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by CPT Dennis P. Lemaster, CMTC

Soldier's lives depend on a responsive evacuation system. To be successful, the combat health support (CHS) system must be consistent from point of injury to the final level of care required.

This article discusses:

1. Key synchronization functions the CHS planner must execute at the brigade combat team (BCT) level.

2. Key support tasks during the battle.

3. A rehearsal technique facilitating operational success.


A. The forward support medical company (FSMC) commander plans CHS for the Brigade Combat Team (BCT). His plan supports the BCT mission. A fluid treatment/evacuation system depends on a seamless exchange of casualties from Task Force (task force) evacuation assets to FSMC evacuation assets at the Battalion Aid Station (BAS).

B. Successful BCT CHS planners at CMTC conduct a face-to-face synchronization drill (SD) with the key CHS players. The SD meeting is different from a rehearsal. During the synchronization drill, the planners examine and resolve problems and exchange information. A rehearsal validates existing plans.

C. The FSMC commander assembles the medical platoon leaders, brigade surgeon, forward support MEDEVAC team (FSMT) leader, ambulance platoon leader, treatment platoon leader, and support operations medical NCO. They synchronize CHS support for the next mission and deconflict problems, including the following key issues:

(1) Ambulance Exchange Point (AXP) Location: Initial locations of the AXP(s) and how they move to support the task force. Additionally, the CHS planner discusses triggers displacing AXPs. Usually, units crossing a certain phase line constitutes a movement trigger.

(2) Ambulance Linkup: How, when, and where evacuation assets (be they M997s from the FSMC, main support medical company (MSMC), corps, or nonstandard evacuation platforms (NSEPs)) link up with supported BASs and FSMC, communications, and, command and the control mechanisms involved.

(3) Evacuation Routes: Discuss evacuation routes, both primary and alternate; dirty and clean. If evacuation routes change, how and when (triggers) will they change. Identify chokepoints, danger areas and security of the route.

(4) Reconstitution/Augmentation: Discuss reconstitution/augmentation of all assets in the Modular Medical System. Reduce time/distance factors by prepositioning additional treatment teams and evacuation platforms (including NSEP) at the AXP under the control of the ambulance platoon leader (APL). The APL pushes these assets forward according to the plan or tactical scenario.

(5) Priority of Support: Weight the main effort with additional CHS assets. Supported units must know what assets they will receive or what assets they will lose depending on the CHS plan.

(6) Use of Air Ambulance: Answer the question, "How do I call an air ambulance?" Dedicate and disseminate a MEDEVAC frequency throughout the BCT. The pilots must know current and future locations of AXPs and BASs. Augment evacuation capability with Aviation Brigade CH-47s. Discuss the aviation communication requirements with the Division Medical Operations Center (DMOC), specifically AM radio frequencies. The FSMC includes its AM radio in its pre-combat inspections (PCIs) before deployment.

(7) CL VIII Resupply: Determine method of resupply. Push or pull CL VIII. Medical platoons must enter a fight fully stocked with CL VIII since high intensity combat has higher consumption rates.

(8) Problem Solving: Wargame anticipated problems and solve actual problems impacting the CHS system. For example, a medical platoon may have four M113A3 ambulances non-mission capable (NMC) before an attack. The FSMC commander may be unaware of this NMC status until told by the platoon leader. A possible solution is to push FSMC M113A3s for evacuation forward of the BAS and use M997s to evacuate from BAS to AXP. Rehearsals, embedded in each function, verify time/distance factors and connectivity.

D. The Critical Link: Ambulance and Medical Platoons

(1) The most critical information exchange occurs between the ambulance and medical platoon leaders. If this exchange is weak, the evacuation system can stop at the BAS level. The success of further evacuation depends on the ambulance platoon leader (APL). The ambulance and medical platoon leaders must exchange at a minimum:

(a) Task Force Graphics/overlays (including obstacles, barriers and mines)

(b) CSS Graphics (objectives, key terrain, and bridges)

(c) Task Force scheme of maneuver (include air, ground, and division assets)

(d) FSMC scheme of support

(e) Execution and CSS matrices

(f) Frequencies (FSMC, task force, brigade, and MEDEVAC for appropriate time periods)

(2) The APL must know how the medical platoon supports the task force. Specifically, how (routes), when (triggers), and where the battalion and/or jump aid stations move. FM communications are essential for fluid operations. However, in the event of FM failure, they must address alternative means of communications including FSMC M113A3 crews, MSE, runners, and alternative nets.


A. After organizing BCT medical units and allocating assets, next comes execution of the CHS system during the battle. Battletracking is an essential task when managing support during combat operations. The FSMC commander, APL, and MPL battletrack during the operation.

B. Reporting to supporting units is critical. The quality of support a combat unit receives depends on the accuracy and timeliness of information passed to its supporting unit. Situational changes, such as use of chemical weapons, unit movement, or loss of assets, must be quickly reported to the supporting unit to secure the required immediate response.

