X-Ray
Operations in a
Forward
Support Medical Company
by
SPC David Maurer and CPT William CarterForward Support Medical Company
The 1stbattalion's fire support officer (FSO) was in obvious pain as the orthopedic surgeon from the forward surgical team (FST) examined his ankle. The FSO said to the surgeon, "Hey doc, at the battalion aid station they said it might not be broken, what do you say?" "I don't think it's broken, but I can't tell without a good x-ray," the surgeon replied. "My battalion is going on the attack tonight and I've got to be back," the FSO exclaimed. "If I send you back to the unit and the ankle is broken, you could make it a hell of a lot worse than it is now. We're going to evacuate you to the CHS [Combat Support Hospital]. They can take the x-rays there." "But the medics at the aid station said you guys could take the x-ray, and I would be back to duty in no time," said the FSO, who started to sound concerned. "Can't do it! The machine hasn't worked right since we got here. The x-ray tech is dead and there is no one here who really knows how to use the thing anyway," the surgeon told the FSO. "Great, #"*$!$%," were the last words heard from the FSO as he left the treatment tent for an awaiting ambulance.
Later that night, the 1stbattalion conducted their attack. A newly assigned lieutenant FSO from A Company replaced the battalion FSO when he was evacuated through the medical channels. He struggled to develop the fire support plan and received little if any assistance from the battalion staff. The new FSO underestimated the risk estimate distance. This resulted in two squads getting caught in the artillery fires near the objective causing the lead platoon with the engineer's sappers becoming combat ineffective. The initiation of fires occurred too early and fell short. The early artillery fires warned the enemy of the ensuing attack. The artillery barrage was ineffective. There was no battle damage to any of the obstacles or the objective. The objective was finally taken late that morning with a larger than expected number of casualties due to, according to the O/Cs, poor development and execution of the fire support plan. The real battalion FSO was released from the combat support hospital with a sprained ankle that night. He returned to duty after the fight was over.
DISCUSSION:
The motto of the Army Medical Department is to "Conserve the Fighting Strength." The goal of the medic on the ground is first and foremost to save lives, but also to return experience warfighters to the battle. The above scenario may overstate the burden of a failed attack solely on an inoperable piece of machinery, but there are numerous factors that contribute to the success or failure of an attack. Poor medical operations and care of equipment should not aggravate an already chaotic situation on the battlefield. The x-ray equipment does provide lifesaving and timely diagnose of an injury or wound. The x-ray machine in the forward support medical company (FSMC) is the closest machine to the front. Most medical personnel have seen the x-ray taken during the Vietnam war of the soldier with the grenade imbedded in his chest. The surgeons were able to remove the grenade quickly and safely due in part to good diagnostic x-rays. The ability to take good x-ray film is a critical factor in saving lives and returning essential warfighters quickly to the battle.
TECHNIQUES and PROCEDURES:
The techniques and procedures listed below should improve x-ray operations in any FSMC, Main Support Medical Company (MSMC), and Area Support Medical Company (ASMC).
1. Conduct Preventive Maintenance Checks and Services on the x-ray machine and processors at least once a quarter at home station. The x-ray technician must report deficiencies to the unit's bio-maintenance technician or the division medical supply officer (DMSO). The x-ray technician must perform a detailed pre-combat inspection prior to deployment and ensure the machine is properly calibrated. He should ensure all components found on the unit assemblage listing (UAL) are present, and check chemicals and films for expiration dates.
2. The x-ray technician must know preventive maintenance procedures, trouble shooting techniques, and how to use the equipment in an austere environment. Training techniques include:
3. The unit must have personnel who are cross-trained on the x-ray equipment to ensure continuity of medical support. Continuity is one of the six principles of Combat Health Support. Ideally, cross-training occurs between the unit's laboratory technician (MOS 91K10) and the x-ray technician.
