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Medical Platoon 1.

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Presentation on theme: "Medical Platoon 1."— Presentation transcript:

1 Medical Platoon 1

2 TASK FORCE COMBAT HEALTH SUPPORT GUIDE
TABLE OF CONTENTS PAGE Chapter 1 TACTICAL DECISION MAKING, MISSION ANALYSIS, & TROOP LEADING PROCEDURES Chapter 2 TASK FORCE TACTICAL OPERATIONS Chapter 3 COMBAT HEALTH SUPPORT IN A MANEUVER TASK FORCE Chapter 4 MEDICAL EVACUATION Chapter 5 MEDICAL PLATOON EXECUTION CHECKLIST Chapter 6 MISCELLANOUS MEDICAL AND GENERAL INFORMATION 3

3 Chapter 1 TACTICAL DECISION MAKING,
MISSION ANALYSIS & TROOP LEADING PROCEDURES TASKS PAGE Troop Leading Procedures “Step by Step Process” Combat Health Support Mission Analysis Combat Health Support Staff Estimate OCOKA METT-TC Medical Platoon Warning Order (WARNO) Medical Platoon Time Management Example/Timeline Information required in a Task Force Operations Order, Paragraph Task Force Medical Platoon Operations Order (OPORD) Task Force Medical Platoon Execution Matrix Fragmentary Order (FRAGO) Backbrief and Briefback Format Rehearsal Checklist Medical Platoon Pre-Combat Checklist 4

4 “Steps and Procedures”
Chapter TACTICAL DECISION MAKING AND MISSION ANALYSIS “Steps and Procedures” Reference ARTEP 7-94-MTP TROOP-LEADING MILITARY BATTLEFIELD PROCEDURES DECISION-MAKING PROCESS VISUALIZATION 1. RECEIVE AND ANALYZE THE MISSION MISSION ANALYSIS (METT-TC) MISSION ENEMY TERRAIN AND WEATHER TROOPS TIME AVAILABLE CIVILIAN CONSIDERATIONS 2. ISSUE A WARNING ORDER “See the terrain” 3. MAKE A TENTATIVE PLAN DEVELOPMENT OF COURSES OF ACTION ANALYSIS OF COURSES OF ACTION “See the enemy” COA COMPARISON 4. INITIATE MOVEMENT 5. CONDUCT RECONNAISSANCE 6. COMPLETE THE PLAN SELECTION OF COA “See yourself” REFINEMENT OF PLAN, INTEGRATION OF CS AND CSS, AND DEVELOPMENT OF BRANCH PLANS 7. ISSUE THE ORDER 8. SUPERVISE & REFINE

5 “Steps and Procedures”
Chapter TACTICAL DECISION MAKING AND MISSION ANALYSIS “Steps and Procedures” Reference ARTEP 7-94-MTP 1. Platoon leader receives the mission (Step 1, TLPs). Clarifies any questions. Coordinates with personnel as needed. 2. Platoon leader analyzes mission to identify the following- Mission and intent of the commander two levels up. Mission and intent of the immediate commander. Specified, implied, and mission-essential tasks. Constraints and limitations. Purpose. 3. Platoon leader produces- A restated mission that contains the unit’s mission-essential tasks and the purpose for which they were assigned. A tentative time schedule (Reference Medical Platoon Timeline, page 17). 4. Platoon leader issues a warning order (reference WARNO Format, page 15) to the platoon sergeant and section leaders (Step 2, TLPs). Includes enough information for subordinate elements to prepare for the mission. Gives warning order immediately after being alerted. Includes movement instructions if movement is to be initiated before OPORD issuance. Addresses the items not covered in the unit TACSOP. 5. Platoon members concurrently perform readiness, maintenance, and functional checks under the supervision of their leader (reference precombat checks, page 28-34). They check- Weapons & Night Vision Goggles. Vehicles. Medical equipment sets (MESs). Communications equipment. NBC equipment. Any special equipment. 6. Platoon members combat-load vehicles IAW the TACSOP or warning order. 7. All personnel test-fire weapons, if the situation permits. 6

6 “Steps and Procedures”
Chapter TACTICAL DECISION MAKING AND MISSION ANALYSIS “Steps and Procedures” Reference ARTEP 7-94-MTP 8. Platoon leader makes a tentative plan (Step 3, TLPs). Platoon leader at a minimum- Uses the estimate of the situation to analyze METT-TC information. Develops courses of action. Includes significant mission specific factors which any course of action must satisfy. Identifies assumptions about the situation on which the analysis is based. Produces at least two general courses of action that can accomplish the mission but that are different enough to allow useful analysis. Makes a reconnaissance plan that- Compares the advantages, disadvantages and risk of each course of action. Identifies the key leaders in each course of action. Identifies the critical events. Identifies the most dangerous contingencies. 9. Platoon initiates movement (Step 4, TLPs), as required, for the quartering party, selected elements, or the entire platoon- Follows instructions for movement given in the warning order. Moves to the assembly area or linkup point NLT the time specified in the warning order. 10. Platoon reconnoiters (Step 5, TLPs). Determines the unit locations. Obtains supported information about the terrain (OCOKA). Request other information from higher. 11. Platoon leader completes the plan (Step 6, TLPs) based on METT-TC considerations, intelligence from the reconnaissance, and other sources. Plan should include- Clear expression of the platoon leader’s or battalion commander’s intent, which addresses the unit’s mission-essential tasks and the purpose of those tasks. Scheme of maneuver. Concept of medical support. Task organization of task force and platoon. Control measures. 7

7 “Steps and Procedures”
Chapter TACTICAL DECISION MAKING AND MISSION ANALYSIS “Steps and Procedures” Reference ARTEP 7-94-MTP 12. Platoon leader issues an order to subordinate leaders (Step 7, TLPs)(reference Medical Platoon OPORD, page 20). Provides ample subordinate leader planning and preparation time by the 1/3 to 2/3 guide. Clarifies any questions. 13. Platoon leader coordinates for the mission. Platoon leader request CS assets (MPs/Engineers) to aid the mission. Platoon leader or representative coordinates plans and actions with higher, adjacent, and supported units. Scheme of maneuver. Current intelligence/Medical threat. Control measures/Graphics. Communications and signals. Time schedules. Additional support requirements. Platoon leader (or platoon sergeant/section leader) receives attachments, as time permits, briefed on- Platoon mission and intent. Specified tasks. Platoon SOPs. Overall plan. Recent platoon activities. Recent enemy activities. Platoon leader or platoon sergeant checks the attachments for mission readiness. Platoon leader or platoon sergeant links up with the individuals who will be their point on contact within the platoon. 14. Platoon leader supervises mission preparation (reference rehearsals, backbriefs, briefbacks, page 26-27). Subordinate leaders conduct briefbacks of their plan to the platoon leader to ensure the intent is understood. Platoon rehearses key platoon actions as the situation permits. Elements prepare all field-expedient equipment needs for their tasks. Key leaders- Supervise. Inspect. Conduct briefbacks. Rehearse. Continue coordination. 8

8 “Steps and Procedures”
Chapter TACTICAL DECISION MAKING AND MISSION ANALYSIS “Steps and Procedures” Reference ARTEP 7-94-MTP 15. Platoon leader plans sustainment of combat health support operations. Platoon sergeant determines anticipated medical supplies and equipment general supplies and ammunition requirements. Platoon leader establishes and carries out a rest plan for all platoon members (particularly key personnel and leaders) based on the unit SOP, mission analysis, and current orders. Platoon sergeant coordinates with CTCP for supplies to support CHS plan. 16. Platoon monitors actions of higher, adjacent, and supporting units. Enemy & friendly locations or actions. Orders from higher headquarters to other units. 17. Platoon leader issues order or modifies the original plan. Order or change must be explained in terms of - Current platoon mission. Higher commander’s mission. Enemy & friendly situation. Terrain. Troops available. 18. Platoon issues FRAGO (reference medical platoon FRAGO, page 24) to the platoon and attached elements. Contains situation, mission, and element tasks. All subordinates must receive and acknowledge. 9

9 “Mission Analysis” Reference FM 8-55, FM 71-123
Chapter COMBAT HEALTH SUPPORT PLANNING “Mission Analysis” Reference FM 8-55, FM 1. Arrive at the Tactical Decision Making Process (TDMP) with current status of assets: Personnel. Vehicles. Critical Class VIII Deficiencies. 2. Then read the Brigade CSS Annex: Identify higher/adjacent CHS elements (location of treatment teams/AXPs/Patient Collection Points) Identify available evacuation resources (Ground/Air) Identify area of operation (See terrain) 3. Analyze the Mission. To ensure effective support, CHS operators and planners must understand the commander's tactical plans and intent. They must know-- What each of the supported elements are doing. When they are doing it. How they are doing it. After analyzing the concept of operations, CHS planners must be able to accurately predict support requirements. They must determine-- What are the number of patients and where are they expected. What type of medical support is required. The priority of medical support, by type and unit. Using the support requirements of the tactical plan as a base, the support capabilities of the task force are assessed by-- What CHS resources are available (organic, lateral, and higher headquarter). Where the CHS resources are. When can the CHS resources be made available to the maneuver units. How can they be made available. Based on this information, CHS plans are developed by applying resources against requirements. 4. Your Mission Analysis Summary: Know current status of medical platoon assets (Cross LD/NLT Defend) Know support available from Brigade. Identify internal nonstandard resources available. METT-TC Commander’s Intent and guidance. 10

10 STAFF ESTIMATE Reference FM 8-55
Chapter COMBAT HEALTH SUPPORT STAFF ESTIMATE Reference FM 8-55 1. MISSION. Restated mission resulting from the mission analysis. 2. SITUATION AND CONSIDERATIONS. a. Characteristics of area of operations. (1) Weather. How will different military aspects of weather affect specific staff area of concern and resources? (2) Terrain. How will aspects of the terrain affect specific staff areas of concern and resources. (3) Other Key Facts. Analyses of political, economic, sociological, psychological, cultural and environmental infrastructure, as they relate to the area. b. Enemy Forces. Enemy dispositions, composition, strength, capabilities, and COAs as they affect specific staff area of concern. c. Friendly Forces. (1) Friendly courses of action. (2) Current status of resources within staff area of responsibility. (3) Current status of other resources that affect staff area of responsibility. (4) Comparison of requirements versus capabilities and recommended solutions. (5) Key considerations (evaluation criteria) for COA supportability. d. Assumptions. 3. COMBAT HEALTH SUPPORT ANALYSIS. Analyze each COA using key considerations (evaluation criteria) to determine advantages and disadvantages. a. Patient Estimates (where, when, & how many). b. Support Requirements. c. Resources Available. d. Courses of Action (supporting the commander’s course of action) 4. EVALUATION AND COMPARISON. Compare COAs using key considerations (evaluation criteria). Rank order of COAs by supportability. Comparison should be visually supported by a decision matrix. 5. RECOMMENDATIONS AND CONCLUSIONS. a. Recommended COA based on the comparison (most supportable from specific staff perspective). b. Issues, deficiencies, and risks with recommendations to reduce their impacts. 11

11 Chapter 1 OCOKA Reference FM 71-2, FM 71-2
1. Observation and fields of fire. Consider the ground that’s allows observation of the enemy throughout the area of operation. Consider fields of fire in terms of the characteristics of the weapons available to the unit: e.g. maximum effective range, requirement for grazing fire, arming range and time of flight for anti-armor weapons. 2. Cover and concealment. Look for terrain that will protect unit from direct and indirect fires (cover) and from aerial and ground observation (concealment). 3. Obstacles. In the attack, consider the effect of restrictive terrain on the unit’s ability to maneuver. In the defense, consider the advantage of tying obstacles to the terrain to disrupt, turn, fix, or block an enemy force and protect your unit from enemy assault. 4. Key terrain. Key terrain is any locality or area whose seizure or retention affords a marked advantage to either combatant. Consider key terrain in your selection of objectives, support positions, and routes in the offense, and on the positioning of your unit in the defense. 5. Avenues of approach. An air or ground route of an attacking force or a given size leading to its’ objective or key terrain in its’ path. In the offense, identify the avenue of approach that affords the greatest protection and place the unit at the enemy’s most vulnerable spot. In the defense, position key weapons along the avenue of approach most likely to be used by the enemy. 12

12 (Mission, Enemy, Terrain, Troops, Time Available, and Civilians)
Chapter METT-TC (Mission, Enemy, Terrain, Troops, Time Available, and Civilians) Reference FM 71-1, FM 71-2 1. Mission. Analyze the platoon mission within the frame work of the battalion commander’s intent (two levels up). a. What role will the platoon play during different phases of the battalion operation? b. What platoon tasks are essential to the success of the battalion and platoon missions? 2. Enemy. Analyze the enemy force, capabilities, and the platoon vulnerabilities. a. What type of force, tactics and weapons system is the enemy likely to employ against the platoon? b. What weaknesses in the platoon could an enemy exploit? c. During the mission, when will the platoon have the greatest exposure to enemy action, and what is that action likely to be? 3. Terrain. Analyze the positive and negative effects of terrain upon the platoon mission using the acronym OCOKA. a. What effect will the terrain have upon the platoon mission in the terms of tasks that the platoon will have to accomplish because of the terrain? b. Where (location) and when (phase of the operation) will the terrain benefit the enemy? c. Where (location) and when (phase of the operation) will the terrain benefit the platoon? 4. Troops Available. What are the strengths and capabilities of: a. The soldiers in the platoon plus attachments? b. The vehicles and equipment in the platoon? c. What additional support can be used to enhance the platoon capabilities? 13

13 (Mission, Enemy, Terrain, Troops, Time Available, and Civilians)
Chapter METT-TC (Mission, Enemy, Terrain, Troops, Time Available, and Civilians) Reference FM 71-1, 71-2 5. Time Available. Allot time based on the tentative plan and any changes to the situation. a. Time for planning by leaders (1/3 of available time). b. Time for soldier preparation tasks and rehearsals (2/3 of time available). c. Backward plan from “mount up,” not “move out.” e.g. (1) cross LD. (2) convoy to staging area. (3) mount up and line up. (4) break. (5) final PCI. (6) platoon rehearsal and final AAR. (7) squad PCI, rehearsals and AARs (8) platoon order. (9) warning order, squad preparation activities. (10) receive mission. 6. Civilians. Identify any civilian considerations that may affect the mission. These factors may include refugees, humanitarian assistance requirements, or specific considerations related to the applicable ROE and or ROI. 14

14 Chapter 1 MEDICAL PLATOON LEADER’S
WARNING ORDER (WARNO) WARNING ORDER (Short Format) 1. What ____________________________________________________________ ____________________________________________________________________ (Situation + Mission Tasks) 2. Who ____________________________________________________________ (Specific Tasks to Subordinates) 3. How ____________________________________________________________ (Tentative Execution Plan) 4. When ___________________________________________________________ ___________________________________________________________________ (Pre-Execution Time Schedule) 5. Where __________________________________________________________ (Time + Location of OPORD +Rehearsal) 15

15 Chapter 1 MEDICAL PLATOON LEADER’S
WARNING ORDER (WARNO) 1. Situation: a. Brief description of enemy situation if changed. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ b. Brief description of friendly situation if changed. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2. Mission: Short, concise statement of task and purpose. 3. Execution: Tentative concept of the operation including: a. Time schedule for OPORD + all pre-execution tasks. ________________________________________________________________________________________________________________________________________ b. Mission tasks to subordinates c. Rehearsal tasks and location. ____________________________________________________________________________________________________________________________________________________________________________________________________________ 4. Service Support: If different from TACSOP. ____________________________________________________________________ 5. Command and Signal: a. Location of CP. b. SOI in effect. c. Signal/code words. 16

16 Chapter 1 MEDICAL PLATOON TIMELINE/TIME MANAGEMENT EXAMPLE
Defend NLT BMNT MOPP2NLT Medical Platoon Reconnaissance Complete (Task Force) EENT Medical Coordination Complete (C Med, Adj Unit, & TF) BDE CSS Rehearsal Platoon Rehearsals Complete TF CSS Rehearsal Platoon PCCs/PCIs Complete TF Maneuver Rehearsal Platoon Conducts Priorities of Work Platoon Conducts Movement = Limited Visibility Platoon Leader Issues his OPORD BMNT / TF OPORD Issued Med PL Completes Medical Platoon OPORD Med PL Finalizes CSS/Medical Annex Med PL Conducts Wargaming at TF TOC Med PL Issues WARNO3 to Platoon Med PL Develops Medical COA and Analyzes it with the TF COAs Med PL Issues WARNO2 to Platoon Med PL Conducts Mission Analysis/Medical Estimates EENT Med PL Issues WARNO1 to Platoon Med PL at TF TDMP Total time available: 36 hours (Daylight hours) (Limited Light 20 hours) Minus 15 hours Total available time: 21 hours MINUS: * Receipt of order hours * Task Force troop hours leading procedures 15 hours 17

17 Chapter 1 MEDICAL PLATOON TIMELINE
TIME EVENT ________________ ________ ____________________________________________________ = LIMITED VISIBILITY 18

18 PARAGRAPH 4 - SERVICE SUPPORT “Medical Evacuation & Hospitalization”
Chapter TASK FORCE OPERATIONS ORDER PARAGRAPH 4 - SERVICE SUPPORT “Medical Evacuation & Hospitalization” Medical evacuation & hospitalization. Location of casualty collection points (in each phase of the operation). Location of task force aid station(s) during the battle (in each phase of the operation). Primary/alternate and dirty/clean evacuation routes. Method of marking vehicles with wounded. Plan for non-standard evacuation. Procedures for evacuation of wounded. AXP locations. FSMC or unit level II medical care. Patient decontamination operations and locations. Air MEDEVAC frequency and LZ Operations. Example Figure 1-1, Example of Combat Health Support Overlay at a Maneuver Task Force 19

19 OPERATIONS ORDER FORMAT
Chapter MEDICAL PLATOON LEADER’S OPERATIONS ORDER FORMAT Task Organization - changes in normal unit organization for this mission. 1. Situation. a. Enemy Forces (and battlefield conditions). (1) Weather and light data. Precipitation. Temperature. Other weather conditions (wind, dust, or fog). Light data: BMNT: __________ Sunrise: __________ Sunset: __________ EENT: __________ Moonrise: __________ Moonset: __________ Percent illumination: __________ (2) Terrain (Factors of OCOKA) Observation and fields of fire. Cover and concealment. Obstacles. Key terrain. Avenues of approach. (3) Enemy Forces. Location Activity Composition/order of battle. Strength b. Friendly Forces. (1) Mission of next higher unit (2) Higher commander’s concept of the operation. (3) Location and planned action of units on left, right, front, and rear. c. Attachments and Detachments. (To the platoon.) 2. Mission. (Who, what, when where and why.) (Picture of Success/End State.) 3. Execution. (How) a. Concept of Medical Support for the Task Force. (1) Scheme of maneuver Passage of lines Routes Movement formations. Movement techniques. Actions on contact, at obstacles, during consolidation and reorganization. 20

20 OPERATIONS ORDER FORMAT
Chapter MEDICAL PLATOON LEADER’S OPERATIONS ORDER FORMAT 3. Execution (Cont.) a. Concept of Medical Support for the Task Force. (2) Mission Essential Platoon Task(s). Patient decontamination locations & operations. Decontamination points. Dirty and clean evacuation routes. AXP locations. FSMC or echelon II locations. Plan for non-standard evacuation. Air MEDEVAC frequency and LZ operations. Location of casualty collection points (in each phase of the operations). Method of marking wounded on the battlefield. Procedure for evacuating wounded. (4) Engineer Support. (5) Military Police Support b. Tasks to subordinate units. (Squads/Teams/Key Individuals.) c. Coordinating Instructions. (1) Specified tasks to more than one element. (2) Rules of engagement/actions on contact. (3) MOPP Status. (4) Coordination with friendly units. (5) PIR and other reporting requirements (phase lines, check points). (6) Essential times not covered. (7) Inspections. (8) Rehearsals. 4. Service Support. a. Concept of Support. (1) Location of task force combat and field trains. (2) Location of task force UMCP. (3) Current and future MSRs. b. Material and Services. (1) Supply. (2) Transportation (schedule of delivery). (3) Services (type, location & schedule). (4) Maintenance (type & location not included in TACSOP). (5) Medical evacuation & additional treatment locations. 21

21 OPERATIONS ORDER FORMAT
Chapter MEDICAL PLATOON LEADER’S OPERATIONS ORDER FORMAT 4. Service Support (Cont.). c. Personnel. (1) EPW collection point. (2) Individual replacements. (3) Uniform and equipment. 5. Command and Signal. a. Command. (1) Chain of command. (2) Location of platoon/squad leader in formation and at the objective. (3) Succession of command if not IAW SOP. b. Signal. (1) SOI index in effect. (2) Listening silence, if applicable. (3) Methods of communication in priority. (4) Emergency signals, visual signals. (5) Code words. 22

22 Chapter 1 TASK FORCE MEDICAL PLATOON “EXECUTION MATRIX”
FSMC FREQUENCY: FSMC CALL SIGNS: NOTES/REMARKS: URGENTS __________________________________________________________________ PRIORITY __________________________________________________________________ ROUTINE __________________________________________________________________ DAY ______________________________________________________________________ NIGHT______________________________________________________________________ TASK FORCE CASUALTY MARKING SYSTEM: PAT DECON STATIION MARKING SYSTEM AID STATION MARKING SPECIALTY PLTS/ATTACH MENTS COMBAT HEALTH SUPPORT PLAN CASUALTY/CHEM CAS ESTIMATE AIR MEDEVAC PLATFORMS AVAIL. AIR MEDEVAC FREQUENCY TRIGGERS FOR BAS TRMT TM A LOCATIONS TRMT TM B LOCATIONS FSMC LOCATIONS PATIENT DECON SITES NON-STANDARD EVAC DIRTY/CLEAN ROUTES # OF URGENT # OF PRIORITY # OF ROUTINE # OF KIA SCOUTS MORTARS ENGINEERS ADA PHASES/H-HOUR AXP LOCATIONS

23 Chapter 1 FRAGMENTARY ORDER (FRAGO)
Task Organization 1. Situation: a. Enemy ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ b. Friendly ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2. Mission: ________________________________________________________________________________________________________________________________________________________________________________________________________________________ 3. Execution: a. Concept - Operation ________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ b. Tasks to Subordinates ________________________________________________________________________________________________________________________________________________ c. Coordinating Instructions 24

24 Chapter 1 FRAGMENTARY ORDER (FRAGO)
4. Service Support (other than SOP): a. Company Trains ____________________________________________________________________________________________________________________________________________ b. Material and Services ____________________________________________________________________________________________________________________________________________ c. Personnel ____________________________________________________________________________________________________________________________________________ d. Medical ____________________________________________________________________________________________________________________________________________ 5. Command & Signal (other than SOP): a. Command ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ b. Signal ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 25

25 Chapter 1 BRIEF BACK & BACKBRIEF FORMATS
Once the OPORD is issued, the platoon leader may be required to brief the commander on what he understands the OPORD requirements to be. This ensures that the platoon leader understands what is expected of him and what the support requirements are and, provides the commander the opportunity to provide additional guidance, if required. (This procedure is sometimes referred to as a brief back.) The information consists of the— Task organization. Enemy situation. Mission analysis. Specified tasks. Implied tasks. Restrictions / constraints. Key coordinating instructions. Questions or assumptions required for planning. Once the platoon leader determines how he will support the plan and prior to issuing that guidance to the platoon (platoon order), the platoon leader will brief the commander on what the platoon order will contain. (This process may be referred to as a backbrief.) Restated mission. Concept (by phase). Combat health support plan. 26

26 Chapter 1 REHEARSAL CHECKLIST
1. Before the Rehearsal. Consider time available. Know specific mission essential tasks (PLT/SQD/IND) plus critical personnel & equipment requirements. Know the teaching order of the tasks (time available). All tasks in chronological order. Critical tasks in chronological order. Teach leaders their individual and collective tasks. Sand table or easel drawing. Platoon, squad & critical leader tasks step by step. Decision & synchronization points. Picture of success for each sub element. Standard(s) for sub element rehearsals, equipment and personnel inspections. 2. During the Rehearsal - Consider time available. Sub leaders teach the plan. Talk thru crawl-walk-run. Sand table discussion (talk thru). Tasks for each element in chronological order. Picture of success/execution standards for each element and task. Ensure leaders inspect the plan-consider time available. Hands on serviceability for each critical item of equipment. (See it - touch it - see it work). Personnel readiness. Ask meaningful, specific questions during brief back. Ensure leaders work the plan. Step by step rehearsal of each phase. Crawl, walk, run. Meaningful AARs - coordinate & change what doesn't work to standard - repeat the task. 3. After the Rehearsal - consider time available. Validate the plan with leaders to ensure each element achieves standard or picture of success with minimum exposure to error. Change what doesn't work & rehearse the changes. 27

27 Chapter 1 PRECOMBAT CHECKLIST FOR CLASS VIII
Authorized number of days of supply are on hand. Medications, reagents, and other time-sensitive supplies are current. Accountability of controlled substances is maintained. Oxygen on hand. Medical equipment is on hand and calibrated, as required. Medical maintenance/repair support is coordinated. Push package from FSB coordinated. Estimated expenditures forwarded to FSB. Re-supply method confirmed with the FSB. PRECOMBAT CHECKLIST FOR PREVENTIVE MEDICINE SUPPORT All authorized equipment on hand and serviceable. Individual PVNTMED supplies (such as insect repellent) issued to soldiers. Individuals trained in the application of PVNTMED measures. Unit field sanitation team trained. Unit field sanitation team supplies are on hand. Provisions for the use of chemical toilets have been coordinated, if appropriate. Waste disposal procedures and facilities have been established. 28

28 Chapter 1 PRECOMBAT CHECKLIST FOR GROUND AMBULANCES
Authorized MES are on hand. Medical equipment is complete and serviceable. Authorized medical gases (oxygen) are on hand and serviceable. Authorized medications are on hand and current. Packing list is available. Strip maps and/or road maps with overlays are available. On vehicle equipment (OVM) is on hand. Log book is present and current. All drivers are licensed. Situational awareness equipment (GPS) is on hand and serviceable. Communications equipment is on hand, serviceable, and set to the correct frequency. Medical unit identification markers (in accordance with the Geneva Conventions) are displayed. (Markers are red on a white background only; camouflaged or subdued markers are not authorized.) PRECOMBAT CHECKLIST FOR MISCELLANEOUS EQUIPMENT Inspect binoculars. Inspect camouflage nets and support systems. Inspect night vision devices and ensure batteries are on hand. Inspect mine detectors. Inspect tentage. Inspect global positioning systems (if available). 29

29 Chapter 1 PRECOMBAT CHECKLIST FOR THE MEDICAL TREATMENT FACILITY
All authorized shelters are on hand and serviceable. All authorized collective protective equipment is on hand and serviceable. Procedures for management of medical waste are established. Provisions for water supply are coordinated. Patient protection measures are instituted. Ambulance turnaround is planned for and established. Area for patient decontamination operations is planned for and established, when required. Camouflage materiel is available if authorized for use. Medical unit identification markers (in accordance with the Geneva Conventions) are on hand. Triage and evacuation signs for day/night operations are on hand. LZ marking kit with pegs/stakes on hand. Litters and litter stands on hand. Treatment, sickcall, patient decon/treatment MESs are on hand. All special medial equipment tested and serviceable. Oxygen on hand. Communication equipment on hand and serviceable. 30

