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Military

CHAPTER IV

HEALTH SERVICES

BATTLE 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.

EXAMPLE: During a movement to contact, the Lead Company team has been given the mission of identifying and fixing the location of the enemy forward security element. From the information gathered, the CHS planner knows that a force of 10-14 combat vehicles with 75-100 soldiers will come into contact with a force of about equal size. If 3-4 of those vehicles become combat losses, then there could be 8-12 casualties requiring evacuation. The casualty estimate in this example is 8-12.

Repeat this step for each phase of the operation, and also for any templated chemical strikes. By doing so, the CHS planner can develop an estimate of casualty numbers and locations through time on the battlefield.

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.

EXAMPLE (continued from the previous example): One M113 can carry four casualties. If it takes 30 minutes (including loading and unloading times) to travel to the Aid Station from the point of injury, then one M113 will take two to three hours to evacuate the 8-12 casualties. Using this logic, if the commander wants all the casualties evacuated in under one hour, then two to three M113s would be required to support the company team. The workload estimate in this example is two to three M113s.

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.

a. Time/distance factors are the most important considerations for selecting the location for evacuation and treatment assets. Page 5-5 of FM 8-10-4, The Medical Platoon Leader's Handbook, states, "To reduce ambulance turnaround time in providing Advanced Trauma Management (ATM) to patients within 30 minutes of wounding, the BAS may split and place its treatment teams as close to maneuvering companies as tactically feasible." Being able to get the wounded soldiers to the aid station within 30 minutes means the aid station must be positioned no more than 15-20 minutes from the forward line of own troops. The company medic and ambulance crew would then have 10-15 minutes to locate, provide treatment, and load the casualty. Use movement time, not distance, as the planning factor for the location of the aid station. Time factors take into consideration the effects of visibility, weather, trafficability (how many vehicles can move through an area at once), and navigability (how fast a vehicle can move over the terrain).

b. Terrain and obstacle choke points affect the amount of time it takes to transport casualties. Consider the impact a narrow passage would have on traffic flow when choosing locations for medical assets. If an entire task force must pass through a narrow mountain pass, the resulting congestion and one-way traffic flow will greatly impede an ambulance from returning through the pass with a wounded soldier. Similarly, it would be difficult (or impossible) for evacuation vehicles to make it back through a single breach lane in an enemy obstacle belt. This situation is analogous to a salmon swimming upstream, except M113s usually lose to M1 tanks.

c. Consider templated locations for chemical strikes and locations of high payoff targets when selecting aid station locations. If a persistent chemical agent has been templated on an obstacle or choke point, then the CHS planner should plan for near- and far-side medical and decontamination support. Occupying a position near a high payoff target that may be targeted by the enemy with either chemical or conventional weapons may result in that medical unit being caught up in the attack. It would not be wise, for example, to set up an aid station in an area that was formerly used as a firing position for a field artillery battery--the aid station could find itself receiving counter-battery fire.

d. The CHS plan should specify support relationships and triggers for movement of the different medical elements. Specific responsibilities for area support should also be detailed in the operations order (OPORD) CSS/CHS annex. If the "follow-on assume" company during a deliberate breach has responsibility for providing evacuation support for the mortar platoon during Phase I, that information should be included in both paragraph 4 of the OPORD and the CSS/CHS annex or overlay. When available, also include the locations and radio frequencies for higher level medical support in the CSS annex.

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.

a. Rehearsals are chronological, event-driven discussions (or practices) of each phase of the operation. They reinforce understanding of the plan by helping subordinates visualize the battlefield.

b. Rehearsals must be conducted at each level of leadership. It is as important for the platoon medic to understand what his infantry platoon is going to be doing as it is for the aid station soldiers to understand the battalion's plan. If possible, the medical personnel should attend the rehearsal of both the unit they are supporting and the rehearsal of the next higher level of command. This allows the medical personnel to understand what they need to do to support their unit and where their supporting medical unit will be located throughout each phase of the battle.

Step 2. Conduct pre-combat checks (PCCs). Every level of leadership should conduct a pre-combat check on the next lower level medical element.

a. Platoon medics should check the combat lifesaver bags to ensure that they have sufficient supplies. Company medics are responsible for checking each platoon medic for supplies, overlays, radio frequencies, etc. The aid station should conduct PCCs on its personnel, vehicles, NBC equipment, and medical equipment sets.

b. Frequently, the medical equipment sets (MESs) are overlooked during the PCCs. The MESs should be checked to ensure that all the required supplies are on hand and serviceable and that medications have not expired. Check that packing lists are up to date and readily available. Check that compressed gas cylinders are full and properly secured. Inspect litters and litter straps. Always remember that a casualty cannot be treated with a "due-out" requisition.

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.

CONCLUSION

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.

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