DRILL: Treat and Evacuate Battlefield Casualties
by MAJ Bruce Shahbazz
"Treat and evacuate battlefield casualties" continues to be one of the most overlooked battle drills at the National Training Center (NTC). During the past three years, the NTC has seen the died of wounds (DOW) rate increase to over 50 percent. Why are more soldiers dying on the battlefield? They are dying because their units do not plan ahead for quick treatment and evacuation.
The most decisive action a unit can take to decrease the DOW rate is to develop a thorough plan to treat and evacuate casualties. This plan is an integral piece of the unit's Combat Health Support (CHS) plan. The process for developing the CHS plan should follow the familiar PLAN, PREPARE, EXECUTE cycle, and should be applied at each task force, company, and platoon level.
PLAN the CHS Plan:
Step 1. At a minimum, the CHS planner should gather the following information:
- Composition and location of supported force.
- Scheme of maneuver for the supported force.
- Size of enemy force and location or avenues of approach of the enemy forces.
- Locations of obstacles or terrain choke points.
- Template locations of chemical strikes.
- Size, composition, and capability of medical support.
- Locations and capabilities of supporting medical elements.
Step 2. Develop the casualty estimate. The composition and location of the supported force provide the first element in developing a plan. When the supported force scheme of maneuver is overlaid onto the enemy template, the CHS planner is able to develop a casualty estimate.
Step 3. Develop the workload estimate. The workload estimate is developed from the casualty estimate. The difference between the casualty estimate and the workload estimate is the application of time/distance factors to the casualty numbers to determine how long it will take to evacuate the casualties given a set number of evacuation vehicles. In other words, determine how many evacuation vehicles will be required to evacuate the estimated number of casualties in a set period of time.
Step 4. Build the CHS Plan. Now that the CHS planner has an estimate of how many casualties there will be, how many vehicles are required, and how long it will take to evacuate them, he can begin to build the CHS plan. The CHS plan should identify the locations for all medical evacuation and treatment assets for each phase of the battle.
PREPARE the CHS Plan.
Failure to conduct either of the following steps often results in mission failure.
Step 1. Rehearse the plan. Conducting rehearsals is one of two critical troop-leading activities that are done during the preparation phase. The other critical activity is conducting pre-combat checks, which is Step 2, below.
Step 2. Conduct pre-combat checks (PCCs). Every level of leadership should conduct a pre-combat check on the next lower level medical element.
EXECUTE the CHS Plan.
The key to ensuring successful execution of treating and evacuating battlefield casualties is to maintain situational awareness. Situational awareness means more than just knowing the location of subordinate units. Situational awareness encompasses knowing where units are (both friendly and enemy), what they are doing, and where they are going. Leaders at every level need to actively pursue the information that they require to maintain this level of awareness. Situational awareness allows the leadership of medical units to anticipate surges in casualties and respond with proactive medical support.
Step 1. Ensure that the medical planner participates in the planning and preparation processes of the unit that is being supported. When a medical planner, be it aid station platoon leader or platoon medic, is involved in combat planning and preparation, he is better prepared to support. With knowledge of what the combat unit plans to do and a thorough understanding of the commander's intent, the medical support unit can anticipate requirements rather than respond to events after they have occurred.
Step 2. Establish and maintain communications. Timely and accurate spot reports from subordinates helps "paint the picture" of what is occurring on the battlefield. The medical support must also be able to monitor the command and control radio net of the supported unit. By monitoring the command nets and receiving spot reports, the medical leadership will be able to modify its support plan as the tactical situation dictates.
Step 3. The final step in achieving situational awareness is battlefield presence. Medical leaders must be able to identify decisive points on the battlefield and provide appropriate overwatch. Sometimes this means the leader goes forward on the battlefield "to the sound of the guns." With a personal look at what is happening on the battlefield, the leader will gain the appropriate insight into what is required to provide seamless, uninterrupted support to the maneuver commander.
Medical support is a complicated, multifaceted activity that requires an in-depth understanding of capabilities and limitations of friendly and enemy forces, aggressive and tenacious planning and coordination with subordinate and superior units, and dedicated leadership. Israel's most decorated Armor Officer, General Avigdor Kahalani, stated in his book, A Warrior's Way: "Commanders on any level who devote less than full attention to their medical teams should not be surprised to find their casualties helpless just when they need help the most." American soldiers deserve the best medical care possible; we must ensure they get nothing less.
Movement Control in Echelons Above Brigade Support Operations
The Role of the CHS Officer in the Forward Support Battalion
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