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Military

CHAPTER IV

HEALTH SERVICES


The Role of the Combat Health Support Officer
in the Forward Support Battalion

by MAJ William E. Carter

EXECUTION PHASE

The new first lieutenant sits stone-faced for six hours in a meeting next to the forward support medical company (FSMC) commander. The briefing room, at the initial staging base (ISB), is crowded and hot. It seems as if the operation order (OPORD) meeting, his fourth for the day, goes on forever. This is his first JRTC experience and his first month anniversary as the combat health support officer (CHSO) in a forward support battalion(FSB). The lieutenant, straight from a medical platoon in a different brigade, is worried about his new responsibilities. Guidance from the battalion's Support Operation Officer (SPO) is to help the FSMC commander and keep the SPO informed on the development of the combat health support (CHS) plan for the brigade. The FSMC commander, also new to the position, tells him to stay close and to be prepared to write out the plan. This very broad and confusing guidance has the young lieutenant worried. He knows he can do more for the SPO and the FSMC commander than only attend meetings, but he is not sure what. He attended every possible meeting that an infantry brigade and an FSB can have at the ISB with the commander and surgeon: wargaming; course-of-action development; OPORD briefing; and military decisionmaking process (MDMP). None of the participants ever broke away from any of the meetings to begin the planning process to develop the CHS plan. He realizes that there is no formalized CHS plan, and little, if any, firm coordination has been made with the other key medical personnel within the brigade. There are no CHS products developed for dissemination to the warfighters. Tomorrow morning is the brigade rehearsal. It will be followed by the combat service support (CSS) and combat health support rehearsal with H-Hour tomorrow night at 2200. Just before the FSMC commander falls asleep, he tells the CHSO, "I hope to get the CHS plan out before the brigade rehearsal." The last thing the lieutenant sees before joining the FSMC commander in a well-needed cat nap is the medical O/C writing in his notebook.

DISCUSSION: The role of the health service support officer (HSSO) in the FSB, more commonly referred to in the field as the combat health support officer (CHSO), is that of staff officer assigned to the support operations section of the FSB Staff. Duties and responsibilities of the CHSO are clouded with mystery and confusion due to the lack of doctrinal guidance. For the SPO, for whom the CHSO works, doctrinal guidance is limited. The SPO usually based the duties and responsibilities of the CHSO on the battalion's current needs and the SPO's experience with CHS. The Support Operation Course does an exceptional job of introducing the non-AMEDD combat service support officers on combat health support operations but does not cover the duties and responsibilities of the CHSO. The only guidance found in a manual is in FM 63-20, Forward Support Battalion. It does not mention the CHSO, but it states that the support operations section provides input to the service support annex on medical evacuation and hospitalization with assistance from the brigade surgeon and medical company commander. The roles and responsibility of the CHSO or HSSO are not defined in the field manuals (FMs). The 8-series FMs (medical) provide limited guidance to the duties and responsibilities of the CHSO. If the unit is lucky, it can get a highly motivated lieutenant who is willing to define his own role and responsibilities in the support operations section. Most CHSOs are junior first lieutenants who have just completed a tour of duty as a medical platoon leader in an infantry battalion. These positions have also been filled by second lieutenants out of the basic course awaiting a platoon leader job somewhere within the brigade or division. The experience and maturity of the CHSO will depend on how much guidance and supervision the CHSO will need. The ability of the CHSO to perform his duties also will depend on the willingness of the SPO and the FSMC to allow that new lieutenant to take the ball and run with it.

RECOMMENDATION: The CHSO's primary duty is that of a staff officer who assists in the planning, coordination and synchronization of the CHS plan. The CHSO can be a valuable asset in developing and disseminating the CHS plan. The unit must develop a standing operating procedure (SOP) for the support operation section that outlines the duties of the CHSO in garrison and in the field. The FSMC commander, the brigade surgeon and the division medical operations center must understand the duties and responsibilities. The SOP must address in detail issues concerning whom and for what the CHSO is responsible during the planning phase of the operation. Ideally, during the planning development, the CHSO works for the SPO and indirectly for the FSMC commander. The CHSO can assist the FSMC commander, who is the main medical planner in the brigade in coordinating, disseminating and executing the CHS plan. Like all good staff officers, the CHSO must be an exceptional listener, communicator, and note taker. The CHSO should read and fully understand FM 101-5, Staff Organization and Operations, with heavy emphasis on chapters three, five, and six. He needs to have access and know how to use all communications and ADP equipment in the battalion tactical operation center (TOC) and maintain his own staff library of CHS and maneuver manuals.

