The author presents a guide to help the medical platoon leader
through the military decisionmaking process.

The asymmetrical threat to U.S. forces is real. The medical platoon leader therefore must be involved in the planning process as early as possible so his resources contribute to conserving the fighting force. One trend I have observed during training exercises at the Joint Readiness Training Center (JRTC) at Fort Polk, Louisiana, is a lack of parallel planning and a failure to integrate the medical platoon leader in the MDMP with the battalion staff. This often is due to the fact that the medical platoon leader is a junior lieutenant in the battalion and does not understand his role as a planner and platoon leader.

If you are a medical platoon leader, you need to take certain steps to gain the confidence of the warfighters and become a player in the MDMP. As a special staff officer, you need to be aggressive and become an active participant in the MDMP. As a platoon leader, you need to follow troop-leading procedures, using your noncommissioned officers to prepare the platoon for operations while you are on the battalion staff conducting the MDMP. The chart on the right will help in the parallel planning process.

Mission Analysis

Once the battalion staff receives the brigade warning order, conduct your mission analysis. First, you must understand the commander’s intent and concept of operations. The intent will define the operation’s nature and give your medics the flexibility to make the right decision if the operation changes. Does the commander intend to win the hearts and minds of local civilians through peacekeeping operations, or does he want to seize or destroy using offensive operations? What are the commander’s medical rules of engagement for the treatment of civilians? What is the expected duration of the operation? Get clarification on the intent from the commander or the S–3. Start developing your combat health support (CHS) plan during mission analysis, starting with an analysis of the area of operations.

Terrain Analysis

While analyzing the brigade warning order, develop an understanding of the area of operations and its potential effect on the treatment and evacuation of casualties. Conduct a terrain analysis with the engineers and the S–2, using tools such as Terra Base—the engineer terrain analysis tool—and the modified combined obstacle overlay. To save time during the upcoming orders production phase, stay organized and put the grid coordinates on your CHS matrix as you conduct the terrain analysis.

Consider the infrastructure of the area of operations. For example, urban operations such as a cordon and search probably will result in trauma injuries caused by falling debris. Ask soldiers who already have operated in the area you are going into, such as your battalion scouts, about obstacles and mines, avenues of approach and mobility corridors, cover and concealment possibilities, observation and fields of fire, and key terrain. Use this information to determine where to locate your medical assets. Find out why a particular area is considered key terrain. Look at the routes and conduct a time-distance analysis to determine where you can put casualty collection points, ambulance exchange points, and helicopter landing zones. Look for any potential chokepoints that could delay casualty evacuation. Coordinate with the medical company to emplace ambulance exchange points.

To make sure your plan covers all contingencies, ask yourself the following questions while looking at the area of operations: What is my plan for getting casualties to a secured casualty collection point during urban combat? If my unit receives an urgent, priority, or routine casualty on a nonlinear battlefield, to which medical treatment facility will I evacuate the casualty? How will we treat and evacuate local national civilians injured during operations? What are the roles and responsibilities of every medic and security-party member during the operation?

Troop Requirements

The next step in mission analysis is to analyze the troop strength you will be supporting and to generate casualty estimates. Answer these questions: How many company teams will I be supporting, and will the task organization change by phase? What is the makeup of each company team? Am I supporting heavy mechanized forces, light forces, or a combination? How will we support far-forward elements, such as the scouts, that have no organic medical support? Where do I anticipate contact, and how many casualties will result from this contact?

The task organization of the maneuver forces will dictate how you organize your medical support. Heavy forces have fewer personnel than light forces, and they have armor protection. Light forces have double the personnel and no armor protection. You may have to provide area support for other members of your task force, such as engineer, field artillery, air defense, chemical, or signal units. Be prepared to brief the commander on your medical task organization based on the maneuver task organization.

Civilian Requirements

After estimating troop casualties, you need to determine what services you will be providing to civilians. You should work with the battalion S–1 to generate civilian estimates, including contractors, local civilians, and displaced civilians throughout the operation. First, ensure that you have a clear understanding of the surgeons’ medical rules of engagement in your area of operations. Next, get an estimate from the S–1 and the fire effects coordination cell of how many local nationals and civilians you will have to support. Analyze the population densities and the capabilities of local hospitals to get an idea of how many civilians you will have to treat in your area of operations. Answer these questions: Based on the population densities and the existing infrastructure, how many displaced civilians can I expect to have to treat? Will we be providing humanitarian assistance for local nationals? Will we be conducting medical civic action programs (MEDCAPs) for local nationals? (MEDCAPs require civil affairs assistance and nonstandard equipment and supplies for pediatric and geriatric medical care.) Do we anticipate a mass casualty situation? Do we have a response team to treat and evacuate both military and civilian casualties?

Medical Intelligence

Now that you have the military and civilian personnel requirements from the mission and the commander’s intent, refine the casualty estimates against the S–2’s intelligence preparation of the battlefield (IPB) and the brigade surgeon’s medical IPB. From the IPB, you should learn two things about the enemy: What is his most likely course of action (COA), and what type of weapons will he employ? Medics need to know likely enemy avenues of approach and weapon ranges to ensure that medical assets are positioned away from enemy threats. The type of weapons you expect the enemy to use will tell you the type of casualties that you will receive and the class VIII (medical materiel) that you will require. Next, ask what the medical threats to your forces are. Disease and nonbattle injuries often produce higher numbers of casualties than combat operations. Study the enemy COA to determine the most likely time and place that casualties will occur.

