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Combat Health Support Estimate
for the Defense

by CPT Stephen D. Sobczak, MS, and CPT John F. Grittman, IN
PVT Byron Whitmarsh of the 99th Division describes what it is like to be a medic in World War II:

There are worse things than being a rifleman in the infantry, not many, but being a medic is one of them. When the shelling and shooting gets heavy, it is never long until there is a call for - Medic! That's when your regular GIs can press themselves into the bottom of their hole and don't need to go out on a mission of mercy.1

This article provides an example and a format for conducting the Combat Health Support (CHS) estimate for battalion aid stations (BASs). The ability to provide comprehensive CHS during defensive operations requires extensive planning, coordination, and synchronization of the entire battalion staff. The staff estimate process is critical to the commander when he is in the decisionmaking cycle. When the plan is in place, the medics will pull through as they have in war after war. The medics can be counted on to accomplish their mission as they have in every war. The CHS estimate is the right place to start. This estimate is an essential element that guides the thoughts and actions of the leaders and planners in the military decisionmaking process (MDMP).

The planner must be a thinker, akin to the thinker described by Adam Smith in Wealth of Nations. A man without the proper use of the intellectual faculties of a man, is, if possible, more contemptible than even a coward and seems to be mutilated and deformed in still more essential part of the character of human nature.2The medical platoon leader has a challenging job that requires mental agility to forge a supportable combat health support plan to accomplish the mission and to give his soldiers direction on the battlefield. The platoon leader must constantly strive to improve the services his platoon provides.

Battalions defend for many reasons: to retain ground, to gain time, to deny the enemies access to an area or to defeat the enemy attack. However, defense entails more than just killing the enemy and destroying his equipment before he can move the resources on the battlefield...whatever its larger purpose, the immediate challenge of any defensive operation is to recapture the initiative and thus to create the opportunity to shift to the offensive.3

The medical platoon's mission of treating casualties and clearing the battlefield plays an important role in a task force's ability to recapture the initiative. The medical platoon leader must conduct a thorough CHS estimate of the situation to enhance his battalion's ability to recapture the initiative and to achieve mission success. FM 8-10-1, The Medical Company, provides a sample format for a CHS estimate. However, the listed format found in this FM requires the planner to provide more specific detail than required for an infantry battalion.

The following example of a CHS estimate for the defense will help the reader prepare future CHS estimates for defensive or offensive operations at the maneuver battalion level. The authors developed their CHS estimate using the estimate format contained in FM 8-10-1.

STAFF ESTIMATES

Each battalion staff member prepares his own staff estimates on his area of interest during the MDMP. The battalion S-1's personnel estimate is a critical step in the process. The portion that is critical to CHS planning is the predicted loss section. Procedures for predicting casualties are found in FM 101-10-1/2, Staff Officers' Field Manual Organizational, Technical, and Logistical Data Planning Factor (Volume 2), and the Commander's Battle Staff Handbook from the U.S Army Research Institute at Fort Benning, GA. The medical platoon leader is able to focus his assets more precisely when the S-1's personnel estimate is detailed. The S-1 must consider the S-2's prediction of the enemy's course of action and the friendly task organization, unit strength and personal readiness and scheme of maneuver. S-1s frequently do not conduct the personnel estimate at the Joint Readiness Training Center (JRTC). The S-1 and the medical platoon leader must work together to conduct the CHS estimate. Tables 1 to 3 below provide information on a hasty personnel estimate.

The S-1 must be able to address the following questions when preparing the casualty estimate:

  • Who will take casualties?

  • Where will casualties occur?

  • When will the casualties occur?

  • How will casualties occur? (What are the types of weapon system used by the enemy direct fire, indirect fire, chemical, and biological. How many disease non-battle injuries (DNBIs) will occur?)

  • What other critical events will occur on the battlefield during and after the battle that may affect movement of casualties? (Where are the forward area scatterable mines, and when will they be used? Where and when is the counterattack? Will we have close air support?)

Once the initial personnel estimate is completed, CHS planners can develop a plan for each proposed friendly course of action.

