Presentation on theme: "Medical Course of Action Tool"— Presentation transcript:
1 Medical Course of Action Tool Basics of using M-COATUpdated by LTC Bruce Shahbaz 12 Dec 2005
2 Agenda Introduction Agenda Learning Objectives Problem Statement Casualty Estimation MethodsMedical Course of Action ToolConclusion
3 Learning ObjectivesTo introduce the fundamental principles of casualty estimation and their effect on CHS planning.To teach the basics of using the Medical Course of Action Tool.
4 Problem StatementThere is no Army approved automated tool for conducting casualty estimation and CHS course of action planning for division and below operationsKuhn Study / JCS Guide Corps level casualty estimation, can drill down to DivisionFM vol 2 - Division and aboveARI’s Commander’s Battle Staff Handbook - Battalion level casualty estimationMedical Analysis Tool (MAT)Corps and above Course of Action toolDoes NOT do Casualty EstimationThe Army has not had an approved method for doing Division or Brigade level estimates in “stand alone” Operations for the past 20 years. You can not just apply Corps level rates to Division level operations, Division rates tend to be higher than Corps rates of similar time periods.
5 Casualty Estimation for 1003V (US/Coalition Forces) Used numerous tools:Medical Analysis ToolCJSC 3161, “Casualty Planner”US AMEDD DNBI DataFM 8-55Dupey Attrition Model -1% and 3%MCOAT (Medical Course of Action Tool)ACE (Army Casualty Estimate)34 days (19 Mar – 20 April)“Shock and Awe” approx 1% for TBCs and 4% for DNBIThis shows 3rd MEDCOM’s estimates for the “shock and awe” (20 March 2003 to 1 May 2003).Overestimated Total Battle Casualties and underestimated DNBIWhy? Battle for Baghdad not as bad as originally forecasted, less resistance than anticipated.Also, a large shift from inpatient care to outpatient care for DNBI – historical models are inpatient care focused.Finally, shorter hospital length of stays for many WIA patients. Quickly evacuated from theater to Germany.Source: BG Weightman AUSA Presentation 2004
6 Casualty Estimation Methods FM Volume 2OPLOG PlannerG1/G4 Battle BookLogistics Estimation WorksheetJCS Guide 3161DiceAgree to what the Commander saysModified Dupuy MethodSome of the historical models:Most are developed from WWI (not a typo, world war one) data.Joint Chief of Staff Guide 3161 is the Army’s approved method. Intended for mulit-day Corps operations, Division and Brigade estimates can be derived from the Corps estiamte.
7 BackgroundM-COAT was originally developed in Force Structure and Analysis at Fort Sam Houston, TX in 1998Confusion on whether it is a casualty estimation tool or medical workload tool – it is a medical workload toolAvailable on AKO 70B Toolkit (It is NOT AMEDD approved!!!!Not an Army or AMEDD approved solution – just a tool that can be used if you choose.
8 AKO Folder – 70B Toolkit https://www.us.army.mil/suite/folder/540490 Current Screen Shot from AKOUsers Book is an instruction handbook with step by step instructions.MCOAT 8a is the most recent version.COFM MCOAT is another approach at examining the Coefficient of Forces or Battlefield Calculus.OOTW MCOAT is an article on using MCOAT for Operations Other Than War.Casualty Estimation and Workload Planning is a basic tutorial.
9 A Low Cost, Low Risk, Near Term Solution M-COAT OverviewBased on COL Trevor Dupuy’s casualty estimation method from Attrition (Nova Pub. 1995)Conventional casualty estimation method onlyIntended to serve as TACTICAL level Course of Action ToolCasualty Estimation is a critical Battle Staff TaskMedical RequirementsPersonnel ReplacementsNot intended to serve as a Force Structure or Programming tool!Attrition: Forecasting Battle Casualties and Equipment Losses in Modern War* by Trevor N. Dupuy (NOVA Publications) ISBN X, Paperback (176 pages), $19.95MCOAT does NOT do NBC / CBRNE, Biological, or displaced civiliansAllows planners to analyze various courses of action.A Low Cost, Low Risk, Near Term Solution
10 M-COAT Five Modules ExcelÒ Spreadsheet Based Casualty Estimation Patient Flow- RTD and Evac LossesWorkloadEvacuation Requirement and CapabilityOperating Room Req. and Cap.Hospital Bed Req. and Cap.Medical SupplyBasis of Allocation RulesExcelÒ Spreadsheet BasedThe casualty estimation module is just the front end of MCOAT, the value liesin the other medical areas.Patient Flow is based on the Total Army Analysis process and assumes a 7-15evacuation policy.Much of workload is based on FM 8-55Medical Supply estimation is based on subject matter experts opinion andprovides a macro level estimate
11 M-COAT Casualty Estimation (con’t) Nine Factors that affect WIA rates:Population at risk (PAR)Terrain (17 variables)Weather (12 variables)Posture (8 variables)*Strength (17 variables)Opposition (31 variables)*Surprise (4 variables)Sophistication (15 variables)*Operational Form (5 variables)*Population – the smaller the population the greater the potential for larger casualty rates. A platoon in combat has a greater probability of having 50% casualties than does a battalion or brigade. As a percentage, more of the platoon is contact with the enemy.Terrain – In general, as terrain becomes more open and line of sight increases; casualty rates increase.Weather – Casualty rates increase as weather becomes less restrictive. Extremely hot or cold weather tends to decrease the casualty rate.Posture – Casualty rates are higher for offensive forces against successful defense positions.Opposition – Better equipped, trained and led enemy forces tend to increase casualty ratesSurprise – the enemy’s ability to surprise friendly forces increases casualty rates.Operational Form – For the Attacker, casualty rates are higher for continuous fronts and lower for disintegrated fronts. For the defender, rates are higher for258,019,200 combinations x PAR* Denotes areas that are modified from Dupuy’s original formula
12 M-COAT Casualty Estimation (con’t) Three Factors that affect DNBIPopulation At RiskBattlefield Location (5 variables)Geographic Location (36 variables)Based on Force Structure and Analysis’ DNBI ratesThe AMEDD Center and School developed this methodology for estimatingDNBI.It is based on:How many people deployedWhere on the battlefield are they? What is their level of infrastructure? The more austere, the higher the DNBI rate.Where in the world are they? The more endemic diseases, the higher the DNBI rate.