30 Chapter 1 PRECOMBAT CHECK ON NUCLEAR, BIOLOGICAL,
AND CHEMICAL EQUIPMENT Individual protective equipment (CPOG and MOPP) is on hand and serviceable. (One set is issued and the extra set remains in supply.) Protective masks are issued and serviceable. Nerve agent antidote is available and distributed (as required). Convulsant antidote for nerve agent (CANA) is available and distributed (as required). Decontamination apparatus is complete and serviceable. Basic load of decontamination supplies is on hand: M291 Skin DECON Kits M295 IEDK DS2 Super Tropical Bleach [STB] Chemical agent alarms are on hand and serviceable. M256A1 detector kits issued. NBC contamination marking kits are distributed. NBC teams are trained and briefed on the current threat and contingency plan. Coordination for patient decontamination team support (non-medical) is completed. Patient protective wraps are on hand, if authorized. Chemical agent monitors are on hand and serviceable. M8 and M9 detector paper is on hand. M272 detector kits are issued. Replacement filters for protective masks are on hand. Nerve agent pretreatment packets (NAPP) are available. Biological agent prophylaxis/immunizations have been accomplished, if appropriate. Radiac sets (AN/PDR 27, AN/PDR 77, or AN/VDR 2) are on hand. Chemical agent patient treatment MES are on hand or available. Chemical agent patient decontamination MES are on hand or available. Biological sample collection equipment/supplies are available. 31

31 PRECOMBAT CHECKLIST FOR INDIVIDUAL WEAPONS
Chapter PRECOMBAT CHECKLIST OF PERSONNEL Ensure soldiers are in the correct uniform. Ask questions to ensure that soldiers have been briefed on mission and situation. Implement appropriate MOPP level. Check for drivers license. Brief soldiers on operations safety and environmental injuries. Individual equipment is on hand and stowed properly. Soldier fed and briefed on future meal consumption. Identification (ID) tags, ID card, Geneva Convention Card, multifunctional automated record card (MARC) are on hand and serviceable. Camouflage self and equipment. Work/rest plan implemented. Water discipline plan implemented, if appropriate. MEDEVAC request on hand. PRECOMBAT CHECKLIST FOR INDIVIDUAL WEAPONS Clean and functional. Cleaning tools/kits, bolts, and ruptured cartridge extractors are present. Range cards are on hand. Ammunition is issued, accounted for, and secured. Magazines issued. Blank adapter installed (if appropriate). Function check has been performed. Test fire (with permission from Bn/Co). 32

32 Chapter 1 PRECOMBAT CHECKLIST ON COMMUNICATIONS EQUIPMENT
Radios are operational (communications check conducted). Telemedicine equipment is available and operational, if available. Speech security equipment functional. Radios filled with one extra battery on hand. Frequencies are set. Matching units are operational. Antennas tied down properly. Connectors clean and serviceable. TA-312 on hand and serviceable, batteries are on hand. WD-1 on hand and serviceable. Manpack sets are complete, batteries are on hand. Switchboard on hand and serviceable. Antennas and remotes are present, batteries are on hand. SOI is available and secured; call signs and frequencies have been disseminated. Perform communications check again. 33

33 Chapter 1 PRECOMBAT CHECKS FOR VEHICLES
Loads are according to load plan; load plan posted in the vehicle. Hazardous cargo properly identified and stored toward rear of vehicle for easy access and inspection. Ammunition issued and properly stored. Vehicle fuel tank topped off. Package POL products and small arms lubricant present. Water cans full. MREs issued and stowed. First aid kits present and complete. Operators' manuals and lubrication orders are present for the vehicle, radios, and associated equipment. Critical toll and basic issue items (BII) are present. Vehicle dispatch is complete; DA Form 2404 is complete; no deadline deficiencies exist. Before operation PMCS has been completed. Wheeled vehicles hardened with sandbags. M11/M13 Decon apparatus present. Fire extinguisher present. Fire evacuation and vehicle rollover drills complete. Chem-lights/other signal equipment present. MEDEVAC request on hand and posted in the medical platoons vehicles. 34

34 Reference FM 71-1, FM 71-2, FM 71-3, FM 7-90
Chapter TASK FORCE TACTICAL OPERATIONS Reference FM 71-1, FM 71-2, FM 71-3, FM 7-90 TOPIC/INFORMATION PAGE Combat Operations In The Offense. Purpose of Offensive Operations Characteristics of Offensive Operations Sequence of Attack Forms of Maneuver Movement Techniques and Formations How the Threat Defends Conducting Attacks Combat Operations In the Defense. Purpose of Defensive Operations Characteristics of Defensive Operations Framework of the Defense How the Threat Attacks Sequence of the Defense Types of Defensive Operations Combat Operations in the Reserve. Counterattack Spoiling Attack Block, Fix, or Contain Reinforce Rear Operations Combat Operations in Other Tactical Operations. Retrograde Operations Delay Withdrawal/Retirement Passage of Lines Relief Breakout from Encirclement Linkup Guard 35

35 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Offensive Operations” Reference FM 7-10, 7-20, 71-1, 71-2 1. PURPOSE OF OFFENSIVE OPERATIONS: A. Defeat enemy forces. B. Secure key or decisive terrain. C. Deprive the enemy of resources. D. Gain information. E. Deceive and divert the enemy. F. Hold the enemy in position. G. Disrupt an enemy attack. 2. CHARACTERISTICS OF OFFENSIVE OPERATIONS: A. SURPRISE: Achieved when the enemy cannot react effectively to the task force commander’s scheme of maneuver, achieved by thorough recon and surveillance, striking at an unexpected direction at unexpected time or using deception efforts. B. CONCENTRATION: The massing and synchronization of over whelming combat power against an enemy weakness. C. SPEED: The task force quickly moves to take advantage of enemy weaknesses. Speed in execution is key to denying the enemy time to reposition or reorient to meet an attack. D. FLEXIBILITY: The ability to divert from the plan and exploit success by maintaining freedom of maneuver. Flexibility in planning results from wargaming. E. AUDACITY: The willingness to risk bold action to win. The commander is quick and decisive, and willing to take prudent risks based on sound tactical judgement, personnel observation of the terrain, and first-hand knowledge of the battle. 3. SEQENCE OF AN ATTACK. A. RECONNAISSANCE. Begins as soon as possible after the task force receives its mission. Gathers information on avenues of approach, obstacles, and the enemy positions in order to plan the attack. Continues throughout the attack. B. MOVEMENT TO A LINE OF DEPARTURE. When attacking form positions not in contact, tasks forces often stage in rear assembly areas, road march to attack positions behind friendly unit in contact with the enemy, conduct a passage of lines, and begin the attack. 36

36 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Offensive Operations” Reference FM 7-10, 7-20, 71-1, 71-2 C. MANEUVER. The task force maneuvers to a position of advantage. D. DEPLOYMENT. The task force deploys to attack or to fix the enemy if bypassing. E. ATTACK. The enemy position is attacked by fire, assaulted, or bypassed. F. CONSOLIDATION AND REORGANIZATION OR CONTINUATION. The task force eliminates resistance and prepares for or conducts further operations. 4. FORMS OF MANEUVER. A. ENVELOPMENT. The preferred form of maneuver. The attacker strikes the enemy’s flank or rear. The envelopment caused the enemy to fight in a direction from which he is less prepared. Requires an assailable flank, flank found by aggressive reconnaissance. One or more companies or teams make supporting attacks to fix the enemy. Other companies of the task force maneuver against the enemy’s flank or rear. May be conducted mounted or dismounted, but must have mobility and combat power to achieve its purpose. Variations of the envelopment include double envelopment and encirclement. B. TURNING MOVEMENT. Is a variant of the envelopment which the attack seeks to pass around the enemy, avoiding his main forces, to secure an objective deep in the rear. The task force normally conducts a turning movement as part of a larger unit’s operation Figure 2-1, Envelopment. C. PENETRATION. Task Force concentrates its forces to rupture the defense on a narrow front, normally a platoon. The gap created is then widened and used to pass forces through to defeat the enemy in detail and to seize objectives in depth. A successful penetration depends on surprise and the attacker’s ability to suppress enemy weapons, to concentrate forces at the point of attack and to quickly pass sufficient force through the gap to destroy the enemy’s defense. Normally attempted when enemy flanks are unassailable, or when the enemy has a weak or unguarded gap in his defense. 37

37 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Offensive Operations” Reference FM 7-10, 7-20, 71-1, 71-2 PENETRATION IS PLANNED IN THREE PHASES Step 1 - The isolation of the site selected for penetration. (Step #1) - Figure 2-2. Step 2 - Initial penetration of the enemy position. Dismounted infantry company teams breach the close-in obstacles and seize enemy positions behind these obstacles. These teams widen and hold the shoulders of the initial penetration. This penetration is overwatched and supported by other elements of the task force. (Step #2) - Figure 2-3. 38

38 Chapter 2 TASK FORCE TACTICAL OPERATIONS “Offensive Operations”
Reference FM 7-10, 7-20, 71-1, 71-2 Step 3 - Exploitation of the penetration. Other companies complete the destruction of the enemy position and move to deeper objectives. (Step #3) - Figure 2-4. D. FRONTAL ATTACK. The frontal attack is the least preferred form of maneuver. In the frontal attack, the task force uses the most direct routes to strike the enemy along his front. This attack is normally employed when the mission is to fix the enemy in position or deceive him. Although the frontal attack strikes the enemy’s front within the zone of the attacking force, it does not require that the attacker do so on line or that all subordinate unit attacks be frontal. Frontal attacks, unless in overwhelming strength, are seldom decisive. E. INFILTRATION. The purpose of an infiltration is to move by stealth to place a maneuver force in a more favorable position to accomplish the mission. This is a preferred form of infantry maneuver, because it permits a smaller force to use stealth and surprise to attack a larger or fortified force. Infiltration helps avoid detection and engagement. Movement is usually by foot or air but can be by vehicle or watercraft. Along with other units, an infiltrating force can attack the rear and flanks of enemy forward positions to accomplish its mission and as a means to facilitate a penetration of a larger force. It can also attack lines of communication, administrative rear installations, headquarters, CPs, and CS or CSS activities and facilities. Infiltrating units can seize key terrain, destroy critical communications nodes, and interfere with the resupply and reinforcement of enemy positions. 39

39 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Offensive Operations” Reference FM 7-10, 7-20, 71-1, 71-2 E. INFILTRATION (Cont.) (a) Types. (1) Land. Infiltration by foot is most common but infiltration by vehicle is also possible. It is most feasible in areas with large gaps between forces or where flanks might be impossible to secure. Many infiltrations have been conducted by vehicle, especially when force-to-space ratios were small. (2) Water. Forces can infiltrate by sea or inland waterway. (b) Advantages. Infiltration can be used when enemy firepower discourages the use of another form of maneuver or when a light force is employed against a mechanized or motorized force. Infiltration can panic and disorganize an enemy oriented physically and mentally to fight to the front. This can sometimes cause the enemy to withdraw even if he is too strong to be driven out by other means. (c) Disadvantages. The main disadvantage of an infiltration is that small infiltrating elements can be destroyed piecemeal if the defending force detects them. Infiltration requires time and for small-unit leaders to have excellent navigational skills. For an infiltration to be successful, all forces must link up as planned behind enemy lines. (d) Conditions. The commander's knowledge of enemy dispositions and the battalion's ability to conceal plans and movements allows infiltration over rough terrain, heavily wooded terrain against a widely dispersed enemy or in a front with fluid positions. (1) A rough, almost inaccessible location is best for an infiltration. (2) Darkness and bad weather reduce the chance that the enemy will detect the infiltration. (3) Infiltration should be conducted through areas not occupied or covered by enemy surveillance and fire. (4) The local population should be avoided unless known to be friendly. Civilians positively confirmed as friendly can help with the infiltration and can be used as guides. 40

40 Chapter 2 TASK FORCE TACTICAL OPERATIONS “Offensive Operations”
Reference FM 71-1, 71-2, 71-3 5. MOVEMENT TECHNIQUES AND FORMATIONS. A. MOVEMENT TECHNIQUES. The three movement techniques are traveling, traveling overwatch, and bounding overwatch. Usually, the task force does not move as a unit using one movement technique. Rather, the task force commander designates the movement technique to be used by the lead unit(s). Movement techniques end upon enemy contact. The unit begins its actions on contact and the overwatching force begins its suppressive fire. B. FORMATIONS. The tack force may move in any of six basic formations: Column, wedge, V, echelon, line, and box or diamond. The task force may use more than one formation in a given movement; especially true when the terrain changes during movement. Other factors are distances of the move and enemy disposition. (1) Column formation The task force moves in column formation when early contact is not expected, and the objective is far away. Normally the lead element uses traveling overwatch while the following units are traveling. Considerations are as follows: Speed of movement, easy to control, useful in defiles or dense woods. Provides for quick transition. Requires flank security. Provides majority of firepower to tanks. Figure 2-5, Column. (2) Wedge Formation. The wedge formation best positions the battalion to attack an enemy appearing to the front and flanks. It is used when enemy contact is possible or expected, but the location and disposition of the enemy is vague. When enemy contact is not expected, it may be used to rapidly cross open terrain. Facilitates control and transition to the assault. Provides for maximum firepower forward and good firepower to the flanks. In forested areas or during poor visibility, is difficult to control. Requires sufficient space to disperse companies laterally and in depth. 41

41 Chapter 2 TASK FORCE TACTICAL OPERATIONS “Offensive Operations”
Reference FM 71-1, 71-2, 71-3 (3) V Formation. The V formation disposes the task force with two companies abreast and one trailing. This arrangement is most suitable to advance against a threat know to be to the front of the task force. It may be used when enemy contact is expected and the location and disposition of the enemy is know. Considerations are as follows: Hard to reorient: control is difficult in heavily wooded areas. Provides for good firepower forward and to the flanks Figure 2-6 (V Formation). (4) Echelon Formation. The echelon formation arranges the task force with the company teams in column formation in the direction of the echelon (right or left). It is commonly used when the task force provides security to a larger moving force. Provides for firepower forward and in the direction of echelon. Facilitates control in open areas; more difficult in heavily wooded areas. Figure 2-7 (Echelon Right) 42

42 Chapter 2 TASK FORCE TACTICAL OPERATIONS “Offensive Operations”
Reference FM 71-1, 71-2, 71-3 (5) Line formation. The line formation arranges the task force with the company teams abreast. Since it does not dispose company teams in depth, the line provides less flexibility of maneuver than other formations. It is used when continuous movement with maximum firepower to the front is required. Considerations are as follows: Permits maximum firepower to the front. Difficult to control. Facilitates the use of speed and shock in closing with the enemy. Figure 2-8, Line Formation (6) Box formation. The box formation arranges the task force with two company teams forward and two company teams trailing. It is the most flexible of all formations because it can easily be changed to any other formation. Provides firepower to the front and flanks. Facilitates speed of movement because it is easy to control. (6) Diamond formation. The diamond formation is a variation of the box formation. In the diamond formation, one company team leads, one company team is positioned on each flank, and the remaining company team is to the rear. Figure 2-9, Box Formation 43

43 “How The Threat Defends”
Chapter TASK FORCE TACTICAL OPERATIONS “How The Threat Defends” Reference FM 71-1 and 71-2 1. The threat normally uses motorized rifle units to defend and used tank forces in the counterattack. Other key notes in how the threat defends are as follows: Perceives the hasty defense as the most probable form of defense, as it allows for a rapid transition to offensive operations. It is most vulnerable to an attack. When halted for more than a few hours, makes the transition from a hasty defense to a prepared defense organized in successive belts and echelons to provide depth. The threat consists of a security zone and a main defense belt. The attacker is faced with a series of mutually supporting platoon and company battle positions or strongpoints in depth. Obstacles are prepared forward to canalize him into “fire sacks” or to expose them to counterattacks by tank-heavy reserves. Security zones try to halt or delay the attacker by forcing him to deploy before reaching the main defense belt. 2. The following are strengths of the threat defense. Mechanized and armored formation fight as a combined arms team. Heavy attack helicopters are used against close targets; fixed-wing aircraft attack artillery unit, nuclear delivery systems, and other deep targets. Massive amounts of field artillery can be brought to bear. Counterfire and close support missions are fired simultaneously. The defense is antitank and strongpoint oriented with tank-heavy mobile reserves. Figure 2-10, Threat Defense 3. Vulnerabilities and weaknesses of the defense are as follows. Communications are excellent; at platoon level, primary command and control is with visual signals. Artillery command observation posts (COP) are the heart of the fire support system. 44

44 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Conducting Attacks” Reference FM 71-1, 71-2, 1. Movement to Contact. The task force conducts a movement to contact to make or regain contact with the enemy and to develop the situation. Task forces conduct movement to contact independently or as part of a larger force. The task force will normally be given a movement to contact mission as the lead element of a brigade attack, or as a counterattack element of a brigade or division. It terminates with the occupation of an assigned objective or when enemy resistance requires the battalion to deploy and conduct an attack to continue forward movement. a. Key planning considerations for the movement to contact are: (1) Movement. Task force movement is oriented on the objective and along any assigned axis advance. The task force moves consistent with the following factors: Speed required by brigade. Available avenues of approach. Requirements to maintain mutual support between maneuver units, security, and fire support to the security force. Making contact with the smallest element possible. Reacting to contact faster than the enemy. Figure 2-11, Movement to Contact (2) Task Organization. The task force is organized with a security force, advance guard, main body, and flank and rear guards. Security Force. Provides adequate warning and sufficient space for the task force to move. Advance Guard. This is the task force commander’s initial main effort, usually a company team. The mission to provide security for the main body and facilitate its uninterrupted advance. It’s composition is METT-TC dependent. In open terrain, a tank-heavy team is preferred. At night, a mech infantry heavy team is preferred. Engineers will follow or are attached to the lead elements. Main Body. Remains 1 to 2 kilometers behind advance guard lead element. Contains the bulk of the combat elements. The Tactical CP follows the advance guard. Main CP moves behind the lead element of the main body. Flank and rear guards. Normally a platoon size element from one or more of the companies. Provides flank guard under company control. Trailing company provides rear security. 45

45 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Conducting Attacks” Reference FM 71-1, 71-2, 71-3 2. Hasty Attack. The hasty attack differs from the deliberate attack only in the amount of time allowed for planning and preparation. The hasty attack is conducted either as a result of a meeting engagement or when bypass has not been authorized and the enemy force is in a vulnerable position. Hasty attacks are initiated and controlled by FRAGOs. Two categories of hasty attack depending on the disposition of the enemy: An attack against a moving enemy force. An attack against a stationary enemy force. a. Attack Against a Moving Force. (1) When two opposing forces converge, the side that wins is normally the one that acts fastest and maneuvers to positions of advantage against the opponent’s flank. The advance guard attacks or defends, depending on the size and disposition of the enemy force. (1) The task force commander will maneuver trailing or adjacent teams against the enemy’s flank or rear, while attacking by fire and interdicting enemy units attempting to do the same (see Figure 2-12). (2) Tanks normally lead the attack; BFVs will overwatch and support the Figure 2-12, Hasty Attack (Moving Enemy) maneuvering tanks by fire. (3) FASCAM, smoke, and other supporting fires maybe used to disrupt enemy maneuver and cover that of the task force. (4) The scouts and advance guard provide initial information on the enemy force and develop the situation. (5) The lead company teams defends from hasty positions to fix the enemy element. (6) A company team seizes high ground to provide overwatch and flank security. (7) The trail team(s) counterattacks the enemy flanks supported by field artillery and CAS. 46

46 Chapter 2 TASK FORCE TACTICAL OPERATIONS “Conducting Attacks”
Reference FM 71-1, 71-2, 71-3 b. Attack Against a Stationary Force. (1) A hasty attack against a stationary force is initiated after scouts or lead company teams reconnoiter the enemy’s positions to find flanks or gaps that can be exploited. (2) The task force commander coordinates the actions of his subordinates through FRAGOs and previously issued contingency plans and control measures. (3) Dismounted infantry assaults supported by direct and indirect fires may be necessary to defeat the enemy. Tanks support by fire and begin their assault timed to arrive on the enemy position at the same time as the dismounted infantry. 3. Deliberate Attack. a. Task force deliberate attacks differ from the hasty attack in that they are characterized by precise planning based on detailed information, thorough preparation, and rehearsals. b. The tank or mechanized infantry battalion will normally conduct deliberate attack a delibrate attack as the main or supporting effort of a brigade attack, or as the brigade reserve. c. A deliberate attack requires time for collecting and evaluating enemy information, reconnoitering, planning, and coordinating. The commander will designate support, breaching, and assault forces and position them in the attack formation for anticipated breaching operations. 4. Attack Of A Strongpoint. During offensive operations, enemy strongpoints may be encountered. The four steps in the process of destroying an enemy strongpoint are: Reconnoiter and task-organize to take advantage of enemy weaknesses. Isolate the point of initial penetration with smoke and fires. Breach or find bypass routes around obstacles and gain a foothold into the position. Exploit this penetration to complete the destruction of the strongpoint. 47

47 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Conducting Attacks” Reference FM 71-1, 71-2, 71-3 a. Reconnoiter and Task-organize. (1) Reconnaissance of the strongpoint is conducted in the same manner as reconnaissance for a deliberate attack. (2) The task force organizes into a breaching force, a support force, and an assault force. A company size reserve is retained or part of the support force is designated as reserve. (a) The breach force is usually formed around a mechanized infantry company. Engineers, if available, are part of the breach force. The breach force makes the initial breach and passes the assault force through it. (b) The support force is organized to provide supporting direct (and indirect) fires to the breach force initially, then to the assault force. The support force may consist of tank companies or tank-heavy company teams. (c) The assault force is usually a mechanized-infantry-heavy company team. The assault force may be required to breach enemy close-in obstacles and should, therefore, include infantry and engineers. The assault force attacks through the breach and destroys the enemy position. b. Isolate the Point of Penetration. The decisive point is the site on which the initial breach of the enemy position will occur. This position is isolated by intense direct and indirect fires and smoke to destroy enemy positions and to prevent lateral movement to reinforce this platoon. c. Breach and Penetrate. The breach of the enemy strongpoint is the task force initial main effort (see figure 2-13). The breach force breaches the enemy’s protective obstacles, gains a foothold in the trench line, and creates a gap in the strongpoint large enough to pass through the assault force Figure 2-13, Attack of a Strongpoint - the breach. 48

48 Chapter 2 TASK FORCE TACTICAL OPERATIONS “Conducting Attacks”
Reference FM 71-1, 71-2, 71-3 d. Exploit the penetration. After the successful breach, the assault force becomes the task force main effort (see figure 2-14). The assault force passes rapidly through the breach, supported by the fires of the support force and the breach force. The assault objective is an isolated enemy platoon position. (1) The assault force will be organized into support, breach, and assault elements. As subsequent platoon positions are encountered, the breaching process may have to be repeated. (2) The task force commander may commit the reserve to complete the destruction of the strongpoint and prepare for a counterattack or continue the attack Figure 2-14, Attack of a Strongpoint - the assault. 5. Exploitation. a. The exploitation is conduct to take advantage of success in battle. It prevents the enemy form reconstituting an organized defense or conducting an orderly withdrawal. It may follow any successful attack. The task force normally participates in the exploitation as part of a larger force. The keys to successful exploitation are speed in execution and maintaining direct pressure on the enemy. b. Exploiting force missions include - Securing objectives deep in the enemy rear. Cutting lines of communication. Surrounding and destroying enemy units. Denying escape routes to an encircled force. Destroying enemy reserves, CS, and CSS units and assets. c. The task force conducting an exploitation moves rapidly to the enemy’s rear area using movement to contact techniques, avoiding or bypassing enemy combat units, and destroying lightly defended and undefended enemy installations and activities. 49

49 “Other Offensive Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Other Offensive Operations” Reference FM 71-1, 71-2, 71-3 5. Exploitation (Cont.) d. The exploitation continues day and night for as long as the opportunity permits. The momentum of the exploitation must not be slowed because of lack of support. 6. Pursuit. a. The pursuit normally follows a successful exploitation. It differs from an exploitation in that a pursuit is oriented primarily on the enemy force rather than on terrain objectives. While a terrain objective maybe designated, the enemy force is the primary objective. The purpose of the pursuit is to run the enemy down and destroy him. The pursuit is conducted using a direct-pressure force, an encircling force, and a follow-and-support force. The direct-pressure force denies the enemy units the opportunity to rest, regroup, or resupply by repeated hasty attacks to force them to defend without support or to stay on the move. The direct-pressure force envelops, cuts off, destroys, and harasses enemy elements. The encircling force moves with all possible speed to get in the enemy rear, block his escape, and with the direct-pressure force, destroy him. The enveloping force advances along routes parallel to the enemy’s line of retreat to establish positions ahead of the enemy main force. The follow-and-support force is organized to destroy bypassed enemy units, relieve units under direct pressure, secure lines of communication, secure key terrain, or guard prisoners or key installations. 7. Raid. a. A raid (see Figure 2-15) is an attack into enemy territory to accomplish a specific purpose and with no intention of gaining or holding terrain. Raids may be conducted to - Capture prisoners. Capture or destroy specific enemy materiel. Destroy logistical installations. Obtain information concerning enemy locations, dispositions, strength, intentions, or methods of operation. Disrupt enemy plans. 50

50 “Other Offensive Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Other Offensive Operations” Reference FM 71-1, 71-2, 71-3 7. Raid (Cont.) b. Battalion task force may conduct, or may direct subordinate elements to conduct, a raid. c. May be conducted mounted or dismounted and may be accomplished through infiltration or air assault. Mounted raids normally are conducted as an exploitation with a limit of advance, or as an attack with a limited-depth objective. Dismounted raids are conducted as a combat patrol. d. Raids may be conducted during day or night. e. Raiding force security is vital, because the raiding party is vulnerable to attack from all directions. Figure 2-15, Raid f. Raids are timed so that raiding force arrives a the objective area at dawn, twilight, or other times of low visibility. g. During daylight, the raid force used covered routes or approach. During reduced visibility, when surprise through stealth is possible, advance and flank security detachments precede the raiding force. h. The withdrawal is usually make over a different route from the one used to approach the objective. i. Logistically, the raiding force carries everything required to sustain itself during the operations. Resupply of the raiding force, if required, is by aircraft. 8. Feint. A feint is a supporting offensive operations to draw the enemy’s attention away form the area of the main attack and induce him to move his reserves or shift his fire support. Feints must appear real. Contact with the enemy is required. 51

51 “Other Offensive Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Other Offensive Operations” Reference FM 71-1, 71-2, 71-3 9. Demonstration. The demonstration is an operation to deceive the enemy about the main attack. Its purpose is similar to a feint; however, no contact with the enemy is made. 52

52 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 1. PURPOSE OF DEFENSE The purpose of defense is to defeat the enemy’s attack and gain the initiative of offensive operations. Defense is a temporary measure conducted to identify or create enemy weaknesses that allow for the early opportunity to change over to the offense. Achieve one or more of the following: Destroy the enemy. Weaken enemy forces as a prelude to the offense. Cause an enemy attack to fail. Gain time. Concentrate forces elsewhere. Control key or decisive terrain. Retain terrain. 2. CHARACTERISTICS OF DEFENSIVE OPERATIONS. a. Preparation. (1) Operational security is the defender’s first requirement to defeat an attack. Unit must maintain operations security, avoid patterns, and practice deception to hide the defender’s position. Enemy reconnaissance efforts and probing attacks must be defeated without disclosing the scheme of defense. The winner of the reconnaissance battle is usually the winner of the final battle. (2) An enemy attack is preceded and accompanied by masses supporting fires. To survey, units must use defilade, reverse slope, and hide positions; use supporting and suppressive fires; and avoid easily targeted locations. The defender must use all available time to prepare fighting positions and obstacles, to rehears counterattacks, and to plan supporting fires and combat service support in detail. b. Disruption. The defender must slow or fix the attack, disrupt the attacker’s mass, and break up the mutual support between the attacker’s combat and combat support elements. A general aim is to force the attacker to fight a nonlinear battle to make the attacker fight in more than one direction. c. Concentration. The defender should be able to rapidly concentrate forces, thereby massing combat power to defeat an attacking force, then disperse and be prepared to concentrate again. 53

