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"Casualty evacuation requires extensive plans, preparation, battlefield initiative, and coordination. The effectiveness of casualty evacuation influences the unit's morale and combat effectiveness."

-- FM 7-20, The Infantry Battalion

"Medical treatment of wounded or injured soldiers during combat operations is a continuous, progressive operation that occurs in a series of separate, but interlocking, stages. It involves personnel, equipment, and facilities at virtually every level of the organization."

-- FM 71-1, Tank and Mechanized Infantry Company Team

• Brigade medical planners must be a part of the brigade military decision-making process (MDMP).

• Brigade planner must produce and publish in the brigade order:
  • Synchronization matrix.
  • Combat health support (CHS) concept sketch.

• Develop a casualty estimate. How else do you know if you have enough resources available to accomplish the mission?

• Develop a casualty time line. Will all of the casualties from your estimate occur at the same time?

• Develop a CHS plan which adheres to the principles of combat health support:
  • Conformity - to the tactical plan.
  • Continuity - for continuous medical treatment and evacuation.
  • Control - to tailor CHS resources and plans to accomplish mission.
  • Proximity - to expected patient density.
  • Flexibility - to accomplish mission on a changing battlefield.
  • Mobility - to keep up with supported forces.

• Rehearse. If casualty evacuation is not discussed in depth at the brigade combat service support (CSS) rehearsal, have a CHS rehearsal with supported medical platoon leaders.

• Plan for, and prepare to, reconstitute and augment supported task force medical platoons.

• Plan for use of medical evacuation (MEDEVAC) aircraft. Where, when, how? Who has mission authority and who has launch authority? Who manages the blade hours to ensure assets are available when we expect to need them?

• Adhere to the priority of support. Does the brigade reserve really need two attached ambulances before being committed?

• Develop realistic, easy-to-understand triggers for movement of CHS assets. The ambulance transfer point (AXP) jumps to QV123456 as brigade lead elements cross PL Gold or when the northern combat security outpost (CSOP) is destroyed.

• Battle track. Be proactive.

• Monitor four radio nets in your command post (CP):
  • Brigade command - situational awareness, battle tracking.
  • Brigade administrative/logistics (A/L) - primary or alternate MEDEVAC net.
  • Forward Support Battalion (FSB) command - brigade support area (BSA) situational awareness.
  • Forward Support Medical Company (FSMC) command - primary or alternate MEDEVAC net. Communication with company assets.

• Mandatory battle updates from supported medical platoon leaders and ambulances attached to supported medical platoons.

• Plan for, train, and rehearse nuclear, biological, chemical, (NBC) patient decontamination.

"Casualty evacuation requires extensive planning, preparation, battlefield initiative, and coordination. Efficient or broken, your CASEVAC system will have a profound impact on the morale and combat effectiveness of your unit."

-- CALL Newsletter No. 89-5, Commander's CASEVAC System

"Internal brigade treatment/evacuation plans must be coordinated/synchronized with the medical company commander, the brigade surgeon, and the brigade S1."

-- FM 7-30, The Infantry Brigade

"Integrating the medical support plan with the tactical scheme of maneuver increases the total plan's effectiveness by synchronizing critical elements of combat power, to include medical assets."

-- CALL Newsletter No. 89-5, Commander's CASEVAC System

"Violent high-tempo combat often results in areas of heavier combat action with resulting heavy casualties. Medical assets then, as with engineer or fire support assets, must be weighted toward those areas of main effort."

-- CALL Newsletter No. 89-5, Commander's CASEVAC System

• Train and use your medical platoon leader in the MDMP. He may have a good idea or two.

• Force your medical platoon leader to be the expert. Demand it. Do not deem him to be an idiot until he proves it.

• Train your medical platoon leader in the basic fundamentals of tactical operations. He cannot support what he does not understand.

• Medical platoon leader: Read a little. Understand tactical operations and the implications they have on your CHS operations.
  • Attack = heavy patient density; long lines of communication (LOC); need to maintain mobility; bypassed enemy.
  • Defend = lower patient density; shorter LOC; difficulty getting casualties from point of injury (POI) to casualty collection point (CCP).

• Medical platoon leader: Develop a Synchronization Matrix and CHS Sketch as part of the OPORD and ensure key players have them. Answer: who, what, where and when both sequentially (matrix) and spatially (sketch).

• Make the medical platoon leader a required member of the task force maneuver rehearsal.

• Enforce a combat lifesaver minimum standard -- one per the smallest maneuver element.

• Ensure casualty evacuation is incorporated into all training.

• Train medics in mounted land navigation. Day and night.

• Maximize the use of non-standard evacuation platforms. Think of non-standard vehicles in terms of medical combat power: one M997 ambulance = four patients where one 5-ton truck = 12 patients. Three times the combat power!

• Ask the forward support medical company for augmentation, particularly if you are the main effort.

• Rehearse casualty evacuation at the CSS rehearsal.

• Perform a route reconnaissance of all possible evacuation routes. Reconnoiter from as far forward as possible to a battalion aid station (BAS) and the AXP.

• Train and conduct casualty evacuation during combat operations. Train as you fight. There is a reason that CTCs have a time limit for evacuation!

• Plan for, train, and rehearse NBC patient decontamination.

