LESSON 1Combat Health Support in the Theater of Operations

LESSON ASSIGNMENT

LESSON 1Combat Health Support in the Theater of Operations.

LESSON ASSIGNMENTParagraphs 1-1--1-16.

LESSON OBJECTIVESAfter completing this lesson, you should be able to:

1-1.Identify the role of the U.S. Army Medical Department.

1-2.Identify the levels of combat health support.

1-3.Identify the tenets, goals, and principles of the combat health support system.

1-4.Identify the elements of the medical threat.

1-5.Identify the medical threat associated with war, conflict, and peacetime.

1-6.Identify the threats to combat health support associated with war, conflict, and peacetime.

1-7.Identify the medical capabilities of the combat health system.

LESSON 1

COMBAT HEALTH SUPPORT IN THE THEATER OF OPERATIONS

1-1.DOCTRINE OF COMBAT HEALTH SUPPORT

a.Keystone Doctrine. The Army's doctrine, the authoritative guide as to how Army forces fight wars and conduct stability and support operations (SASO), lies at the heart of its professional competence. Field Manual (FM) 100-5, Operations--the Army's keystone doctrine, describes Army thinking about the conduct of operations. In addition, FM 8-10, Health Service Support in a Theater of Operations, and FM 8-55, Planning for Health Care Service Support, describe Army thinking about providing CHS to the combat forces.

b.Flexible Combat Health Support System to Support Diversity of Operations. The above-named manuals focus on how to win wars. Since wars are fought for strategic purposes, the doctrine addresses the strategic context of the application of force. The dynamics of our global responsibilities requires a combat health support (CHS) system that is flexible enough to support the diversity of operations (see Figure 1-1).

[Note: Aid Sta = battalion aid station; Tmt/Clr Sta = division treatment/clearing station; CSH = combat support hospital; FST = forward surgical team; FIELD = field hospital; GEN= general hospital; MEDDAC = Medical Department Activity (hospital); MEDCEN = medical center (hospital). COMMZ = Communications Zone, now referred to as Echelons Above Corps (EAC)]

Figure 1-1. Levels of combat health support.

1-2.THE ROLE OF THE UNITED STATES ARMY MEDICAL DEPARTMENT

a.The United States Army Medical Department (AMEDD) plays a key role in developing and maintaining combat power. Its mission is to maintain the health of the Army. By maintaining the health of the Army, the AMEDD helps to conserve the Army's fighting strength.

b.Commanders need to retain experienced and seasoned personnel to perform their particular operational mission. If injured soldiers can be treated and returned to duty as far forward as possible, the load on the replacement system is diminished and the requirements for patient evacuation are decreased. On the other hand, the accumulation of patients within any combat unit restricts the unit's movements. A perceived lack of CHS may also reduce a soldier's willingness to take necessary risks.

1-3.STABILITY AND SUPPORT OPERATIONS

The range of operations includes war, conflict, and peacetime activities (see Figure 1-2).

a.Peacetime. The United States classifies its activities during peacetime and conflict as stability and support operations (SASO). Although the Army's prime focus is war, its frequent role in SASO is critical. During peacetime, the United States attempts to influence world events through actions that routinely occur between nations below the threshold of conflict.

b.Conflict. Hostile forces may seek to provoke a crisis or otherwise defeat our purpose by creating a conflict. When diplomatic influence alone fails to resolve a potential conflict, persuasion may be required. The physical presence of the military, coupled with its potential use, can serve as a deterrent and facilitate the achievement of strategic objectives. Should this deterrence fail, the United States may use force to compel compliance, thus entering a more intense environment in order to resolve the conflict and pursue its ultimate aims. Conflict is often protracted, confined to a restricted geographic area, and constrained in weaponry and level of violence. The goal in conflict is to deter war and resolve the conflict.

c.War. War is the sustained use of armed force between nations or organized groups within a nation. It may involve regular and irregular forces in a series of connected battles and campaigns to achieve vital national objectives. War may be limited with some self-imposed restraints on resources or objectives, such as in Operation Desert Storm in 1990. This was an armed conflict short of general war. A war may also be general, as in World War I and World War II, with the total resources of a nation or nations employed and the national survival of the belligerents at stake.

