Medical Evacuation

Medical Evacuation: When played realistically, the problem of casualties becomes a war of movement in itself. .. by CW3 William L. Tozier ARTEPs in the 1st Armored Division (1AD) took on a new realism when full battlefield play with MILES gear transferred from the NTC to Hoehenfels, Germany. This became the first opportunity for many medical personneI in armored battalions to train in a complete medical evacuation situation. Each casualty the battle generated had to be evacuated to the battalion aid station (BAS) and “reconstituted before returning to the battle. By doctrine, the medical platoon of an armored battalion consists of one surgeon, one physician’s assistant, one Medical Service Corps (MSC) officer, one platoon sergeant, and 27 medics. The latest TOE authorizes one HMMMV, two M577s, two 2-112-ton trucks, and eight M113 armored personnel carriers (APC). For communication, the platoon is authorized 11 radios and 11 sccure speech devices (VINSON). Normal configuration teams up two medics with each APC, one as driver, and one as track commander (TC). Each line company receives one such team. The lour remaining APCs and medics remain at the BAS with the evacuation (Evac) sec-lion. Each APC has its own radio and VINSON. The BAS consists of the two M577s, two 2-112 tons, and a 114-ton in lieu of the HMMWV. The M577s can be used for either patient treatment or commmand and control centers, and the 2-112- tons can be used lor hauling either cargo or patients. The remaining medics support the BAS, its equipment, and missions. There are currently no surgeons and very few MSC officers in the battalion positions, so the physician’s assistant accomplishes the platoon leader and medical officer duties. The medical platoon sergeant (E7), the aid station NCO (EG), and the evacuation NCO (E6) lead the medical platoon. The BAS and Evac sections are normally colocated with the administrative and logistical operations center (ALOC) in the combat trains. Battalion-level evacuation of a casualty begins at the time and place ol injury and proceeds to the BAS. Normal casualty flow starts with a radio call on the company net to the assigned company medical team, although medics may see a damaged tank and move to evaluate. At this point, the medics triage the casualties, then treat and return as many to duty as possible. Other soldiers may also give initial treatment. 36 ARMOR - September-October 7988

Common skills training and other programs, such as buddy aid and combat casualty lifesaver, teach medical skills to non-medical personnel. After initial medical treatment, aid personnel arrange evacuation for those patients requiring further medical care. The evacuation is in stages, moving from the initial treatment area to an intermediate point, a patient collection point (PCP). This initial move is the responsibility of the company, which may use the medical APC, or any other vehicle, but an armored vehicle is preferred, because it provides better protection to the patient in the forward combat areas and greater mobility in rough terrain. Air evacuation is not a consideration at this point, due to the assumed lack of an air umbrella and aircraft vulnerability to surface-to-air missiles in the forward sections of the battlefield. Once the casualty arrives at the PCP, the Evac section moves forward to bring the casualty to the BAS. The Evac section may use one of the four APCs (each with four-litter capacity) and/or one of the two 2-1/2 tons (each with 12-litter capacity). Again, any vehicle returning from the PCP to the BAS may carry casualties. Communication may be either directly by radio with the BAS, or routed through the ALOC. No prior communication is needed if there is a vehicle at the various staging points ready to proceed. Standard Operation Procedures (SOPS) and operations/orders can help simplify casualty flow and make it almost automatic. To use empty vehicles returning to the rear eases the load of the Evac section. Unit SOP should alert all support platoon and maintenance personnel, as well as any vehicle drivers, to this need. Prior designation of PCPs, perhaps in conjunction with logistical resupply points (LRPs), allows for casualty transfer in the event of crippled radio communications. The requirement to evacuate and treat casualties during an exercise provided not only realism, but also an insight into our readiness and the adequacy of our evacuation sys-lem under the present TOE. Equipment and personnel shortages caused varying degrees of deviation from the standard plan of evacuation. These shortages reflected what could be expected in a real call-out. None of the battalion medical sections had an assigned surgeon. Only one medical section had an MSC officer. Most sections had only 20-22 medics. Only one platoon had both M577s, and fewer than half had both 2-1/2 ton trucks. APCs ranged from five to eight. Although all M577s and APCs had a radio, few had VINSONs. At the first level of medical care, initial treatment is critical to the survival rate of casualties. Casualties receiving serious wounds (not immediately causing death) must have stabilizing treatment, such as cleared airways, controlled bleeding, dressings, and fluid replacement (IVs) within a matter of minutes. Due to distance and terrain, the medics were rarely able to provide this immediate care on the battlefield. Periods of time ranged from 30 minutes to two hours before professional medical care was available. Once the casualty was identified and/or treated, evacuation became paramount. Any particular battle would usually generate far more than the four patients that can be carried in the medical APC. Many battalions looked to the medical APC as their sole means of evacuation. Others had anticipated or were quick to recognize that they had to use other means to carry casualties, such as partially disabled vehicles returning for repairs. A serious factor complicating the medical mission was the first sergeant’s use of the medical APC as his command and control vehicle. This limited the number of litters that could be carried, and caused a conflict in mission for the APC, as the 1SG attempted to accomplish his tasks. In all of these instances, medical care of the troops at the front lines was compromised. Almost all battalions used a PCP. Some were included in the operation order; others were organized as the battles flowed. In most cases, the PCP located with a maintenance collection point or LRP. Usually, these were identified by using reference points on tactical map overlays. The use of reference points as identification allowed for ease in communicating PCPs when no secure means of radio transmission was universally available. Organization of the PCPs varied drastically, and little or no organization was often evident. An NCO or I ARMOR - September-October 7988 37 I officer was rarely in charge to provide further direction in the evacuation chain. Medics were able to provide medical treatment, but evacuation from the PCP depended on the BAS'S knowledge of the situation and coordination of the evacuation. Lack of vehicles complicated evacuation to the BAS. Although most battalions had almost their full authorization of APCs, many of them had been reassigned to other sections. On the average, three of the medical APCs in all battalions had the red cross covered. The battalion commander or the company first sergeants used them as command and control vehicles, which left most Evac sections with only one APC and a 2-112 ton. The remaining 2-112 ton was usually uploadcd with the BAS'S equipmcnt and therefore was unavailable for casualty transport. In most battles, the