53 Chapter 2 TASK FORCE TACTICAL OPERATIONS
“Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 2. CHARACTERISTICS OF DEFENSIVE OPERATIONS (Cont.) d. Flexibility. Commanders designate reserves and deploy forces and logistic resources in depth to ensure continuous operations and to provide options for the defender if forward positions are penetrated. Figure 2-16, Defensive Framework 3. FRAMEWORK OF THE DEFENSE The task force normally defends as part of a larger force. The defensive framework which the corps and divisions organize and fight are organized into five elements (see Figure 2-16). Deep operations forward of the forward line of own troops (FLOT). Security force operations forward of and to the flanks of the defending force. Main battle area (MBA) operations. Reserve operations in support of the main defensive effort. Rear operations to retain freedom of action in the rear area. 54

54 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 a. Deep Operations. (1) Deep operations are actions against those enemy forces not yet in direct contact with the FLOT. Deep operations are conducted using indirect fires, EW, air force and army aviation, deception, and maneuver forces. (2) Task forces have no deep operations capabilities, although they maybe part of a deep maneuver operation. b. Close Operations. (1) Security area operations. (a) The forward security force normally established by corps is called a covering force. It fights against the attacker’s leading echelons in the covering force area (CFA). Covering force actions weaken the enemy; allows repositioning of forces; deceives the enemy as to the size, location, and strength of the defense. (b) A battalion task force may fight as a part of a covering force operation. When it disengages the enemy, it becomes part of the MBA forces or reserve. (2) Main battle area operations. (a) Based on the estimate of the situation and intent the brigade commander assigns sectors or battle positions to task forces. He will identify the main effort and give assets required to the force responsible for the most dangerous avenue of approach into the MBA. (b) Task force commanders structure their defenses by deploying units in depth within the MBA. A mounted reserve of one-quarter to one-half of the task force strength provides additional depth. (3) Reserve Operations. (a) The commitment of reserve forces at the decisive point and time is key to the success of a defense. When the task force is designated as a reserve force, it can expect to receive one or more of the following missions: counterattack, spoiling attack, block, fix or contain, reinforce, or rear operations. c. Rear Operations. The battalion task force does not have a rear operations fight within its assigned sector. However, a maneuver battalion assigned a rear mission by a higher headquarters may conduct offensive operations against enemy conventional or unconventional forces in the rear area. 55

55 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 4. HOW THE THREAT ATTACKS. The threat strives to sustain continuous operations with overwhelming numbers through momentum, mass, and echelonment. The threat uses combined arms formations of massed tanks, motorized (mechanized) infantry, and other armored vehicles supported by massed fires. (See Figure 2-17 for an example threat motorized rifle regiment attack.) Figure 2-17, The Offensive Threat 5. SEQUENCE OF THE DEFENSE. a. Occupation. During this phase, the scouts are usually the first to clear the proposed defensive position. Leaders then reconnoiter and prepare their assigned areas. Security is established forward of the defense area to allow occupation of positions and preparation of obstacles without compromise. b. Covering Force Fight. The covering forces makes initial contact with the approaching enemy. Depending on the mission, organization, and size of the covering force, it may do anything from provide early warning to defeat of the enemy’s lead echelons. The counter reconnaissance fight begins here. 56

56 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 5. SEQUENCE OF THE DEFENSE (Cont.) b. Passage of the Covering Force. The task force establishes contact with, and assists the disengagement and passage of the covering force or other security elements. c. Defeat of Enemy Reconnaissance, Infiltration, and Preparatory Fires. Consistent with security requirements, task force elements remain in defilade, hide, and prepared positions to avoid the casualties and shock associated with indirect fires. The enemy will attempt to discover the defensive scheme by reconnaissance and probing attack of the advance guard. d. Approach of the Enemy Main Attack. Task force security elements observe and report enemy approach movement. The task force commander repositions or reorients his forces to mass against the enemy’s main effort. Enemy formations are engaged at maximum range by supporting fires and close air support to slow, disorganize or to impair his communications. Obstacles are closed, direct fire weapons are repositioned as required. The task force may withhold fires to allow the enemy to enter the engagement area. e. Enemy Assault. As the enemy deploys, he becomes increasingly vulnerable to obstacles. The task force uses obstacles, blocking positions, and fires to break up the assaulting formation. Continued maneuver to enemy flanks and rear is used to destroy him. f. Counterattack. As the enemy assault is slowed or stopped, the task force commander will launch his counter attack (by fire or by maneuver) to complete the destruction of the enemy forces. g. Reorganization and Consolidation. The task force must quickly reorganize to continue the defense. Casualties are evacuated, ammunition and other critical items are cross-leveled and resupplied. Security and obstacles are reestablished and reports are submitted. Figure 2-18, Reorganization and Consolidation 57

57 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 6. TYPES OF DEFENSE a. Defense of a Sector. (1) A defensive sector is an area designated by boundaries that define where a unit operates and the terrain for which it is responsible. Defense in sector is the most common defense mission for the task force. (2) Sectors maybe used in the MBA and CFA. Task force sectors are oriented on regimental avenues of approach and are used when the brigade commander wishes to allow maximum freedom of action to his task forces. A commander defending a sector is expected to defeat enemy forces within his sector, and maintain his flank security. (3) Defend in sector is the least restrictive mission. It allows the task force commander to plan and execute his defense using whatever technique is necessary to accomplish the mission He may use sectors, battle positions, Figure 2-19, Three Company Teams strongpoints, or a combination of in Sector measures to accomplish his mission. (4) If the commander cannot concentrate fires, he distributes his forces and fires using company sectors. For example, in Figure 2-19, the commander used three companies in sector because multiple avenues of approach promoted decentralization. The reserve is positioned near where it probably will be used, and the reserve force commander prepares and reconnoiters routes to on-order counterattack positions. (a) To control his forces, the task force commander establishes coordinating points, phase lines, on-order battle positions, and contact points. (b) In Figure 2-20 , the commander has established coordinating points for control along the FEBA. His intent is to destroy the enemy force forward in the MBA. He establishes a security force consisting of a reinforced mech infantry company to provide early warning, conduct counterreconnaissance, and assist the rearward passage and battle handover of the covering force. 58

58 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 (c) As the battle develops, the security force identifies the main effort against the middle company sector. The enemy’s attack is initially blunted by the defending company. The left flank team commander sees an opportunity to conunterattack from the flank to destroy the enemy force (see figure ). Figure 2-20, Company team sectors with control and coordination measures. Figure 2-21, Task Force Counterattack. (d) The commander may compensate for changes in the battle by moving the reserve positioned in depth forward to assume responsibility for the vacant sector. Following the counterattack, he may then direct the counterattack force to conduct a rearward passage and occupy positions in depth to become the reserve. 59

59 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 Figure 2-22, Company battle positions. (f) As depicted in figure 2-22, the commander may choose to employ companies in battle positions. This technique restricts maneuver and complicates flank coordination by the companies, but it gives greater control of the overall defense to the task force commander. (g) There are many combinations of techniques that the commander could use to position his forces. The examples show some of the possible combinations and conditions that could exist. Figure 23, Sector and BP Defense 60

60 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 b. Defense of a Battle Position. A BP is a general location and orientation of forces on the ground, from which units defend. The BP can be for units from battalion TF to platoon size. A unit assigned a BP is within the general area of the position. Security forces may operate well forward and to the flanks of BPs for early detection of the enemy and for all-around security. Units can maneuver in and outside of the BP as necessary to adjust fires or to seize opportunities for offensive action in compliance with the commander's intent. Figure 2-24, Battle Position The commander may maneuver his elements freely within the assigned BP. When the commander maneuvers his forces outside the BP, he notifies the next higher commander and coordinates with adjacent units. Task force security, CS, and CSS assets are frequently positioned outside the BP with approval from the headquarters assigning the BP. c. Defense of a Strongpoint. The mission to create and defend a strongpoint implies retention of terrain with the purpose of stopping or redirecting enemy formations. Battalion strongpoints can be established in isolation when tied to restrictive terrain on their flanks. A bypassed strongpoint exposes the enemy's flanks to attacks from friendly forces. Figure 2-25, Strongpoint The TF pays a high cost in manpower, equipment, material, and time for the construction of a strongpoint. It takes several days of dedicated work to construct one. Strongpoints also sacrifice the inherent mobility advantage of heavy forces. Strongpoints may be on the FEBA, or in depth in the brigade MBA. 61

61 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 1. Other Defensive Operations and Techniques. a. Counterreconnaissance Operations. (1) Enemy reconnaissance operations will begin well ahead of any planed tactical operation. The task force will attempt to prevent the enemy from seeing its preparations. Enemy reconnaissance elements will conduct mounted and dismounted patrols to define positions, identify units, and detect friendly activities. His patrols will be small, move with stealth, and use concealment to observe friendly forces. It is important that these elements be detected and denied information, or destroyed before they can report their observations. The task force countersurveillance operations are integrated into the brigade plan to counter the enemy reconnaissance and surveillance efforts. (2) Counterreconnaissance needs to be planned so as to use all assets available to detect the enemy reconnaissance elements early. The following tasks have to be preformed to ensure that this gets done: (a) Specify the security force mission. Screen, in addition to preventing direct observation by the enemy, implies long range observation of enemy avenues of approach to provide early warning and detection, and neutralization or destruction of enemy reconnaissance elements. (b) Provide sufficient assets. At least a screening force is needed to detect the enemy’s approach and defeat the enemy’s reconnaissance efforts. (c) Establish security early and well forwarded. In coordination with covering force operations, the task force security element should be in place before the company teams move into their battle positions and before work on obstacle begins. (d) Put security in the right place; ensure complete coverage. Based on terrain and threat analysis, the S2 templates likely enemy reconnaissance objective and route and recommends the general location of the security force to the S3; the commander approves the plan. (3) The following are elements used in the counterreconaissance activities. (a) Scouts. The primary counterreconnaissance asset of the task force. (b) GSR. Usually limited to open terrain and best used to cover open, high-speed avenues of approach where early detection is critical. (c) TOW/ITV. These elements can be used to occupy OPs and destroy enemy reconnaissance vehicles. These crews are smaller and less familiar with security operations than a scout squad. 62

62 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 a. Counterreconnaissance Operations (Cont.) (d) Maneuver units (tanks and infantry). Manning OPs and patrolling are normal infantry missions. Considerations for using infantry squads must be tempered by the MBA preparation time these squads need. Each tank crew can man only one OP, and the OP should be used to cover a relatively open, high-speed avenue of approach. b. Stay-Behind/Hide Forces. (1) The purpose of stay-behind forces is to surprise, counterattack, defeat, and confuse the enemy. The stay-behind or hide force counterattacks enemy combat forces from the rear, or attacks and or ambushes his command and control, combat support, and combat service support elements (see Figure 2-26). This is a high risk operation and should not be considered lightly. (2) In example shown in Figure 2-27, a mechanized-infantry heavy battalion task force hides in a covered and concealed position forward of the FEBA. This task force Figure 2-26, Stay-Behind in is position to outflank an enemy avenue of force attack approach or attack a likely location or enemy command and control, air defense, or trains elements, and can defend BP 8. In the brigade plan, after passage of the covering force, the stay-behind/hide force is to counterattack to Objective RED. The commander’s intent is to destroy enemy command and control, air defense, and supply vehicles. Upon completion of the counterattack or on order, the task force delays to Route Bill, returns through passage point 1, and occupies assembly area JIM to reconstitute, refit, rearm, refuel, and rest. The task force maintains radio-listening silence as it crosses the FEBA. It must be in position before battle handover at PL HARRY and should not begin the attack until the covering force has passed and the enemy can be surprised. Figure 2-27, Stay-behind force attack and withdrawal 63

63 “Combat Operations in the Defense”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Defense” Reference FM 71-1, 71-2, 71-3 c. Perimeter Defense. A perimeter defense is oriented in all directions (see Figure 2-27). A task force organizes a perimeter defense to provide self-protection. A perimeter is established when the task force must hold critical terrain in areas where the defense is not tied in with adjacent units. The task force may also form a perimeter when it has been bypassed and isolated by the enemy and must defend in place. Figure 2-27, Perimeter Defense d. Reverse Slope Defense. The reverse slope defense uses the topographical crest to mask the defender from the supporting direct fire and observation of the attacker. The task force rarely conducts a reverse slope defense along it’s entire front; however, there maybe situations where subordinate units and weapons systems maybe employed on the reverse slope. The task force commander may adopt a reverse slope position for elements of the battalion: When the forward slope is made untenable by enemy fire. When the forward slope has been lost or not yet gained. When the terrain on the reverse slope affords better or equal fields of fire than on the forward slope. When the possession of the forward slope is not essential for observation. To avoid creating a dangerous salient in friendly lines. To surprise the enemy and to deceive him as to the location of the battalion main defensive positions. To deny the enemy direct observation and fires on to the defensive position and facilitate resupply. When time to prepare positions is limited. When seeking to gain protection from the effects of nuclear or chemical fires that are anticipated forward of the friendly position. Figure 2-28, Organization of Reverse Slope Defense 64

64 “Combat Operations in the Reserve”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Reserve” Reference FM 71-1, 71-2, 71-3 RESERVE OPERATIONS When designated as a reserve for a higher headquarters, the battalion TF may be assigned one or more of the following missions: Counterattack. Spoiling attack. Block, fix, or contain enemy force. Reinforce. Rear operations. a. Counterattack. (1) Attack Assignment. Counterattack planning and execution is assigned by brigade to committed and reserve TFs. Normally, more than one counterattack option is planned for and rehearsed. Counterattacks may be conducted to block an impending penetration of the FEBA; to stop a force that has penetrated; to attack through forward defenses to seize terrain; or to attack enemy forces from the flank and rear. (2) Timing the Attack. A counterattack, at any level, is usually the decisive point in an engagement. The commander's timing in committing Figure 2-29, Counterattack his reserve to the counterattack is critical. To ensure success, the counterattack must be well planned and precisely executed. The battalion medical operations officer must be in touch with the tactical scenario and prepared to execute the HSSPLAN. b. Spoiling Attack. This is a preemptive, limited objective attack aimed at preventing; disrupting; or delaying the enemy's ability to launch an attack. The objective of the spoiling attack is the enemy force, not terrain. The reserve is often used to conduct spoiling attacks so that forward units can concentrate on defensive preparations within the MBA. Spoiling attacks are normally directed against an enemy force that is preparing to conduct an attack; that has temporarily halted to rearm and refuel; or is making the transition from mounted to dismounted operations. Enemy artillery is also a prime target. 65

65 “Combat Operations in the Reserve”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in the Reserve” Reference FM 71-1, 71-2, 71-3 c. Block, Fix, or Contain. The reserve may be ordered to establish a hasty BP to block, fix, or contain enemy forces within a portion of the battlefield. This action may be necessary to blunt a penetration while other forces maneuver against the flanks or rear of the enemy force. An enemy force may be held in one area of the battlefield while he is defeated in another. d. Reinforce. Reserve forces may be committed to reinforce units that have sustained heavy losses; also to build up stronger defenses in critical areas of the battlefield. Considerations must be given to how they will be integrated into the defensive scheme, C2 arrangements, and where they will be positioned. The techniques used to reinforce are similar to those used during a relief in place. e. Rear Operations. The reserve battalion may operate as a division combined arms tactical combat force with a rear operations mission. The TF must not allow itself to become so dispersed that it cannot mass for other reserve missions. Nevertheless, the TF normally uses dispersed company positions; this reduces the TF signature on the battlefield and helps spread its companies to accomplish rear operations. The TF completes intelligence preparation of the rear area for probable enemy avenues of approach and for likely enemy landing zones (LZs) and drop zones (DZs). It positions forces at the locations to interdict the rear area threat. Based on the IPB, location of CS and CSS elements within the brigade rear area, and their own dispositions, the TF assigns areas of responsibility to its companies or teams. Task forces are responsible for their own security within assigned areas. The TF also coordinates with CS and CSS base clusters for their defense, to include -- Critical CS and CSS assets to be protected. Intelligence preparation of the battlefield, to include local enemy approaches and possible LZs/DZs Review of base and base cluster defensive preparations to include perimeter defensive sketches, OPs, patrols, obstacles, AD weapons sites, and reaction forces. Coordination of fire support and aviation operations including reconnaissance and transport. Coordination with MP and other combat-capable units and base cluster reaction forces. Events or contingencies that will trigger commitment of the TF to destroy a rear area threat. 66

66 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 Retrograde Operations Retrograde operations are organized movements away from the enemy. A retrograde may be forced by enemy action or executed voluntarily. The underlying reason for conducting a retrograde operation is to improve a tactical situation or prevent a worse one from occurring. A retrograde operation may be used to economize forces, maintain freedom of maneuver, or avoid decisive combat. A battalion TF conducts a retrograde as part of a larger force to -- Avoid combat under unfavorable conditions. Gain time. Reposition or preserve forces. Use a force elsewhere. Harass, exhaust, resist, and delay the enemy. Draw the enemy into an unfavorable position. Shorten lines of communication and supply. Clear zones for friendly use of chemical or nuclear weapons. Conform to the movement of other friendly forces. a. Types. There are three types of retrograde operations: delay, withdrawal, and retirement. They can be characterized as follows: Delay-trade space for time and avoid decisive engagement to preserve the force. Withdrawal-break contact. (Free a unit for a new mission.) Retirement-move a force not in contact to the rear. b. Planning Considerations. All retrogrades are difficult and inherently risky. To succeed, they must be well organized and well executed. A retrograde operation requires the following elements: (1) Leadership and Morale. Maintenance of the offensive spirit is essential among subordinate leaders and troops in a retrograde operation. Movement to the rear may be seen as a defeat or a threat of isolation; therefore, soldiers must have confidence in their leaders and know the purpose of the operation and their role in it. 67

67 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 Retrograde Operations (Cont.) (2) Reconnaissance, Surveillance, and Security. Timely and accurate intelligence is especially vital during retrograde operations. Reconnaissance and surveillance must locate the enemy; then security elements must deny him information and counter his efforts to pursue, outflank, isolate, or bypass all or a portion of the TF. The commander must establish a security force that is strong enough to -- Secure enemy avenues of approach. Deceive the enemy and defeat his intelligence efforts. Overwatch retrograding units. Provide rear guard, flank security, and choke point security. c. Mobility. To conduct a successful retrograde, the TF seeks to increase its mobility and significantly slow or halt the enemy. The TF improves its mobility by -- Reconnoitering routes and BPs. Positioning AD and security forces at critical points. Improving roads, controlling traffic flow, and restricting refugee movement to routes not used by the TF. Rehearsing movements. Evacuating casualties, recoverable supplies, and excess materiel before the operation. Displacing nonessential CSS early in the operation. Covering movements by fire. The TF degrades the mobility of the enemy by -- Occupying and controlling choke points and terrain that dominate high speed avenues of approach. Destroying roads, bridges, and rafting on the avenues not required for friendly forces. Improving existing obstacles and covering them with fire. Employing indirect fire and smoke to degrade the enemy's vision and to slow his rate of advance. To ensure continuous coverage, TF mortars normally move in split sections. Conducting spoiling attacks to keep the enemy off balance and force his deployment. 68

68 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 Retrograde Operations (Cont.) d. Deception. The objective of deception is to hide the fact that a retrograde is taking place; this is essential for success. Deception is achieved by maintaining normal patterns of activity in radio traffic; artillery fires; patrolling; and vehicle movement. Additional considerations include using dummy minefields or decoy positions, and conducting feints and demonstrations under limited visibility conditions. Retrograde plans are never discussed on unsecure radio nets. e. Conservation of Combat Power. The commander must conserve his combat power by -- Covertly disengaging and withdrawing less mobile units and nonessential elements before withdrawing the main body. Using mobile forces to cover the withdrawal of less mobile forces. Using minimum essential forces to provide security for withdrawal of the main body. 1. Delay. a. Purpose. A delay is an operation in which a force trades space for time while avoiding decisive engagement. The delay incorporates all of the dynamics of defense, but emphasizes preservation of the force and maintenance of a mobility advantage. The TF may attack, defend, or conduct other actions (such as ambushes and raids) during the delay to destroy the enemy or to slow the enemy. The battalion TF may be given a delay mission as part of the covering force; as an economy-of-force operation to allow offensive operations in another sector; or to control a penetration to set up a counterattack by another force. Figure 2-30, Delay from Successive Positions b. Control of Actions. A delay may be conducted from successive positions or from alternate positions. Successive positions are used when the delay is conducted over a wide front; alternate positions are preferred for a narrow sector. The delay is normally well planned and uses graphic control measures to display the commander's intent. Incorporate these control measures in the CHS overlay. 69

69 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 2. Withdrawal. A withdrawal is an operation in which all or part of the battalion frees itself for a new mission. A withdrawal is conducted to break contact with the enemy when the TF commander finds it necessary to reposition all or part of his force; or when required to attain separation for employment of special purpose weapons. It may be executed at any time, during any type of operation. a. Types of withdrawals. (1) Withdrawal not under enemy pressure. (2) Withdrawal under enemy pressure. b. Both types begin while the battalion is under the threat of enemy interference. Preferably, withdrawal is made while the battalion is not under enemy pressure. Withdrawals are either assisted or unassisted. An assisted withdrawal uses a security force provided by the next higher headquarters in breaking contact with the enemy and to provide overwatching fires. In an unassisted withdrawal, the TF provides its own security force. 3. Retirement a. Purpose. A retirement is a retrograde operation in which a force that is not in contact with the enemy moves to the rear in an organized manner. A retirement is usually made at night. If enemy contact is possible, Figure 2-31, Sequence on-order missions are given to the march units. of withdraw al not under pressure b. Leadership Responsibilities. A retirement may have an adverse impact on the morale of friendly troops. Leadership must be positive; they must keep troops informed of the retirement purpose and future intentions of the command. 4. Passage of Lines a. Purpose. A passage of lines is an operation in which one unit is passed through the positions of another. When a unit moves toward the enemy through a stationary unit, it is a forward passage. Rearward passages are movements away from the enemy through friendly units. The covering force withdrawing through the MBA, or an exploiting force moving through the initial attacking force, are examples. 70

70 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 4. Passage of Lines (Cont.) b. Conduct. A passage of lines is necessary when one unit cannot bypass another. A passage of lines may be conducted to -- Continue an attack or counterattack. Envelop an enemy force. Pursue a fleeing enemy. Withdraw covering forces or main battle forces. c. Vulnerability of Units. The TF vulnerable during a passage of lines. As units are concentrated, the fires of the stationary unit may be masked and the TF is not dispersed to react to enemy action. Detailed reconnaissance and coordination are key to ensure a quick and smooth passage. 5. Relief Operations a. Responsibilities. A relief is an operation in which a unit is replaced in combat by another unit. Responsibilities for the mission Figure 2-32, Passage of Lines and assigned sector or zone of action are assumed by the incoming unit. Reliefs may be conducted during offensive or defensive operations and during any weather or light conditions. They are normally executed during limited visibility to reduce the possibility of detection. b. Purpose. The purpose for relief is to maintain the combat effectiveness of committed elements. A relief may be conducted to -- Reconstitute a unit that has sustained heavy losses. Introduce a new unit into combat. Rest units that have conducted prolonged operations. Decontaminate or provide medical treatment to a unit. Conform to a larger tactical plan or make mission changes. Figure 2-33, Relief 71

71 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 6. Breakout from Encirclement a. Encircled Force. A breakout is an offensive operation conducted by an encircled force. A force is considered encircled when all ground routes of evacuation and reinforcement are cut off by the enemy. b. Conduct. A breakout is conducted to allow the encircled force to regain freedom of movement; or to regain contact with friendly units. Encirclement does not imply that the battalion TF is surrounded by enemy forces in strength. Threat doctrine stresses momentum and bypassing of forces that cannot be quickly reduced. An enemy force may be able to influence the TF's subsequent operations while occupying only scattered positions; it may not be aware of the TF location, strength, or composition. The TF can take advantage of this by attacking to break out before the enemy is able to take advantage of the situation. Figure 2-34, Organization of a Breakout Figure 2-35, Conduct of a Breakout 7. Linkup a. Purpose. A linkup is the meeting of two or more friendly ground forces that have been separated by the enemy. The battalion TF may participate as part of a larger force, or it may conduct a linkup with its own resources. Linkup is conducted to relieve or join a friendly force, or to encircle an enemy force. 72

72 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 7. Linkup (Cont.) b. Coordination of Maneuver Schemes. All elements in a linkup carefully coordinate their operations to minimize the risk of fratricide. This coordination is continuous and increases as the units approach the linkup points. Control measures used are as follows: Zones of attack or axes of advance. If one or more of the forces are moving, their direction and objective are controlled by the higher headquarters. Phase lines. Movement is controlled by a higher headquarters through the use of phase lines. Restrictive fire lines. Restrictive fire lines (RFLs) are used to prevent friendly forces from engaging one another with indirect fires. One technique is to make the phase lines on-order RFLs. As the unit crosses a phase line, the next phase line becomes the RFL. Checkpoints. Checkpoints are used to control movement and designate overwatch positions Figure 2-36, Linkup Operation Linkup and alternate linkup points. The linkup point is a designated location where two forces meet and coordinate operations. The point must be easily identifiable on the ground, and recognition signals must be planned. Alternate linkup points are established in the event that enemy action precludes linkup at the primary point (see FM 31-71). Changes in personnel and equipment authorizations are the result of emphasis on mobility; maintenance; communications; and CSS. Equipment is eliminated or added based on its suitability to the terrain and environment. 8. Guard Operations a. Mission. A guard operation is a security operation in which a unit protects a larger unit by -- Maintaining surveillance. Providing early warning. Destroying enemy reconnaissance elements. Preventing enemy ground observation of main body. Preventing enemy use of direct fire against the main body. 73

73 “Combat Operations in Other Tactical Operations”
Chapter TASK FORCE TACTICAL OPERATIONS “Combat Operations in Other Tactical Operations” Reference FM 71-1, 71-2, 71-3 8. Guard Operations (Cont.) b. Functions. The guard force provides the larger force warning, reaction time, and maneuver space. The guard force delays, destroys, or stops the enemy within its capability. The commander conducting the guard operation must know the intent of the higher force commander and the degree of security required. c. Performance. Guard operations can be to the front, rear, or flanks of the main body (see figure 2-35). Battalion TFs have Figure 2-37, Rear, flank, and the mobility, organization, and equipment advance guard operations. to perform a guard operation as a part of a brigade or division offensive operation. They may be assisted by air cavalry or attack helicopter units under their OPCON. 74

74 Reference FM 8-10, 8-10-4, FM 8-55, FM 7-20
Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATION Reference FM 8-10, , FM 8-55, FM 7-20 TOPIC PAGE Combat Health Support in a Tactical Operation. Planning, Preparing, & Executing Follow-and-Support Concept Communications Maintenance and Casualty Evacuation Color- Coded Triage System Specialty Platoons Marking and Locating Casualties On The Battlefield Evacuation Techniques Combat Health Support in Offensive Operations. General Information and Guidelines Combat Health Support in Movement to Contact Combat Health Support in a Hasty Attack Combat Health Support in the Deliberate Attack Combat Health Support During Exploitation Combat Health Support During a Pursuit Combat Health Support in Defensive Operations. Combat Health Support Flexibility in Defensive Operations General Information and Guidelines Combat Health Support to the Covering Force Combat Health Support during the Battle Handover Combat Health Support in Reserve Operations. Combat Health Support in the Counterattack Combat Health Support in the Reinforce Combat Health Support in the Rear Operations Combat Health Support in Other Tactical Operations. Combat Health Support in the Delay Combat Health Support in the Withdrawal/Retirement Combat Health Support in the Passage of Lines Combat Health Support in the Breakout from Encirclement Combat Health Support in the Linkup 75