C. Successful FSMC commanders at CMTC monitor the Brigade command frequency for the complete battlefield picture. The APL can either monitor this push or the supported task force command and the medical platoon frequency. Track key events, such as a vertical envelopment, as they occur during the battle, and respond to either improve the support posture or maintain survivability of CHS assets.

(1) Battletracking relates to four key support tasks during combat operations.

(a) Movement: CHS assets move by triggers. Battlefield events, such as a unit crossing a particular phase line, initiate movement. AXPs and BASs move to better support or displace if threatened by the enemy. CHS assets move to shorten time/distance factors according to the plan.

(b) Backhaul: This consists of evacuation of casualties rearward and hauling CL VIII to supported units by returning evacuation platforms. The CHS planner must anticipate backhaul requirements and adjust assets accordingly.

(c) Augmentation: Depending on the situation, a BAS may need augmenting (reinforcement) with additional treatment teams, evacuation assets, or individual medics. Preposition these assets at the AXP, making the APL responsible for their timely movement. Address routes, time/distance factors, and triggers at the rehearsal.

(d) Reconstitution: Assets lost entirely or partially during or after the battle may require reconstitution. The Modular Medical System supports this task. For example, push a treatment team forward if the BAS loses one.

(2) Battletracking is the common denominator in fulfilling the sustainment imperatives.

(a) CHS leaders must know the current the battlefield situation. They anticipate operational changes and posture assets accordingly. By staying current, the CHS plan remains integrated with BCT operations with no loss of continuity. When changes do occur, the CHS leaders must respond for uninterrupted support.

(b) Managing CHS assets may require improvisation if changes occur.


A. Rehearsals validate synchronized plans, ensure continuity of supporting plans, and verify the sustainability of the tactical plan within the maneuver commander's intent.

B. Like all other CSS activities, key players, such as the brigade S1 and S4, must participate for successful rehearsals. The CHS rehearsal constitutes a critical part of the CSS rehearsal. However, if no CSS rehearsal occurs, the CHS players must still conduct a "stand-alone" rehearsal.

(1) FRAMEWORK: The CHS rehearsal address those essential CHS tasks necessary BEFORE, DURING, and AFTER the brigade mission. It must address the WHO, WHAT, WHEN, WHERE, and WHY of support.

(a) Assist attendees in visualizing each phase of the operation.

(b) Orient personnel to terrain, friendly and threat forces, time and phase lines, and future operations.

(c) Consider contingency plans to support the decision template.


Before: The Forward Support Medical Company (FSMC) commander briefs the threat and latest intelligence data including artillery and aviation threats. He then transitions to a quick overview of the BCT mission including the critical decision points impacting support.

(1) The MPLs from each task force brief their initial Brigade Aid Station/Jump Aid Station (BAS/JAS) locations and assets currently available at each company/team.

(2) The APL briefs current location of AXP(s) and assets on hand, including non-standard evacuation platforms (NSEP). The FSMC CDR discusses assets on the battlefield, specifically treatment teams and assets from corps, the MSMC, current holding capability, location of Level III facilities, CL VIII on hand, and patient decontamination assets.

(3) Finally, the Forward Support MEDEVAC Team (FSMT) leader briefs aircraft availability, air corridors, and how to call for MEDEVAC. The brigade S-3 Air briefs additional A2C2 information, including additional information impacting on MEDEVAC operations such as Attack Helicopter escort requirements.

During: The transition to DURING is the Line of Departure (LD) time. The MPLs brief BAS/JAS movement, evacuation routes, and casualty collection points. Additionally, they discuss the triggers moving their assets.

(1) The APL briefs AXP(s) movement in support of the task force. The FSMC CDR discusses how he will move CHS assets during the battle. The FSMT leader briefs MEDEVAC operations during the battle.

(2) It is in the DURING phase of the rehearsal that the FSMC CDR analyzes contingency plans supporting the Decision Support Template.

After: The AFTER phase begins when, or after, the BCT accomplishes its objectives. This phase discusses the consolidation (reinforcement and/or reconstitution) of CHS assets. Also addressed is CL VIII resupply, blood, and replacement or repair of medical equipment. Finally, analyze integration of Corps and division assets, including DMOC interface into future operations.

(3) THE FINAL PRODUCT: The final product resulting from the CHS rehearsal is the CHS matrix which describes CHS support for the BCT mission. Ensure all CHS leaders, FSB SPO, brigade S1, and brigade S4 have the matrix.


A. Successful planning and execution of CHS require both synchronization and rehearsal. Key CHS leaders, SPO, and brigade S1 and S4 attend the synchronization drill and rehearsal. Absence of key leaders may result in a disjointed evacuation system.

B. The synchronization drill supports details examined and where CHS leaders resolve coordination problems. The rehearsal validates existing plans and adjusts for any last minute changes.

C. Soldier's lives depend on a reliable and consistent treatment and evacuation system. It is the responsibility of the CHS leaders to deliver this product to them.

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