"Health service support planners must understand the tactical commander's plans, decisions, and intent. CHS planning is an intense and demanding process. The actions of the CHS planner must be proactive, not reactive."

-- FM 8-10-4, Medical Platoon Leader's Handbook

"Rather than planning and executing Far Forward Care during the battle, the Task Force usually initiates CASEVAC following Change of Mission. This delayed treatment increases the number of DOW."

-- Center for Army Lessons Learned Observation

"All key personnel, especially evacuation NCOs, conduct personnel through reconnaissance before and between phases of an operation."

-- FM 8-10-4, Medical Platoon Leader's Handbook

"If combat medics are not readily available in the troop area, patients may be evacuated on any suitable vehicle already moving to the rear, such as a recovery vehicle or maintenance vehicle."

-- FM 17-95, Cavalry Operations

"To support task force operations, the medical platoon leader or battalion surgeon and medical operations officer must understand the scheme of maneuver as well as the support plan of the FSB medical company."

-- FM 71-2, The Tank and Mechanized Infantry Task Force

"The medical platoon leader, like any staff officer, must understand the concept of the tactical operation as well as the support plan of the medical troop."

-- FM 17-95, Cavalry Operations

• Analyze and plan for all options -- air and ground.

• Include: brigade/battalion S3, FSMC commander, brigade surgeon, aviation assets, and troop leadership in planning for casualty evacuation (CASEVAC).
  • Template enemy locations.
  • Identify projected observation post (OP) locations.
  • Identify infiltration routes.
  • Determine ground evacuation limit of advance.
  • Identify casualty collection points.
  • Identify air extraction pickup zones (PZs).
  • Identify ingress and egress routes for aircraft.
  • Develop a suppression of enemy air defenses (SEAD) plan to secure air corridor.

"If wounded crewmen require evacuation, the platoon leader or PSG can take one of these steps:

• Coordinate for aerial evacuation through the troop or battalion.
• Conduct self-evacuation with organic platoon assets.
• Request that the battalion or troop task-organize a dedicated ambulance to the platoon for operations forward of the larger element. In the case of the HMMWV platoon, the ambulance should be a HMMWV variant located, for security, with the nearest company team.
• Coordinate with the closest troop or company team for ground evacuation."

-- FM 17-98, Scout Platoon

"Regardless of the method of evacuation, all scout leaders must have the necessary CSS graphics available, including locations of battalion or troop casualty collection points. Evacuation procedures must be part of the platoon plan and should be rehearsed as part of mission preparation."

-- FM 17-98, Scout Platoon, and FM 17-15, Tank Platoon

• Appoint a commander in chief (CINC) CASEVAC -- responsible, resourced, and accountable.

• Plan for CASEVAC. Train as you fight. Would you really accept died of wounds (DOW) in combat?

• Rehearse the plan?

• Train CASEVAC -- during operations, not as an afterthought.

• Demand resources. Pole-less litters are available, easy to use, and compact.

• Establish CCPs. Do we really want the evacuation vehicles to waste time driving from vehicle to vehicle? Consolidate and prioritize casualties in one or two spots so that time and resources are not wasted.

• Get maximum soldiers trained as combat lifesavers and outfit them to do the job.

• Develop a vehicle marking system to identify vehicles with casualties on board. Plan for night identification also.

"The commander has overall responsibility for medical services; his primary task is to prepare the team to properly treat and/or evacuate casualties.. The commander designates the location for the company team's casualty collection point and ensures that all vehicle commanders record the location on appropriate overlays. He also develops and implements appropriate SOPs for casualty evacuation."

-- FM 71-1, Tank and Mechanized Infantry Company Team

"The first sergeant should position troop medical aid and evacuation teams on the battlefield where they can be most responsive. They will usually operate under the control and direction of the first sergeant in the troop combat trains. The medics must know the locations of, and routes to, each platoon, the troop combat trains, the squadron combat trains, and each collection point."

-- FM 17-97, Cavalry Troop

"An effective technique. is to task-organize a logistics team under the 1SG. These soldiers carry additional ammunition forward to the platoon and evacuate casualties to either the company or the battalion casualty collection point."

-- FM 7-10, Section V, The Infantry Rifle Company

"Unit SOPs and OPORDs must address casualty evacuation in detail. They should discuss duties and responsibilities of key personnel.."

-- FM 7-10, Section V, The Infantry Rifle Company

"The use of crewmen who are trained as combat lifesavers is absolutely critical. As a minimum, one crew member of each tank crew must be a trained combat lifesaver."

-- FM 17-15, Tank Platoon

CINC-MEDEVAC: Sabre Bandaid
FREQ: F000

Notes
All Route Recon completed NLT 031300
SPT PLT attach 2x5 ton to Med PLT NLT 031300
CSS Rehearsal 031300

References:

FM 7-10, The Infantry Company
FM 7-20, The Infantry Battalion
FM 7-30, The Infantry Brigade
FM 8-10-4, Medical Platoon Leader's Handbook
FM 17-15, Tank Platoon
FM 17-95, Cavalry Operations
FM 17-97, Cavalry Troop
FM 17-98, Scout Platoon
FM 71-1, Tank and Mechanized Infantry Company Team
FM 71-2, The Tank and Mechanized Infantry Task Force
CALL Newsletter No. 89-5, Commander's CASEVAC System