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Medical Task Force Defense:
A Simple Primer


by LTC Richard L. Agee, O/C, EAD, JRTC


U.S. combat forces began their insertion at 1800. Their mission: defeat the Cortinian Liberation Front (CLF), defend the Leesville Industrial Complex against the Peoples' Republic of Atlantica, and assist in the restoration of peace. High casualty rates were expected as planners examined the historic data covering years of conflict in the area.

The medical task force called upon to support the division and care for the deluge of casualties planned well. All the requisite medical functions deployed ready to provide the best combat care available anywhere in the world. But the CLF are not signatories of the Geneva Convention and they see the medical task force as a soft, high payoff target that can be used to demoralize U.S. forces, disrupt operations, and break the will to fight of front-line soldiers.

Tables of organization and equipment (TOE) require medical units to defend themselves against a level one threat -- attack by up to a squad-size unit. But how does a medical task force best set a defense against such a force? The defense is particularly difficult when the attacker has the advantage of readily available technology such as night-vision devices and rifle scopes -- the typical corps-level medical task force has no night-vision devices, no scopes, no sensors, no cameras, or crew-served weapons. So how does a unit with 1960's combat technology defend against an enemy with superior equipment and combat training?

The following observations from 24 rotations at the Joint Readiness Training Center (JRTC) provide some tactics, techniques, and procedures that have proven successful for many. Commanders and leaders must remember, however, that every situation depends on mission, enemy, terrain, troops, and time available (METT-T) and the tactics, techniques, and procedures (TTP) implemented must consider all these factors as they plan and prepare for the defense.

Much of the defense of a facility is common sense. Unfortunately, common sense is often left at home as leaders plan their perimeter. For instance, medical task forces routinely place and construct fighting positions with fields of fire that extend less than 10 meters - well within hand grenade range of concealment for the opposing forces (OPFOR). Clear fields of fire for observation and early engagement of enemy forces just make sense, but are seldom seen.

Using a typical medical task force layout, let's consider some key aspects of a successful perimeter defense knowing the task force (TF) is facing a better-trained, and -equipped combat force bent on disrupting or destroying the medical support operations.

Command and control of the guard force and quick reaction force (QRF) must be clear with a clear chain of command. The task force commander normally delegates the responsibility to the hospital company commander for defense of the compound. No problem, as long as the company commander really has command and control of those forces. The soldiers detailed for guard, or QRF must understand for whom they work. They cannot be torn between multiple bosses and maintain effectiveness in force protection. It is okay to rotate guard duty so that there is equitable distribution of work, but the commander, sergeant of the guard, and leader at each level must have sufficient time to organize, train, and brief guards before they begin their duties. Then senior officers must let the guard force do its job. The middle of a firefight is not the time for the tactical operations center (TOC) to interrupt junior leaders trying to deal with life-and-death situations and ask for an update. Instead, train leaders to report significant information using size, activity, location, unit identification, time, and enemy (SALUTE) or standing operating procedure (SOP) formats, then trust them to do their jobs and ask for the right help at the right time.

Fighting positions seldom meet standards of FM 5-34, Engineer Field Data, or STP 21-1-SMCT, Soldier's Manual of Common Tasks. Overhead cover generally doesn't exist; soldiers do not have range cards or interlocking fires with adjacent positions, and are generally positioned on the outer perimeter with no stand-off space between themselves and the outer perimeter wire. Additionally, at JRTC, soldiers invariably sit in guard positions without any knowledge of what the enemy looks like until after the first engagements. Often they have no communication with a central command and control center. Seldom are they inside fighting positions because of poor construction that allows them to fill with water and the soldiers cannot see more than 30 feet in front of them anyway. Consequently, the first shots by the OPFOR result in kills opening significant portions of the perimeter to uncontested breach. A significant step toward improvement of these conditions can be brought about through leader involvement in teaching and enforcing common task standards. The Army assumes soldiers know common tasks - it consistently proves to be a bad assumption.

Common mistakes with guards themselves begin with basics. Fighting positions provide no protection if the soldier sits on top of it instead of inside it. Enemy cannot be spotted and engaged if guards are looking toward the inside of the perimeter to see what is going on instead of observing their assigned area outside the perimeter. This problem stems from guard mounts that extend several hours. Soldiers cannot remain alert and maintain effective search techniques when they have been in a foxhole for four or five hours - at night - without NVGs!

Poor to non-existent maintenance on individual weapons result in jammed weapons in the middle of engagements. Zeros must be for infantrymen, not medics since they are seldom performed.

Challenge and password use are sporadic at best. Situational awareness shows common sense was left at home as soldiers move about the compound paying no attention to gunfire, mortar rounds, or soldiers dressed in funny uniforms all around them.

A host of individual skills must be addressed at the soldier level for a successful defense. However, leaders plan the overall construction that will determine to a great extent the success of soldiers in their defense roles. Some simple steps may help the leadership focus properly and provide an adequate template for force protection of large facilities.

