SECTION VI
LEVEL
ONE COMBAT HEALTH SUPPORT (CHS)
FOR
THE LIGHT INFANTRY DELIBERATE ATTACKby
CPT Stephen D. Sobczak and SFC James Freshour, O/Cs, JRTC
Medical platoons that support light infantry battalions frequently experience major difficulties in supporting the deliberate attack at the JRTC at Fort Polk, LA. This article identifies the challenges that these medical platoons face while planning and executing CHS for the deliberate attack and explain, by example, tactics, techniques and procedures (TTPs) to help these units successfully accomplish their mission. This is not intended to serve as a "cookie-cutter" solution; rather, an azimuth to follow toward the Army Medical Department's primary mission to "Conserve the Fighting Strength."
A light infantry brigade is preparing to conduct a counterattack against an enemy Main Force Battalion and Assault Battalion. The Main Force Battalion is conducting limited combat operations against the remaining elements of the Republic of Pitkin Army to establish a liberated zone.
The light infantry brigade is currently conducting consolidation and reorganization in preparation for a deliberate attack. The scheme of the maneuver planned consists of an infiltration of two infantry battalions to destroy suspected enemy company strong points. The light infantry brigade is currently postured in a battalion assembly area conducting local security. The battalion staff is conducting the military decisionmaking process (MDMP) at the battalion tactical operations center (TOC). The medical platoon leader, battalion surgeon, physician's assistant (PA), and the medical platoon sergeant are discussing the warning order. The order indicates that the attack will occur this evening at 1900. The discussion includes the specified tasks, implied tasks, the constraints, and additional considerations. The medical platoon leader is now outfitted with the appropriate information to actively and intelligently participate in the MDMP with the battalion staff.
The medical platoon leader in a light infantry battalion is frequently the most junior, inexperienced officer on the battalion staff. These young officers frequently falter when conducting the mission analysis because they do not consult with other key leaders from the medical platoon or from the battalion staff. As a result, employment of the battalion aid station is often incidentally or without a solid doctrinal/tactical/medical basis. The medical platoon has a wealth of knowledge and experience from among the physician, PA, and the Non-Commissioned Officers. With this fact in mind, the platoon leader should consult with his "special staff" prior to going to the battalion MDMP and coming up with a slipshod plan.
Level One CHS planning and integration/synchronization and executing for the deliberate attack continues as a negative trend at the JRTC. Medical platoons often conduct CHS operations at the JRTC the way it always occurred in the past. Platoons do not have SOPs or battle drills to conduct CHS operations for deliberate attacks. These platoons often become mired in how to support this type of operation.
Current doctrine for supporting offensive operations is located in FM 8-10-4, FM 8-10-6, and FM 8-55. These publications provide general information, yet, much of the details and TTPs do not exist in written form.
The battalion's mission is to conduct a night deliberate attack on a fortified company strongpoint to destroy enemy forces and facilitate the forward passage of the 313th Separate Mechanized Brigade. The plan is for infantry companies to move from their battle positions to attack positions at 1800. The battalion has three infantry companies and a platoon of M-1 tanks attached. The scheme of maneuver entails two companies, Bravo Company and Charlie Company proceeding in column north on infiltration routes 200 meters apart. A gravel road is approximately 300 meters to the east of Charlie Company. The terrain on the infiltration lane does not permit wheeled vehicles to travel down these routes. Alpha Company is conducting an infiltration 600 meters to the West. This route is also untrafficable for wheeled vehicles. The battalion reserve consists of the platoon of tanks and is postured to deploy forward from their attack position as required. The scout platoon has identified obstacles along the gravel road which must be cleared prior to moving vehicles toward the objective.
The weather for tonight's mission indicates 10-percent illumination, a temperature high of 42 degrees and a low of 25 degrees. The terrain provides good aerial concealment for dismounted troops. Creek bed vegetation provides excellent direct cover and aerial/ground concealment. There is a small town with a population of 250 people in the area; however, intelligence indicates that only 15-20 civilians remain in the village and are neutral to the U.S. government.
Recent trends at the JRTC illustrate the fact that Level One CHS planning is not integrated or well developed for the deliberate attack. Plans have frequently included deploying treatment teams forward to maneuver with the company headquarters section. This is a good concept when terrain/mission dictates. However, to simply send a dismounted treatment team forward without the appropriate amount of Class VIII supplies, medical equipment, or a well-rehearsed, integrated CASEVAC plan, is not a sound TTP. Units forward deploy the physician and PA to decrease the died of wounds rate, which is laudable. Yet, several other key factors are not addressed. A forward deployed treatment team can only provide medical treatment commensurate with the tactical situation and medical supplies/equipment available. The medical planner must determine the most feasible CHS plan that provides far forward treatment, casualty acquisition, and rapid evacuation. Training medics to perform airway management skills, breathing management, bleeding control initiating IVs, applying bandages and splints and performing cardiopulmonary resuscitation is critical to the success of these types of missions on the modern battlefield.
Level One CHS includes providing immediate lifesaving measures, emergency medical treatment (EMT) and advanced trauma management (ATM) to stabilize the patient for evacuation to the level of medical treatment required. It also provides routine medical treatment to return the soldier to duty. Level One is not capable of performing surgery or patient holding. The battalion aid station consists of a treatment squad that can spilt into two treatment teams. The squad consists of the following individuals: Medical Officer, PA, one EMT NCOs 91B30, two medical sergeants 91B20, one medical specialist 91B10, and two drivers/RTOs 91B10.