During the development phase of the CHS plan, the CHSO should be responsible for the following:

  • Provide liaison between the battalion and the medical community at large, for example: Level III hospitals, the Forward Support MEDEVAC Team (FSMT) and the Division Medical Operations Center (DMOC).
  • Write, based on guidance from the FSMC commander, and disseminate the medical annex to the brigade order plus other associated CHS graphics and documents.
  • Coordinate with the DMOC or Division Medical Supply Officer for Class VIII, medical supplies.
  • Prepare a CHS matrix in coordination with the FSMC and brigade surgeon.
  • With the brigade S1, plan for and coordinate the CHS rehearsal. This would also include developing a rehearsal timeline. The CHSO should be the recorder at the brigade CHS rehearsal.
  • Keep the SPO, FSMC and the brigade surgeon informed on any meetings or significant events that could affect the CHS plan.
  • If present, coordinate with the Aeromedical Evacuation Liaison Team (AELT). This includes requesting DD Form 601, Patient Evacuation Manifest, and DD Form 602, Patient Evacuation Tag, from the team.
  • Develop, with the FSMC commander and the SPO, a CHS timeline using the back-planning method.
  • Pass on information to the brigade's medical community concerning CHS operation and significant events, i.e., new fragmentary orders (FRAGOs), changes to graphic, meetings and rehearsals.
  • Attend meetings for the FSMC commander. The CHSO must take informative notes and be aware of any issues affecting CHS operations.
  • Collect and consolidate the CHS plans from the units with organic medical assets. This will assist the FSMC commander in developing a brigade-level CHS plan that supports the elements within the brigade task force.

The following are additional activities in which the CHSO should be involved with the FSMC commander, the brigade surgeon and the SPO:

  • Scanning operation plans and orders for prudent information affecting CHS operations.
  • Developing, with the FSB S2 and the FSMC commander, a medical intelligence preparation of the battlefield (IPB) for the operation.
  • Working with the brigade surgeon in disseminating the Medical Threat Report to the brigade.
  • Ensuring the inclusion of the Armor team's medical assets in the CHS planning and operations.
  • With the brigade signal officer, coordinating for adding the Army standard 9-line medical evacuation (MEDEVAC) request in the brigade communication exercise (COMMEX). The 9-line MEDEVAC request is found in the signal operating instructions (SOI).
  • Arranging for the deployment of the preventive medicine (PVNTMED) section with the reverse osmosis water purification unit (ROWPU). (Pre-positioning the PVNTMED section with the ROWPU will decrease the amount of time it takes to issue water to the brigade.)
  • Coordinating for security for the ground ambulances assigned to the FSB.
  • Linking the FSB's medical assets with brigade units.
  • Ensuring that there is medical support and coverage for the ground convoy operations into the area of operations.
  • With the FSMT leader and the SPO, coordinating for Class III for the vehicles and air ambulances.
  • Planning medical support for units without organic medical assets.
  • Issuing litters to the Aviation battalion for nonstandard MEDEVAC helicopters.
  • Developing with the FSMT leader and the brigade S3 Air the method and means of requesting nonstandard MEDEVAC helicopters.
  • With the brigade signal officer and the FSMC commander, coordinating and developing a MEDEVAC communication plan.
  • Planning medical support for Civil Affairs (CA) operations, if required.

This list of duties and responsibilities of a CHSO is not all inclusive. These techniques and procedures serve as planning guidelines for the CHSO, SPO and the FSMC commander. Proper time management is important to properly use the CHSO. Delegation of the numerous tasks involved in developing and coordinating the CHS plan is essential. Time is the planner's worst enemy. Not properly using the time and assets available will only ensure failure.