PCP

processed 50-llH) casualties, and reliance on non-medical vehicles became heavy. Transportation of casualties from the battle to the BAS averaged from 4-6 hours, with some taking two hours and some taking as long as 12 hours or more. The experience of this type exercise provided realistic training for armor battalion medical sections. It demonstrated that armor battalions in battle will generate large numbers of casualties requiring evacuation over fairly long distances to get definitive medical care. Recommendations for planning, given the existing strengths of equipment and personnel, should include the following: 0 Crewmembers must have more medical training and the decisive-Wthough most battalions had almost their full authorization of APCs, many of them had been reassigned to other sections. On the average, three of the medical APCs in a// battalions had the red cross covered. The battalion commander or the company first sergeants used them as command and control vehicles, which left most Evac sections with only one APC and a 2-7/2 ton." ness to use it. They cannot save their wounded companions by yelling, "Medic!" They are the ones who must establish the airway, control the bleeding, and start the IVs. It may be an hour or more before the casualty can receive medical care, and evacuation to the BAS may take the better part of a day, or more. Traumatic injuries must receive treatment in the first few minutes, if the casualty is to survive. Courses such as buddy aid and the Combat Casualty Lifesaver Course can provide the needed training, and small packets of dressings and 1V materials could easily fit into the "stuff spaces" in a tank. 0 Awareness of the use of nonmedical vehicles for evacuation must be stressed all the way down to the individual soldier. Battalion-level SOP must integrate the resources of the support and maintenance platoons to include loading casualties on returning vehicles. 0 Every leader must know the stages and routes for casualty movement. PCPs should be planned so that the system does not require radio coordination. The use of tacti- ~ tal overlays with reference points eliminates the dependence on secure radio communications. 0 Medical platoons must retain control of all their assigned APCs. The best vehicle for transporting a litter casualty is the medical APC; if medics do not have these vehicles, they cannot effectively meet evacuation demands. Assignment of other tasks compromises the mission of the medical APC, detracts from the scant medical resources available - and violates the Geneva Conventions. Exercises in which casualties must be evacuated provide realistic combat training that involves all elements of an armored battalion. Commanders are able to see how the large number of casualties generated by battles would cripple their mission. To provide must take an important role in future training. CW3 William L. Tozier is a graduate of the physician's associate program at Duke University, where he earned a Bachelor of Health Science degree, cum faude. He served in the 2d Sqn, 116th ACR, of the Idaho ARNG prior to coming on active duty in

1982. He was assigned to 1st Bn, 35th Armor at Erlangen, FRG, when he participated in IRONSTAR 86, the exercise that forms the basis for this story. 38 ARMOR - September-October 1988