The ability to provide continuous combat casualty care forward of the LD/LC is a considerable challenge. "The prehospital phase of caring for combat casualties is critically important, since up to 90 percent of combat deaths occur before the casualty ever reaches a medical treatment facility."1A casualty management protocol is important to develop and train for when considering operational deployments. In a recent article "Tactical Combat Casualty Care in Special Operations," the authors present three distinct phases which include the following: "1. Care under fire: care rendered by the medic at the scene of the injury while he and the casualty are still under effective hostile fire. Available medical equipment is limited to that carried by the medic in his aid bag. 2. Tactical field care: care rendered by the medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred on a mission but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by the medic and other personnel. 3. Combat casualty care evacuation: care rendered once the casualty has been picked up by an aircraft, vehicle, or boat.2The key to keeping soldiers alive is to provide treatment as far forward as the tactical situation permits and aggressively executing an effective evacuation plan. These phases offer a sound plan that medical platoons should strive to become proficient with and incorporate into their training program.
The battalion surgeon and the PA play a critical role in helping the medics achieve and sustain the standards identified in the protocols listed in Figure 1. To deploy a treatment team forward without proper supplies, equipment, and a responsive evacuation plan is not a combat multiplier. Physicians, PAs, and medics require certain tools and supplies to provide EMT and ATM. The Battalion Aid Station is outfitted to provide these supplies and equipment which are packed in medical chests. If treatment teams do not establish SOPs/battle drills and packing lists to conduct dismounted treatment teams, then casualties will die. The doctrinal method to determine the most feasible course of action for a deliberate attack is through the TDMP and CHS estimate.
A casualty management plan is important to develop as an SOP for medics performing lifesaving care forward of the battalion aid station. Medics must have the training to be confident in their procedures and skills to save lives on the battlefield. The following plan for conventional forces medical soldiers is modified from a plan in a recent article in Military Medicine, "Tactical Combat Casualty Care in Special Operations." This plan presented below is a generic sequence of steps designed as a starting point from which treatment teams may alter to fit their units unique mission. Phase One: Care Under Fire
Phase Two: Tactical Field Care
|
Figure
1. Protocols
The ensuing list of questions is provided as a guide which can easily become a checklist. Developing a planning checklist will assist the staffer when time is of the essence and lack of sleep is inevitable.
- Does the platoon have the experience/training to conduct a dismounted treatment team operation?
- Is the BAS at 100-percent strength?
- Does the platoon have an SOP battle drill for conducting dismounted treatment team operations? Has the platoon ever conducted this type of mission before?
- Do the infantry companies have all authorized combat medics? How many combat lifesavers do they have?
- Do the infantry companies have Skedco litters and/or poleless litters? Do they know how to make and use improvised litters?
- Do combat medics have all required Class VIII? Are Class VIII supplies cross-loaded among platoon members? Does the first sergeant have a resupply chest in his vehicle to get resupplied? How do combat lifesavers get resupplied?
- Does the medical platoon issue IVs to each individual soldier? Who maintains the starter sets?
- Do treatment teams have an established packing list for the minimal types of supplies and equipment required for the mission? Does the platoon have a plan to cross-load Class VIII supplies with supported unit and with attached litterbearers?
- Are medics trained to initiate IVs with night-vision devices?
- Are soldiers physically fit? Are litterbearers capable of moving casualties over extended distances?
- Can
each medic on the treatment team perform the following procedures? Is the equipment
available to perform the following procedures?
- nasopharyngeal airway
- endotracheal intubation
- laryngeal mask airway
- cricothyroidotomy
- needle thoracostomy
- apply tourniquet
- start an IV
- administer Morphine
- splint fractures
- administer antibiotics
- perform cardiopulmonary resuscitation
- apply bandages
- Do the infantry companies have aid/litter teams identified?
- Does the treatment team have FM communication or access to a radio?
- Does the unit have a sound air/ground evacuation plan? Is the plan coordinated with the FSMC/MEDEVAC unit? Are CASEVAC procedures rehearsed along with the maneuver rehearsal and at the Brigade CSS rehearsal?
- Does the battalion have a plan to clear a ground route for CASEVAC?
- Are landing zones/patient collecting points identified? Do the MEDEVAC helicopters have hoist capability?
- Is there a CHS plan for actions at the breach site?
- Is the Mech/Armor team M113 ambulance integrated into the CHS plan? Does the senior medic attend the Task Force rehearsal?
- Are additional litter bearers requested from the field trains/brigade support area?
- Are non-standard CASEVAC vehicles/aircraft on standby and identified? Do they have litters/communications capability?
- Are reinforcing treatment teams provided form the FSMC?
- Is there a plan to use ambulance exchange points (AXPs)? Is there any treatment capability at the AXP? Can a helicopter land at the AXP?
- Is the MEDEVAC communication net identified? Does the task force conduct a communications exercise?
- Is there a contingency plan to bring additional medical assets forward for MASCAL situations?
- Is CHS planned beyond the objective?
- Is there a plan for marking casualties during limited visibility operations? Is there a plan to leave personnel with the wounded to treat for shock? When do medics stop moving forward? Who receives this report?
- What is the triage system during limited visibility operations? Is this plan briefed to evacuation vehicle drivers?
The medical platoon leader should answer these questions for the mission analysis. Once the questions are answered, then develop courses of action to best support the mission. Medical platoons must have the opportunity to train this complex task at home station prior to deploying to a contingency mission.
Table
of Contents
Section
V: React to Armor While Dismounted Battle Drill
Section
VI: Level One CHS for the Light Infantry Deliberate Attack, Part 2
|
NEWSLETTER
|
| Join the GlobalSecurity.org mailing list |
|
|
|
