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Anticipating and adequately providing CASEVAC are fundamental to a sound medical plan. Care and disposition of a large number of casualties can be a tremendous operational handicap. However, a substantial number of unanticipated casualties or casualties in an unanticipated location cannot only hinder but defeat the attack.

Integrated medical support planning is the essence of proactive medical CASEVAC. 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.

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. Commanders and medical platoon leaders must plan beyond the immediate tactical objectives when planning medical operations. This positions medical support so that the tactical commander can exploit the opportunities created by tactical success.


1. Medical Support Characteristics of Offensive Operations:

a. General

(1) Penetration of enemy defenses normally produces the heaviest medical work load.

(2) Use non-standard ground evacuation (other than medical vehicles) for CASEVAC of lightly wounded patients.

(3) As areas of casualty density move away from hospital/aid station locations, routes of casualty evacuation lengthen.

(4) The major casualty area of the battalion will frequently be the zone of the main attack. The commander's allocation of forces generally indicates area of greatest casualty loads.

(5) Identify areas of anticipated casualty density by analysis of the tactical plan and terrain. The S1 is an integral part of Battle Staff IPB and wargaming process.

b. Leader considerations:

(1) Locate Battalion Aid Station (BAS) as far forward as the Task Force Commander and METT-T will allow. Heavy enemy direct and indirect fires may make forward deployment of the BAS too risky.

(2) Maintain the mobility of the BAS.

(3) Pre-designate casualty collection points.

(4) BAS must have sufficient medical supplies to treat the maximum number of expected casualties.

(5) Aid station location must mutually support company teams.

(6) Task organize and allocate evacuation assets in relation to projected casualties.

(7) In a meeting engagement, the aid station should consider traveling with the combat trains or trailing maneuver company.

(8) Avoid premature deviation from the medical support plan. Allow the situation to develop, but be proactive.

(9) Casualty collection starts slowly but will become rapid as the attack progresses.

(10) A decision to establish two Treatment Teams must be balanced against the loss of flexibility which may be later required to exploit tactical opportunities.

(11) Plan for and request additional CASEVAC and treatment support from Forward Support Medical Company.

(12) Units conducting the main effort will have the highest casualty load. Weight the main effort.

(13) Plan for and use Ambulance Exchange Points (AXP) routinely.

(14) During movement to contact, casualties may occur in isolated groups over long distances as units engage pockets of resistance.

Exploitation and pursuit rarely involve direct breaching of enemy defensive positions, so medical support is not confronted with as heavy a work load in the opening phases of this operation.

(15) When exploitation and pursuit precludes prompt CASEVAC, carry patients forward to the next site or leave with a medic.

(16) Speed of exploitation and pursuit extends the battle and distance increases the use of air ambulances in medical resupply and casualty evacuation operations.

(17) Use appropriate ground and air evacuation techniques based on patient categories of precedence (URGENT-PRIORITY-ROUTINE) and METT-T.

2. Medical Support Characteristics of Defensive Operations

a. General

(1) The depth and dispersion of the defense creates significant time and distance problems. In a non-linear defense, enemy and friendly units will be intermingled, especially in poor visibility. MSRs and routes between positions may be interdicted at one time or another.

(2) Make maximum use of tactical and logistics vehicles for patient evacuation, as they are available without adversely affecting their mission. For example, empty ammo trucks can back-haul casualties. Consider using damaged vehicles being towed to the BSA as casualty carriers.

(3) Security forces will most likely be required to withdraw while simultaneously carrying their casualties.

(4) Attacker initiative may preclude accurate prediction of initial areas of casualty density.

b. Leader Considerations:

(1) Use available aviation elements for evacuation in addition to their normal role.

(2) Preserve aid station mobility to provide flexibility.

(3) Evacuate patients by ground to nearest Casualty Collection Point (CCP).

(4) Integrate medical support matrix with defensive overlays.

(5) If deviating from the matrix, maintain contact with supported units. Ensure aid station location is known at all times.

(6) Consider ground ambulances moving with a logistical convoy whenever practical. That provides help in navigation and assistance in the event of breakdowns.

(7) Request assistance from the supporting medical company when casualty evacuation workload exceeds your unit's capability.

(8) Medical support must eventually be in position to support the counterattack.

(9) BAS should remain on location as long as practical.

(10) Issue litters and other additional medical supplies to maneuver elements to assist them to collect, treat, and evacuate casualties. For example, the 1SG could carry a litter in his vehicle. One tank per platoon may require a litter.

Preparation is the second phase of the Army's Plan - Prepare - Execute model. How well a unit prepares for combat can often determine the outcome of the battle. The next section discusses the fundamentals of sound Preparation for combat.

Table of Contents
Section I: Historical Example
Section III: Preparation

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One Billion Americans: The Case for Thinking Bigger - by Matthew Yglesias