75 IN A TACTICAL OPERATION
Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATION Reference FM 8-10, , 8-55, 7-20 1. PLANNING. Large numbers of unexpected casualties and casualties in unexpected locations can hinder or defeat an attack. Commanders and medical platoon leaders must plan beyond their immediate tactical objectives. Medical support must be positioned so the commander can exploit the opportunities created by tactical success. The BAS must mutually support companies; however, as with any battlefield system, its positioning should weight the main effort. Evacuation assets should be task organized and allocated by projected casualties. (Reference Chapter 6, “Medical Platoon Leader’s Planning Checklist”, page 163) 2. PREPARATION. The medical platoon leader is the coordinating staff officer most concerned with casualty evacuation and is an integral war gamer during the IPB process. This allows the medical platoon leader to analyze the tactical plan and terrain and to identify areas of anticipated casualty density. The BAS should be located as far forward as METT-TC allows. The BAS must have enough medical supplies to treat the highest number of expected casualties. Casualty collection points should be predesignated and routinely planned. Ambulance exchange points (AXP) should be used. Extra medical evacuation and treatment support should be planned for and requested from the forward support medical company. The medical support matrix should be integrated with the tactical overlay. If deviation from the matrix occurs, the BAS location must be known at all times. The BAS should remain on location as long as practical. Additional medical supplies should be issued to maneuver elements for various missions. This will assist the medics and combat lifesavers in providing far forward care. In addition, the CHS plan must be rehearsed and synchronized with all key CSS/CHS nodes in the task force. The rehearsal should be rehearsed from point of injury to platoon/company CCPs to the BAS or treatment team locations. The plan should also be rehearsed at the Brigade CSS rehearsal. This allows final adjacent unit coordination to occur and to finalize the plan prior to execution. a. Offense. BAS mobility must be maintained. During offensive operations, BAS can travel with the combat trains or with the last maneuver company in the order of movement. This way the BAS can obtain aid in the event of a breakdown or navigational help. (Reference Chapter 6, “Considerations in the Offense”, page 164) b. Defense. The depth and dispersion of the defense creates important time and distance considerations. In a nonlinear defense, enemy and friendly units intermingle, especially in poor visibility. MSRs and routes between positions might be interdicted. Tactical and logistical vehicles should be used as needed for patient evacuation, as this does not adversely affect their mission. For example, empty ammunition trucks can backhaul casualties. Also, damaged vehicles can be towed to the BSA and used to carry casualties. A platoon can be tasked to "follow and provide casualty evacuation support" to the main effort. (Reference Chapter 6, “Considerations in the Defense”, page 169) 76

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATION Reference FM 8-10, , 8-55, 7-20 3. EXECUTION. Casualty evacuation is a team effort. It is the responsibility of all soldiers-not just the medics. This includes combat lifesavers, infantry squad leaders, staff officers, the medical platoon leader, and the battalion commander. The primary duty of a combat lifesaver is the mission. Providing enhanced first aid of casualties is secondary. Appropriate ground and air evacuation techniques should be used based on METT-TC and on patient evacuation precedence (URGENT, URGENT-SURGICAL, PRIORITY, ROUTINE, and CONVEINCE). 4. FOLLOW-AND-SUPPORT CONCEPT. Use of a "jump" aid station by the medical platoon can be effective. In anticipating surge requirements, the medical platoon leader should forward deploy, or jump, part of the BAS. The distance is determined mostly by the operation (offensive or defensive) and by the enemy threat. The physician assistant should accompany the forward aid station to provide medical advice and expertise. This "follow and support" concept simplifies triage forward, which in turn improves the rate at which casualties are treated. To prevent ambulances and aid stations from being positioned accidentally at risk from enemy action, "jump" aid stations must be properly controlled. Planned checkpoints that are possible aid station locations must be designated along the MSR. They should be included in the operation overlay in the OPORD. The jump aid station follows the lead maneuver units; as one of these maneuver units comes into contact, the jump aid station should move to the nearest checkpoint and prepare to treat casualties. As the jump aid station moves into position, the administrative/logistical net should be used to inform units of its location. Medical leaders must be proactive and push forward. Ambulance drivers must have mounted land navigation skills to allow them to move over unfamiliar terrain at night. This makes finding CCPs, aid stations, and AXPs easier. Some wounded soldiers require limited treatment only and can be returned to duty at once. While they wait to rejoin their units, these soldiers can carry litters, freeing medics for patient care. They can also help guard the perimeter, act as ground guides, handle patient administration, or work mess duty. 5. COMMUNICATIONS. Redundant communications are important to timely casualty evacuation. In the BAS, they monitor the battalion command net. If message traffic indicates units in contact and casualties, the jump aid station moves forward IAW a predetermined plan and begins treating patients. This works faster than if the jump aid station waits for a message. It also provides a backup in case the administrative/logistical net is jammed. 6. MAINTENANCE AND CASUALTY EVACUATION. Collocating maintenance and medical assets can be useful in evacuating casualties. Maintenance soldiers should be cross trained as combat lifesavers and should know how to extract casualties from combat vehicles. They should have appropriate medical supplies such as litters and IV units. Vehicles evacuated to the rear for repair can also carry casualties. 77

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATION Reference FM 8-10, , 8-55, 7-20 7. COLOR-CODED TRIAGE SYSTEM. This system involves the use of color-coded signs during daylight hours and color-coded chemical lights at night. The signs are placed in front of the appropriate treatment areas. Any color combination can be used. For example, red can be used for expectant, blue for immediate, and green for minimal. When casualties arrive, a DA Form 1380 is marked for each with the appropriate color. The litter team then takes the casualty to the treatment area for that color code. Litter bearers are seldom medics; this method helps get the patients treated faster. The color codes used should not conflict with other tactical signals. 8. SPECIALTY PLATOONS. Members of specialty platoons are not authorized medics. Scouts often operate forward of the FEBA; mortars operate up to 1,500 meters behind the FEBA. These distances from the companies (which have medics) can inhibit timely casualty evacuation. This situation may also apply to other dispersed elements such as ADA and GSR teams. To offset this problem, thorough coordination with maneuver units near the dispersed unit is required. Maneuver units can help the scouts by evacuating casualties from forward of the FEBA to preplanned CCPs in the company zone or sector. Battalions must maximize combat lifesaver training for mortar and scout platoons. (Reference Chapter 6, Specialty Platoons “Planning Considerations”, page 171) 9. MARKING AND LOCATING CASUALTIES ON THE BATTLEFIELD. Locating casualties during and after a battle can be a time-consuming and difficult task, especially at night or in dense woods. Whatever the signal used, it must conform with the unit TACSOP and not conflict with other signals. Several techniques to facilitate patient locating follow: a. Vehicles carrying critically wounded personnel can be identified by a red flag or VS-17 panel during daylight and a red chemluminescent light at night. This tells medics which vehicle they should go to first. b. Fallen casualties can be marked with visible or infrared chemiluminescent lights or glint tape. These can be located at night by medics using the infrared source on night vision goggles. 78

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATION Reference FM 8-10, , , 7-20 10. EVACUATION TECHNIQUES The rapidly employable lightweight litter, referred to as the SKED litter, is designed to be used as a rescue system in most types of terrain, including mountains, jungle, waterborne, and on snow or ice (see Figure 3-1). a. The SKED litter is made of durable plastic. It can be rolled and carried in a camouflage case. The basic litter weighs 16 pounds complete with carrying case, straps, snap link, and a 30-foot kernmantle rope. Other optional items, such as the spine immobilize and flotation system, increase the weight to 32 pounds. Figure 3-1, SKED Litter b. The SKED is an excellent litter for evacuating light forces and scouts from forward OPs. Reason being, is the SKED litter enables a single soldier to pull a casualty over most types of terrain; a field-expedient poncho litter requires two soldiers or more. Up to four soldiers can use hand loops to carry a SKED litter containing a seriously injured casualty across difficult terrain. c. The SKED can be used to move equipment, ammunition, or other heavy loads to and from DZs, LZs, and objective areas in addition to its medical use. d. The litter is listed in the GSA Federal Supply Schedule, March 1989, FSC Group 42, Part I, Section B, Special Item Number , Emergency Stretchers, Brand SKEDCO Incorporated, page 8. 11. SAFETY. Leaders must retain common sense and attention to safety considerations despite their concern for casualties. Ambulance drivers or soldiers working around MEDEVAC helicopters must keep the risks in balance. 79

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Reference FM 8-10 & FM 12. Combat Health Support in Offensive Operations. a. General. The offensive operations of armored and mechanized forces are characterized by speed, heavy direct and indirect fires, and audacious, independent actions by subordinate elements. The potential for high casualty rates is greater for offensive operations than for any other type of operation. It follows that CHS for offensive operations will be a challenging endeavor. Through detailed planning and realistic training in peacetime, creative methods of supporting offensive operations may be developed. Some facts to consider in planning include -- The M113A3, although an improvement over the A2, cannot match the top speeds of the M1 and the M2/3. The need for mobility may preclude the use of company aid posts and will limit BAS capabilities. Evacuation lines will lengthen. Combat medics may not be able to reach individual casualties in armored vehicles. Casualties will be incurred in uneven numbers among the attacking companies/company teams. b. Combat Health Support Guidelines. General guidelines for supporting offensive operations include (Also reference Chapter 6, “Considerations in the Offense”, page 164) -- Pre-position medical evacuation vehicles as far forward as possible prior to the attack. Provide additional ambulance teams to main attack companies/teams. Request additional ambulances from the FSMC. Use casualty collecting points. Use AXPs. Depend on combat lifesavers. Operate the BAS as treatment teams,either the follow-and-support method or leap frogging them forward as the attack progresses. Practice tailgate medicine. Concentrate on stabilization care and rapid evacuation. 80

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IN A TACTICAL OPERATIONS Reference FM 8-10 & FM c. Combat Health Support in the Movement to Contact. To support the movement to contact, medical personnel and evacuation vehicles are positioned within the battalion. One arrangement is to place one combat medic with the scouts; the company and platoon medics with the other elements; two ambulance teams with the advance guard, one with each of the other companies, and the remainder with the treatment teams; split BAS elements into treatment teams with one following the tactical CP behind the advance guard and the other following the main CP in the main body. FSMC ambulances move with the main body. The uncertainty inherent in the movement to contact means the medical platoon must be prepared for any situation. Evacuation routes are planned throughout the axis of advance. Ambulance teams must know the location of the treatment teams at all times. The treatment teams must expect to perform tailgate medicine and facilitate rapid evacuation. The medical platoon must be prepared for a meeting engagement and whatever follows. d. Combat Health in a Hasty Attack. Support for the hasty attack incorporates basic principles of CHS to offensive operations. In the hasty attack, little time will be available for planning and preparation. The tactical SOP is the primary guide to CHS operations in this case. Key considerations in support of hasty attacks are -- Ensure rapid patient evacuation. (Preplan and use your evacuation SOP.) Maintain mobility by practicing tailgate medicine. Locate BAS/treatment teams near MSRs. The follow -and-support method is effective in supporting the task force during a movement to contact, but situational awareness and battle tracking are key to the success of the medical platoon. e. Combat Health Support in the Deliberate Attack. The deliberate attack is supported through a detailed, coordinated CHSPLAN. Task organize medical assets in support of elements in which high casualty rates are expected. Prepare a detailed overlay indicating current and future treatment team locations, AXPs, and primary and alternate evacuation routes. Inform the FSMC of the situation; request additional assets if necessary (see chapter 6, “Breach Operations”, page ). f. Combat Health Support During Exploitation. In exploitation operations, speed becomes even more important. Medical elements must maintain their mobility; rapid treatment and evacuation are essential. Because an exploitation follows immediately upon a successful attack, medical supplies may become a problem. Ensure that necessary supplies are brought forward in FSMC ambulances. Use FSMC drivers to communicate urgent medical supply needs to the FSMC. g. Combat Health Support During a Pursuit. Support is the same as for exploitation operations. Covering force area forces will have conducted an intense fight and may be considerably attrited and may require assistance in reaching and passing through MBA forces. Worst case, the handover presents the potential for confusion, disorganization, and resultant high casualty rates within both CFA and MBA elements.

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Reference FM 8-10 & FM 13. Combat Health Support in Defensive Operations. a. Flexibility in Support. To support a battalion defending in sector requires flexibility in adapting medical assets to the changing tactical situation. A sector defense combines offensive, defensive, and retrograde actions within an overall mobile defense framework. This combination results in a nonlinear front which creates confusion among attacking forces and complicates CHS operations. The nonlinear front means that planned evacuation routes, usable in some sectors, may be blocked by enemy penetration in others. Some defending elements may become temporarily encircled or bypassed by enemy forces. Rapidly moving enemy units may threaten or over-run the BAS. (Reference Chapter 6, “Considerations of planning in the Defense”, page 169”) b. General. (1) Difficulties encountered. Combat Health Support in the defense is more difficult than in the offense. Casualty rates may be lower, but due to the defensive rearward maneuver, patient collection and evacuation will be more complicated. Combat medics and ambulance teams will be exposed to more direct enemy fires. They will have less time to locate, treat, and evacuate the wounded. Defensive operations will generally produce higher casualty rates among medical personnel, thereby reducing treatment and evacuation capabilities. (2) Combat Health Support plan. The medical platoon should use the defensive preparation time to resupply combat medics and to replace battle losses. The platoon leader and medical operations officer should develop a detailed CHSPLAN. They should contact the FSMC and thoroughly coordinate the CHS relationship. Either the medical platoon leader or the medical operations officer must participate in the TF's battle planning. When planning and coordinating CHS for defensive operations, consider the following actions: Select covered and concealed BAS and company aid post sites. Ensure adequate medical supplies are available. If necessary, request additional supplies. Plan for evacuation within the defensive area. Plan and coordinate in detail evacuation by the FSMC from BAS to the DCS. Plan to continue CHS should the unit become encircled. Consider the potential of having to hold patients for an indefinite period of time, without adequate resources. Discuss with the FSMC commander the possibility of positioning a FSMC treatment team within the BP/strongpoint. Have a detailed plan for the use and control of non standard evacuation assets. 82

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Reference FM 8-10 & FM (3) Patient load. The heaviest patient load can be expected during the initial phase of the enemy attack. Many casualties will be evacuated using nonmedical vehicles during this phase (FM ). The BAS, operating as a whole or as separate treatment teams, should be established further rearward than in offensive operations. Evacuation lines will shorten as the forward companies maneuver rearward. Communication difficulties may arise due to enemy jamming. Enemy use of NBC weapons is possible. (4) Increased risk. Combat Health Support to a battalion defending from a BP or a strongpoint is considerably different from that for a sector defense. Battle positions and strongpoints are restrictive measures which limit maneuver. Reduced dispersion will create shorter interval evacuation lines and a more centralized, controlled medical operation. The reduced dispersion also creates increased risk of high casualty rates. Evacuation out of a BP or strongpoint may be difficult or temporarily impossible. c. Covering Force Support. (1) Problem encountered. Support to a covering force can be extremely complicated. The covering force will most likely face a much larger enemy force. It is expected to trade minimum geographic space for maximum time. To be effective, the covering force must remain highly mobile and avoid decisive engagement. The medical platoon of a covering force unit faces all of the difficulties inherent in defensive operations. Its mission is further complicated by the rapid movement and overpowering number of attacking units. (2) Employment. The medical platoon of a covering force unit will most likely choose to operate its BAS in the split team configuration. It should concentrate on providing expeditious stabilizing care and rapidly evacuating patients. Combat medics and evacuation sections should be employed as for any other defensive operation. When participating in a covering force operation, mobility of the medical platoon is critical. (3) Preparation. Some preparation time may be available prior to enemy contact. During this time, the medical platoon leader meets with the supporting FSMC commander or covering force medical staff officer. A detailed CHSPLAN is prepared. The medical platoon leader must know who is providing evacuation support (a covering force medical company or one from the MBA). Priorities for use of nonmedical vehicles are established with the commander and S3. The medical platoon leader must clearly establish with his unit commander situations under which patients may be abandoned. This information is disseminated so that medical elements can continue to operate without communications and while taking casualties among themselves. 83

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Reference FM 8-10 & FM d. Battle Handover. (1) Transition. As the covering force moves to the rear, the TF commander prepares for the battle handover. The handover is the transition from the CFA battle to the MBA battle in which the MBA forces begin to engage the enemy. Retirement is the movement of a force not in contact to the rear. (2) Coordination requirements. The battle handover can be a hazardous operation and requires extensive coordination. Covering force area forces will have conducted an intense fight and may be considerably attrited. They may require assistance in reaching and passing through MBA forces. In the worst case, handover presents the potential for confusion, disorganization, and resultant high casualty rates within both CFA and MBA elements. The medical platoon must be prepared for this. (3) Combat Health Support coordination. The medical operations officer should contact the CFA battalion/TF medical operations officer to coordinate CHS responsibilities for the battle handover and rearward passage, if possible. If the CFA element has suffered heavy casualties, they may require augmentation of personnel/equipment; if casualties have been light, they may be able to provide the MBA medical platoon with Class VIII supplies or evacuation assistance, as necessary. The medical operations officer should then contact the FSMC and pass on information concerning enemy forces; casualty experience; evacuation routes; requisite site selection; and possibly logistical assistance. (4) Operation. The medical operations officer must stay on top of the tactical situation in order to maneuver treatment teams and evacuation assets. Patient collecting points and AXPs will contribute to CHS efforts. Treatment by CLS and combat medics will be essential. Company medics and evacuation NCOs must be capable of performing independently; this will ensure continuity of CHS under disrupted communications or loss of key medical leaders. 15. Combat Health Support in Reserve Operations. a. Counterattack. In preparing and executing the CHSPLAN, consider the following: Forward movement may be very swift. Medical assets must keep up. Ambulance teams should move with supported companies. If attack covers a broad frontage, consider splitting BAS into two treatment teams. The commander may be forced to continue the mission under high casualty rates. The initial engagement will be violent and decisive. A successful counterattack will likely result in the capture of EPWs; some EPWs will be in need of medical treatment. Consideration for support of offensive operations apply. 84

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Reference FM 8-10 & FM 15. Combat Health Support in Reserve Operations (Cont.) NOTE: The Geneva Convention requires that sick, injured, or wounded enemy prisoners be treated and evacuated through normal medical channels, but units must ensure physical segregation from US, allied, or coalition patients. b. Spoiling Attack. NOTE: Combat Health Support considerations for offensive operations apply. c. Block, Fix, or Contain. NOTE: Combat Health Support considerations for offensive operations apply. d. Reinforce. Reserve forces may be committed to reinforce units that have sustained heavy losses; also to build up stronger defenses in critical areas of the battlefield. Considerations must be given to how they will be integrated into the defensive scheme, C2 arrangements, and where they will be positioned. The techniques used to reinforce are similar to those used during a relief in place. e. Rear Operations. The dispersion common to a battalion performing a rear operations mission complicates the CHS situation. Evacuation lines are lengthy. Use AXPs and FSMC or MSMC ambulances, if practical. Company aid posts are vital and must operate somewhat autonomously- company medics must know their business. Due to the dispersion, the BAS may choose to operate as separate treatment teams. Level II support may come from the MSMC in the DSA-if this is a new support relationship it should be well coordinated. 16. Combat Health Support in Other Tactical Operations. A. Delay. Detailed CHS planning is essential to the medical platoon's ability to support a delay operation. The nature of a delay, with its inherent mix of operations (offensive and defensive), creates a complicated battlefield situation. Combat medics, evacuation NCOs, and other key medical personnel must have a good understanding of the commander's intent and the CHSPLAN. This will occur if planning is effective and includes the following considerations implicit in delay operations: Expect evacuation difficulty. Patient evacuation in delay operations is complicated due to the changing forward and rearward movement; to possible communication disruptions; and to congested evacuation routes. Ambulance crews may be at increased hazard due to the rearward movement of the force. Locate BAS further toward the rear and consider operating separate treatment teams to support the successive or alternate positions. Plan for possible necessity to abandon patients. Plan for frequent BAS relocations. Plan for future operations; what happens when the retrograde ends? 85

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Reference FM 8-10 & FM 16. Combat Health Support in Other Tactical Operations (Cont.) b. Withdrawal/Retirement. Support of a withdrawal or retirement should be conducted much as for a movement to contact. However, in a withdrawal or retirement, most of the medical vehicles are in the rear of the main body. Since these operations are normally conducted as part of a larger force, necessary coordination with the FSMC should be relatively easy. c. Passage of Lines. The passage of lines may offer the medical platoon leader the opportunity to interface with his counterpart in the unit being passed. This is an excellent opportunity to share information concerning enemy forces; casualty experience; evacuation routes; requisite site selections; and possibly logistical assistance. The passage of lines can be a hazardous operation, particularly when conducted while in contact with the enemy. Combat Health Support must be planned and coordinated between participating units. Some essential pieces of coordination are as follows: Communications (callsigns, frequencies/hopsets, communication checks) Locations of each task force FAS/MAS. Dirty and clean routes for the each task force. CCPs. Unit day and night marking systems for casualties, FAS/MAS, and vehicle marking systems. Visualization signals used day and night. Recognition signals. d. Breakout from Encirclement. During the breakout, patients will most likely have to be transported by combat units using nonmedical organic assets. Emergency medical care will be given by self aid/buddy aid, combat lifesaver or unit medic. Aid station care may be delayed until the operation is completed. e. Linkup. Tailgate medicine will be employed during linkup movement. Upon linkup, all medical assets will be consolidated into a medical platoon operation. f. Guard Operations. Combat Health Support for offensive operations equally apply to guard operations. 86

86 Chapter 4 MEDICAL EVACUATION Reference FM 8-10-6 TASKS PAGE
Medical Evacuation Tenets Planning for Patient Evacuation Calculation of Patient Evacuation Requirements Evacuation Factors Evacuation Categories Evacuation by Medical Air Ambulances MEDEVAC LZ Example MEDEVAC Request Format 87

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1. Evacuation Tenets a. Patient evacuation is the timely and efficient movement of wounded, injured, or ill persons from the battlefield and other locations to the Medical Treatment Facilities (MTFs). Evacuation begins at the location where the injury or illness occurs and continues as far as the patient’s medical condition warrants or the military situation requires. Medical personnel provide en route medical care during patient evacuation. b. Service component commanders are responsible for evacuation of patients within their Area Of Responsibility (AOR). c. The unified commander is responsible for issuing procedures for evacuation of formerly captured or detained US military personnel. d. The unified commander will issue procedures for evacuation of Enemy Prisoners of War (EPW) and civilian internees, other detainees, and civilian patients. (See FM 8-10 for discussions on the Geneva Conventions. The Conventions contain many provisions which are tied directly to the Combat Health Support (CHS) mission. Also, see AR for disposition of an EPW after hospital care.) (1) Sick, injured, or wounded EPW are treated and evacuated through normal medical channels, but remain physically segregated from US and allied patients. Helmets, gas masks, and like articles issued for personal protection will remain in the possession of each Individual. Enemy prisoners of war are evacuated from the Combat Zone (CZ) as soon as possible. Only those sick, injured, or wounded prisoners who would suffer a great health risk by being evacuated immediately may be treated temporarily in the CZ. (2) The MTF commander is responsible for the treatment of sick, injured, or wounded EPW patients. The echelon commander is responsible for the security of EPW patients. (See FM for further information concerning EPW evacuation and control. Also, see FM 19-4 for a discussion on EPW operations.) e. Procedures and policies for evacuation of injured and sick military working dogs (MWDs) will be issued by the unified commander. f. Army aeromedical evacuation units must be able to communicate with other Service hospitals. 88

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2. Planning for patient evacuation. a. Planning patient evacuation involves considering all available forms of transportation and providing appropriate CHS personnel in the evacuation system to assure continuity of patient care. It also involves planning the routing, controlling evacuation movements, and planning the location of evacuation facilities. Patient collecting points, ambulance exchange points, and an ambulance shuttle system (ambulance loading points, relay points, and ambulance control points) must be planned. Thorough investigation of all the available lines of communications is an essential prerequisite to such planning. Field Manual provides a comprehensive discussion on medical evacuation in support operations across the operational continuum. b. The AMEDD does not have dedicated fixed-wing aircraft for evacuation of patients from the COMMZ or from the COMMZ to the CONUS. For additional means of evacuation, coordination must be effected with-- (1) The particular Service controlling aircraft and ships. (2) The transportation command controlling the locomotive power for trains and other forms of transportation. c. Coordination with other Services and commands is usually accomplished through medical regulating (MEDREG). The surgeon, however, must forecast the requirements for air and surface evacuation so that coordination for its procurement may be done in advance of the need. Aircraft are requested on the basis of anticipated needs and to meet emergencies such as those occurring in nuclear warfare where CZ hospitals are suddenly filled to capacity. 3. Evacuation Means. a. The USAF Airlift System is primarily responsible for moving patients from the CZ to the COMMZ, within COMMZ, and from COMMZ to CONUS. If movement requirements exceed the capability of the USAF AE system, the MEDCOM medical regulating officer (MRO) may have to seek alternative modes of transportation. He or She may task the MEDCOM’s medical battalion (evacuation) for movement of patients by Army aircraft or ground ambulances. b. In addition to using ground evacuation when the USAF AE system cannot support the number of patients requiring air evacuation, other factors that may require the use of ground evacuation: (1) Tactical considerations that prevent the use of aircraft for patient evacuation during certain periods. (2) Patients whose medical condition prohibits their evacuation by aircraft. (3) Weather conditions. (4) Lack of adequate or properly located airfields. (5) Insufficient numbers of aircraft available. 89

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3. Evacuation Means (Cont.) c. When patient evacuation by air from the CZ to the COMMZ is not possible or appropriate, ambulances from medical ambulance companies assigned to the medical battalion (evacuation) of the COMMZ medical brigade, MEDCOM, may be used. d. If air or ground ambulances must be used to transport large numbers of patients to or within the COMMZ, the MEDCOM MRO must obtain clearance through the TA movement control center (MCC), which is an agency of the TA transportation command. This agency coordinates and controls the movement of Army aircraft and ground transportation within the theater. When capabilities are expected, the MCC coordinates requests for additional air and ground resources. It also obtains the necessary clearances to support the mission from the CZ. e. Modern warfare is likely to generate more casualties than the airlift system can handle. Surface evacuation is then a possibility. It is possible that, under certain circumstances, patients may be returned to CONUS by surface vessel rather than by air. Such transportation is the responsibility of the Military Sealift Command (MSC). Deliberate planners should strive to make requirements estimates known so that MSC planners are able to provide medical evacuation. The MEDCOM MRO would be responsible for coordinating the evacuation requirements. After coordination is complete, the MEDCOM establishes patient-holding facilities at COMMZ ports. Patients would be delivered to these facilities and held until loaded aboard designated ships. Once in CONUS, patients would normally be taken to the nearest Air Mobility Command (AMC) terminal for further airlift to destination hospitals. 90

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4. CALCULATION OF PATIENT EVACUATION REQUIREMENTS a. Methodology. This section presents a methodology for calculating the time and the number of units of transport required to evacuate a given number of patients, or to support a specific operation. b. Time Factors. The following are time factors for evacuation of patients (including loading and unloading): (1) Litter Squads. (a) Average terrain, four-person squad—900 meters and return in 1 hour. (b) Mountainous terrain, six-person squad—350 meters and return in 1 hour. (2) Ambulance (wheel and track vehicle). During combat in the division area—eight kilometers and return in 1 hour (optimal weather and terrain). (3) Aircraft. (a) Helicopter—150 kilometers one-way in 1 hour (based on the operational capability and patient-loading ease of UH-60 helicopter). (b) Transport—360 kilometers one-way in 2 hours (based on 1 ½ hour mission for C-130E aircraft and 30 minutes patient- loading time). (c) Army airplane—200 kilometers one-way in 1 hour (based on the operational capability of U-21 aircraft, including patient-loading time). c. Computations (1) The following formulas may be used to calculate the time and the number of units or transport required to evacuate a given number of patients: (a) Time required: T = N X t U X n (b) Unit required: U = N X t T X n N = Total number of patients to be evacuated. n = Number that can be transported in one load. T = Total time. t = Time required for one round-trip. U = Number of units of transport (litter, ambulances, and aircraft). 91

