CASEVAC AT THE TASK FORCE LEVEL
by SFC David G. PhillipsCasualty Evacuation (CASEVAC) planning and execution continues to challenge units at the Combat Maneuver Training Center (CMTC). Failure to plan and synchronize CASEVAC results in the inability to evacuate casualties from the point of injury to treatment facility in a timely manner and the improper position of treatment assets.
RESULT: Soldiers die of wounds. The average died of wounds (DOW) rate for a Task Force during a 10-day rotation ranges from 50 to 60 percent. A synchronized plan, thorough rehearsals at the CO/TM and Task Force levels during the preparation phase, and liberal use of nonstandard evacuation platforms and certified combat lifesavers in all platoons during execution are the keys to reducing DOW rates.
How do you reduce the died of wounds rate?
The DOW is an accepted fact for training exercises. If we train as we fight and equate those losses to real-world casualties, the number of casualties is unacceptable. Units frequently seem to get caught up in the MILES game. They know, for example, what the time span is for recovery of wounded personnel. Later they forget to place casualties in the medical evacuation system.
Every day at CMTC is a mass casualty day. All plans for medical support should reflect this grim reality. Yet, it seems as though the system always develops flaws in the planning phase. Consequently it is doomed to fail throughout the preparation and execution phases. For example, the S-4 often develops and briefs the CSS plan without any input from the Medical Platoon Leader. All too often, the Medical Platoon Leader is the junior officer in the CSS arena and is, therefore, overlooked as a valuable asset. Without input from the medical platoon, the S-4's plans often lack a strong far forward care plan that omits the scouts and ADA evacuation support. The result is reactive versus proactive medical support.
During the planning phase, the Medical Platoon Leader must brief the S4 on vehicle status, equipment and personnel. The S-4 can then include those assets in the plan to support forward elements. The S-4 is often unaware or unconcerned with this status and subsequently overlooks the possibility of effective use of multiple Advanced Trauma life Support teams. Under no circumstances should the S4 assume that he is aware of all the medical assets available to the Task Force.
During the preparation phase, the Medical Platoon should direct all medical assets to reconnoiter the routes to and from all primary and alternate sites. The breakdown usually occurs when the other evacuation assets, such as unit 1SGs, are not directed by the S4 to conduct route reconnaissance during CSS rehearsals. The S4 assumes that these assets and all other nonstandard evacuation assets know where to find the BAS. On many occasions, we have seen casualties picked up very early in the battle but they die while the evacuation crew tries to find out where the aid station has relocated. Better overlays and route reconnaissance by the Medical Platoon during the planning phase ease the transition to the preparation phase.
The S4 and the Medical Platoon Leader must have a strong commitment to communicate with each other. Effective communications between these two parties helps the entire task force develop a fluid evacuation plan from the front lines all the way to the rear. When these lines of communication are not available or only operate in one direction, neither party fully understands how to support their soldiers or the unit's mission.
The execution phase of any mission always shows the unit exactly where they had problems in the plan and preparation phases. Unfortunately, once the after-action reviews are completed, the lessons learned from the previous missions are too often ignored in planning or preparing the next mission.
The Medical Platoon Leader has very definite guidance on the planning, preparation and execution phases. No matter what the mission, he needs to assume a more aggressive stance with the S4 during the planning phase. This ensures that the S4 fully understands the capabilities of the medical assets and uses them to their fullest potential. If soldiers on the ground feel that they will receive the best medical care available promptly, they will perform without reservation to a higher standard.
Units training at CMTC usually react very quickly to casualties on the battlefield. What they fail to do is establish Casualty Collection Points (CCPs). The use of CCPs tremendously reduces the died of wounds rate for all urgent patients. Instead, unit 1SGs end up making "house calls." The 1SG goes from one vehicle to another throughout the battle collecting casualties until evacuation assets are full and then pushes them back to the Battalion Aid Station (BAS). For example, the load may consist of one urgent, one priority and two wounded in the first two vehicles. Only after the evacuation vehicles depart for the BAS do they realize they have left two critically injured patients in the next vehicle.
A firm understanding of a Casualty Collection Point is beneficial to all members of the organization. Combat Lifesavers and Medics can operate these points to ensure the most critical patients are evacuated first. Mission execution will be far more effective if all units better understand the roles that Combat Lifesavers should play in any unit casualty evacuation plan.
CASEVAC is a difficult process. It requires detailed planning at all levels of evacuation to integrate FSB medical assets. Once the Health Service Support (HSS) plan is finalized, it must be disseminated to the lowest level. Squad and crew must rehearse CASEVAC drills, reconnoiter evacuation routes, and evacuate casualties by priority. A synchronized plan, thorough rehearsals at the CO/TM and Task Force levels, liberal use of nonstandard evacuation platforms and certified Combat Life Savers in all platoons are key to reducing DOW rates and ultimately saving a soldier's life in combat.
Convoy
Management
Acknowledgements
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