STATES OF
THE
ENVIRONMENT / GOAL / MILITARY
OPERATIONS / EXAMPLES
WARTIME / Fight
and
Win / WAR /  Large-scale combat
operations.
 Attack.
 Defense.
CONFLICT
(RESOLUTION) / Deter
War
and
Resolve
Conflict / SASO /  Strikes & raids.
 Peace
enforcement.
 Support to
insurgency.
 Anti-terrorism.
 Peacekeeping.
 NEO.
PEACETIME / Promote
Peace / SASO /  Counterdrug.
 Disaster relief.
 Civil support.
 Peace building.
 Nation assistance.
The three states of the environment listed above (war, conflict, and peacetime) could well co-exist at the same time in a given theater commander's strategic environment.
The commander can respond to requirements with a wide range of military operations.
Noncombatant operations might occur during war, just as some SASO might require combat.

Figure 1-2. The range of military operations in the theater strategic environment.

1-4.THE TENETS OF ARMY OPERATIONS

The Army's success on and off the battlefield depends, in part, on its ability to operate IAW five basic tenets of Army operations. It also entails the successful integration of these tenets with CHS goals and principles. To enhance the maneuver commander's chances of success, medical commanders must apply the tenets of Army operations in executing their mission. All training and leadership doctrine and all combat, combat support, and combat health support doctrine derived directly from these fundamental tenets. Tenets of Army operations are initiative, depth, agility, synchronization, and versatility. The Army believes that its five basic tenets are essential to victory, though in and of themselves the tenets do not guarantee victory.

a.Initiative. The first tenet of Army operation is initiative. The tactical operation must not be affected by a lapse in CHS. To prevent any lapse, CHS units must move rapidly to provide the continuity of care needed to protect and sustain the force, thus preserving the initiative. Leaders must anticipate events on the battlefield so that they and their units can act and react faster than the enemy. Combat health support commanders must take the initiative to place medical support in harmony with the movement of the units and casualty projections.

b.Depth. Depth, the second tenet, is the extension of operations in terms of time, space, resources, and purpose. Most importantly, it means the ability to gain information and to influence operations throughout the depth of the battlefield in conjunction with other services. From the CHS perspective, commanders and staffs must understand the maneuver commander's plan. They must be able to visualize the battlefield in depth and breadth.

c. Agility. Agility, the third tenet, is the ability to rapidly adjust to changes in the tactical situation. Agility is a prerequisite for seizing and holding the initiative. It is as much a mental as a physical quality. Combat health support must be capable of rapid adjustment to changes in the tactical situation. Success in sustaining the force depends on a well-developed and responsive CHS system. The medical commander must retain the ability to shift medical resources to provide CHS to areas of large patient concentration or density. Responsive CHS is important to the individual soldier's morale and hastens an early return to duty (RTD).

d. Synchronization. Synchronization, the fourth tenet, means effectively arranging and integrating activities in time and space for a common end. For example, the evacuation of patients requires synchronizing movement with logistical support, air support, and the availability of beds. With unity of purpose throughout the force, every resource is more likely to be used where and when it will make the greatest contribution to success. Ideally, with proper synchronization, nothing is wasted or overlooked. The hallmark of good CHS is creativity. Combat health support commanders must seek innovative solutions to CHS challenges. Every action must flow from an understanding of the higher commander's concept of the operation. The CHS requirements must be integrated into operational planning to increase the capability of medical units at all echelons to provide effective support. Ultimately, the product of effective synchronization is maximum use of every resource to make the greatest contribution to success. It requires judgment in choosing among simultaneous and sequential activities. Good synchronization requires a clear statement of the commander's intent.

e. Versatility. Versatility, the fifth tenet, was added as a result of the proliferation of SASO in recent years. Versatility means the ability of units to meet diverse mission requirements. (It may not be in your job description of duties assigned, but it has to get done.) Commanders must be able to shift focus, tailor forces, and move from one role or mission to another rapidly and efficiently. Versatility implies a capacity to be multifunctional, to operate across the full range of military operations, and to perform at the tactical, operational, and strategic levels. Combat health support forces must be able to move rapidly from one geographic region to another and from one type of warfare to another in a force projection Army.