13 M-COAT Modules Patient Flow- Derived from TAA05 patient flow Workload - Uses FM 8-55 evacuation planning factorsClass VIII consumption- Medical Resupply Sets, FST supplies, and BloodBasis of Allocation rules (MRI and MF2K)Most of the other planning factors come from AMEDD approved planningfactors, taken from FM 8-55.The blood planning factor is based on the experience of the InternationalCommittee of the Red Cross and their blood usage at Red Cross hospitals,which have two Operating Rooms and 20 cots, limited lab and X-Ray.
14 A Graphic Comparison Of Various Casualty Estimation Methods +1566%-1566%G1/G4 Battle Book+1416%-1416%FM+42%-42%Dupuy+30%-30%M-COAT (Modified Dupuy)Blind analysis done on 13 “modern” battles shows the accuracy of variousmethods. The battle included:Anzio Breakout in 1944Mortan in 1944Chinese Farm (Yom Kipper War) in 1973Panama (Just Cause) in 1989Iraq / Kuwait (Desert Storm) in 1990Casualty Estimate (Standard Error of the Estimate)Based on 13 Battles ( )
15 Medical Course of Action Tool A screen shot of M-COAT shows the drop down menus used in the casualtyestimation tab
16 Conventional vs. Operations Other Than War M-COATConventionalOOTWPostureOffensiveRecon - ScreenOppositionSignificant AdvantageOverwhelming AdvantageSurpriseMinorSubstantialPattern of OperationDisrupted FrontReconAn example of how M-COAT could be used for operations other than war.It is important to do daily estimates that vary based on the changing enemy and friendly situation.When doing OOTW estimates, it is important to account for smaller unit combat engagements.Examples of the different settings that COULD be used
17 Conventional vs. Operations Other Than War Example –Constant: 5k Soldiers, Urban, Dry Sunshine, No Sophistication AdvantageVary: Posture, Opposition, Surprise and Pattern of OperationM-COATConventionalOOTWTotal Battle Casualties18965WIA16155KIA2810This show how changing the settings decreases the TBC by about 2/3.Examples of the different settings that COULD be used
18 Medical Course of Action Tool A screen shot of the workload tab, which shows level 1 combat health support.It is important to remember to use average vehicle speed, not max speed. Youmust take into account the time it takes to load and unload patients. Also, don’t use the max vehicle capacity as your planning factor – we don’t usually waitaround for an ambulance to be full before we start evacuation.This tab will provide lots of information, but solutions to problems are notprovided. It is up to the planner to figure out what is problematic and how toresolve the problems.
19 Airborne OperationsEstimates the additional number of casualties that suffer injury from the jumpAirborne casualties are in addition to conventional casualtiesInfluences:Day vs. Night (night has higher casualty rate)Equipment weight (greater weight increases casualties)Drop Zone Conditions (harder surface increase casualties)Based on data provided by Ranger Regiment surgeon, the airborne operations method has been modified. This data came from 4 combat jumps (2 Iraq and 2 Afghanistan) and four training jumps. Several hundred jumpers total.Bottom line, the more stuff you jump with and the harder the DZ – the more casualties you are going to have.
20 Creditable Casualty Range The estimates are based on a number of assumptions: the operational success and the enemy resistance are the two most critical. This graph shows the WIA estimate in red and the high and low range of possible casualties. A good medical planner should have a contingency plan for the high end estimate.
21 ConclusionOne of several tools available for use by medical planners, it is NOT the only / best / preferred wayRoutinely updated and improved based on user feedback, tell me how to make it more usefulDo not hesitate to call or and ask questionsThe end