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.
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
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?
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
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?
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
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.
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.
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.
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.
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
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.