 8-10-6, Medical Evacuation in a Theater of Operations, Tactics, Techniques, and Procedures, is a place on the ground where casualties are transferred from one vehicle to another. The medical personnel at these places must be well trained and capable individuals who can not only anticipate what needs to be done medically for saving lives, but are also tactically proficient at keeping abreast of the battle around them so as to keep themselves in the fight. The AXP is where the utilization of nonstandard assets, both air and ground, becomes critical. Time-distance factors are key at this point, and often times ground vehicles are too slow in getting the urgent casualties back to the forward support medical company. When casualties are transported by ground, it is critical to have personnel who are well trained in land navigation. Time is working against the patient, and any other external stressors only decrease the patient's chances of survival.

Unit dynamics and training are two characteristics that play a vital role in the ability of a medical unit to save lives on the battlefield. Medics must be skilled craftsmen. They must perform their duties without hesitation in order to sustain the lives of wounded soldiers until they transport the patients to higher levels of care. They must also be able to locate casualties both during daylight hours and at night. If the medics are unable to read a map, utilize a global positioning system, or drive successfully with night vision goggles, the entire medical plan is strained. The medic must be able to locate the casualty and exercise his capabilities. The commander is the primary trainer in the company, and he must draw on his experience to train his unit to face the challenges on the battlefield. A commander’s ability to successfully accomplish his plan and his ability to flex on the battlefield during execution of the plan rests on the level of training within his unit.

Where leaders position themselves on the battlefield directly affects the execution of the plan. The successful execution of the medical plan relies heavily on the efforts of the entire brigade and demands flexibility, anticipation, decisiveness, and brute force. The medical company commander must be able to determine where he needs to be on the battlefield in order to most affect the execution. He must be able to communicate effectively with his subordinates, and they must know in their minds that they have the flexibility to make decisions on their own in the absence of orders. They must also understand the absolute importance of maintaining communications with the supported units and with all adjacent units. The brigade CSM, when properly integrated, can impact the execution at the point of injury. He is able to energize his subordinate CSMs, 1SGs, and PSGs, to be proactive in the evacuation of their wounded. The quicker this happens, the more successful the execution.

Units who come to the National Training Center displaying discipline and sound planning ability tend to perform to standard and are more flexible on the battlefield. There is simply no substitute for training. Combat health support planning and execution are extremely difficult tasks that require countless hours of effort on the part of the planners. The combat health support plan is just as important as the brigade’s scheme of maneuver and requires just as much thought to make it seamless. When medical plans fail, people die.