Organic Capabilities

Once you have determined the number of expected casualties, you need to estimate your expected shortfalls by comparing the anticipated casualties to your unit’s organic capabilities. As the platoon leader, you should always know the true status of your organic capabilities to support the casualty load. This includes the current and projected status of all personnel and equipment. Keep running estimates that can answer the following questions: Do all of the company teams have their assigned medics and equipment? Are any of the vehicles not mission capable because of maintenance deficiencies? Do I have 48 hours of class VIII on hand? Do I have enough organic capability to support the customer base? Do I need support from the forward support medical company to augment my shortfalls?
You have to know your own capabilities to support the fight. At the conclusion of your mission analysis, you will have to brief the commander. Be prepared to brief your requirements based on the IPB, your capabilities, and any help you will need with shortfalls.

COA Development

The next phase of the MDMP after mission analysis—COA development—is creating a COA that can be compared to the enemy and friendly situations during the COA analysis. Visualize a COA based on the commander’s guidance and on the most likely casualty-producing event, as determined by the IPB. For example, assume that the driver of a high-mobility, multipurpose, wheeled vehicle (HMMWV) is critically injured by a rocket-propelled grenade attack and becomes an urgent surgical casualty. Follow this casualty through the entire evacuation process and use your medical battlefield operating systems, including communications, command and control, treatment, evacuation, hospitalization, and logistics, to create an integrated plan to take care of him. Who will be the first responder? How will the first responder get the casualty to the casualty collection point? Will the first responder have a combat lifesaver bag on hand with the appropriate supplies to stabilize the casualty? Will the first responder have the means and ability to evacuate this casualty to a medical treatment facility? Which radio frequency will the first responder use? If only ground transportation is available, how exactly will the casualty be evacuated to the battalion aid station? Are your soldiers familiar with this route, and have they conducted a route reconnaissance? Will this plan work at night? The result of COA development will be a clearer understanding of the medical concept of operations to take into the COA analysis.
 
COA Analysis

The next MDMP phase, COA analysis, is performed as a war game. The war game is the critical point of the MDMP; it is where you will apply the casualty estimates that you developed during mission analysis and COA development to the enemy and friendly COAs. Make sure that the S–2 fights you hard and that you must deal with the worst casualty scenario possible. This is the “so what” portion of MDMP, during which you determine when and where casualties will be produced and under what conditions.

During the war game, the S–1 should brief casualty estimates and you should brief the medical concept of support for these estimates by phase. Speak up! The commander needs to know how many casualties you expect and how you plan to evacuate them. The expected result of the war game is knowledge of when and where patient densities will occur on the battlefield.

Time Considerations

The final phase of the planning process is orders production, which centers on developing the CHS casualty treatment and evacuation plan. Look at the critical time and distance factors when positioning your treatment teams. Start by considering the first 10 minutes after a casualty occurs, when bleeding from a severed artery can cause death. This short time period means that combat lifesavers must be nearby during all operations to stop bleeding and initiate the use of intravenous fluids. Next, consider the trauma specialist’s (medic’s) goal of getting the casualty to advanced trauma management within 30 minutes. Field Manual (FM) 4–02.4, Medical Platoon Leader’s Handbook—Tactics, Techniques, and Procedures, states that, for an ambulance to leave the battalion aid station and pick up a patient and return within 30 minutes, the aid station must be within 4 kilometers of the soldier’s point of injury.

Finally, consider how to get the stable urgent surgical casualty into the operating room within the “golden hour.” To provide stabilization and evacuation, you may need to split your treatment teams and send a forward treatment team to the main effort with the most anticipated urgent casualties.

Doctrinal Time and Distance Factors

FM 8–55, Planning for Health Service Support, offers some time and distance factors for using your treatment teams. In light operations in normal terrain, use a four-man litter to evacuate dismounted soldiers 900 meters and return in 1 hour. In mountainous terrain, this factor reduces to 350 meters for return in 1 hour. For heavy forces, position evacuation assets within 4 kilometers for return within 30 minutes. Remember, these factors are calculated under favorable conditions of terrain, weather, and light, and they do not include the time needed to load and unload the casualty.

CHS Matrix

Finally, ask the battalion S–4 to include a simple one-page CHS matrix in his concept of support plan. This matrix should be linked by phase and trigger to the maneuver plan and include command and control, landing zones, evacuation routes, casualty collection points, ambulance exchange points, decontamination points, communication frequencies, phase lines, and all brigade medical treatment facilities and air evacuation triggers from the point of injury to the aircraft launch point. FM 7–20, The Infantry Battalion, has a good example of a CHS matrix. Start filling in this matrix during COA development and complete it after the war game. Ensure that all grid coordinates from your graphics and overlays are included so the CHS matrix is a stand-alone document. This will enable first sergeants to have a one-page snapshot of the casualty evacuation plan to use at the combat service support rehearsal.

To build credibility with the warfighters, the medical platoon leader has to be an active participant throughout the MDMP. During mission analysis, you are looking at your patient requirements, the status of your capabilities, and forecasted shortfalls. The mission analysis will allow you to visualize a general medical COA to prepare you for the war game. The war game will tell you under what conditions, where, and when patient densities will occur. During the orders production phase, you will roll it all up into a simple, easy-to-read, one-page CHS summary for the commander.

Become a player on the combined arms team, and take every opportunity to participate in an MDMP. The more you participate, the better skilled you become. The plan the team generates should result in bold warfighter momentum and preservation of life on the battlefield. ALOG

Captain James D. Clay is a medical observer-controller at the Joint Readiness Training Center at Fort Polk, Louisiana. He has a B.S. degree in neuroscience from the University of Pittsburgh and an M.S. degree in engineering systems management from Texas A&M University. He is a graduate of the Combined Logistics Officers Advanced Course and the Combined Arms and Services Staff School.