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Reference FM a. Computations (Cont.) (2) The amount of evacuation resources required to support a specific operation may be calculated by using the following formula for either WIA or DNBI patients: (A X B) X E = ambulance requirements by type per day C D where: A = The total patients (WIA or DNBI) generated for a specific operation per day. This figure may be calculated using projected figures for the specific AO. B = The percentage of those patients in A, above, requiring evacuation. Normally, this figure will exceed 100 percent as a recognition of the fact that many patients will need to be moved more than once. The number of times a patient will be moved will depend on many factors. In assigning a specific percentage as a planning factor, the CHS planner must consider— Terrain. Force structure. Enemy weapons systems. Weather. Airfield or seaport locations. Other factors affecting patient flow. C = The average number of patients moved by means of evacuation. The figure will vary depending on the type of ambulance (ground or air), or the specific model of vehicle. D = The average number of missions a particular evacuation vehicle can complete per day. E = The dispersion allowance for the specific types of evacuation vehicles in the formula. The dispersion allowance is a recognition that a specific percentage of vehicles in the force will be unavailable for missions due to maintenance, crew rest, combat loss, or replacement lag time. The CHS planner will determine the specific percentage used by reviewing maintenance historical data and considering the threat in terms of the enemy, terrain, and weather. 92

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5. EVACUATION FACTORS a. In addition to METT-TC, the following factors should be considered when planning casualty evacuation: The BN/TF’s plan for employment of combat troops. Expected areas of patient density. Evacuation resources available. Location and type of MTFs available. Terrain and road networks. Weather conditions. Locations of CCPs. Location of AXPs. Primary/alternate evacuation routes. Lines of patient drift. b. The primary means of evacuation is by ground. The preferred means of evacuation is by air when assets are available. c. Patients will be evacuated by the means that best meets the treatment demands based on wounds, keeping METT-TC in mind. Patients will be treated as far forward, maximizing RTDs. The casualty destination is determined by the treating element. d. The medical company is responsible for evacuation from the BASs back to the FSMC. It is key to remain in close proximity of the supported unit with continuous communication. e. Ambulances will normally be pre-positioned forward to facilitate rapid evacuation based on METT-TC. f. Ambulances will only be used for patient evacuation, Class VIII, and medical personnel. g. All medical units will monitor and use the BN/TFs designated medical evacuation frequency. This frequency will be published in the OPORD/OPLAN. i. Prior to all operations an evacuation plan will be established and rehearsed, which will include the following as a minimum: Indigenous personnel. Primary and alternate channels to be used in submitting MEDEVAC requests. Primary and alternate routes. Methods of evacuation available. Location of all medical treatment facilities and their capabilities. Actions and assets available in the event of a MASCAL situation. 93

93 Chapter 4 MEDICAL EVACUATION Reference FM 8-10-6
3. EVACUATION FACTORS (Cont.) j. Medical evacuation requests will be submitted by the most direct means available to the supporting medical unit. MEDEVAC requests are submitted using the nine-line format and brevity codes as required. All MEDEVAC requests will be submitted through secure means. k. Evacuation in an immature theater may have to be accomplished by C-130 backhaul to the CONUS. In this event, prior coordination must be accomplished. 4. EVACUATION CATEGORIES. URGENT: Should be evacuated as soon as possible and within a maximum of two hours in order to save life, limb, or eyesight. URGENT-SURG: Must receive far forward surgical intervention to save life and stabilize for further evacuation. PRIORITY: Sick or wounded requiring prompt medical care within a maximum of four hours. ROUTINE: Sick or wounded requiring prompt medical care within a maximum of 24 hours. Psychiatric patients should be placed into this category. CONVENIENCE: Patient for whom evacuation by medical vehicle is a matter of medical convenience rather than necessity. 5. DEFINITION OF TERMS. Casualty -- Any person who is lost to his organization by reason of having been declared dead, wounded, injured, diseased, interned, captured, retained, missing, missing in action, beleaguered, besieged, or detained. Casualty Evacuation (CASEVAC) -- The movement of sick, injured, or wounded soldiers by non-medical vehicles to a medical treatment facility. The casualty receives no medical care en route. It may also be referred to as casualty transportation. Medical Evacuation (MEDEVAC) The movement of sick, injured, or wounded soldiers in medical vehicles with the provision of en route medical care to a medical treatment facility. Patient – A sick, injured, or wounded soldier who receives medical care or treatment from medically trained personnel. (NOTE: Once a casualty has been acquired by the CHS chain [treated by a medic], he is referred to as a patient.) 94

94 Chapter 4 MEDICAL EVACUATION Reference FM 8-10-6
6. EVACUATION BY MEDICAL AIR AMBULANCES a. Helicopter Landing sites (1) Responsibility. The unit requesting aeromedical evacuation support is responsible for selecting and properly marking the helicopter Landing Zones (LZs). (2) Criteria for Landing Sites. Helicopter LZ and the approach zones free of obstructions. Sufficient space for hovering and maneuvering during landing and takeoff. Approach zones should permit the helicopter to land and take off into the prevailing winds. Allows helicopter the opportunity to make shallow approaches. Definite measurements for LZs cannot be prescribed since they vary with temperature, altitude, wind, terrain, loading conditions, and individual helicopter characteristics. Minimum requirement for light helicopters LZ is 30 meters in diameter with an approach and departure zone clear of obstructions. (3) Removing or Marking Obstructions. Any object (paper, cartons, ponchos, blankets, tentage, or parachutes) likely to blow about by rotorwash should be removed from the landing area. Obstacles, such as cables, wires, or antennas at or near LZs, which cannot be removed and may not be readily seen by a pilot, must be clearly marked. Use red lights to mark all obstacles that cannot be easily eliminated within a LZ. (In most combat situations, it is impractical for security reasons to mark the tops of obstacles at the approach and departure ends of a LZ). If obstacles or other hazards cannot be marked, pilots should be advised of existing conditions by radio. NOTE In a training situation or at a rear area LZ, red lights should be used whenever possible to mark obstructions. 95

95 Chapter 4 MEDICAL EVACUATION Reference FM 8-10-6
b. Identify the Landing Site. (1) When the tactical situation permits, a landing site should be marked with the letter “H” or “Y,” using identification panels or other appropriate making material. Special care must be taken to secure panels to the ground to prevent them from being blown about by the rotor wash. Firmly driven stakes will secure the panels tautly; rocks piled on the corners are not adequate. (2) If the tactical situation permits, the wind direction may be indicated by a - Small wind sock or rag tied to the end of a stick in the vicinity of the LZ. Man standing at the upwind edge of the site with his back to the wind and his arm extended forward. Smoke grenades which emit colored smoke as soon as the helicopter is sighted. Smoke color should be identified by the air crew and confirmed by ground personnel. c. In night operations, the following factors should be considered: (1) One of the many ways to mark a landing site is to place a light, such as a chemical light, at each of the four corners of the usable LZ. These lights should be colored to distinguish them from other lights which may appear in the vicinity. A particular color can also serve as one element in identifying the LZ. Flare pots or other types of open lights should only be used as a last resort. They usually are blown out by the rotor down wash. Further, they often create a hazardous glare or reflection on the aircraft’s windshield. The site can be further identified using a coded signal flash to the pilot from a ground operator. This signal can be given with the directed beam of a signal lamp, flashlight, vehicle lights, or other means. (2) When using open flames, ground personnel should advise the pilot before he lands. Burning material must be secured in such a way that it will not blow over and start a fire in the LZ. Precautions should be taken to ensure that open flames are not placed in a position where the pilot must hover over or be within 3 meters of them. The coded signal is continuously flashed to the pilot until recognition is assured. After recognition, the signal operator, from his position on the upwind side of the LZ directs the beam of light downwind along the ground to bisect the landing area. The pilot makes his approach for landing in line with the beam of light and toward its source, landing at the center of the marked area. All lights are displayed for only a minimum time before arrival of the helicopter. The lights are turned off immediately after the aircraft lands. (3) When standard lighting methods are not possible, pocket-sized white (for day) or blue (for night) strobe lights are excellent means to aid the pilot in identifying the LZ. (4) During takeoff, only those lights requested by the pilot are displayed; they are turned off immediately after the aircraft’s departure. 96

96 Chapter 4 MEDICAL EVACUATION Reference FM 8-10-6 (c) The Approach.
(1) When the helicopter approaches the LZ, the ground contact team can ask the pilot to turn on his rotating beacon briefly. This enables the ground personnel to identify the aircraft and confirm its position in relation to the LZ (north, south, east, or west). The rotating beacon can be turned off as soon as the ground contact team has located and identified the aircraft. The ground contact team helps the pilot by informing him of his location in relation to the LZ, observing the aircraft’s silhouette, and guiding the aircraft toward the LZ. While the aircraft is maneuvering toward the LZ, two-way radio contact is maintained and the type of lighting or signal being displayed is described by the pilot and verified by ground personnel via radio. The signal should be continued until the aircraft touches down in the LZ. (2) The use of FM homing procedures can prove to be a valuable asset, especially to troops in the field under adverse conditions. Through the use of FM homing, the pilot can more accurately locate the ground personnel. The success of a homing operation depends upon the actions of the ground personnel. First, ground personnel must be operating an FM radio which is capable of transmitting within the frequency range of 30.0 to megahertz; then they must be able to gain maximum performance from the radio (refer to appropriate technical manual for procedure). The range of FM radio communications is limited to line of sight; therefore, personnel should remain as clear as possible of obstructions and have knowledge of the FM homing procedures. For example, when the pilot asks the radio operator to “key the microphone,” he is simply asking that the transmit button be depressed for a period of 10 to 15 seconds. This gives the pilot an opportunity to determine the direction to the person using the radio. NOTE When using FM homing electronic countermeasures, the possible site detection of LZs by means of electronic triangulation presents a serious threat and must be considered. 97

97 NIGHT LZ OPERATIONS “The NTC Standard”
LZ CRITERIA Use chemical lights or bean bag lights Slope not to exceed 8 degrees Clear of debris Will land into the wind Ground guides not needed All lights should be turned off when aircraft approaches LZ “Day glow” panel markers used during the day DIRECTION OF LANDING 7 PACES DIRECTION OF WIND 14 PACES 14 PACES AIRCRAFT WILL LAND HERE BETWEEN LIGHTS 98

98 Chapter 4 MEDICAL EVACUATION
Reference FM MEDEVAC REQUEST FORMAT LINE ITEM/BREVITY CODES 1 Location of pickup site 2 Frequency/Call sign of pickup site 3 Number of patients by precedence A - URGENT B - URGENT SURG C - PRIORITY D - ROUTINE E - CONVENIENCE 4 Special equipment A - NONE B - HOIST C - EXTRACTION EQUIPMENT D - VENTILATOR 5 Number of patients by type L + # LITTER A + # AMBULATORY 6 Security of pickup site N - NO ENEMY P - POSSIBLE ENEMY E - ENEMY IN AREA X - ARMED ESCORT NEEDED 7 Method of marking pickup site A - PANELS B - PYROTECHNICS C - SMOKE D - NONE E - OTHER 8 Patient nationality and status A - US MILITARY B - US CIVILIAN C - NON US MILITARY D - NON US CIVILIAN E - EPW 9 NBC contamination N - NUCLEAR B - BIOLOGICAL C - CHEMICAL 99

99 Chapter 5 MEDICAL PLATOON EXECUTION CHECKLIST
Reference ARTEP MTP TASKS PAGE Disestablish Area Prepare Medical Platoon for Operations Prepare all Elements for Movement Conduct Medical Platoon Movement Establish Treatment Area Maintain Equipment & Supplies Prepare for Medical Evacuation Mission Provide Continuing Care And Comfort Measures For Patients Debrief Squad and Crews Perform Triage Employ Physical Security Measures Provide Sick Call Services Process Captured Documents And Equipment Perform Maintenance Establish Patient Decontamination Station On An Integrated Battlefield Chemical Environment Decontaminate Ambulatory Patients Chemical Environment Decontaminate Litter Patients-chemical Environment Use Passive Air Defense Measures Perform Personnel Consolidation And Reorganization Prepare for Operations in an NBC Environment Respond to an NBC Attack Perform Decontamination Camouflage Vehicles & Equipment Evacuation of EPWs 100

100 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: DISESTABLISH AREA ( ) TASK STANDARD: Patients are evacuated as tactical situation permits and treatment section is disestablished within 15 minutes. TASK STEPS 1. Treatment section pack and loads. a. Packs supplies and equipment as specified by packing list and manufacturer's instructions. b. Strikes and loads erected shelters. c. Load equipment and supplies as directed by unit loading plan to permit use en route (tailgate medical support) or at relocation site. d. Accomplished within 15 minutes or less. 2. Treatment section members police area. a. Remove sources of intelligence. b. Close waste facilities. c. Remove trash. 3. Ambulance section evacuates patients. a. Moves patients to new location according to established procedures if tactical situation permits. b. Notifies the tactical commander when the tactical situation does not permit patient evacuation. NOTE: The tactical commander must make the decision as to whether or not patients must be left behind. (1) Provides information on tactical operation's impact on the medical situation. (2) Stresses the urgent need for a timely decision. c. IAW Geneva Conventions, If the decision is made to leave patients behind, the commander must leave medical personnel and supplies will patients. 101

101 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: DISESTABLISH AREA ( ) TASK STEPS *4. Platoon leader or field medical assistant notifies brigade surgeon and supporting medical facilities. (MQS ) a. Includes in notification: (1) Movement of BAS. (2) New coordinates or location. (3) Planned time to be operational at new site (if known). b. Submits report to Bn S3 or S4. c. Treatment section members disestablish treatment area on an integrated battlefield. (1) Keep the M51 shelter, with overhead cover, operational until supported unit is withdrawn from contact. (2) Provide tailgate medical treatment for lifesaving measures until all patients have been evacuated. (3) Disestablish and prepare for movement within 45 minutes in daylight or 60 minutes during hours of darkness, in accordance with TM (4) Avoid further contamination of supplies. (5) Maintain MOPP level 4. NOTE: If M51 shelter is operational and conditions exist which prohibit movement of M51 shelter and auxiliary equipment after withdrawal of the supported unit, the M51 shelter and generator unit are destroyed as directed by TM to prevent enemy use. 102

102 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: PREPARE FOR MEDICAL PLATOON OPERATIONS TASK STANDARD: The platoon leader (physician) and medical operations officer develop and implement a medical support plan that meets the needs of the maneuver element. Platoon leader (physician) briefs commander on plan; makes required modifications immediately; issues operations order to subordinates at specified time and location; and supervises execution of mission. Medical platoon issues class VIII resupply to unit combat lifesavers. TASK STEPS *1. Platoon leader and medical operations officer develop tentative operational plan. ( , , , ) a. Analyze and review all available information to ensure that all specific and implied task limitations and constraints are in the order. b. Use information to develop a plan that provides for: (1) Coordination with higher, lower, adjacent, and supported headquarters (HQ). (2) Movement. (3) Establishment. (4) Disestablishment. (5) Utilization of available resources. (6) Reporting and replacement of personnel. (7) Maintenance and accountability procedures. (8) Operation security (OPSEC). (9) Signal security (SIGSEC). (10) Training and orientation of newly arrived personnel. (11) Preventive medicine measures. (12) Nonorganic support. (13) Accomplishing the mission. (14) Control. (15) Use of existing resources. (16) Fixed responsibilities. (17) Contingencies. (18) Patient evacuation to include: - Coordinate with commander or Bn S3 for primary and alternate routes. - Development of strip maps for primary and alternate routes of evacuation. (19) Coordination to ensure that attached medical assets are adequate to support attached units. (20) Adequate medical support for units detached to another Bn task force. 103

103 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: PREPARE FOR MEDICAL PLATOON OPERATIONS *2. Platoon leader briefs commander and modifies plan. (MQS , ) a. Briefs commanding officer (CO) on plan and modifies as directed by commander. b. Resubmits modified plan for final approval. c. Briefs approved to treatment section leader, evacuation section leader, and supported elements, as required. d. Presents briefing that includes: (1) Situation. (2) Mission. (3) Execution. (4) Support requirements. (5) Command and control. (6) Communication information, such as requirements, nets and frequencies. *3. Platoon leader or medical operations officer issues OPORD to subordinates. ( ) a. Issues order at the specified time and location. b. Issues OPORD that includes: (1) Friendly and OPFOR situation. (2) Clear, concise, mission statement. *4. Platoon leader or medical operations officer supervises execution of platoon mission. ( ) a. Implements and follows operational plan. b. Communicates changes in plans or order to subordinate personnel and supporting units. Fragmentary orders (FRAGO) include: (1) Changed objectives/task organization. (2) Situation. (3) Control measures. (4) Concept of operation. (5) Coordinating instructions. 104

104 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: PREPARE FOR MEDICAL PLATOON OPERATIONS *4. Platoon leader or medical operations officer supervises execution of platoon mission. (Cont.) c. Monitors and directs operations of sections and subordinates. d. Monitors to ensure that sections and subordinates accomplish the mission as planned and directed. e. Modifies support plan each time unit status, location, or mission changes. 5. Medical platoon/combat medics issue class VIII resupply to combat lifesavers and requisitions shortages. 105

105 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: PREPARE ALL ELEMENTS FOR MOVEMENT TASK STANDARD: Medical platoon is directed to move from its present location. Platoon is to be uploaded and prepared to move by time specified in FRAGO and OPORD TASK STEPS *1. Platoon leader or sergeant briefs personnel. (MQS , , , , ) a. Briefs subordinates on: (1) Routes to destination. (2) Location in convoy. (3) Nearest radio vehicle. (4) Security. (5) Coordination for emergency medical treatment and medical evacuation. (6) Support available and pertinent times. b. Informs subordinates of their specific duties during convoy. 2. Platoon members assemble equipment and supplies and load vehicles. a. Medical assistant or platoon sergeant supervises operation. b. Medical platoon members assemble and load supplies and equipment as directed by load plans. c. Medical platoon members assemble special equipment and load according to instructions. d. Medical platoon members load medical equipment so that it is available for immediate use for en route emergency treatment. *3. Medical operations officer or platoon sergeant inspects personnel, equipment, and loads at staging area. (MQS ) a. Inspects vehicles prior to departure. b. Inspects cargo to ensure it is properly secured. c. NCOIC of each section inspects personnel for compliance with uniform and equipment requirements. d. Inspects vehicles to ensure all equipment and personnel are accounted for. 106

106 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: CONDUCT MEDICAL PLATOON MOVEMENT TASK STANDARD: Movement is conducted as specified in FRAGO and OPORD. Communication and control of all elements are maintained throughout the movement. TASK STEPS *1. Platoon sergeant enters radio net. (MQS , ) a. Opens the radio net at least one-half hour before crossing start point (SP). b. Performs minor radio repairs as required or replaces inoperable sets. 2. Medical platoon prepares to cross SP and crosses SP. a. Assembles at convoy SP. b. Lines up in order of march consistent with OPSEC, in sufficient time to cross the SP. 3. Medical platoon participates in motor march. a. Crosses start point, checkpoints, and release point within times listed in movement order. b. Maintains intervals and speed as specified by convoy commander and order. c. Reports convoy locations as directed when crossing critical points or arriving at release points (RPs), using SOI provided. d. Drivers utilize ground guides and other nighttime convoy procedures specified by convoy commander to minimize safety hazards, when conducting night convoy. e. Make effective use of cover, camouflage (when directed), dispersion, radio silence, blackout procedures, air guards, attached security, and so on. f. Designated air guards remain upright and scan for aircraft throughout movement. g. When a vehicle is disabled due to mechanical failure, the driver: (1) Pulls to the side of the road and waves the convoy past. (2) Attempts to repair the vehicle. (3) Flags down the first recovery vehicle for assistance or towing. (4) Stays with the vehicle. 107

107 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: CONDUCT MEDICAL PLATOON MOVEMENT *4. Platoon and convoy make halts for rest, personnel comfort and relief, messing, refueling, maintenance, and scheduled adjustments. (MQS , , ) a. Platoon leader, medical operations officer, or platoon sergeant checks the welfare of the men, security of loads, vehicle performance, and the performance of at-halt maintenance. b. Drivers move vehicles sufficiently off the road to keep march route clear. c. Platoon establishes security immediately. At least one airguard remains alert, manning authorized weapons at all times. d. Drivers inspect their vehicles and loads and perform operator vehicle maintenance and refueling. e. Feed personnel and perform resupply of depleted supplies as required, if time permits, and if movement is of long duration. f. Leaders enforce light, noise, and trash discipline. g. Drivers keep unauthorized personnel away from vehicles. h. Drivers remain alert for immediate resumption of march, and platoon resumes march on schedule. 108

108 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: ESTABLISH TREATMENT AREA ( ) TASK STANDARD: Treatment area is established within 15 minutes. *1. Medical operations officer coordinates operational sites. (MQS ) a. Obtains approval from S3 to establish BAS at selected site within designated area. b. Provides higher headquarters or brigade surgeon site location. c. Notifies treatment teams of S3 approval. *2. Platoon leader (physician) or PA selects operational site. (MQS , , , ) a. Surveys designated area for placement of assets. b. Selects site that provides: (a) Access to evacuation routes and main supply routes (MSR). (b) Concealment and cover without hampering communication. (c) Avoidance of likely target areas. (d) Helicopter landing site. (e) Proximity to likely lines of patient drift. (f) Drainage. (g) Area for decontamination if required. (h) Effective area for support for tactical operation. (i) Effective communication with supported units and platoon HQ. 3. Treatment section establishes BAS. a. Establishes as directed by higher HQ. b. Becomes operational within fifteen minutes of arrival. c. Provides tailgate medical support during establishment. d. Establishes treatment area that provides for: (1) Access by evacuation vehicles and their turn around. (2) Cover. (3) Concealment. e. Establishes patient treatment and holding areas. f. .Arranges supplies and equipment in accordance with standardized procedures. g. Camouflages unit with prescribed procedures if tactical situation permits. (1) When the tactical commander makes the decision to camouflage, platoon follows commander's directives. (2) Does not display Geneva Convention markings with camouflage. NOTE: Camouflage of the Geneva emblem is authorized on medical facilities where the lack of camouflage may endanger tactical operations. If failure to camouflage compromises tactical operations, the camouflage of medical facilities may be ordered by a task force commander of at least brigade level or equivalent. (STANAG 2391) 109

109 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: ESTABLISH TREATMENT AREA ( ) 3. Treatment section establishes BAS (Cont.) h. Establishes a helicopter landing site that is of sufficient length and width to handle the largest available aircraft if the tactical situation permits. i. Clearly marks landing site. 4. Ambulance Section. a. Selects site that provides: (1) Access to evacuation routes. (2) Suitable hardstand or terrain for parking ambulances. b. Parks ambulance vehicles and prepares for evacuation mission. (1) Refuels and resupplies. (2) Backs into parking area. (3) Disperses. (4) Covers, conceals, and camouflages, as necessary. (5) Performs preventive maintenance, checks and services (PMCS). (6) Checks medical supplies. 5. Medical platoon unloads supplies and equipment. a. Unloads expeditiously. b. Does not damage or handle excessively. c. Organizes storage area to expedite the use of frequently used items. d. Protects supplies and equipment from weather. e. Removes vehicles not used as a part of the battalion aid station from the area as soon as unloading is completed. *6. Medical operations officer reports location. (MQS , , ) a. Platoon leader (physician) or PA notifies medical operations officer of the following: (1) Movement of BAS. (2) New coordinates of location. (3) Planned time to be operational at new site, if known. b. Medical operations officer reports the following information to higher headquarters and supporting medical facilities: (1) New location of BAS. (2) Operational times. c. Medical operations officer submits reports to Bn S3 or S4 as appropriate. 110

110 LZ 5 TON Chapter 5 EXECUTION CHECKLIST
“A WAY TO ESTABLISH BATTALION AID STATION” TASK: ESTABLISH TREATMENT AREA DS AMBULANCES HASTY GREGG SITE M113 M113 5 TON 75-100M M LZ ROUTINE PRIORITY URGENT M577 M577 EXPECTANT CLS VIII RESUPPLY 5 TON DELAYED IMMEDIATE MINIMAL PATIENT DROP OFF POINT M113 M113 MEDICAL PLATOON AMBULANCES M113 M113 DISTANCE BETWEEN VEHICLES M or Terrain dependent 110

111 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: MAINTAIN MEDICAL EQUIPMENT AND SUPPLIES TASK STANDARD: Platoon members maintain supplies to meet mission requirements and appropriately utilize the ambulance section to transport replacement supplies. Perform operator and preventive maintenance on equipment as directed by equipment TM. *1. Platoon sergeant requests supplies. ( ) a. Submits request to the Division Medical Supplyt Officer (DMSO). b. Forwards request for items not available at forward support medical company (FSMC) to DMSO. NOTE: Items not available will be placed on back order and procured or substituted at higher levels. c. Obtains supplies as rapidly as possible, using available medical transportation assets for back haul. d. Submits request on DA Form 2765 or DA Form , Request for Issue or Turn-In. *2. Platoon sergeant receives supplies. ( ) a. Conducts a physical inventory of supplies. b. Reports any errors to DMSO. c. Resubmits request if supplies are missing or inadequate. 3. Medical platoon members maintain and transport medical supplies. a. Platoon sergeant maintains operational levels of Class VIII supplies. (1) Projects operating levels of Class VIII supplies to meet mission requirements based on: (a) Type of operation. (b) Number and types of units supported. (c) Expected casualties. (2) Reorders Class VIII supplies as required from DMSO. (3) If the BAS or treatment squad is supporting units conducting combat operations, formal supply request procedures are not required. Medical supply requirement may be informal between: (a) BAS or treatment squad and FMSC forward. (b) BAS or treatment squad and combat medics. (c) BAS or treatment squad and ambulance teams. b. Ambulance section transports supplies. (1) Uses evacuation vehicles to transport supply requests from section or squads to headquarters company or supply element. (2) Utilizes back haul method (using evacuation vehicles) to transport medical supplies to subordinate units. (3) Logs and accounts for control items and medical supplies. 111

112 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: MAINTAIN MEDICAL EQUIPMENT AND SUPPLIES *4. Platoon sergeant stores, maintains, and issues medical materials. ( , ) a. Stores and handles medical materials requiring special handling. ( ) (1) Protects gases from dampness and excessive heat (150 degrees Fahrenheit or 66 degrees Celsius). (2) Uses adequate ventilation and flameproof covers. (3) Takes advantage of natural and man-made protection against exploding ordnance. (4) Stores filled and empty cylinders separately and ensures cylinder valve protection caps are securely in place. (5) Stores cylinders on trucks, trailers, or pallets; however, vertically stored cylinders must be securely banded or strapped. (6) Stores medical gases separately from flammable gases and marks area "NO SMOKING." (7) Locates all storage containers for note R and Q items (items that require special security) in limited access areas. (8) Establishes procedures for the strict protection of locks and keys to facilities and containers in which controlled medical substances and sensitive items are stored. b. Stores other medical materials. (1) Protects supplies from environmental conditions (sun, rain, or cold). (2) Stores supplies where they are accessible, centrally located, and easily maintained and issued. c. Maintains accountability and control of medical materials. (1) Provides surveillance consistent with threat of theft or unauthorized possession. (2) Follows quality control standards as directed by higher headquarters. d. Reports capture of medical material. (1) Identifies, inspects, segregates, and evacuates captured medical materials to designated medical supply facility. (2) Forwards samples of all captured medical materials through medical intelligence channels. e. Issues medical supplies. (1) Issues from stock on hand or forwards requisitions to DSMO utilizing Tactical Army Combat Service Support Computer System (TACCS), if available. (2) Issues items with the earliest expiration date first. Maintains a record of receipt, expenditure, and stock balance of controlled medical items without error on the Stock Accounting Record (DA Form 1296). 112