SAMPLE - COMBAT HEALTH SUPPORT ESTIMATE TEMPLATE

The medical planner must conduct a CHS estimate and develop a course of action for each proposed friendly maneuver course of action. Once the maneuver course of action (COA) is determined, then the CHS plan can be refined and issued in the battalion operations order. Changes to the plan are issued in a Fragmentation Order (FRAGO) based on improved situational awareness. The bottom line is this exercise is a continuous process.

These are the basic steps in developing a CHS estimate:

Step 1 - The planner must conduct a mission analysis.

Step 2 - The planner should determine if the proposed friendly maneuver course of action is supportable. A technique to determine this is the use of the COA support chart.

Step 3 - The medical planner then conducts a CHS course-of-action development for the chosen maneuver course of action. The planner must consider a minimum of two different CHS COAs.

Step 4 - The planner must next analyze the CHS course of action and then compare COAs.

Step 5 - Finally, the planner decides on a CHS COA that is best and publishes the CHS annex for the operations order.

The CHS estimate listed below includes headings and sub-headings listed in boldface type. The italicized text provides general information that the planner must consider for each heading and sub-heading. The estimate is based on a defensive scenario light infantry battalions may face at JRTC. However, a medical planner can apply this template to any situation, terrain, or environment.

CHS Estimate

References: Map, Series V785HQ, 2/54 INF
Republic of Bunkee
8 DEC 97

1. MISSION: (The statement of the unit mission comes from the mission analysis.) TF 2/54's medical platoon provides level I CHS to TF 2/54 during defensive operations in area of operations Bulldog not later than 091800DEC97 to conserve the strength of the battalion.

2. SITUATION AND CONSIDERATIONS: (This consists of facts, assumptions, and deductions that can affect the successful support of an operation.)

a. Enemy Situation: (Includes enemy's ability to interfere with the CHS mission, attitude toward the Geneva Conventions, ability to inflict casualties and types of weapon systems.) The Republic of Pitkin Army (RPA) has invaded the Island of Bunkee. The 4th Motorized Infantry Division will conduct an attack into our division sector with two regiments abreast and one behind. The enemy will be task-organized into mechanized/armor task forces. They will push dismounted infantry to destroy our forces over-watching obstacles. Objective will be to seize key crossing sites along avenues of approach and break through our defenses to seize Deridder.

The RPA forces are at 85-90-percent strength and have used chemical warfare in the past. We expect a motorized Infantry Battalion will conduct an attack into our area of operations in 48 hours. We expect the enemy to attack in a doctrinal formation with a main and supporting attack. The timeline for the attack is as follows:

H-48 hours (Time Now): Insurgents and stay-behind forces will continue to conduct reconnaissance, identifying and marking obstacles, and conducting harassing attacks on command and control (C2), as well as logistics nodes.

H-36 hours: A division reconnaissance consists of two to three BDRMs. Its purpose is to collect information on possible attack routes. It will avoid open areas and roads and attack soft targets.

H-12 hours: The regimental reconnaissance consists of six BDRMs. It will also collect information on possible attack routes. Dismounted infantry are positioned forward of the BDRMs. These teams will operate with two vehicles and will attack and destroy soft targets.

H-9 hours: The motorized battalion consists of 140-200 dismounted infantrymen. Its mission is to breach obstacles, attack defensive positions and seize key terrain.

H-8 hours: A chemical attack is expected using a non-persistent agent delivered by aircraft or artillery to support dismounted attacks. The enemy will most likely target friendly locations adjacent to the attacking unit's objective.

H-2 hours: An artillery preparation will target friendly positions and breach points.

H-1 hour: An air assault of an infantry platoon into our rear area will be aimed at the brigade C2center and the brigade support area (BSA).

H-30 minutes: A Combat Reconnaissance Patrol (CRP) of two mechanized platoons will follow each of the two major attack routes. They will breach obstacles, seize crossing sites, and destroy friendly forces to facilitate the movement of the main body.

H-hour: Main Body is a mechanized infantry battalion (minus). Its mission is to break through friendly defenses and proceed to secondary objectives.

H-hour: Supporting attack consist of a mechanized infantry battalion (plus). The battalion will be the deception force and move parallel to the main body. Its purpose is to draw friendly forces away from the main body.

H+15-20 Minutes: Follow-on forces consist of a tank battalion (minus) and the battalion will exploit the success of the main body.