1-5.GOALS OF THE COMBAT HEALTH SUPPORT SYSTEM

Combat health support goals must be integrated with the five tenets of Army operation. By so doing, accomplishment of CHS goals will be more likely. Combat health support goals are:

a.Reduce disease and nonbattle injury (DNBI).

b.Provide medical and surgical treatment for illness, injury, and wounds.

c.Evacuate patients to appropriate medical treatment facilities (MTFs).

d.Maintain aggressive and robust science and technology base.

1-6. COMBAT HEALTH SUPPORT PRINCIPLES

Combat health support principles must also be integrated with the Army operations tenets. Combat health support principles are given below.

a.Conformity. Conformity with the tactical plan is the most basic element for effectively providing CHS. By taking part in the development of the commander's plan of operation, the CHS planner can determine requirements and plan the support needed to conform to tactical operations.

b.Proximity. The objective of proximity is to provide CHS to sick, injured, and wounded soldiers at the right time and to keep morbidity and mortality to a minimum. The CHS resources are employed as close to the area of combat operations as time, distance, and the tactical situation allow. Military treatment facilities may be moved to areas in which the patient population is greatest, but they are not placed in areas that might interfere with combat operations. Proximity to the patient population without hampering combat operations is the desired outcome. This is achieved through continuous coordination of medical commanders and staff.

c.Flexibility. Combat health support leadership must be prepared to shift resources to meet changing requirements. Changes in tactical plans or operations make flexibility in CHS an essential factor. Since all CHS units are used somewhere within the theater and none are held in reserve, alternate plans must be made for redistribution of CHS resources, as required.

d.Mobility. The objective of mobility is to ensure that CHS assets remain close enough to support maneuvering combat forces to be effective. The mobility of medical units organic to maneuver elements should be equal to the forces being supported. Major CHS headquarters in the theater of operations (TO) continually assess and forecast unit movement and redeployment. Through the use of organic and nonorganic transportation resources, commanders can rapidly move CHS units to best support combat operations. For example, if one unit is immobilized, a similar unit may be leapfrogged past it. An immobilized unit may be given priority in evacuating its patients so it can again become mobile and move forward.

e.Continuity. Continuity in care and treatment is achieved by moving the patient through a progressive, phased CHS system to an area as far rearward as the patient's condition requires, possibly all the way to the continental United States (CONUS). Each type of CHS unit contributes a measured, logical increment appropriate to its location and capabilities.

f.Control. The objective of the final CHS principle, control, is to ensure that scarce CHS resources are efficiently employed in support of the tactical and strategic plan. Control also ensures that the scope and quality of medical treatment meet professional standards and policies.

1-7.MEDICAL THREAT

The AMEDD views the threat from two perspectives, both of which are rooted in a potential adversary's capability to conduct combat operations. The first of these viewpoints is similar to the way in which the threat is viewed throughout the Army, that is, a potential enemy's capability to disrupt CHS operations. The second perspective focuses more on the AMEDD's responsibility to anticipate and prevent the degradation of soldiers' health and performance by environmental hazards and military capabilities. The second perspective is called the medical threat. Note that the wounds suffered by the casualty as a result of combat operations are considered to be a part of the medical threat.

