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Medical Evacuation: Clearing the Mechanized Battlefield

by CPT Steven Matson and SFC Betty Bennett

An analysis of CTC medical trends reveals a very common thread: the majority of died of wounds (DOWs) result from casualties who never make it into the evacuation system. That is to say, they are never cleared from the battlefield. Detailed planning and rehearsals start from the company's casualty collection point (CCP) and not the point of injury (POI). Non-standard evacuation assets are positioned at the battalion aid station (BAS) and the ambulance exchange point (AXP) where they usually sit idle because casualty evacuation (CASEVAC) from POI to the CCP has not been thoroughly planned, resourced, or rehearsed.

Reconnaissance Elements: One of the most difficult missions in combat health support (CHS) is the evacuation of scouts and combat observation and laser teams (COLTs). They operate far forward with unsecured evacuation routes and no organic medical support.

Successful evacuation requires integrated medical and tactical planning. Using scouts as the example, a typical CHS evacuation plan reads, "Company 'X' has area evacuation responsibility for the scouts." But what does that mean? It could mean anything from simply allowing the scouts to pass through the company's lines to sending a platoon-size element to facilitate the scout's withdrawal. The point is that very rarely are the parameters for the scout evacuation mission clearly defined and, therefore, very rarely rehearsed.

TECHNIQUE: One successful method is for the S3, medical, and scout platoon leaders to develop three contingency plans for scout evacuation based on the probability of enemy contact. The plans would be incorporated into the battalion TACSOP or playbook so that any company with the scout mission would support the scouts with minimal planning and maximum rehearsal time.

EXAMPLE of three effective contingencies:

1. When enemy contact is not likely or expected, send one ambulance, possibly with a C2 escort, to retrieve casualties resulting from accident or injury shortly after scout LD.

2. When contact is likely with dismounted enemy elements up to squad size, send one ambulance with a Bradley escort.

3. In the event scouts become compromised and face a significant threat, the ambulance accompanies a combat maneuver platoon to facilitate the extraction and evacuation of all scouts in the area.

NOTE: Medical planning for reconnaissance elements without the integration of tactical planners and executors has proven ineffective.

Maneuver Company: Planning for the evacuation of casualties from the maneuver platoons to the company CCP is the responsibility of the maneuver company XO; responsibility for execution of the evacuation lies with the First Sergeant. To remove injured soldiers from the battlefield, the 1SG uses the medic and mechanic tracks, as well as his own vehicle, as evacuation platforms. Unfortunately, all too often it is assumed that the 1SG's concern for the welfare of the troops is all that is needed to get soldiers from the POI to the CCP. First Sergeants do not receive sufficient evacuation assets or ample training time during STX lanes to rehearse and refine casualty evacuation. It is understandable that commanders do not want soldiers to lose valuable maneuver training time because they are in the evacuation system. But evacuation by the 1SG from POI to the CCP should be trained with each iteration. Evacuation to the BAS or AXP can be done more sparingly. Remember, most died of wounds occur because soldiers never make it into the evacuation system.

TECHNIQUES: The following techniques will improve company CASEVAC:

  • Weight the main effort with an additional medic team.
  • Augment the 1SG with additional trucks based on casualty estimates.
  • Train all personnel on extracting casualties from various vehicle compartments.
  • Combat Lifesaver certify those personnel the 1SG uses for CASEVAC.
  • Develop a vehicle marking system to quickly identify vehicles containing casualties.
  • Incorporate CASEVAC to the CCP into all STX lanes.
  • Try to designate easily identifiable terrain features or man-made objects close to the road as enroute CCPs during offensive operations.
  • In the defense, identify and rehearse the safest route possible from each position to the CCP.
  • In the defense, inspect weapons or serve chow at the CCP so soldiers can associate an event with the location.

Area Supported Units: These are units that are not organic to the maneuver battalion but still operate within the battalion sector. They receive support from the nearest medical unit (either the BAS or AXP), but are not supported directly with treatment or evacuation assets. Such units include field artillery, engineer, air defense artillery, and signal.

In most rotations a lack of situational awareness, both by the supported unit and the BAS or AXP, result in needless DOWs. The supported unit typically does not update its CSS graphics, nor do they verify the location of the nearest medical unit. BASs and AXPs do not keep abreast of units operating within their areas of responsibility. Two-way communications or route recons are not accomplished until casualties occur. As a result, during almost every rotation, artillery and engineer soldiers die within two to three kilometers of the BAS or brigade AXP.

TECHNIQUE: The cure is simple coordination and updated graphics.

Successful CASEVAC occurs when medical units plot and update the location of everyone operating in their area of responsibility. The supported units do the same with medical units on the battlefield. These units do not necessarily monitor each other's nets, but they do establish contact, exchange frequencies and call signs, conduct periodic radio checks, and update each other on current location and situation.

Conclusion: Effective casualty evacuation cannot be accomplished by merely assigning broad sweeping responsibilities in the Service Support paragraph of an OPORD. It must be the result of detailed and integrated planning between medical and tactical planners. It must be integrated into training and rehearsals. Above all, it must come from the desire and commitment of both medical and maneuver personnel to treat and evacuate casualties.

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