1. Geneva Convention: (What is the enemy's attitude toward the Geneva Convention?) The RPA does not abide by the Geneva Convention. It will attack medical vehicles and medical facilities.

2. Combat Efficiency: (This section consists of enemy information on training, previous battles, degree of fatigue.) The enemy is currently operating at 85-90-percent strength. Projected operations will reduce the enemy's strength, but expect their morale to remain high.

3. Capabilities: (What is the enemy's conventional warfare capabilities and potential to use NBC weapons?) The enemy uses non-persistent agents on key crossing sites and logistics activities. The RPA will attack us with a battalion-size force. We can expect a main and supporting attack in our sector. The main body will reach our sector not earlier than 100300DEC97, with immediate and subsequent objectives in our rear area.

4. Enemy Prisoner of War (EPW) Casualty Estimate: (What is the anticipated forecast for the EPW population?) Fifteen EPW. (See FM 8-55, Planning for Health Service Support, pp 5-30.)

b. Friendly Forces: (In this section, the planner considers the tactical plan, task organization to include all attached, detached and units under operational control.)

Strength and Disposition: (This includes entire troop population and location.)

Battalion Mission: TF 2/54 defends in sector to prevent the enemy bypass of the brigade main effort (ME) TF 1/54 in the West. Companies defend in sector to retain crossing sites and to prevent the bypass of the brigade's main effort in the West. 1st/23d Attack Aviation Task Force will destroy enemy elements to deny the enemy from setting the conditions against the main effort. Scouts will screen forward in sector to provide early warning of motorized dismounted attack and mechanized infantry and armor attack and trigger indirect fires and attack helicopter fires.

1. Alpha Company: supporting effort, 95 soldiers.

2. Bravo Company: main effort, 102 soldiers.

3. Charlie Company: supporting effort, 78 soldiers.

4. Delta Company: supporting effort, 70 soldiers.

5. Lima Troop (Cavalry): supporting effort, 115 soldiers.

6. Battalion Tactical Operation Center (TOC): mortars, scouts, combat trains, 150 soldiers.

3. CHARACTERISTICS OF THE AREA OF OPERATIONS (AO):

a. Terrain. (Includes any special equipment required to conduct the mission; effect on medical evacuation.)

(1.) Observation and Fields of Fire: (The planner must examine the effects on the unit's location.) The AO consists of rolling plains with ridges and dense vegetation. This affects our ability to move our wheeled ambulances in and around the company's battle positions. The vegetation adversely affects ground evacuation in Alpha Company and Lima Troop.

(2.) Avenues of approach: (Where are the primary and alternate evacuation routes?) There are numerous trails, streams, and gullies in our AO. The extensive trail network is an advantage for ground evacuation assets if reconnaissance of these routes occur before execution.

(3.) Key Terrain: (From a CHS perspective, what key terrain is the availability of landing zones in close proximity of the battle positions.) Identified possible landing zones in our AO are PA12345, PA 126349, PA 132427, and PA 126349.

(4.) Obstacles: (Identify both existing and/or reinforcing obstacles in proximity of evacuation routes and patient lines of drift.) There are numerous creeks, ponds, marshes, and swampy areas are major obstacles to movement in our AO. Water depth can be an obstacle during rain. The battalion's obstacle plan will affect our use of evacuation routes to Charlie and Delta Company from H-30 minutes to H+ 3.5 hours.

(5.) Cover and concealment: (The planner should consider routes, possible unit locations, and engineer support available.) None.

(6.) Civilians: (The planning should include potential requirements for providing CHS to the civilian military operations. Additionally, the planner needs to consider the medical rules of engagement and pertinent cultural aspects of the country.) Expect 200-300 displaced civilians moving from south to north through the battalion defensive sector.

b. Medical Threat: (What types of casualties will the unit incur?)

(1.) Naturally occurring infectious diseases.

(2.) Environmental extremes.

(3.) Battle injuries.

(4.) Nuclear, biological, chemical injuries.

(5.) Flame and incendiary.