1-8.ELEMENTS OF THE MEDICAL THREAT

a.Naturally Occurring Infectious Diseases. Naturally occurring infectious diseases (NOID), also referred to as endemic diseases, represent a significant threat to United States armed forces deployed the outside the continental United States. Historically, infectious diseases have been responsible for more lost foxhole days than battle injuries. Many naturally occurring infectious diseases have short incubation periods, which may cause significant numbers of casualties within the first 48 hours to 2 weeks of deployment.

b.Environmental Extremes. When troops go into areas with environmental extremes, the soldiers' performance may suffer if they have not had the opportunity to get acclimated. Thus environmental extremes can contribute to mission failure. Many regions of the world where the United States has vital national interests have areas of high altitude, high humidity, and extremes in temperature.

c.Battle Injuries--Kinetic Energy and Fragmentation Antipersonnel Ordnance and Munitions. Any injuries that the casualty sustains are part of the medical threat. Small arms, high velocity weapons, rockets, bombs, and artillery, as well as bayonets and other wounding devices, may cause these injuries. Protective gear can help reduce this part of the medical threat.

d.Biological Warfare. Biological warfare (BW) is defined as the intentional use of disease-causing organisms (pathogens), toxins, or other agents of biological origin to cause adverse effects on soldiers. If the enemy has the capability for using BW, then BW is considered to be a part of the medical threat. The goal of BW is to cause casualties. The causative agents of anthrax, tularemia, plague, and cholera, as well as botulinum toxin, staphylococcus enterotoxin, and mycotoxins, are believed to have been developed as BW agents by potential adversaries of the United States. Many governments recognize the virtually limitless potential of biotechnology as a tool for the production of BW agents.

e.Chemical Warfare. Russia has the most extensive chemical warfare (CW) capability in the world. It can deliver chemical agents with almost all conventional weapons systems, from mortars to long-range tactical missiles available to ground, air, and naval forces. Chemical warfare continues to be a medical threat because the technology is being sold. Despite the dissolution of the Union of Soviet Socialist Republics (USSR), many of our potential enemies continue to be equipped with former Soviet technology and weapons systems.

f.Laser Blindness. Laser blindness is also a medical threat. Although laser goggles are issued to United States troops, the troops may not always be wearing the goggles when they are needed.

g.Combat Stress. Combat environments affect soldiers mentally as well as physically. Combat stress (battle fatigue, shell shock) can result.

h.Nuclear Warfare. Use of nuclear devices remains a threat.

1-9.THE MEDICAL THREAT IN WAR

Commanders should anticipate increased casualty densities as compared to levels experienced in previous conflicts. The elements of the medical threat with the greatest potential for force degradation are:

a.Battle injuries --injuries due to artillery, small arms, and fragmentation. [Note: Land mine incidents were one of the primary causes of United States casualties in Somalia, accounting for 26 percent of the Americans killed in action (KIA) during Operation Restore Hope (ORH).]

1. Combat stress casualties.

1. Nuclear, biological, and chemical (NBC) casualties and combined casualties

(casualties with both battle injuries and NBC injuries).

1-10. THE THREAT TO COMBAT HEALTH SUPPORT OPERATIONS IN WAR

a.Overload. Significant increases in casualty densities will cause local or general overload of the CHS system.

b.Premeditated Attack. Premeditated attack upon medical organizations, personnel, or Class VIII stores is not anticipated, but it cannot be completely ruled out. The degrees of adherence to the laws of land warfare are adversary-dependent. A steady erosion of battlefield medical resources will result based on ever-increasing range of indirect fire weapons, enhanced wounding capacity, and indirect fire on medical units. Treatment facilities are part of the rear-to-base clusters. The enemy seeks lucrative, cost-effective targets rich in potential casualties. Knocking out a supply unit is one such lucrative target. With their proximity in the rear to supply units, MTFs could sustain injury due to proximity.

c.Disruption of Communications and Logistics Activities. Enemy combat operations in friendly rear areas will interdict lines of communication and disrupt necessary logistics activities. This will produce a serious negative effect on the AMEDD's ability to retrieve and evacuate wounded, sick, and injured soldiers and deliver medical care. Lack of air superiority will seriously reduce the use of aeromedical evacuation (AE) in the forward edge of the battle area (FEBA).