First, before deployment, before moving to the field for training, before checking the first container - sit in a well-lit room with a blank piece of paper and dream the best fortification possible for the task force. With unconstrained resources (personnel, equipment, and materiel) what type of perimeter would you build? How many rows of triple strand concertina? How big is a berm? What type of fighting positions? Where would they be in relation to the normal layout of the facility? What type of communications web would you have? Let your mind wander and dream of the best you could make using standard Army equipment and materials. FM 5-34, Engineer Field Data, Chapters 3 and 4, is a great place to start with its design of countermobility and survivability positions.

As you dream, think -- detect, delay, and destroy. These come from combat manuals, but when your facility is under attack, the most important focus is to keep your soldiers alive to do their service support job. You must think like a combat soldier at that point to be successful. Analyze your assets and determine their criticality. For instance, power constitutes the most important physical resource in a medical facility. You can work without an X-ray, you can perform surgery on a kitchen table, you can use save lives on the floor, but you can't do any of those things without lights or power! Once you prioritize the importance of equipment, protect it in that priority. If power is critical, it must not be placed 10 feet from the perimeter! Do the same analysis for personnel. Who are your most critical personnel? Remember they may not be your highest salaried or most highly educated (read that Doctors!). Whose loss would be a war stopper for the unit? What if the unit generator mechanic was missing? How important is your only respiratory therapist? Prioritize their protection as well. Your one-of-a-kind specialist that probably has no business in the guard force or QRF.

Now that you know what to protect in the order of priority, apply the detect, delay, and destroy philosophy. Detect - see the enemy before the enemy sees you. That is a tall order for a medical unit covering 20 acres of ground. The secret lies in making the enemy the target before the enemy makes you its target. The best marksman in the world cannot hit a target if he cannot see it. Design the facility in such a way that routine movement throughout the compound cannot be seen from outside the perimeter. Use MILVAN type of vehicles, and the arrangement of tents and equipment to mask the movement of individuals. That includes the movement of guards to their fighting positions. You don't need to advertise your shift changes to the OPFOR. Do not worry that the unit does not look dress right dress. The goal is not a story-book facility, but survival. If a sniper cannot see a person, he cannot kill the person! Make the enemy show himself, not vice versa.

Next, devise ways to see the enemy before he gets within range. Early warning devices placed properly (noisemakers, poppers, and flares) to get the attention of the guard force as an enemy approaches is critical to success, particularly in the dead spaces around the compound. Night-vision devices help in low illumination. Lights are an equalizer especially if the enemy has night-vision goggles and you do not. However, guards must be extremely well trained if exterior lights are used since the human tendency is to look toward the light instead of toward the shadows. The shadows befriend the OPFOR. Motion detectors fixed with lights and/or sirens work very well. Remote cameras may also aid early detection.

The next step in defense of the perimeter is delay. One cardinal rule that can never be forgotten, however, "An obstacle not observed is only a nuisance." The only chance of keeping the enemy from coming inside the perimeter is to make the price high enough that they will not attempt it. Routinely, medical task forces place a 360o triple strand concertina barrier with yards of unobserved areas and unsupported fighting positions as their only protection. Experience shows a four-man OPFOR team can cross that triple strand in less than 30 seconds! So what is the answer? At a minimum, a second barrier of triple strand concertina 20 - 30 meters inside the first with clear land between them. Tangle foot or loose concertina between the barriers is even more effective. A moat with snakes and alligators is even better! The point is, make it hard. Give the guards a chance to get a sight picture on the enemy before they are loose on the inside of the compound. Slow the OPFOR down enough to make their detection probable. And do not depend on terrain to do the job for you. Although, medics may be averse to low crawling in the mud, an enemy that wants to kill you will not mind it at all. Continually create challenges that will require time for breaching. Effort up front in the establishment of the perimeter will buy precious seconds (maybe minutes) for the guard force to detect the enemy so he can then be destroyed.

Next, the intruder must be destroyed before he gets in. Two things that always work but are seldom executed at JRTC. These work whether you are talking about lasers or lead. Marksmanship, including a good zero, is at the top of the list. Soldiers do not fire enough to be proficient with individual weapons. Zero every shift. Know where your round will hit when you pull the trigger. If you have trouble across the board, find the unit hunters! They use weapons often and if they bring game home, they know how to shoot. Use them to train others. Get to ranges as often as possible. Familiarization once a year is just not enough to effectively engage targets. Second, mass fires. Even if all the guards are bad shots, five or six rifles firing at the same person at the same time will mean the OPFOR is going down! Even the world-class OPFOR at JRTC cannot go through a wall of lead. Of course at JRTC there are a couple of other pointers that may help like making sure the laser on the weapon is on, changing the battery occasionally, and keeping the laser lens clean.

Some final thoughts when dreaming about your perimeter defense. Keep the open ground on the enemy's side. Make him cross the open ground, not you. If necessary, compact the sleep areas, motor pools, and other facilities to ensure there is space between the enemy's concealment and your fighting positions. Minimize the distance guards must be exposed to get to their positions. Prioritize assets in terms of criticality for the mission, then protect them in that order. Keep in mind - detect, delay, destroy. Remember, if the target is difficult enough, and the price for its attack high enough, a desperate enemy is more likely to leave it alone. Are the OPFOR better equipped and better trained for combat than the medical task force? Absolutely! Does that mean we must die in place? Absolutely not! We can protect ourselves by applying common sense and soldier standards. The kill ratio does not have to be 27:1 in their favor.


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