(6.) Combat stress.

c. Weather: (What is the effect on aeromedical and ground evacuation of casualties; care of the wounded in adverse weather conditions; effect on supplies and equipment.)

d. Battlefield Operating Systems (BOS) Considerations: (These functions help the commander build and sustain combat power. The planner must consider the BOS elements/effects before, during, and after the mission.)

(1.) Maneuver: (What is the scheme of maneuver? While remembering the medical tenets of proximity, continuity, flexibility, mobility and control.) The ambulances will require an evacuation lane through the minefield and will need to reconnoiter an alternate route. The evacuation rehearsal should focus on both day and night operations.

(2.) Fire Support: (What is the friendly fire support plans' effect on both ground and air evacuation operations?) The platoon completes all force protection positions NLT H-2 because we will be within range of the enemy's artillery. Additionally, the FASCAM (Family of Scatterable Mines) is on order and is in effect for four hours at grid PA 123567.

(3.) Air Defense: (What is the ADA coverage for ground routes and the enemy's ability to interrupt the mission with attack aviation?) The platoon must ensure passive air defense measures are to standards. The MEDEVAC helicopter will be escorted on evacuation missions.

(4.) Battle Command: (What command and control measures are required to influence mission success? The medical planner should involve the battalion signal officer to develop a CHS communications plan. Together they should anticipate possible communications problems and build flexibility into their plan with redundant means of communication.) Personnel will use the battalion's Administration/Logistic (A&L) net for all MEDEVAC requests. Soldiers will use, at a minimum, lines 1,2,3,and 5 from the MEDEVAC request found in the signal operating instructions (SOI). The alternate means for communication is via MSE (mobile subscriber equipment) in the combat trains. The battalion scouts will use the Operation and Intelligence (O&I) net to transmit their MEDEVAC request. The S-2 will monitor this net. The S-2 will forward the MEDEVAC request directly to the Medical Platoon Leader or the S-1.

(5.) Intelligence: (What information is gathered and analyzed on the environment of operations and the enemy?) The enemy attack timeline will determine the casualty estimate. The S-2's enemy template will determine medical support until a change is required to the overall concept of support. See enemy situation above.

(6.) Mobility and Survivability: (What are the natural and manmade obstacles, minefields and the impact they will have on the mission? What protection is required for friendly forces, i.e., bunkers and defile positions for vehicles?) The battalion's obstacle plan will delay the ground evacuation plan. We must ensure both the FSMC and the BAS ambulances know how to maneuver through the lanes. Engineer assets are not available for the medical platoon to dig in at the battalion aid station, but will dig in the treatment teams supporting the companies.

(7.) CSS: (What classes of supplies are needed, and what supply constraints may hinder the mission?) The class VIII push packages from the FSMC will bring our status up to a level that will support this defense. Currently, no medical supply constraints exist.

4. ASSUMPTIONS: (These are suppositions about the current or future situation that are assumed true in the absence of facts. These suppositions fill the gaps in what the commander and staff know about a situation.)

a. The battalion obstacle plan will interfere with the ground evacuation plan throughout the operation.

b. At H-12, C-Company (Medical), 221 FSB will be attached to a treatment team to the TF.

c. Evacuation will not occur during the main attack that will last approximately four hours.

d. The 69th Air Ambulance Detachment will conduct MEDEVAC operations during the consolidation and reorganization phase.

e. Treatment and evacuation assets forward with line companies will receive engineer survivability support assets.

f. The enemy will use non-persistent chemical agents before the artillery preparation.

5. CHS ANALYSIS:

a. Patient Estimates: Refer to FM 101-10-1/2 or above for format. Number of patients anticipated by unit:

Alpha Company: (supporting effort)19 casualties
Bravo Company: (main effort) 25 casualties
Charlie Company: (supporting effort) 16 casualties
Delta Company: (supporting effort) 14 casualties
Cavalry Troop: (supporting effort) 21 casualties
BN TOC, mortars, scouts, combat trains 10 casualties
Total
105 casualties

b. Assets available: (Consider both air/ground standard/nonstandard and Air Force assets.) Air Evacuation time of the flight from the battalion aid station (BAS) to the 82d Combat Support Hospital (CSH) is 14 minutes round trip.

c. Non-standard evacuation support assets available:

(1.) Three 5-ton cargo trucks positioned at the combat trains.