113 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: MAINTAIN MEDICAL EQUIPMENT AND SUPPLIES *5. Platoon sergeant performs preventive maintenance (PM) on medical equipment. ( , , ) a. Establishes and distributes procedures for PM. (1) Distributes procedures to subordinate elements. (2) Conducts follow-up, if tactical situation allows time, to ensure procedures are known and complied with. b. Schedules and performs preventative maintenance (PM). (1) Schedules inspections and PM as in current established procedures. (2) Accomplishes PM inspections and PM by applicable TM. 6. Medical platoon members perform operator maintenance. a. Operators perform maintenance on equipment as directed in the equipment TM. b. Operators inform organizational maintenance personnel or supply as soon as possible of any maintenance problems beyond unit capabilities. c. Platoon sergeant processes equipment requiring repairs beyond unit capabilities for turn-in to the supporting medical maintenance shop or DMSO on DA Form 2407 (Maintenance Request). Ensures entries on the request are accurate and complete. 113

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Reference ARTEP MTP TASK: PREPARE FOR MEDICAL EVACUATION MISSION TASK STANDARD: Ground reconnaissance (recon) is accomplished if necessary to prepare strip maps for ambulance teams. Routes are planned that facilitate evacuation from forward areas to the BAS as the tactical situation permits. Evacuation requests are processed and ambulance teams briefed within 5 minutes. TASK STEPS *1. Platoon leader, medical operations officer, or evacuation NCO conducts ground reconnaissance. (MQS , ) a. Verifies information identified in map reconnaissance when additional information is required and when time allows, conducts a physical inspection of possible routes without compromising mission. Obtains information required to confirm or change the map reconnaissance and original information. b. Identifies: landmarks, obstacles, hazards, obstructions, problem areas, distances, travel time, enemy activity (movement, potential ambush, and defensive positions), terrain, weather conditions, traffic conditions (volume and patterns), and routes that provide cover and concealment. c. Makes accurate sketch map(s) of routes with appropriate annotation during reconnaissance for use by ambulance personnel. d. Forwards new intelligence information collected to higher headquarters in a timely and secure manner. *2. Medical operations officer and ambulance section sergeant portrays information on strip maps or map overlays. (MQS , ) a. Portray accurate and legible representation of all essential elements of information on strip map or map overlay. b. Special attention is given to identifying landmarks (known and unknown points), obstacles, obstructions, distances, enemy location, symbols of man-made objects, adjacent units, collection points, routes, and camps. 114

115 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: PREPARE FOR MEDICAL EVACUATION MISSION *3. Medical operations officer and ambulance section sergeant coordinates field siting of ambulances. (MQS ) a. Coordinate details of field siting with supported unit. b. Ensure that Class I, II, maintenance, and Class V support is available. c. Establish and follow administrative procedures for dispatch, use, and control of ambulances. *4. Ambulance section sergeant rotates ambulance teams and squads. (MQS , ) a. Ensures adequate evacuation support is provided. b. Schedules adequate rest for squad members when possible. c. Maintains vehicle readiness. 5. Ambulance section members receive and process evacuation request. a. Acknowledge receipt of request. b. Obtain required information when tactical situation allows (location and number of casualties, nature of wounds, nationality, and EPW). c. Follow proper communications authentication and security procedures; authenticate by receiving or transmitting as directed by SOP; and communicate information to squad or team en route. *6. Leader briefs ambulance squad. (MQS , ) a. Presents briefing in a clear and concise manner. b. Incorporates basic items such as strip maps or overlays, information from SOI to include frequencies, call signs, and passwords. 115

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Reference ARTEP MTP TASK: PREPARE FOR MEDICAL EVACUATION MISSION *6. Leader briefs ambulance squad (Cont.). (MQS , ) c. Presents briefing that contains all necessary information (pickup point, destination, route to follow, purpose of mission, procedures to follow in event of difficulty such as maintenance problems or enemy action, authorized special equipment and supplies required [such as cold weather equipment], support to be provided at supported site, security, and safety). 7. Ambulance section NCO dispatches ambulances. a. Records and maintains the dispatch log. b. Records and maintains the following dispatch information on the dispatch log: ambulance (bumper number), squad, time out, destination, purpose of mission, and ETR. c. Dispatches ambulance to designated area. d. Maintains radio contact between ambulance driver and supported unit. 8. Squad team notifies supported unit of status. a. Reports arrival to NCOIC of supported unit. b. Reports departure to parent unit, medical company, and platoon leader. c. Notifies nearest treatment team after patients have been picked up. d. Provides BAS with estimated time of arrival (ETA), number of patients, and type of injuries. e. Provides any special information that will help a smooth efficient reception. f. Follows proper communications security measures. 116

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Reference ARTEP MTP TASK: PROVIDE CONTINUING CARE AND COMFORT MEASURES FOR PATIENTS ( ) TASK STANDARD: Care is given to patient to prevent further or undue discomfort. TASK STEPS 1. EMT NCO or medical specialist administers prescribed treatment and care. a. Provides care and treatment according to physician or PA's directive. b. Monitors and records patient's vital signs. c. Reports any charges in patient's condition. 2. Treatment member provides for patient safety during attack. a. Briefs patients on actions or safety procedures to take in case of fire, ground, air, or chemical attack. b. Assists patients as needed in masking and movement. 3. Treatment section member prepares patient and records for disposition. a. Briefs ambulance crew. b. Instructs patients being returned to duty on self-care and follow-up. c. Briefs patients to be evacuated. d. Returns personal items. e. Ensures DD Form 1380, FMC, is properly filled out. 117

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TASK: DEBRIEF SQUAD AND CREWS ( ) TASK STANDARD: Debriefing is conducted, pertinent information concerning mission is obtained and recorded, information is given to platoon leader and medical platoon members. *1. Section leader conducts debriefing and reports through chain of command. (MQS , MQS ) a. Obtain information. b. Records all pertinent information concerning mission. Includes: (1) Deviations from scheduled mission and situations which pose a threat to the accomplishment of future medical missions of the unit. (2) Problems encountered with patients or routes. (3) Problems with link-up to supported unit. *2. Section leader updates situation maps and overlays. (MQS ) a. Updates situation maps and overlays immediately as appropriate. b. Forwards pertinent information to higher headquarters and adjacent units, as required. 118

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TASK: PERFORM TRIAGE ( ) TASK STANDARD: All patients are assessed and categorized for priority of treatment. Most seriously injured patients are treated first. Evacuation priorities are established. 1. Combat medic examines each patient. a. Conducts quick visual examination. b. Determines which patients are most seriously ill or injured. 2. Combat medic treats the most seriously ill or injured first. a. Reexamines the general condition, type of injuries, and need for immediate lifesaving measures. b. Conducts examination that is complete enough to identify injury or illness so that priority and type of treatment can be determined and initiate lifesaving treatment as condition indicates. 3. Combat medic reexamines patients. a. Reexamines after all patients have been examined for life threatening injures and lifesaving treatment. b. Reexamines for extent of injury or previous nonapparent injury and determines treatment needs. c. Determines treatment needs. 4. Combat medic requests patient evacuation. a. Requests additional evacuation support as needed. b. Establishes priority for evacuation based on patient category, load, and vehicle availability. 119

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TASK: EMPLOY PHYSICAL SECURITY MEASURES (19-3-C006) TASK STANDARD: No vulnerable information, equipment, or operations are accessible to the enemy. *1. Platoon leader or platoon sergeant plans for physical security. (MQS , , ) a. Prepares and has access to platoon security plan. b. Includes the following in plan: (1) Prevention of vehicle entry to perimeter. (2) Selection and manning of perimeter positions which detach and report enemy intrusion or observation of perimeter. (3) Prevention of civilian access to unit and defensive areas. (4) Maintenance of communications between the perimeter posts and the reaction force. (5) Initial response to a ground attack. (6) Establishment of primary and alternate means of communications from the security Headquarters to the dismount point and perimeter posts. 2. Designated medical platoon members operate a guard force to protect medical personnel and patients. a. Establish communications with guard commander. b. Stop unauthorized entry to restricted areas. 3. Designated medical platoon members react to enemy ground attack. a. Assume preplanned positions. b. Protect medical personnel and patients. 120

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TASK: PROVIDE SICK CALL SERVICES ( ) TASK STANDARD: Routine sick call is established as tactical situation allows. Patients are returned to duty without undue delay. TASK STEPS 1. Treatment and combat medic section members conduct a screening sick call for supported unit personnel. a. Treat patients with minor illnesses and injuries and return to duty. b. Aidmen refer patients requiring care beyond their capability to sick call at the BAS. c. Initiate DD Form 1380, FMC, and utilize for each patient. d. Enter basic information on each patient seen in aid station Daily Disposition LOG (FM ). NOTE: Use of Individual Sick Slip (DD Form 689) is not required during combat operations (AR 600-6). Use of DD 689 is at unit commander's discretion. 2. Treatment and combat medic section member’s record treatment. a. Initiate FMC if necessary. b. Record type of treatment, time, date, drugs administered, dose, and route, immediately after each procedure. 3. Prepare patient for further evacuation. a. Initiate evacuation request as soon as possible. b. Coordinate with HQ and ambulance platoon or squad as required. c. Transmit evacuation request to the FSMC for supporting air or ground evacuation. 4. Treatment section members prepare patient and records. a. Brief patient to be evacuated. b. Position non-ambulatory patients securely on litter. When preparing heat or cold injury patients for evacuation, take the appropiate precautions. 121

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TASK: PROVIDE SICK CALL SERVICES ( ) TASK STEPS 4. Treatment section members prepare patient and records (Cont.) c. Return personal items to patient. d. Attach the FMC to patient. (1) Ensure FMC is signed and initialed. (2) Record special instruction on FMC. 5. Treatment and combat medic section members initiate FMC for each patient when first treated, if time allows. a. Enter all identifying data on initial form along with known or estimated time of injury. b. Record all treatment and pertinent observations. Include: (1) Name of medication. (2) Dose. (3) Route of administration, and time. (4) IV solution. c. Mark continuation copies of FMC in upper right corner "FMC #_____" and enter appropriate sequence number, name, SSN, and grade. d. Send original copy of FMC with patients transferred to other treatment facility. e. Retain carbon copy and place in field medical file (See FM ). 6. Maintain Daily Disposition Log. a. Treatment section records information in disposition logbook. (1) Mark front cover ”Daily Disposition" with: (a) Unit designation. (b) Dates of initial and closing entry. (2) Each set of facing pages has vertical columns drawn with the following titles: (a) Patient number, name, grade/rank, SSN, and unit. (b) Diagnosis and impression. (c) Time seen. (d) Disposition. (e) Date-time group (DTG) of disposition. 122

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TASK: PROVIDE SICK CALL SERVICES ( ) TASK STEPS 6. Maintain Daily Disposition Log (cont.). (3) Make speculative entries for name, rank, and unit in pencil; change to ink as verification is obtained or available. (4) Enter all available data required in the log for each patient seen in the BAS within one hour, and complete disposition of patient (except under mass casualty situation). (5) Begin patient numbering system with "1" each day. b. Close log at end of each day (2400 hours local time or Zulu time as directed by the command surgeon). c. Retain and dispose of Daily Disposition Log as directed by DA Pam and AR 123

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TASK: PROCESS CAPTURED DOCUMENTS AND EQUIPMENT (19-3-C005) TASK STANDARD: Enemy equipment and documents are secured and processed to higher headquarters as the tactical situation permits. TASK STEPS 1. Medical platoon members tag documents and captured medical equipment with necessary information, to include: a. Type of document (such as map, photo, or orders) or medical equipment. b. Date and time of capture. c. Place of capture (grid coordinates). d. Capturing unit. e. Circumstances of capture. f. Prisoner's name (if taken from EPW). *2. Designated medical members report capture of documents or equipment to company XO or 1SG. (MQS ) a. Report type of document or equipment. b. Report date or time of capture. c. Report place of capture (grid coordinates). *3. Designated medical platoon members process captured equipment. (MQS ) a. Request disposition instructions. b. Evacuate documents through the chain of command to intelligence personnel. 124

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TASK: PERFORM MAINTENANCE (91-3-C020) TASK STANDARD: Scheduled operator maintenance is performed daily. Emergency repairs are made as far forward as possible. PMCS is accomplished in accordance with unit SOP. TASK STEPS *1. Platoon sergeant supervises maintenance of medical platoon equipment. (MQS , , ) a. Platoon sergeant schedules PMCS. (STP 10-76C12-SM-TG) (1) Keeps a preventive maintenance schedule and record on hand as required for each item of equipment. (2) Schedules PMCS appropriately. (3) Properly records maintenance, lubrication, and non-available days. (4) Checks to see that visual signal system is correct. (5) Makes proper disposition of the form when a new form is prepared or equipment has been transferred. b. Platoon sergeant directs PMCS. (1) Directs scheduled PMCS and notifies operators and crews accordingly. (2) Keeps equipment, operator and crew, publications, tools, equipment, POL, supplies, and repair parts on hand for scheduled PMCS. (3) Performs PMCS in accordance with the applicable publications and scheduled services on DD Form 314. (4) Monitors and spot-checks performance of the PMCS. c. Medical platoon members perform preventive maintenance. (1) Perform PMCS as directed by appropriate TM. (2) Note all malfunctions. d. Platoon sergeant provides maintenance assistance and instruction to operator and crew performing PMCS. (1) Instructs operators and crews in proper operating and maintenance procedures as outlined in the applicable TM. (2) Instructs personnel in the correct interpretation and application of instructions contained in appropriate TMs, TBs, and other technical publications and directives. (3) Maintains control of all DA Forms 348 (Equipment Operator's Qualification Record). 125

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TASK: PERFORM MAINTENANCE (91-3-C020) TASK STEPS e. Platoon sergeant supervises PMCS. (1) Checks to assure that the operator of each equipment item has the TM -10 for the equipment and that it is used. (2) Makes a record of faults which cannot be corrected on the spot. (3) Assigns specific maintenance objectives for each scheduled period of preventive maintenance. 2. Medical platoon members perform operator maintenance. a. Perform maintenance on their assigned vehicles, individual weapons, and equipment when tactical situation permits. b. Inform organization maintenance personnel or company supply element as soon as possible of any maintenance problems beyond unit capabilities. 3. Medical platoon members perform emergency repair. a. Make repairs in accordance with equipment TM. b. Make repairs as far as possible to ensure continued function of equipment. 126

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Reference ARTEP MTP TASK: ESTABLISH PATIENT DECONTAMINATION STATION ON AN INTEGRATED BATTELFIELD CHEMICAL ENVIRONMENT ( ) TASK STANDARD: Decontamination station is operational within 45 minutes of WARNING (60 minutes in darkness). TASK STEPS. 1. Treatment section provides tailgate medical services. a. Immediately assumes MOPP level as directed. Increases MOPP level if necessary. Remains in MOPP while operating outside M51 shelter. NOTE: M51 shelters will not be established if unit is to remain for less than 6 hours. b. Provides emergency medical services within five minutes; continues until M51 shelter is operational, and the decontamination, triage, and holding areas outside the shelter are established. 2. Treatment section and augmentee personnel erect M51 shelter. a. Erect one M51 shelter with all necessary medical equipment placed inside. Become operational and are prepared to receive first patient within 45 minutes (60 minutes during hours of darkness). . NOTE: The M15 shelter can be erected in a contaminated atmosphere but must be purged for eight minutes. b. Establish and disestablish shelter as directed in TC 8-12. c. Platoon sergeant supervises personnel performing assigned specific tasks in erecting shelter in accordance with TM d. Erect only one M51 shelter. The second shelter remains on the trailer and is protected against chemical contamination. Use this shelter upon relocation of the treatment element. e. Pad all litter stands and equipment placed on the floor of the M51 to prevent puncture of the floor. f. Place medical equipment and supplies in treatment area. Place litter stands in shelter. place plastic bags and clean FMCs (DD Form 1380) in airlock. Place patient protective wraps (PPW) in the shelter. 127

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Reference ARTEP MTP TASK: ESTABLISH PATIENT DECONTAMINATION STATION ON AN INTEGRATED BATTELFIELD CHEMICAL ENVIRONMENT ( ) 3. Treatment section and augmentees establish overhead cover. a. Establish decontamination and holding areas. b. Erect plastic sheeting downwind of M51 shelter, overlapping airlock entrance for the decontamination and triage areas. c. Erect plastic sheeting adjacent to the first sheeting and the side of the M51 shelter opposite the generator for the evacuation holding area. d. Erect sheeting within ten minutes. e. Check to ensure sheeting for decontamination and triage area measures at least 6 meters by 15 meters f. Check to ensure sheeting for holding area measures at least 6 meters by 7.6 meters. g. Do not erect overhead cover if wind speed is greater than 10 knots. NOTE: Camouflage netting should be erected over the area within fifteen minutes. 4. Treatment section and augmentees establish shuffle pit. a. Position shuffle pit 3 to 4.6 meters from the center of the airlock entrance. Enter shuffle pit not less than 3 meters nor more than 4.6 meters away from the M51 shelter airlock. b. Dig shuffle pit, 3 meters wide by 1.2 meters long by 15 centimeters deep, within ten minutes, (humus soil), while M15 is being inflated. Harder soils will require a longer time. c. Fill shuffle pit with super tropical bleach and earth as directed by TM d. Position litters on litter stands in center of shuffle pit. 5. Treatment section establishes hot line. a. Establishes hot line through shuffle pit around the waiting area, M51 shelter, and holding area, and mark with engineer tape or other marking material. b. Marks hot line within five minutes after shuffle pit is established. 128

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TASK: ESTABLISH PATIENT DECONTAMINATION STATION ON AN INTEGRATED BATTELFIELD CHEMICAL ENVIRONMENT ( ) 6. Treatment section and augmentees establish decontamination and triage areas. a. Position litters, litter stands, EMT equipment, and required decontamination materials contained in the Chemical Agent Patient Decontamination Set and Chemical Agent Patient Treatment Set. Decontamination Set should be in the vicinity of patient decontamination area. Patient Treatment Set should be with Trauma Treatment Set. b. Place physical barriers and sentries, if available, around hot line area to maintain security and prevent transfer at other points. c. Equip contaminated emergency treatment area with selected emergency lifesaving equipment and supplies, including Chemical Agents Casualty Treatment Set. d. Set up clothing removal area with one pair of litter stands, large plastic bags, extra plastic bags for personal effects and FMCs, two pails or buckets filled with five percent aqueous sodium hypochlorite solution (undiluted liquid bleach used for laundry is near correct strength), four pair heavy-duty scissors (with spare ones available), gauze or sponges, and M258A1 kits. e. Establish patient decontamination area with one litter on a pair of litter stands. NOTE: Standard litter is covered with plastic sheeting. f. Equip decontamination area with plastic bags, two pails or buckets with five percent sodium hypochlorite solution, gauze or sponges, M258A1 kits, replacement tourniquets and bandages (for severe bleeding only), and M8 detector paper. 7. Treatment section and augmentees clean treatment area. a. Establish clean treatment area inside hot line in front of the M51 shelter to the side away from the generator. b. Equip treatment area with PPW, medical supplies, and equipment as directed by unit SOP. 8. Treatment section and augmentees establish patient waiting area. a. Establish patient waiting area, inside hot line in front of M51 shelter to the side near the generator trailer. b. Equip with medical supplies, equipment, and PPW for those patients waiting over 10 minutes for entry into M51 shelter. 129

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Reference ARTEP MTP TASK: ESTABLISH PATIENT DECONTAMINATION STATION ON AN INTEGRATED BATTELFIELD CHEMICAL ENVIRONMENT ( ) 9. Treatment section and augmentees establish contamination sump. a. Establish 75 meters downwind from the end of the overhead cover for disposition of all contaminated waste. b. Keep sump separate from contaminated holding area. 10. Treatment section and augmentees establish contaminated holding area. a. Establish contaminated holding storage area for recoverable equipment 75 meters downwind. b. Keep area separate from contaminated sump. c. Establish contaminated holding area for expectant patients near triage area, downwind. NOTE: Reference page , Battalion Aid Station Using the M51 Shelter System and layout of a chemical agent patient decontamination station, in an uncontaminated area, without collective protective shelter. 130

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TASK: DECONTAMINATE AMBULATORY PATIENTS CHEMICAL ENVIRONMENT ( ) TASK STANDARD: Patient is decontaminated and no cross-contamination occurs. TASK STEPS NOTE: If individual is returning to duty in a contaminated environment, only decontaminate sufficiently enough to treat wound or injury. 1. Augmentees decontaminate patient's hood. a. Ask patient to cover his air inlets. b. Decontaminate hood with high-test hypochlorite solution or M258A1 skin decontamination kit with litter patient. NOTE: HTH is the same sodium chlorite chemical used for swimming pools. In liquid form, it is the same as laundry bleach. c. Ask patient to uncover air inlets. 2. Augmentees cut off patient's hood. a. Dip scissors in decontaminating solution. b. Cut off hood, redipping scissors in HTH every two or three cuts. c. Fold hood out and away from patient's face. d. Remove and discard hood in contaminated disposal container. 3. Augmentees decontaminate patient's mask and exposed skin. a. Use decontaminating solution or M258A1 skin decontamination kit. b. Decontaminate mask and exposed skin. 4. Augmentees remove gross contamination from patient's outer garments. a. Wipe all obvious contaminated spots with HTH solution or package 1 and 2 from M258A1 skin decontamination kit or chlorine bleach. b. Cut out large contaminated spots. c. Place cutaway materials into contaminated disposal container. 131

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Reference ARTEP MTP TASK: DECONTAMINATE AMBULATORY PATIENTS CHEMICAL ENVIRONMENT ( ) 5. Augmentees maintain patient's FMC. a. Cut FMC tie-wire. b. Allow FMC to fall into plastic bag. c. Seal plastic bag. 6.Augmentees remove load-bearing equipment. a. Unfasten and unbutton or cut all zippers and buttons or tie straps. b. Place contaminated equipment in plastic bag. c. Place plastic bag in designated contaminated storage area. NOTE: Depending on battlefield situation or medical transport method, load-bearing equipment may or may not have been removed 7. Augmentees remove personal articles from outer garment pockets. a. Ask patient to remove personal articles from breast and side pockets. b. Place patient's personal articles in a clean plastic bag. c. Give personal articles to the patient. 8. Augmentees check for and remove spot contamination. a. Use M8 chemical agent detector paper. b. Dab all areas of patient's clothing. c. Pay particular attention to: (1)Discolored areas. (2)Damp spots. (3)Tears in clothing. (4)Neck. (5)Wrists. (6)Ears. (7) Area around dressings. 132

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Reference ARTEP MTP TASK: DECONTAMINATE AMBULATORY PATIENTS CHEMICAL ENVIRONMENT ( ) 8. Augmentees check for and remove spot contamination (cont.). d. Remove contamination. (1)Cut away clothing with a large border around the contaminated area, using scissors dipped in HTH solution. (2) Use M8 chemical agent detector paper for contamination. (3) Spot decontaminate with HTH or M258A1 decontamination kit. 9. Augmentees remove overgarment jacket. NOTE: This procedure can easily be done with one decon person or with one decon person on each side of the patient working simultaneously. a. Instruct patient to: (1)Clench his fists. (2)Stand with arms held straight down. (3)Extend arms backward at about 30-degree angle. (4)Place feet shoulder-width apart. b. Stand in front of patient. (1) (1) (2) (2) (3) Unsnap jacket front flap. (4) Unzip jacket front. c. Move to the rear of the patient. (1)Grasp jacket collar with both hands at sides of the neck. (2)Peel jacket off shoulders at a 30-degree angle down and away from the patient. (3)Smoothly pull the sleeves inside out over the patient's wrists and hands. d.Cut to aid removal, if necessary. (1)Cut around all splints, bandages, and tourniquets. (2)Cut sleeves from inside waist to armpit. (3)Cut across shoulder through collar. (4)Peel jacket back and downward to avoid spreading contamination. (5)Insure that the outside of jacket does not touch the patient or inner clothing. e. Place overgarment jacket into contaminated disposal bag. 10. Augmentees remove patient's overboots. a. Unzip trouser leg zipper and cut overboot laces with scissors dipped in HTH solution. 133

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Reference ARTEP MTP TASK: DECONTAMINATE AMBULATORY PATIENTS CHEMICAL ENVIRONMENT ( ) 10. Augmentees remove patient's overboots. b. Fold lacing eyelets flat on the ground. c. Step on (or hold down) the toe and hell eyelet to flatten eyelets on the ground. d. Instruct patient to step out of the overboot onto clean area. e. Use same procedure for the other overboot. 11. Augmentees remove patient's overgarment trousers. a. Unfasten or cut all ties, buttons, or zippers. b. Grasp trousers at the waist. c. Peel trousers down over the patient's boots. d. Cut trousers to aid removal, if necessary. (1) Cut around all bandages, splints, and tourniquets. (2) Cut from inside pant leg, ankle to groin. (3) Cut up both sides of the zipper to the waist. (4) Allow the narrow strip with the zipper to drop between the legs. (5) Peel or allow trouser halves to drop to the ground. e. Place trousers into contaminated disposal bag. 12. Augmentees remove patient's butyl rubber gloves. a. Remain at the rear or at the side of the patient. b. Dip your gloved hands in HTH solution. NOTE: Patient's arms are still extended backward at a 30-degree angle. c. Use thumbs and forefingers of both hands. d. Grasp the heel of patient's glove at top and bottom of forearm. e. Peel glove(s) off with a smooth, downward motion. f. Place glove(s) in contaminated disposal bag. g. Tell patient to reposition his arms, but not touch his trousers. 134

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Reference ARTEP MTP TASK: DECONTAMINATE AMBULATORY PATIENTS CHEMICAL ENVIRONMENT ( ) 13. Augmentees direct patient to remove glove inner liners. a. Tell patient to remove white glove liners. (1) Grasp heel of gloves without touching exposed skin. (2) Peel inner liner downward and off. (3) Drop in contaminated disposal bag. b. Remove the remaining liner in the same manner. 14. Augmentees spot decontaminate. a. Use M8 detector paper. b. Dab all areas of patient's clothing. c. Give particular attention to: (1) Discolored areas and damp spots. (2) Tears in clothing. (3) Neck. (4) Wrists. (5) Area around dressings. f. Decontaminate gross contamination by cutting away areas of clothing or washing with HTH solution. 15. Augmentees route patient to skin decontamination area and check patient with M8 chemical detector paper. a. Route to skin decontamination area. b. Decontaminate detected areas with HTH solution or M258A1 decontamination kit. c. Decontaminate exposed neck and wrist areas. d. Decontaminate areas exposed by cutting clothing. e. Decontaminate around dressings, splints, and tourniquets. 135