EXECUTION PHASE

The CHSO has been sitting by the radio in the FSMC command post (CP) for over 12 hours mostly dealing with miscellaneous company and battalion business. He received four MEDEVAC requests. He is learning about FSMC operations, but has a feeling of being underutilized as a staff officer. He is starting to think of himself as one of the highest paid radio and telephone operators (RTOs) in the U.S. Army.

DISCUSSION: Once the FSB is established in the Brigade Support Area (BSA), the CHSO duties and responsibilities again become ambiguous. The duties of the CHSO ranged from RTO in the FSMC CP to assisting the battalion sergeant major (SGM) with perimeter defense and the quick reaction force. The CHSO is an integral part of the support operations section and should perform the duties as a member of that section.

TACTICS, TECHINIQUES AND PROCEDURES: Once in the field, the CHSO's place of duty is the battalion tactical operations center. As a member of the battalion staff, he can coordinate and work issues for the FSMC commander that affect the FSB's ability to provide medical support. This will allow the FSMC commander to be free to work company-level issues and plan for future CHS operations. The benefits of the CHSO at the battalion's tactical operation center (TOC) are many. The tasks that the CHSO should perform include:

  • Coordinating evacuation of casualties from casualty collection points (CCPs) and battalion aid stations (BASs) using nonstandard MEDEVAC platforms especially using LOGPACs or resupply helicopters.
  • Arranging the movement of patients using pre-planned LOGPACs and other types of resupply missions.
  • Orchestrating with the SPO for use of supply helicopters or "LOG BIRDS" from the rear area to evacuate patients to a Level III medical treatment facility (Combat Support Hospital or Field Hospital).
  • Communicating with the brigade S1 located in the adjoining administration/logistical operations center (ALOC). This direct interface will facilitate immediate access to information allowing the medical community to keep abreast of any upcoming brigade- or battalion-level operation plus improving personnel replacement operations.
  • Passing current information, weather and intelligence to the FSMC for dissemination. This information is used in planning future operations and ground evacuation missions.
  • Ensuring that pickup zone (PZ) and landing zone (LZ) operations do not hinder air MEDEVAC operations. (The ideal situation would be for the BSA to have two separate LZs, one for MEDEVAC operations and one for logistic operations.)
  • Updating the battalion's CSS/CHS execution matrix and the position of battalion medical assets on the battalion graphics.
  • Keeping the FSB commander and staff informed on issues concerning the brigade CHS plan.
  • Tracking the status of main supply routes (MSRs) and alternate supply routes (ASRs) and other routes used for evacuation of casualties and supplies.
  • Serving as a point of contact for mass casualty (MASCAL) operations with tenant BSA elements.
  • Coordinating for trucks for use during a MASCAL.
  • Assisting in coordinating patient decontamination operations when they require tenant BSA personnel.
  • Tracking patients out of the brigade area.
  • Forecasting and tracking critical Class VIII supplies throughout the brigade (for example: Ringer's Lactate, field dressing and blood).
  • Publishing and disseminating FRAGOs and updated graphics to the CHS plan.
  • Requesting and coordinating with the FSMT OIC or the brigade S3 air for a flyover by MEDEVAC or other Army aircraft of proposed MEDEVAC LZs.
  • Coordinating ambulance exchange points, if required.
  • Consolidating medical reports and analyzing them with the brigade surgeon for any significant medical trends that could affect combat operations to the brigade task force.

The CHSO is a valuable asset that is often underused as a staff officer. The CHSO can drastically improve CHS operations in the brigade by maximizing the use of nonstandard evacuation platforms, tracking patients, tracking Class VIII (medical supplies), and serving as a liaison within the brigade medical community at large. A well-used CHSO will allow the FSMC commander to run the medical company and give him the time and opportunity to develop the CHS plan for the next brigade operation.

"My war experience led me to believe that the staff must be the servants of the troops, and that a staff officer must serve his commander and the troops but himself be anonymous."
--Montgomery of Alamein, Memoirs, 1958
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