(2.) One CH-47 and two UH-60 will be on 20-minute recall during the main attack. Their radio NET ID is 526.

d. Distribution within the area of operation: (The dispersion of troops throughout the battlefield will affect patient densities, areas requiring augmentation, and projected patient workloads.)

(1.) Alpha Company.

* Ground evacuation time from company battle position to BAS is 25 minutes round trip (RT) during the day and 40 minutes RT at night.

* Helicopter landing zone at grid PA 123456 (200 meters north of the BP).

* Evacuation Route HONDA (primary).

(2.) Bravo Company.

* Ground evacuation time from company battle position to BAS is 20 minutes RT during the day, 35 minutes RT at night.

* No Helicopter landing zone near.

* Evacuation Route JETTA.

(3.) Charlie Company.

* Ground evacuation time from company battle position to BAS is 30 minutes RT during the day, 45 minutes RT at night.

* Helicopter landing zone at grid PA 126349.

* Evacuation Route VOLVO (primary).

(4.) Delta Company.

* Ground evacuation time from company battle position to BAS is 35 minutes RT during the day, 50 minutes RT at night

* Helicopter landing zone at grid PA 134247.

* Evacuation Route CAMARO (primary).

(5.) Cavalry Troop.

* Ground evacuation time from company battle position to BAS is 35 minutes RT during the day, 50 minutes RT at night

* Helicopter landing zone at grid PA 126349.

* Evacuation Route CAMARO (primary).

(6.) Bn TOC and Combat Trains (collocated).

* Ground evacuation time from combat trains to C-Co. (Medical), 221 FSB is 35 minutes RT during the day, 50 minutes RT at night.

* Helicopter landing zone at grid PA 112349.

* Evacuation Route CAMARO (primary).

(7.) Scouts.

* Ground evacuation time from Scouts will occur until h-12 hours is 55 minutes RT during the day, 70 minutes RT at night.

* Helicopter landing zone at grid PA 152349.

* Evacuation Route CAMARO (primary).

6. Courses-of-Action Development: (Based on the above considerations and analysis, the medical planner should determine and list all logical courses of action that will support the tactical plan.)

a. Course of Action One: The medical platoon will position one treatment team and two ambulances with both Bravo Company and Alpha Company to provide forward treatment and stabilization and evacuation at H-48 hours.

b. Course of Action Two: The medical platoon will position two ambulances forward with Alpha and Bravo Company to provide evacuation support at H-48 hours. The treatment squad will remain in combat trains ready to move forward after the main attack concludes.

7. Evaluation and Comparison of COAs: (The medical planner compares the probable outcome of each COA to determine which one offers the best chance of success.) Evaluation Criteria:

Evacuation: COA provides ground evacuation forward.

Command and control: facilitates command and control of assets forward on the battlefield.

Location: provides suitable location for CHS assets forward.

Risk: requires minimal risk to unit/personnel.

Class VIII re-supply: promotes ease of re-supply.

Treatment: provides Emergency Medical Treatment (EMT)/Advance Trauma Management (ATM) to casualties within one hour.

8. COA Selection: The best course of action to support this defensive mission after conducting the CHS Estimate is COA One which provides both treatment and evacuation assets forward with company battle positions.

CONCLUSION

The medical platoon leader plays a critical role in the staff planning process and in conserving the battalion's fighting strength. He must be an integral part of the staff and make the best plan with the time and assets available. An important tool for the planner is using the CHS estimate. As stated in CALL Newsletter No. 95-12, "the MDMP is a continuous process; it never really ends. Remember the original order was probably published with approximately 30-percent situational awareness with respect to enemy, terrain, and friendly situation."4With that fact in mind, consider how your battalion staff performs the decisionmaking process and determine if you can improve your input by using the CHS estimate during your next planning process.

____________

Endnotes:

1. Ambrose, Stephen E., Medic, American Heritage, Nov 1997, p.79.
2. Smith, Adam, Wealth of Nations, "Expense of the Sovereign," 1976.
3. FM 7-20, The Infantry Battalion, Chapter 4, p. 4-1.
4. CALL Newsletter No. 95-12 Update,May 97, Military Decision Making: "Abbreviated Planning."



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