4. When deploying to the field, the quartering party of the brigade support area (BSA) or the medical company must find a site to establish the x-ray tent that is hard, flat, and will not flood during a storm. Additional consideration in selecting a site for the x-ray tent includes the placement of the generator. The generator must be in close proximity to the tent to maximize the voltage received through electric cables. (Additionally, the unit should connect the dental compressor directly to the convenience outlet on the generator. This circuit is independent from the main source and will allow a more consistent flow of power to the x-ray machine.) FM 8-10-1, Medical Company, paragraph 3-3 and 3-4, and Handbook For Leaders, Doctrine Review Team, dated December 1996, from the Army Medical Department Center and School, contains more information concerning site selection and unit layout.
5. The x-ray technician should ensure the film processor (Curix 60 Processor, NSN 6525-01-345-6089) is level during the set-up to get good quality x-ray films. The level found inside the unit's carpentry sets will help in determining if the processor is level. The unit should have on hand a separate level just for the film processor. If a level is not available, there are other methods to check the processor to ensure it is level. Some methods include:
6. If possible, the unit should sign for or order the Kodak cassettes used in most garrison MTFs. On average, using the Kodak cassettes and film result in a superior radiograph at a reduced rate than other x-ray cassettes authorized in the Medical Equipment Set (MES) field x-ray.
7. Proper storage and management of the processing chemicals and film will increase the quality of x-ray films. Old chemicals will result in light x-ray films.
8. Processor chemicals used for over two days will lose their potency. This will result in underdeveloped film. Cleaning the processor and changing the chemical every third day will prevent crystallization of the chemicals in the processor and will ensure a higher quality of developed film.
9. Do not mix developer and fixer together. Mixing of the developer and the fixer chemicals will produce a hazardous material. Treatment and disposal of the material must be in accordance with laws and regulations from national and local agencies. Additional information concerning hazardous material is in annex G of FM 8-10-1, Medical Company.
10. The unit must practice sound safety precautions for operating x-ray equipment. The unit must block and, if the tactical situation allows, mark radiation hazard areas adjacent to the x-ray tent. The technical manual of the machine lists the appropriate safe distance, but a safe planning factor is to block an area fifty feet in a semi-circle in front of the x-ray machine. If the tactical situation and mission allow, the x-ray technician can sound a warning to let everyone in the area know the x-ray tech is about to take an x-ray.
11. The x-ray technician must have a dosimetry badge plus an account to get the badge read. A badge can be obtained through the post's radiation safety officer (RSO). The RSO will work at the hospital or the post's preventive medicine section. If no RSO is available, the company can establish an account with the Ionizing Radiation Dosimetry Center at Redstone Arsenal. The address is Ionizing Radiation Dosimetry Center, US Army TMDE Activity, ATTN: AMSAM-TMD-SR-D, Redstone Arsenal, Alabama 35898-5400. The number for the customer support clerk is 205-876-76345 or DSN: 746-7634.
12. The medical company should establish an annex in its company standing operating procedure (SOP) or, preferably, the treatment platoon's SOP. Topics covered in this annex should include: policies and procedures for operating x-ray equipment, radiation safety, radiation protection, equipment records, radiographic film storage and disposition, and maintenance procedures.
CONCLUSION:
The TTPs described should help improve x-ray operations in the forward support medical company or the area support medical company. The operator of this equipment must know the techniques involved in maintaining and operating the equipment in an austere environment in order to accomplish his medical unit's mission. The skills required to take a quality x-ray film are highly technical and require the soldier to think in abstract terms, but that same soldier must use common sense as well. Establishing an x-ray operation is not difficult, but represents an essential operation in making the medical unit responsive to the combat unit's needs. A soldier technician must have the expertise to survey the area, think about the specifics of his operation, select the best location for his x-ray tent, and plan for all factors that will have a direct effect on his operation. No other soldier in the brigade will have that kind of expertise. The x-ray machine may not make or break a brigade operation. As demonstrated in the opening vignette, if the x-ray equipment is functioning as required and being effectively used by the medical soldier technician, it becomes an integral part of the medical team. Properly employed, it has the potential to be a combat multiplier for any combat unit.
--Paul von Hindenburg, Out of My Life, 1920 |
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