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TASK: DECONTAMINATE AMBULATORY PATIENTS CHEMICAL ENVIRONMENT ( ) 15. Augmentees route patient to skin decontamination area and check patient with M8 chemical detector paper. f. Decontaminate face. (1) Use or provide patient with M258A1 decontamination kit or HTH solution. (2) Wet sponge with HTH solution or open decontamination wipe packets. (3) Tell patient to hold his breath and close his eyes. (4) Lift mask off his face at the chin and wipe and sponge patient's face, or have patient wipe and sponge his face. (6) Wipe face quickly and around top of ears and wipe carefully all folds of skin: top of upper lip, chin, dimples, ear lobes, and nose creases. (8) Wipe all surfaces inside the mask which touch the face. (9) Drop used wipes into contaminated disposal container. (10)Instruct patient to reseal, clear, and check his mask. 16. Treatment section members replace tourniquets. a. Place new tourniquet 1.27 centimeters to 2.54 centimeters above the old tourniquet. b. Remove old tourniquet and decontaminate the exposed skin area. 17. Treatment section members remove splints and cut away bandages. a. Replace bandages only to control bleeding and instruct combat medics not to replace splints. b. Decontaminate any exposed skin. 18. Augmentees recheck patient for contamination. a. Use M8 detector paper. b. Redecontaminated, if necessary. 19. Platoon leader (physician) or PA determines patient's disposition. a. Assign as augmentee. b. Route for evacuation or return to unit. 20. Augmentees route patient to clean treatment area. a. Instruct patient to shuffle his feet as he crosses the hot line. b. If patient is to remain on the contaminated side as an augmentee, reissue complete MOPP 4 uniform. 136

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TASK: DECONTAMINATE LITTER PATIENTS-CHEMICAL ENVIRONMENT ( ) TASK STANDARD: Patient is decontaminated and no cross-contamination occurs. TASK STEPS. 1. Augmentees decontaminate patient's hood. a. Cover mask air inlet valves. (a) Get help from your assistant. (b) Use clean gauze pads. (c)Ask patient to cover his air inlet valves with his hand (if he is able). b. Wipe off front, sides, and top of hood with sponge soaked with HTH or use M258A1 skin decontaminating package 1 and 2. NOTE: HTH is the same sodium chlorite chemical used for swimming pools. In a liquid form it is the same as laundry bleach. c. Uncover mask air inlet valves. 2. Augmentees cut off patient's hood. a. Dip scissors in HTH solution. b. Release or cut hood straps. c. Cut or untie neck cord. d. Cut off zipper cord. e. Cut away drawstring below voicemitter. f. Unzip the hood zipper. g. Begin cutting at zipper "V" below voicemitter. (1) Proceed cutting upward, close to the filter-inlet covers and eye-lens outserts. (2) Cut upward to top of eye outsert. (3) Cut across forehead to the outer edge of the next eye outsert. (4) Cut downward toward patient's shoulder staying close to the eye lens and filter inserts. (5) Cut across the lower part of the voicemitter to the zipper. (6) Cut from center of forehead over the top of the head. (7) Fold left and right sides of hood to the side. 137

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TASK: DECONTAMINATE LITTER PATIENTS-CHEMICAL ENVIRONMENT ( ) 3. Augmentees decontaminate patient's mask and exposed skin. a. Use M258A1 skin decontamination kit or HTH Solution. b. Cover both air inlet valves with gauze or hands. (1) Wipe external parts of mask. (2) Wipe mask straps and strap buckles. c. Uncover both air inlet valves. d. Wipe exposed skin area. (1) Chin and neck. (2) Back of ear. 4. Augmentees remove gross contamination from patient's outer garments. a. Wipe all evident contaminated spots with HTH solution or M258A1 packages 1 and 2. b. Cut out large contaminated spots and place any cutaway material into contaminated disposal container (plastic bag). 5. Augmentees maintain patient's FMC. a. Cut FMC tie-wire. b. Allow FMC to fall into a plastic bag. c. Seal plastic bag. (a) Zip lock, if appropriate. (b) Tie opening into a knot. d. Wash plastic bag with decontamination solution. e. Place plastic bag under mask head straps. 6. Augmentees remove and secure personal effects. a. Remove articles from breast and side pockets. b. Place articles in plastic bag. 138

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Reference ARTEP MTP TASK: DECONTAMINATE LITTER PATIENTS-CHEMICAL ENVIRONMENT ( ) 6. Augmentees remove and secure personal effects. c. Print patient's social security number (SSN) and name on a piece of paper. (1) Get the patient's name from: (2) Patient. (3) Patient's FMC. (4) Right battle dress uniform (BDU) breast pocket after carefully unzipping outer garment jacket. (5) Get from other sources: (6) Identification card. (7) Buddy. (8) Other patient. d. Place the paper with the name and SSN into plastic bag. e. Seal plastic bag. f. Place plastic bag in clean holding area. 7. Augmentees remove patient's protective overgarment jacket. a. Cut overgarment jacket. (1) Make initial cut at neck area down to groin area of right side. (2) Cut from inside cuff area of right sleeve up to armpit, then through the collar. b. Roll chest sections to respective sides with inner surface outward. c. Carefully tuck clothing between arm and chest. d. Repeat procedure for other side of jacket. 8. Augmentees remove butyl rubber gloves. a. Lift patient's arm up and out of the cutaway sleeve. b. Grasp the cuff of patient's glove on the raised hand. c. Roll the cuff over the fingers, turning the gloves inside out. d. Lower patient's arm across his chest. e. Place removed gloves in contaminated disposal container. 139

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Reference ARTEP MTP TASK: DECONTAMINATE LITTER PATIENTS-CHEMICAL ENVIRONMENT ( ) 9. Augmentees remove overgarment trousers. a. Cut down from waist along zipper and each inner leg seam. b. Cut both sides of zipper from waist. c. Fold trouser halves onto litter with contaminated sides away from patient. 10. Augmentees take off patient's protective overboots. a. Stand at foot of litter facing patient. b. Cut overboot laces. c. Unzip protective trouser leg zippers. d. Hold legs up and slightly off the litter with one hand. e. Grasp heel of overboots with the free hand. f. Pull heels up and toward you until removed. g. Place overboots in contaminated disposal container. 11. Augmentees remove inner boots. a. Position yourself at foot of the litter. b. Cut bootlaces along the tongue. c. Grasp boot at heel and toe. d. Pull the heel upward and toward you until removed. e. Place boots in contaminated disposal container. 12. Augmentees cut off BDUs. a. Unbuckle or cut belt material. b. Cut off fatigue or BDU trousers following same procedure as for outer garment trousers. 140

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Reference ARTEP MTP TASK: DECONTAMINATE LITTER PATIENTS-CHEMICAL ENVIRONMENT ( ) 12. Augmentees cut off BDUs. c. Cut off fatigue or BDU shirt. (1) Uncross patient's arms. (2) Cut shirt using same procedure as for outer garment jacket. (3) Recross patient's arms over his chest. 13. Augmentees cut off undergarments. a. Cut off undershorts or panties following the same procedure as for outer garment trousers. b. Cut off T-shirt following the same procedure as for outer garment jacket. c. Cut off brassiere. (1) Hold patient’s arms off chest. (2) Cut the elastic between the cups. (3) Cut both shoulder straps where they attach to the cups. (4) Lay the cups away from patient onto litter. (5) Lay shoulder straps up and over the shoulders onto the litter. 14. Augmentees remove patient's identification tags. a. Cut ID tag chain. b. Allow chain to fall to the litter. c. Slip ID tags from chain. c. Place chain in contaminated disposal container. d. Rinse ID tags in HTH solution. e. Place ID tags in clean plastic bag. f. Seal plastic bag. g. Place plastic bag on patient's chest. 15. Augmentees remove glove inner liners. a. Pull off glove liners using the same procedure as for removing butyl rubber gloves. b. Cross patient's arms over his chest. 141

142 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: DECONTAMINATE LITTER PATIENTS-CHEMICAL ENVIRONMENT ( ) 16. Augmentees remove socks. a. Position yourself at foot of the litter. b. Slightly raise patient's leg off litter with one hand. c. Grasp top of sock in the back with free hand. d. Pull top of sock toward you, over the heel and off the foot. e. Place socks into contaminated disposal container. 17. Augmentees lift patient, using three personnel (Cont.). a. Rinse aprons and gloves in HTH solution. b. Lift patient out of cutaway garments. (1) Man #1 slides his arms (palms turned upward) under the patient's head and shoulders. (2) Man #2 slides his arms (palms turned upward) under the patient's back and buttocks. (3) Man #3 slides his arms (palms turned upward) under the patient's thighs and calves. (4) Lift patient on Man #1's signal and turn the patient in against your chest. (6) Carry the patient to the decontamination litter and lower the patient to litter in supine position, if possible. c. Place the patient's contaminated clothing in contaminated disposal container. 18. Augmentees check for and perform skin decontamination. a. Check patient for contamination: (1) Dab patient with M8 chemical agent detector paper. (2) Decontaminate detected areas with decontamination kit or HTH solution as necessary. b. Pay particular attention to: (1) Neck and wrists. (3) Lower part of face. (4) Areas which may have been touched during clothing removal. (5) Areas around wounds. 142

143 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: DECONTAMINATE LITTER PATIENTS-CHEMICAL ENVIRONMENT ( ) 19. Treatment platoon members cut off splints and bandages and replace tourniquets. a. Remove splints. (1) Cut off all tie stays holding splints in place and remove splints. (3) Cut off the clothing that was covered by the splints. (4) Place splints, tie stays, and clothing in contaminated disposal container. (5) Decontaminate area where splint(s) were with M258A1 decontamination kit or HTH solution. b. Remove bandages. (1) Cut off bandages and the clothing that was covered by the bandage(s). (3) Decontaminate areas covered by bandages and clothing with HTH solution. (4) Irrigate wound with water or saline solution. (5) Wrap massive wounds with plastic sheeting or plastic bags. (6) Secure with tape or clean tourniquet. (7) Mark wound as "contaminated" as directed by local SOP. (8) Place removed bandages and clothing in contaminated disposal container. c. Replace tourniquets. (1) Decontaminate a large area above the present tourniquet. (2) Place a new tourniquet 1.27 centimeters to 2.54 centimeters above the old tourniquet. (3) Cut off or remove old tourniquet. (4) Cut off any remaining clothing sections covered by old tourniquet. (5) Decontaminate area covered by old tourniquet and clothing. (6) Place old tourniquet and clothing into contaminated disposal container. 20. Augmentees recheck patient for contamination. a. Dab patient with M8 chemical agent detector paper. b. Decontaminate detected areas, as necessary. 21. Augmentees transfer patient through shuffle pit to ensure uncontaminated and sterile area. a. Lift patient from litter and carry patient to clean litter in shuffle pit. c. Place patient on clean litter on litter stand. 143

144 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: USE PASSIVE AIR DEFENSE MEASURES (44-3-C001) TASK STANDARD: Unit members successfully identify enemy aircraft and implement passive defense measures to defend against attack from enemy aircraft. TASK STEPS *1. Platoon leaders/medical operation officer supervises platoon members use of air defense measures in a tactical position. (MQS , O ) a. Use all available resources (camouflage when authorized, cover, concealment, dispersion, and so on) to hide the platoon and limit its vulnerability. b. Cover or shade shiny items, particularly windshield and optics. c. Establish and rehearse air attack alarms. d. Disperse vehicles, tents, and supplies to reduce vulnerability to air attack. e. Construct field fortifications with organic equipment as necessary to protect personnel and vulnerable mission-essential equipment. f. Man observation posts (daytime and nighttime) to provide warning of approaching aircraft. g. Visually identify threat aircraft. h. Report any aircraft action to higher headquarters.* *2. Medical platoon members use passive air defense measures in a convoy. (MQS ) a. Leader ensures the convoy commander briefs all unit personnel. b. Camouflage vehicles and equipment when authorized (personnel wear BDUs and helmet cover) before moving out. c. Selects column interval based on instructions, mission, and terrain. 144

145 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: USE PASSIVE AIR DEFENSE MEASURES (44-3-C001) *2. Medical platoon members use passive air defense measures in a convoy. (MQS ) d. Alternate individual weapons throughout the convoy to cover front, rear, and flanks (avenues or approach). e. Assign soldiers to air guard duties with specific search sectors covering 360 degrees. f. Visually identify threat aircraft. g. Leader reports all aircraft actions to higher headquarters. h. Establish and rehearse air attack alarms. *3. Medical platoon members use passive air defense measures when the unit is occupying or displacing. (MQS ) a. Maintain vehicle interval specified in the unit order. b. Stagger vehicles to avoid linear patterns. c. Leader assigns airguards to designated sectors of search that covers 360 degrees and maintain coverage until movement is completed. d. Visually identify threat aircraft. e. Leader reports all aircraft actions to higher headquarters. f. Establish vehicle order according to precedence. 145

146 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: PERFORM PERSONNEL CONSOLIDATION AND REORGANIZATION ( C019) TASK STANDARD: Unit personnel are reassigned to key leadership positions to reestablish the chain of command and fill key positions vacated by casualties. Casualties and EPWs are appropriately treated, reported, and evacuated. TASK STEPS 1. Senior platoon member present cross-levels personnel and reassigns responsibilities. MQS ) a. Fills leadership positions. b. Verifies local security. 2. Senior platoon member present determines personnel and equipment status. (MQS , ) a. Accounts for all assigned and attached personnel. b. Medics provide emergency medical treatment and initiates medical evacuation. c. Assesses personnel and weapon system and equipment conditions. +3. Report personnel and weapon system and equipment status to next higher headquarters. a. Report killed, wounded, missing, and captured personnel using DA Forms 1155 and 1156. 146

147 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: PREPARE FOR OPERATIONS IN AN NBC ENVIRONMENT (03-3-C013) TASK STANDARD: Medical platoon prepares for NBC environment without interruption of the mission. Medical platoon takes actions necessary to minimize effects of friendly nuclear blast within 30 minutes prior to detonation. TASK STEPS *1. Leaders issue NBC defense equipment. (MQS , ) a. Issue to each soldier individual NBC defense equipment authorized by TOE and applicable common table of allowances (CTA). b. Check to ensure that unit NBC defense equipment authorized by TOE and applicable CTA is operational and is issued to designated, trained, and knowledgeable operators. c. Identify shortages, and take replacement action. d. Fill decontamination apparatuses. 2. Medical platoon members check M258A1 kit. a. Check components to ensure expiration dates have not been reached. b. Check to ensure kit contains a minimum of five samplers--detectors, instruction card, and NBC M8 paper. *3. Leaders adjust operations based on the situation. (MQS ) a. Check to ensure subordinates are equipped to comply with MOPP level. (1) Each soldier carries (protective mask with hood, skin decontamination kit, and detector paper). (2) In MOPP 0, the soldier carries or stores nearby (mask, overgarment, overboots, and gloves). (3) In MOPP 1, the soldier wears overgarment with M9 paper affixed and carries overboots, gloves and mask. b. Inform ambulance teams of location of protective shelters. c. Direct platoon members to harden positions (defense only). (1) Improve foxholes and bunkers. (2) Locate natural and man-made features which provide protection (such as caves, ditches, ravines, culverts, overpasses, tunnels, basements). 147

148 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: PREPARE FOR OPERATIONS IN AN NBC ENVIRONMENT (03-3-C013) *3. Leaders adjust operations based on the situation. (MQS ) d. Check to ensure M13 decontamination apparatus is full. e. Fill decontamination apparatuses. f. Identify shortages of NBC equipment and request resupply as needed. g. Enforce field sanitation measures. *4. Medical platoon members prepare for nuclear attack. (MQS , ) a. Warn personnel. b. Medical platoon members place vehicles and equipment in a position that provides the best terrain shielding. c. Turn off and disconnect nonessential electronic equipment. Tie down essential antennas and take down nonessential antennas and antenna leads. d. Improve shelters giving consideration to blast, thermal, and radiation effects. e. Zero dosimeters, if available. f. Secure loose, flammable, explosive items, food, and water containers. Protect them from nuclear weapon effects. g. Leaders check to ensure individuals know the appropriate action if an attack occurs. h. Leaders conduct periodic monitoring. i. Take additional actions consistent with the tactical and medical situation. 5. Medical platoon members prepare for a chemical attack. a. Leaders warn teams. 148

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Reference ARTEP MTP TASK: PREPARE FOR OPERATIONS IN AN NBC ENVIRONMENT (03-3-C013) 5. Medical platoon members prepare for a chemical attack. b. Determine and follow MOPP-level guidance. (1) Ensure all individuals are at or above required MOPP-level. (2) Adjust levels based on weather, work rate, and threat (identify criteria for automatic masking, identify "buddy" for first-aid decontamination, and disseminate criteria for automatic masking and buddy-aid decontamination). (3) Identify activities that become more difficult due to MOPP and take actions to compensate; for example, allow more time, assign additional personnel, or rotate ambulance crews. c. Use expendable or readily decontaminated material to cover all equipment, munitions, POL, food, and water containers that cannot be placed in a shelter. d. Place detector paper to provide maximum exposure to toxic rain and where it can be easily observed. e. Check to ensure M258A1 kits are serviceable and are issued down to crew level. f. Fill decontaminating apparatuses. g. Leaders check to ensure individuals know the appropriate action if an attack occurs. h. Take additional actions consistent with the tactical situation. 6. Medical platoon members prepare for a friendly nuclear strike. a. Acknowledge warning (STRIKWARN). b. Leaders warn and advise platoon personnel of: (1) Time, location, and area coverage of the planned decontamination. (2) Element vulnerability to immediate effects and residual contamination. (3) Measures required to prevent casualties, damage, and interference with the mission. c. Leaders monitor to ensure platoon personnel execute directed actions. (1) Minimize skin exposure by rolling down sleeves, buttoning collars, or wearing additional clothing, such as MOPP gear. (2) Take cover in foxholes, bunkers, armored vehicles, basements, culverts, caves, or tunnels. (3) Place vehicles so that terrain provides shielding. (4) Protect electronic equipment from electromagnetic pulse (EMP) by (removing or tying down antennas, and disconnecting power and antenna leads. 149

150 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: PREPARE FOR OPERATIONS IN AN NBC ENVIRONMENT (03-3-C013) 6. Medical platoon members prepare for a friendly nuclear strike. (5) Move loose items that could be blown around by the explosion so that they do not represent a hazard. (6) Warn all individuals. (7) Leaders brief personnel on the actions to take and when to take them. d. Leaders implement protective measures as directed by company HQ. e. Complete actions before detonation occurs. 150

151 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: RESPOND TO AN NBC ATTACK (03-3-C016) TASK STANDARD: Platoon members react immediately to minimize effects of chemical or nuclear attack. MOPP 4 is reached within 8 minutes of identified alarms. Protective measures are taken immediately in the case of a nuclear attack. TASK STEPS *1. Medical platoon members respond to chemical agent attack. a. Take immediate protective action. (1) Recognize the chemical alarm or hazard. (2) Put on assigned protective mask with hood and give the alarm. (3) Put on chemical protective clothing and equipment to reach MOPP 4 within 5 minutes. b. Evaluate contamination and decontaminate skin. *2. Leaders reconstitute the platoon. a. Reestablish chain of command and communications. b. Receive evacuation section status, consolidate, and report to higher headquarters. c. Identify, treat, mark, and evacuate medical platoon casualties. Decontaminate medical platoon personnel wounded in action (WIA) before medical evacuation. Wrap, mark, and evacuate medical platoon personnel killed in action (KIA) to designated collection point. d. Resume mission operations. e. Leaders provide NBC reports. (1) Submit initial NBC 1 (chemical reports). (2) Identify type of agent, and submit subsequent NBC 1 (chemical) report within 20 minutes after the attack. f. Leaders initiate unmasking procedures. g. Adjust MOPP level as required. h. Replenish chemical defense equipment and supplies, as required. 151

152 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: RESPOND TO AN NBC ATTACK (03-3-C016) 3. Medical platoon members respond to residual effects of nuclear attack. a. Take immediate protective action. (1) Immediately drop to the ground or floor if you are in a building or vehicle. (2) Close your eyes. (3) Turn your body so your head is away from the flash of light, as you fall. (4) Put your hands under your body and keep face down. (5) Keep your helmet on. (6) Stay down until the blast wave passes and the debris stops falling. b. Reconstitute the unit. (1) Leaders reestablish chain of command and communications and report the situation. (2) Identify, treat, and evacuate casualties. (3) Check to see if any equipment has been damaged. (4) Evacuate KIAs to designated collection point. (5) Resume mission operations (6) Leaders provide NBC reports. c. Commence continuous monitoring and report dose rate readings if area survey meter is available. d. Check dosimeters and report total dose, as required. 152

153 Chapter 5 EXECUTION CHECKLIST
Reference ARTEP MTP TASK: PERFORM DECONTAMINATION (03-3-C017) TASK STANDARD: Decontamination measures are started immediately and personnel are decontaminated within 15 minutes and recontaminate is negligible. TASK STEPS 1. Medical platoon members perform chemical decontamination. a. Conduct basic skin decontamination. (1) Start skin decontamination within one minute after contamination. (2) Resume mission operations on completion of decontamination. b. Conduct decontamination by performing personal wipe down and spray down within 15 minutes. (1) Personnel use buddy system and M258A1 towelettes to wipe hood, mask, gloves, weapon, helmet, and individual use items. (2) Operators use M11 or M13 decontaminating apparatus. Spray the control surfaces of vehicles and crew-served weapons that must be touched during entry, exit, occupancy, and operation. c. Exchange MOPP gear if tactical situation permits and a secure area is available. (1) Prepare dry mix STB by mixing the container of STB with 1-1/2 containers of uncontaminated soil. (2) Pair soldiers into buddy teams, and space them around a circle with 1 to 3 meters between teams. (3) Squad leader and a companion direct exchange from center of circle as they go through it themselves. (4) Teams follow these steps: (5) Drop gear. (6) Use dry mix to decontaminate gear. (7) Decontaminate hood. (8) Remove overgarment. (9) Remove boots and gloves. (10) Put on new overgarment. (11) Put on new boots and gloves. (12) Secure hood. (13) Secure gear. d. Resume mission operations. 153

154 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: PERFORM DECONTAMINATION (03-3-C017) *2. Medical platoon performs radiological decontamination. a. Perform individual sustainment decontamination. (1) Brush and shake dust off their clothing. (2) Wash exposed skin, paying particular attention to hair and finger nails. (3) Use M258A1 towelettes if soap and water are not available. (4) Brush or scrape contamination off equipment, vehicles, and crew-served weapons. If runoff can be controlled and water is available, flush away the contamination. b. Leaders update platoon radiation status. (1) Read dosimeters, average the total dose, and round off to nearest 10 centigray (cGy) or radiation absorbed dosage (rad). (2) Report results to higher headquarters. (3) Resume mission operations. 154

155 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: CAMOUFLAGE VEHICLES AND EQUIPMENT WHEN AUTHORIZED TASK STANDARD: The platoon camouflages individual positions and equipment so that it cannot be detected from 35 meters or greater. Vehicles are camouflaged so that they cannot be detected from 100 meters or greater. *1. Platoon leader and squad leader selects concealed vehicle positions and traffic routes. (MQS , ) a. Make vehicle tracks follow terrain lines such as edge of woods or fields. b. Make sure vehicle tracks continue past park location to some other logical spot. c. Use concealed routes whenever possible. d. Drive all vehicles in the same tracks. e. "Obliterate" tracks where they turn into concealed positions. f. Position vehicles under natural cover or in shadows. g. Position vehicles so their shape will blend with surroundings. h. Avoid terrain features, which may be used as reference points by enemy ground and aerial fires (such as hill tops and road intersections). 2. Medical platoon members conceal vehicle or equipment. a. Use natural materials that blend with surrounding area to break up shape or shadow. b. Change natural materials when they start to wilt and remove them from the area. c. Cover shiny objects as windows and headlights. d. Use nets to create shadows. e. Use camouflage-screening systems to enhance natural materials. f. Keep heat sources (such as generators and engines) under screening systems even when natural concealment is used. 3. Medical platoon members enforce light and noise discipline. a. Use only blackout lights. b. Use other noise to muffle or mask noise that cannot be eliminated. 155

156 Chapter 5 EXECUTION CHECKLIST Reference ARTEP-17-236-12-MTP
TASK: EVACUATE EPW PATIENTS ( ) TASK STANDARD: EPW patients are transported without danger to ambulance team members or other patients. 1. Ambulance team evacuates EPWs with same medical evacuation standards as friendly patients. a. Maintains continuous security of EPW patients. b. Transports guards along with EPW patients. c. Secures EPW patients by restraining devices, if guards are not available. d. Ensures that EPW patients have been searched for weapons and ordnance prior to boarding the ambulance. e. Searches EPW patients, if required. Squad personnel ensure that there are no weapons or ordnance accessible to the EPW patients throughout the mission. . *2. Platoon sergeant sends information concerning EPW through command channels. (MSQ , , ) a. Reports date, time, and location of capture. b. Forwards equipment or document found on EPW. c. Reports destination of EPW. 156

157 Chapter 6 MISCELLANOUS INFORMATION/CHECKLIST
Reference FM , FM 8-55 TASKS PAGE Principles of Combat Health Support Checklist Task Force Medical Platoon Leaders Planners Checklist Task Force Medical Checklist for the Offense Task Force Medical Checklist for the Breach Task Force Medical Checklist for the Defense Task Force Medical Support Checklist for the Scouts Combat Health Support In Specific Environments Mountain Operations Desert Operations Jungle Operations Cold Weather Operations River Crossing Operations Medical Support in a Light Infantry Task Force Medical Planning Checklist for a Light Infantry Task Force Rear Operations and Damage Control Military Operations on Urbanized Terrain Health Service Support in an NBC or Directed Energy Environment Humanitarian Assistance Evacuation Capabilities Divisional Medical Assets Air Force Evacuation Assets Two Man Fighting Positions Defend Assigned Area Checklist Triple Strand Concertina Range Card Sector Sketch Informal After Action Review 157

158 Chapter 6 COMBAT HEALTH SUPPORT
IN A TACTICAL OPERATION Reference FM & FM 8-55 1. PRINCIPLES OF COMBAT HEALTH SUPPORT: A. CONFORMTIY. Conforms with the tactical plan CHS planner must participate in the tactical operations planning to ensure CHS is at the right place and time Use of medical intelligence CHS planning is forward oriented Plan for rapid replacement of forward echelons B. CONTINUITY. CHS is continuous from the FLOT through CONUS Modular in design C. CONTROL. Must ensure CHS resources are effective employed to support tactical plan Centralized control with decentralized execution D. PROXMITY. Location is directed by: METT-TC factors Requirements far forward for stabilization Early identification and forward treatment of RTDs Forward orientation of evacuation assets Other logistical units/complexes Doesn’t interfere with combat operations E. FLEXIBILITY. CHS has the ability to quickly shift medical assets On the battlefield F. MOBILITY. CHS units organic to maneuver elements must have mobility equal to the forces supported Must retain mobility to support combat operations 158

159 Chapter 6 COMBAT HEALTH SUPPORT
IN A TACTICAL OPERATION Reference FM & FM 8-55 G. PLANNING. Must understand the tactical commander’s plan, decisions, and intent. Must be proactive, not reactive, and must know: What what each supported element will do When will it be done Where it will be done How it will be done Must know CHS requirements needed to support the tactical plan H. PREVENTION. Preventive medicine programs Leadership emphasis at all command levels Field Sanitation Teams Immunizations I. FAR FORWARD CARE. Identify and treat casualties close to the FEBA as tactical situation permits Self aid/buddy aid, combat lifesavers, unit level medical support Emergency medical treatment with 30 minutes of wounding Location of FAS/MAS J. EVACUATION. Starts at point of injury to BAS (manual/litter/non-standard carries) Must provide enroute care to medical treatment facility Use of air evacuation assets Use of non medical evacuation assets 159

