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Military

CHAPTER IV

HEALTH SERVICES

CASEVAC at Task Force Level

by SFC David G. Phillips

FACT: The average died-of-wounds (DOW) rate for a task force during a 10-day rotation at the Combat Maneuver Training Center (CMTC) is 50 to 60 percent.

Task force commanders would agree that to leave wounded soldiers lying on the battlefield to bleed to death would be a deplorable and grievous thing to do. Yet that is exactly what occurs during every rotation on the CMTC battlefield. If units are to "train as they fight," they need to get serious about reducing the DOW rate during their CMTC rotation.

CMTC observers/controllers (O/Cs) have reported the following problem trend:

PROBLEM TREND: Planning and executing casualty evacuation (CASEVAC) continues to be a challenge for units at the CMTC. The most frequently observed indicators of inadequate planning and poor synchronization are:

1. Casualties are not evacuated from the point of injury to the treatment facility in a timely manner.

2. Treatment assets are not properly positioned.

RESULT: Soldiers die of wounds before treatment arrives.

At a training center, a DOW rate of 50-60 percent is often accepted during the training exercises. But, if we equate those losses to real-world casualties, the number of casualties becomes unacceptable. Every day at CMTC is a mass casualty day. Therefore, all medical support should be planned accordingly. Yet the system too often becomes flawed in the planning phase and is, therefore, doomed to fail throughout the preparation and execution phases. This article provides some tactics, techniques and procedures (TTPs) for synchronizing task force medical assets during the planning, preparation and execution phases. The result of synchronization is a reduction of the DOW rate.

TTPs FOR REDUCING THE DOW RATE

Plan: Develop a synchronized plan.

Prepare: Conduct thorough rehearsals at the CO/TM and task force levels.

Execute:

  • Liberal use of nonstandard evacuation platforms.
  • Sufficient certified combat lifesavers in all platoons.

1. THE PLANNING PHASE.

Problem: The S4 often develops and briefs the CSS plan without input from the medical platoon. The S4 is often unaware or unconcerned with the status of medical platoon assets and subsequently overlooks the possibility of effectively using such assets as multiple treatment teams.

TTPs:

a. Although the medical platoon leader is often the junior officer in the CSS arena, do not overlook him as a valuable asset during the planning phase of any mission. As part of the planning phase, medical platoon leaders must brief the S4 on the status of their vehicles, equipment and personnel.

b. The S4 should include all medical assets in the CSS plan to ensure availability for deployment to support forward elements.

c. The S4's plans must include a strong far forward care plan based on input from the medical platoon. This should include evacuation support for scouts and ADA units.

2. THE PREPARATION PHASE.

Problem: The S4 often does not include evacuation route reconnaissance during CSS rehearsals. The S4 frequently assumes that evacuation crews and other nonstandard evacuation assets know where to find the battalion aid station (BAS). On many occasions, casualties have been picked up very early in the battle, but they die while the evacuation crew tries to find the aid station.

TTPs:

a. During the preparation phase, the medical platoon should direct all medical assets to reconnoiter the routes to and from both primary and alternate sites. Provide easy-to-read overlays and route reconaissance during the planning phase to ease the transition to the preparation phase.

b. The S4 and the medical platoon leader must maintain two-way lines of communication. Effective communications between these two parties forms the task force cornerstone for a fluid evacuation plan which covers all aspects of the operation from the front lines all the way to the rear.

3. THE EXECUTION PHASE.

Problem: The events in the execution phase of any mission usually highlight exactly where the unit experienced problems in planning and preparation. Unfortunately, the recommended corrections that are briefed in after-action reviews (AARs) are rarely included in the planning and preparation phases for the next mission.

TTPs:

a. Medical platoon leaders should assume a more assertive stance during the planning phase to make sure the S4 heeds recommendations in the AARs.

b. The S4 must fully understand the capabilities of available medical assets and learn how to use them to their fullest potential. If soldiers on the ground feel that they will receive the best, most responsive medical care available, they will perform to a higher standard without reservation.

Problem: Units training at CMTC usually react very quickly to casualties on the battlefield, but than have no methodology for evacuating the urgent casualties first. Instead, the unit 1SG makes "house calls," going from one vehicle to another collecting casualties until the unit's evacuation assets are full. The evacuation assets are then pushed back to the BAS with the injured. If the 1SG finds any critically injured soldiers after the evacuation assets have left, he has no way to treat them and must leave them there until the evacuation assets return from the BAS.

TTPs:

a. Establish casualty collection points (CCPs) to reduce the DOW rate for urgent patients. The use of a CCP during the execution phase would greatly improve the survival rate of critically injured soldiers. Combat lifesavers and medics operate CCPs to ensure the most critical patients are evacuated first.

b. Units should gain better understanding of the role of combat lifesavers in any unit CASEVAC plan.

SUMMARY

Medical evacuation (MEDEVAC) is a complex process that includes the integration of the FSB medical assets and requires detailed planning at all levels.

  • Thoroughly PLAN for MEDEVAC and disseminate the plan to the lowest level.
  • REHEARSE squad- and crew-level CASEVAC drills, remembering to reconnoiter all evacuation routes.
  • Prioritize your casualties for evacuation during execution.

In review, the keys to reducing DOW rates are:

1. A synchronized plan.
2. Thorough rehearsals at the CO/TM and task force levels during the preparation phase.
3. Liberal use of nonstandard evacuation platforms.
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