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by CPT Robert Burks, SECOPS, NTC

0430, Brigade Support Area, Mojavia

SPC Williams is jerked awake by explosions. He quickly rolls out of his cot. Trying to pull on his gear, he stumbles out of the tent. Barely three steps later, the concussion from an artillery shell exploding nearby knocks him to the ground. Williams screams as white-hot 152-mm artillery shell fragments tear through his body. Fighting to maintain consciousness, Specialist Williams attempts to call for help as he watches the confusion unfold around him. Under the blanket of darkness, the unit slowly tries to make sense out of the confusion that always follows an artillery attack. Meantime, still lying on the ground, waiting for medical treatment, SPC Williams drifts into unconsciousness as life slips from his body.

This is a routine event at the National Training Center. NTC trends show that logistics companies typically average 53 percent died of wounds rates in the Brigade Support Area. This rate is discouraging when you know that these companies are only 600 to 1,000 meters from the medical company.

Primary causes for the high mortality rate:

1. Units take too long to evacuate the casualty.
2. Improper transportation and treatment techniques.

Why? Failure to develop an integrated casualty evacuation plan that includes both medical treatment and evacuation from the point of injury to the medical company.

The company commander must understand that he will take casualties. He must develop a company casualty evacuation plan that assigns responsibility for both treatment and evacuation for each individual soldier in the unit, the Area Damage Control (ADC) team and the company casualty collection point.

The commander's casualty plan must start with immediate treatment at the point of injury. When a casualty occurs during an attack, the first soldier on the scene to render assistance is normally the casualty's fighting position buddy. It is this soldier's responsibility to start the treatment process by conducting buddy aid at the point of injury. Trends at NTC indicate that logistics units are not training their soldiers in basic first aid. The unit must understand that this initial treatment is the first building block in a successful company medical plan. Depending on the nature of the attack, the unit may not be in a position to provide additional medical attention to the casualty for a prolonged period of time. The company commander must ensure all soldiers are trained to execute at least the first aid tasks found in STP 21-1-Soldier's Manual of Common Tasks.

Buddy Aid

1. Complete initial treatment.
2. Mark the casualty's location so additional medical and evacuation help can easily locate the site.
3. Pass the casualty information through the chain to the company command post.


1. Mark location. Use anything from orange VS-17 panels to flags.
2. Develop and implement an SOP. Consider both day and night markings.
3. Ensure every soldier knows the marking system.
4. Ensure marking materials are readily available.

Note: Depending on the nature of the attack or type of injury, the casualty's buddy may be able to move the casualty directly to the casualty collection point. The unit's marking system becomes essential if the injury or situation does not allow the soldier to move the casualty.

The company's Area Damage Control (ADC) team will use this marking system to help rapidly identify casualties as it moves through the area. This team should consist of at least an NCOIC with communication, several stretcher bearers, and at least one combat lifesaver. The combat lifesaver is critical to the company's casualty evacuation plan. Each section or area in the company should have an assigned combat lifesaver that can move through the area and provide additional medical treatment. The commander must realize that the combat lifesaver is likely to be the first medically trained individual on the scene who has the capability to stabilize and prolong the casualty's life.

NTC experience shows that logistics units not only fail to have sufficient combat lifesavers to support the company, they also typically fail to meet the standards for combat lifesaver bags outlined in the Combat Lifesaver Course, Edition Bravo. Combat lifesavers are combat multipliers. Units must train these soldiers. They must maintain their bags to standard and keep them handy at all times.

The ADC team begins working the movement of the casualty once the combat lifesaver finishes treatment. The ADC NCOIC must relay casualty numbers and locations to the company command post. This information is essential to ensure that the casualty collection point is properly resourced. The company's ADC team must understand it is responsible for directing and assisting with the transportation of casualties to the company's Casualty Collection Point (CCP).

The company commander must designate the location of the company CCP and resource it. The CCP is normally a static location. It is identified by the commander in order; e.g., vicinity of the company command post. This concept works when the unit has casualties equally distributed throughout the company area. But the commander must maintain the flexibility to move this point to another area of the company if the casualty situation changes.

The key to making this shift occur smoothly is communication between all elements.

1. Every soldier in the unit needs to know where the collection point is and rehearses moving to it prior to the event.

2. The commander must ensure that this rehearsal is conducted based on how the unit will actually transport the casualty to the medical company. Imagine walking the ground to the medical company at night as part of a four-soldier litter team carrying a casualty.

3. Identify soldiers who can carry a litter patient.

4. The commander must conduct this rehearsal both day and night, in Mission-Oriented Protective Posture (MOPP) IV, and carrying a simulated casualty.

Minimum requirements for a CCP are:

1. An NCOIC.
2. Communication with the company command post.
3. An evacuation vehicle with litters and a combat lifesaver.


1. Orchestrates the flow of casualties.
2. Collects and transmits the required casualty information to the company command post.
3. Must understand what data the commander requires.
4. Capability to call for additional assistance based on the number of casualties.

The commander:

1. Must designate a vehicle to transport casualties to the medical company.
2. Station this vehicle at the casualty collection point.
3. Ensure it is ready to roll; i.e., completely downloaded.
4. Ensure that the unit understands the lift capability of the designated casualty evacuation vehicle.

EXAMPLE: A 5-ton cargo can carry litter casualties.

The unit:

1. Must have litters on hand to ensure proper transportation of the casualties. May be stretchers or any makeshift device -- cots for example.

2. Identify required items ahead of time instead of foraging for them while casualties wait.

The combat lifesaver is the key to a successful company casualty collection point operation. An observation at the NTC shows that many noncritical casualties are transported to the medical company before their more seriously injured comrades. This action results with soldiers dying of their wounds while waiting for transportation, simply because the unit did not locate them first. This is why the combat lifesaver's role at the casualty collection point is to triage the casualties, prep, and prioritize them for movement to the medical company.

One technique is to evaluate casualties based on the following three categories:

  • urgent
  • priority
  • routine

The collection point NCOIC coordinates transport for the casualties based on the seriousness of their injuries.

Cut transportation requirements and time: Consolidate the routine casualties, normally minor injuries. Have them walk escorted by a combat lifesaver to the medical company. This combat lifesaver must be different from the NCOIC's.

All leaders must understand that taking care of the unit's casualties will help build unit morale and confidence in the chain of command. Our soldiers will do anything their leaders ask if they know that the unit will do everything in its power to help them in the event they become a casualty. However, if logisticians allow the trend of 53 percent died of wounds rates to continue, our soldiers will question the sincerity of leaders who talk about taking care of soldiers.

The commander must stress the requirement for continuous training and rehearsal of the unit's casualty evacuation plan. Logistics units must use their available resources to provide the best possible care for its casualties. Soldiers must know their responsibilities and what is required of them to make the commander's plan work.

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