160 Chapter 6 COMBAT HEALTH SUPPORT
IN A TACTICAL OPERATION Reference FM & FM 8-55 2. CONSIDERATIONS OF THE MEDICAL PLATOON LEADER WHEN PLANNING Attends all operational briefings/planning sessions. Must stay informed of the concept of operations, commander's intent, and anticipated CHS requirements. Develop a task force patient estimate. Develops CHS plan and provides overlays of preplanned evacuation routes, treatment teams, patient collecting points, and AXPs to the task force. Plan is published in medical support/synchronization matrix with overlay. Ensures adequate medical elements are in the support package. To reduce turnaround time in providing ATM to patients within 30 minutes of wounding, the BAS may slit and place its treatment teams as close to maneuvering companies as tactically feasible. Treatment teams within 1000 meters of maneuver unit must be ready to withdraw to preplanned positions When anticipating large numbers of casualties, augment with one or more treatment teams from the FSMC. Augmenting teams are under the S4s tactical control, but operational control of the battalion surgeon Ground vehicle planning factors: 8km and return in 1 hour 4 km support distance = 30 minutes round trip for ground ambulance under ideal circumstances Plan aid station/treatment team movement triggers Planned checkpoints along MSR can be used as possible aid station locations Integrate medical operations into the task force maneuver and CSS rehearsals 4 man litter team 900 meters and return 1 hour avg. terrain 6 man litter team 350 meters and return 1 hour mountainous terrain 160

161 Chapter 6 COMBAT HEALTH SUPPORT
IN A TACTICAL OPERATION Reference FM & FM 8-55 3. PLANNING OF COMBAT HEALTH SUPPORT Considerations in the Offense: Pre- position medical evacuation vehicles as far forward as possible prior to the attack. Provide additional ambulance teams to main attack companies/teams. Request additional ambulances from the FSMC. Use patient collecting points. Use AXPs. Concentrate on stabilization care and rapid evacuation. Depend on combat lifesavers. Leap frog teams forward as attack progresses or follow-and-support concept. Practice tailgate medicine. Select covered and concealed BAS and company aid post sites. Ensure adequate medical supplies are available, if necessary, request additional supplies. Plan for medical evacuation within the defensive area. Plan and coordinate in detail medical evacuation to FSMC from BAS. Plan to continue CHS should the unit become encircled. 161

162 Chapter 6 COMBAT HEALTH SUPPORT IN A TACTICAL OPERATION
Reference FM & FM 8-55 4. PLANNING HEALTH SERVICE SUPPORT FOR BREACH OPERATIONS a. Medical Assets prior to/at LD: Split BAS into two teams (Team A and Team B) Divide FSMC ambulances up between Teams A and B accordingly. Ensure each company team has 1 - M113 for casualty evacuation. If engineer company is the breach force ensure they have 1 - M113 for evacuation. Preposition Teams A and B within the task force prior to LD (FAS follows one of the supporting company teams, MAS follows the task force formation). The AXP operated by FSMC must be integrated into the task force scheme of maneuver. (Without the AXP the task force medical elements will lose their ability to move forward, as casualties collect at Teams A and B) The AXP should be augmented with a treatment team and wheeled ambulances, the wheeled ambulances will move forward with the task force combat trains. The task force combat trains should move within four, but no more than ten kilometers behind the lead elements of the task force. If passage of lines are conducted with another task force ensure proper coordination is with the medical platoon prior to execution of the mission. (The stationary task force should provide medical support to the passing unit, this allows the other medical platoon to provide continuous medical support for his task force) 162

163 THE NEAR SIDE OF A BREACH
A WAY TO SUPPORT THE NEAR SIDE OF A BREACH 4. PLANNING COMBAT HEALTH SUPPORT FOR BREACH OPERATIONS b. Medical Assets at Execution: Team A positions behind the support element, establish near side medical support and begins medical evacuation. Casualties at the breach are moved to Company CCPs on the near side of the breach lane, but out of the fire sack, then evacuates casualties to Team A When breach opens company medics establish far side CCP. Team B follows the assault force moves through breach lane and establishes and supports far side of the breach (Synchronization is the key!) x OBJ C . . AE0006 LO1 TEAM A AE0005 . . AE0004 S CTB FSMC AXP OBJ B x LO2 AE0003 BCT S3 - HOW DID YOU WEIGHT THE MAIN EFFORT TO SUPPORT THE ATTACK THRU THE ENEMY’S DEFENSE? (LACK OF ENGINEER COMBAT POWER - 38% FOR C CO, 32% FOR A CO - MADE IT DIFFICULT TO MASS COMBAT POWER. BCT CHOSE TO PROVIDE 3 PLATOONS TO INITIAL M.E. -AND 1 PLATOON TO INADEQUATE DETAILS ON PLAN TO TRANSITION ENGINEERS TO 3-69 AFTER PASSAGE ) AE0002 ISOLATE x POINT OF BREACH OBJ A ASLT PSN BLUE . . L03 AE0001 OBSCURATION TEAM B x PL RIFLE PL BAYONET 163

164 A WAY TO SUPPORT IN THE BREACH
4. PLANNING COMBAT HEALTH SUPPORT FOR BREACH OPERATIONS c. Medical Assets in the Breach: Medics must be at the breach rehearsal and understand the breach operation. Medics must understand how the lane is marked and where they will need to pass to go to the far side of the breach. Casualties are evacuated to Team A, until Team B is established on the far side. All casualties on the far side are sent to the Company CCP established on the far side, this will occur until Team B is in position and ready to receive casualties x OBJ C . . AE0006 LO1 TEAM A AE0005 . . AE0004 S CTB FSMC AXP OBJ B x LO2 AE0003 . . BCT S3 - HOW DID YOU WEIGHT THE MAIN EFFORT TO SUPPORT THE ATTACK THRU THE ENEMY’S DEFENSE? (LACK OF ENGINEER COMBAT POWER - 38% FOR C CO, 32% FOR A CO - MADE IT DIFFICULT TO MASS COMBAT POWER. BCT CHOSE TO PROVIDE 3 PLATOONS TO INITIAL M.E. -AND 1 PLATOON TO INADEQUATE DETAILS ON PLAN TO TRANSITION ENGINEERS TO 3-69 AFTER PASSAGE ) AE0002 ISOLATE x OBJ A TEAM B L03 AE0001 OBSCURATION x PL RIFLE PL BAYONET 164

165 THE FAR SIDE OF THE BREACH
A WAY TO SUPPORT THE FAR SIDE OF THE BREACH 4. PLANNING COMBAT HEALTH SUPPORT FOR BREACH OPERATIONS d. Medical Assets on the FAR Side of the Breach: Once Team B is established on the far side all casualties will be sent to Team B. Once Team B is established, Team A prepares to move. FSMC AXP moves to Team A’s location and assumes responsibility for their casualties. Team A moves forward and follows the task force to its objective, providing continuous medical support. METT-TC DEPENDENT, Team A and B may consolidate after the attack. This depends on were the casualties are and what the tactical situation is. x OBJ C AE0006 LO1 AE0005 . . AE0004 S FSMC AXP CTB OBJ B x LO2 AE0003 . . BCT S3 - HOW DID YOU WEIGHT THE MAIN EFFORT TO SUPPORT THE ATTACK THRU THE ENEMY’S DEFENSE? (LACK OF ENGINEER COMBAT POWER - 38% FOR C CO, 32% FOR A CO - MADE IT DIFFICULT TO MASS COMBAT POWER. BCT CHOSE TO PROVIDE 3 PLATOONS TO INITIAL M.E. -AND 1 PLATOON TO INADEQUATE DETAILS ON PLAN TO TRANSITION ENGINEERS TO 3-69 AFTER PASSAGE ) AE0002 ISOLATE TEAM A x L03 AE0001 OBSCURATION x . . OBJ A PL RIFLE PL BAYONET TEAM B 165

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IN A TACTICAL OPERATION Reference FM & FM 8-55 5. PLANNING OF COMBAT HEALTH SUPPORT Considerations in the Defense. Select covered and concealed BAS and company aid post sites. Ensure adequate medical supplies are available. Plan for medical evacuation within the defensive area. Plan and coordinate in detail evacuation to FSMC from BAS. Plan to continue CHS should the unit become encircled. Consider the potential of having to hold patients for an indefinite period of time, without adequate resources. Coordinate and position FSMC TX team within a battle position/strongpoint. Designate area for chemical contaminated patients. Request Air MEDEVAC for urgent personnel. Have the non-standard evacuation assets identified and know what the plan is to use them, who controls them, and what is the trigger for their use. 166

167 A WAY IN THE DEFENSE . . . . . . 90 90 TX TEAM A CCP MSR CAT MSR DOG
LZ TX TEAM A CCP MSR CAT LZ . . MSR DOG CMED TX TM CCP CTCP CCP CONSIDERSATIONS Select covered and concealed BAS and company aid post sites. Ensure adequate medical supplies are available. Plan for evac within the defensive area. Plan and coordinate in detail evac to FSMC from BAS. Plan to continue CHS should the unit become encircled. Consider having to hold patients for periods of time. Position FSMC TX team within a battle position/strongpoint. Designate area for NBC contaminated patients Request air medevac for urgent & urgent-surg personnel. CCP . . LZ TX TEAM B 90 167 90

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Reference FM & FM 8-55 6. SPECIALTY PLATOONS - “Planning Considerations” Scouts often operate forward of the FEBA Mortars operate up to 1500 meters behind the FEBA Coordination with maneuver units near the dispersed unit/platoon is required. The maneuver unit can then assist in casualty evacuation. Below is “A way” of planning scout extraction within a task force: STEP 1 - Template enemy locations. STEP 2 - Identify projected OP locations. STEP 3 - Identify infiltration routes. STEP 4 - Determine ground evacuation limit of advance. NOTE: project number of ambulances required for MEDEVAC & determine which route the ambulance will use moving into sector. STEP 5 - Identify casualty collections points. STEP 6 - Identify air extraction PZs. NOTE: dedicate aircraft to CASEVAC (day and night) STEP 7 - Identify ingress and egress routes. STEP 8 - Develop SEAD plan to secure air corridor Task Force Commander and S3 must establish priorities for the use of non-medical vehicles for scout extraction. Use of far and near recognition signals greatly assist in identifying scout CCPs and conducting scout extraction. The scout extraction plan must be understood and rehearsed by all key elements to ensure proper execution. Position Treatment Team forward prior to LD to provide echelon I medical care to the scout platoon. Position Treatment Team forward in the defense to provide echelon I medical care to the counter recon force and the scout platoon. All scouts should be trained as combat lifesavers and have to standard CLS bags. Understand the importance of non-standard evacuation, have standard and non-standard litters (SKED) readily available for their use. 168

169 SCOUT PLATOON EXTRACTION “A WAY”
Ground Evac Limit of Adv LD LZ LZ CAR LOCATION RTE 3 RTE 1 RTE 2 .. Plt AA LZ RTE 3 LZ Step One - Template enemy locations Step Two - Identify projected OP locations Step Three - Identify Infiltration routes Step Four - Determine ground evac limit of advance NOTE: Project number of ambulances required for CASEVAC (Casualty Estimate By BCT S1) NOTE: Determine which route the Ambulance will use moving into sector Step Five - Identify Casualty Collections Points Step Six - Identify Air Extraction PZs NOTE: Dedicate Aircraft to CASEVAC (day and night) Step Seven - Identify ingress and egress routes for Air Step Eight - Develop Sead Plan to secure Air Corridor Once this is done, you give your soldiers a fighting chance to survive being wounded.. STEP 1 - TEMPLATE ENEMY LOCATIONS STEP 2 - ID PROJECTED OP LOCATIONS STEP 3 - ID INFILTRATION ROUTES STEP 4 - DETERMINE GROUND EVAC LIMIT OF ADVANCE NOTE: PROJECT NUMBER OF AMBULANCES REQUIRED FOR MEDEVAC & DETERMINE WHICH ROUTE THE AMBULANCE WILL USE MOVING INTO SECTOR STEP 5 - ID CASUALTY COLLECTIONS POINTS STEP 6 - ID AIR EXTRACTION PZS NOTE: DEDICATE AIRCRAFT TO CASEVAC (DAY AND NIGHT) STEP 7 - ID INGRESS AND EGRESS ROUTES STEP 8 - DEVELOP SEAD PLAN TO SECURE AIR CORRIDOR A15A 169

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM 7. General. Combat Health Support is limited to the same degree as combat effectiveness when operating in areas of extreme weather and/or terrain hazards. Medical units require special purpose equipment (primarily shelter and transportation) in quantities commensurate with their support mission to overcome these restrictions. Operations in freezing or extremely hot temperatures require continuing protection of medical items that deteriorate rapidly. Environmental restrictions may reduce the capability of the division's evacuation assets; therefore, litter bearers and ground/air ambulance elements must be reinforced with other medical and/or nonmedical resources. Medical treatment elements require special shelter protection which neutralizes extremes in weather; adapts easily to difficult terrain; and can be erected and dismantled quickly. Unusual types and larger numbers of patients often result from prolonged exposure to extreme nature hazards; therefore, prevention is the most effective method in dealing with extreme conditions. Abnormally high numbers of patients require augmentation of division treatment and/or evacuation resources. 8. Mountain Operations. a. The tactical problems of the division medical companies in mountain operations are similar to those encountered in other terrain. Lack of good road networks will add to the difficulties. One DCS should be established in support of each committed brigade. These should be as close as possible to the BAS supported, yet must be situated so as to permit easy evacuation by the units in support. Use of ambulances forward of the DCS may be impossible. Personnel normally employed in this link of evacuation may be used as litter bearers; or they may supervise litter bearers furnished from other sources. Problems will arise, but by maximum use of personnel and equipment, the division medical company can give support within its area of responsibility. b. Troops operating in mountainous terrain are subject to unusual illnesses; these include mountain sickness, high altitude pulmonary edema, and cerebral edema. All three are caused by rapid ascent to altitudes of 2,400 meters (about 7,875 feet) and above. c. Mountain operations require medical personnel to carry additional equipment. Items such as ropes, pitons, piton hammers, and snap links are all necessary for the evacuation of patients and establishment of a BAS. Unnecessary items of equipment including those for which substitutes or improvisations can be made are left behind. Heavy tentage, bulky chests, extra splint sets, excess litters, and non-essential medical supplies should be stored. If stored, these supplies should be readily available for airdrop or other means of transport. Medical items that are subject to freezing must not be exposed to the low temperature experienced in mountainous areas. 170

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM d. For forward medical elements to maintain a satisfactory level of medical supplies, all personnel, vehicles, and aircraft going forward should carry small amounts of medical supplies and equipment; examples are IV fluids, dressings, and blankets. Smaller supplies and equipment may be rolled in blankets and lashed to packboards or carried in partially folded litters. e. Since the transportation of heavy tentage may be impracticable, shelter for patients must be improvised to prevent undue environmental exposure. In the summer or in warm climates, improvision may not be necessary, but there is a close relationship between extreme cold and shock; thus medical personnel should always consider the need to provide shelter for patients. Shelter may be found in caves, under overhanging cliffs, behind clumps of thick bushes, and in ruins. They may be built using a few saplings, evergreen boughs, shelter halves, or similar items. The time a patient is to be held will influence the type of shelter used. When patients are to be kept overnight, a weatherproofed shelter must be constructed. f. The evacuation of patients in mountain warfare presents varied problems. In addition to the task of carrying a patient to the nearest medical element, there is the difficulty of moving over rough terrain. (1) The proportion of litter cases to ambulatory cases is increased in mountainous terrain; even a slightly wounded individual may find it extremely difficult to move across the terrain. Because of the added exertion and increased pain, it may be necessary to transport a patient by litter who would normally be able to return to the BAS by himself. (2) In cold weather and in high mountains, speed of evacuation is vital; there is a marked increase in the possibility of shock among patients in extreme cold. (3) Special consideration must be given to the conservation of manpower. Litter hauls must be kept as short as the tactical situation will permit. A litter team is not capable of carrying a patient for the same distance over mountainous terrain as over flat territory. To decrease the distance of litter hauls, medical elements should locate as close as possible to the troops supported. (4) It is important to be able to predict the number of patients that can be evacuated with available personnel. It has been demonstrated that when the average terrain grade exceeds 20° to 25° the four-man litter team is no longer efficient; it should be replaced by a six-man team. The average mountain litter team should be capable of climbing 120 to 150 vertical meters of average mountain terrain and return with a patient in approximately one hour. 171

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM (5) Another problem is evacuation at night. The wounded should be located and evacuated during the day. Many casualties would not survive the rigors of the night on a mountain in cold weather. Night evacuation over rough terrain is impractical and results are rarely equal to the effort. When possible the night evacuation route should be marked with tracing tape and rope handlines; they are installed during daytime. However, if routes are exposed to enemy observation and fire by day, patients must be removed from the area by night; but only as far as necessary. At the first point affording shelter from enemy observation and fire, a holding station should be established; shelter, warmth, food, and supportive care should be provided. Patients should be brought from forward areas to this point; they are held until daylight, then evacuated to the rear. (6) Before initiating evacuation, conduct a reconnaissance of the terrain and the road network in the area. To this, add information on climatic conditions, facilities and personnel available, and the tactical mission. Only after all of these factors are assembled and evaluated can a sound medical evacuation plan be formulated. The following factors peculiar to mountain operations should be considered before making the final selection of evacuation routes: Snow and ice are firmest during the early morning hours. Glacial or snow fed streams are shallowest during the early morning. Mountain streams afford poor routes of evacuation because of rough, slippery rocks and the force of moving water. Talus slopes (those slopes with an accumulation of rock debris strewn around) should be avoided; they are difficult to traverse. Loose and slippery rocks on such slopes will often cause litter bearers to fall or drop the patient; compounding his existing injury and possibly causing injury to members of the litter bearer team. Choose routes that are just below the crest of a ridge. These trails are usually easiest to follow and the ground affords the best footing. (7) The difficulties of medical evacuation encountered in mountain operations emphasize the advantages of air evacuation. The time between injury and treatment is a determining factor in the patient's recovery. Evacuation by air, which is the most rapid, most comfortable, and the safest means is the optimum method. However, total reliance on air ambulances is inadvisable; rapidly changing weather conditions in mountainous areas adversely affect aeromedical evacuation. All available means of collection and evacuation should be used. 172

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM g. When operating in mountainous terrain, the maneuver battalion is often decentralized to an extent that a centrally located BAS is not practical In these circumstances, it may be necessary to split the medical platoon into two small sections capable of minimal CHS. Close-terrain conditions severely limit the platoon's capabilities; personnel and equipment augmentation may be required. h. In mountainous terrain, there is usually adequate concealment and defilade to allow the medical platoon to establish the BAS close to the FLOT. If one station is operated, it should be located as close as possible to the fighting troops, generally in the center of the battalion's area of operations. If the platoon is required to operate more than one treatment site, each treatment team is given a specified area of responsibility; it is located centrally as far forward as possible in support of the troops for which the station is responsible. The term centrally located does not necessarily mean the geographical center of an area. Many factors must be considered in determining a central location for a given area. These include expected patient loads; lines of drift; roads or paths for evacuation to and from the station; and terrain features having a direct influence on litter carry. The following advantages are obtained when consideration is given to the location of BAS: Relatively short or easy litter hauls. Medical facilities closer to the units they support. Closer contact with company commanders affords greater ease in following changes in the tactical plan. Adequate shelter. Patients are sorted, given necessary emergency medical care, RTD, or provided shelter and warmth until transportation becomes available. i. When the BAS is in a split mode, it is desirable that the medical platoon headquarters section be augmented with additional six-man litter teams. The augmentation litter teams may be recruited from all available sources (including the use of indigenous personnel); they must be familiar with military mountaineering techniques. The augmentation should be completed before the actual need. j. As in normal situations, combat medics will be furnished to the rifle companies by the medical platoon. Emphasis should be placed on training the combat medics in hazards of cold and wind; relationship of these factors to the problem of shock; conservation of body heat and improvised methods of providing warmth (to include the construction of small windbreaks and shelters); and techniques of military mountaineering and mountain evacuation procedures. 173

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM k. Supported companies should establish patient collecting points. (1) In mountainous terrain, it will often be necessary to consider the establishment of patient collecting points. These patient collecting points operated by combat medics are designated intermediate points along the route of evacuation where patients may be gathered. Whenever patients are to be transferred from one type of transportation to another, a patient collecting point/AXP is needed. (2) Defilade positions are abundant in mountainous areas. Patient collecting points should be established as far forward as possible. An AXP may be established behind each of the BASs, or a centrally located point may be operated; whichever will ensure the most efficient CHS and provide the greatest relief to litter bearer personnel. (3) Patient collecting points are movable and should be placed, whenever possible, away from difficult terrain. Patient collecting points along routes of march should not be established routinely, unless -- It is certain that these points will be in territory under secure control of friendly forces. The number or severity of wounded justifies such a point. l. Litter relay points may also have to be established during mountain operations. (1) If sufficient litter bearers are available, a chain of litter relay points, from the BAS to a point where evacuation can be taken over by ambulances, should be established. (2) Each relay point should have one NCO and four litter bearers. However, when short of personnel, one NCO could be used to supervise more than one relay point. Each point is responsible for the evacuation of all patients received. When returning to their relay point, litter bearers bring empty litters and other medical supplies which are required by forward medical personnel. This will permit maximum use of available litter bearers; litter bearers operating in a chain of relay points can evacuate far more wounded than teams attempting to evacuate the wounded from the frontline to the BASs; or from the BASs to the ambulance pickup point. Personnel can rest on the return to their post; they also become familiar with the short section of mountain trail over which they travel. This makes it possible for them to operate over the trail at night; also gives the wounded a much smoother ride. 174

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM 9. Desert Operations. a. Planning for CHS is especially important in the desert; the greater distances used in maneuver and deployment complicate medical treatment, evacuation, and supply procedures. Roads and trails are scarce and usually connect villages and oases. Wheeled vehicles can travel in any direction over much of the desert; they need not be confined to roads and trails because much of the desert area is flat and hard surfaced. Limited water supplies, coupled with the increased demands created by very high temperatures, low humidity, and dust, cause additional concerns for CHS planners. Use FM 90-3 when preparing CHS plans for desert operations. b. The greater distances between units limit the availability of combat medics. Medical units should be augmented when possible; also troops should be given additional first aid training before desert operations. c. The large area over which a battle is fought presents special problems in the timely acquisition, treatment, and evacuation of patients. Any number of patients in a fighting unit may restrict the maneuverability of that unit and jeopardize its mission. Medical units may be furnished a greater number of evacuation vehicles for operating in deserts. Medical treatment elements are located farther to the rear in desert operations. Medical evacuation by fixed-wing aircraft and helicopters is valuable because of their speed and the reduced turnaround time. d. Many diseases of military significance may be found in the desert. The diseases are found in its human inhabitants, animals, arthropods, and local water and food supplies. The cold of the desert night, even in summer, may require warm clothing. Cold weather injuries may occur during the desert winter. It is the desert sunshine, wind, and heat, however, that have the greatest effect upon military operations. The dryness of the desert heat distinguishes it from the heat of the tropics; this adds to the problem of coping with it. Medical elements must be provided additional water supplies to treat heat injuries (heat cramps, heat exhaustion, and heat stroke). All water, except from quartersmaster water points, is considered contaminated and unfit for drinking; it may also be unfit for bathing or for washing clothing. e. Intestinal diseases tend to increase among personnel living in the desert. This may be prevented by good food service sanitation, including supervision of cleaning eating and cooking utensils; supervision of food handlers; disposal of garbage and human wastes; and protection of food and utensils. Solid wastes should be burned when the situation permits. Soakage pits are used to dispose of liquid wastes; they are filled with soil when leaving an area. Deep pit latrines should be used if the soil is suitable. Arthropods and rodents must be controlled to prevent the diseases they carry. Preventive medicine measures include protective clothing; clothing impregnants; arthropod repellents; residual and space sprays; immunizations; and suppressive drugs. 175

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM 10. Jungle Operations. a. Difficult terrain, wide dispersion of combat units, inadequate roads, and insecure lines of communication all have a direct influence on CHS in jungle operations. The manner in which medical units support tactical organizations depends on how they are employed. Wide variations may be expected, but the general principles of CHS will apply. b. The evacuation of wounded in jungle warfare presents difficult problems. Ambulances may not be practical on trails, unimproved muddy roads, and in swamps. There is a higher proportion of litter cases; even a slightly wounded individual may find it impossible to walk through dense undergrowth. As a result, the patient normally classified as ambulatory may become a litter case. Evacuation is usually along supply routes which are adequately protected against enemy action. c. There are other problems encountered in jungle operations; personal hygiene and sanitation is a serious and continuous one, as is the incidence of diseases peculiar to jungle areas. The incidence of fungus diseases of the skin is especially serious. In addition to maintaining high standards of personal hygiene and sanitation, strict preventive medicine measures must be observed and enforced at all times. For more detailed information on jungle operations see FM For management of skin diseases in the tropics, see FM 8-40. 11. Cold Weather Operations. a. The environment in cold weather operations is a primary factor. Individuals must understand the effects of the cold environment; they must have the training, stamina, and willpower to take protective actions. In this climate, the human element is all-important; The effectiveness of equipment is greatly reduced; therefore, specialized training and experience are essential. The climate does not allow a margin of error for the individual or the organization. The mobility of units is restricted; their movement must be carefully planned and executed; a movement can be as difficult to overcome as the enemy. Momentum is difficult to achieve and can be quickly lost. b. Changes in personnel and equipment authorizations are the result of emphasis on mobility; maintenance; communications; and CHS. Equipment is eliminated or added based on its suitability to the terrain and environment. 176

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM c. The conduct of military operations is limited by considerations that are foreign to more temperate regions: Long hours of daylight and dust of summer. Long nights with bitter cold and storms of winter. Mud and morass in the transition periods of spring and autumn. Scarcity of roads and railroads. Vast distances and isolation. The lack of maps can adversely affect mobility, firepower, and communications. In spite of these conditions, operations are accomplished; they require employment of aggressive leadership; a high state of training; and full logistical support. d. Because of the hostility of cold weather, units operating in northern latitudes should establish a relatively short patient holding period. Adverse environmental conditions make it difficult for medical units to provide definitive care over an extended period. The evacuation policy is changed as the tactical situation dictates. The general nature of the terrain makes surface evacuation of patients difficult in winter and virtually impossible in summer. The lack of good evacuation routes and the need to move supplies over the same route greatly restrict patient evacuation. The most practical means of patient evacuation is air evacuation. Aircraft resupplying the area can be used to carry patients on the return trip. Total reliance on air evacuation must be avoided; aircraft operations will be restricted by cold weather conditions. e. To enhance CHS in extremely cold weather, the following operational principles apply: (1) Prompt acquisition and evacuation of patients to heated treatment stations. (2) Augmentation of unit collecting elements by division level medical elements. (3) Use of enclosed and heated vehicles for medical evacuation. (4) Provision of heated shelters at frequent intervals along the evacuation route. (5) Readily available air transportation for patient evacuation. (6) Special vehicles for surface evacuation of patients. (7) Heated storage for medical supplies. 177

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM f. In the deep snows, storms, and bitter cold of winter, prompt evacuation and treatment of patients is even more essential. It is extremely difficult to find and evacuate patients; early medical care can be rendered only if medical personnel are immediately available. Procedures should be established for medical care on patrols, at strongpoints, and in heated aid stations near front lines. If medical personnel are not readily available, other personnel must promptly evacuate casualties. Medical treatment elements must be well forward in the combat area to prevent unnecessary losses due to evacuation delays. 12. River Crossing Operations. a. The river barrier itself exerts decisive influence on the use of CHS units. Attack across a river line creates a medical problem comparable to that of the amphibious assault. Medical elements cross as soon as combat operations permit. Early crossing of treatment elements reduces turnaround time for all crossing equipage which must load patients on the far shore. Maximum use is made of air evacuation assets to prevent excessive patient buildup in far shore treatment facilities. Near shore treatment facilities are placed as far forward as assault operations and protective considerations permit; this reduces evacuation distances from off loading points. For more detailed information on river operations, see FM b. In defensive operations, CHS resources deployed on the far shore are restricted to the minimum needed to provide support. Evacuation from far shore treatment facilities is accomplished using both surface and air evacuation; this reduces the accumulation of patients forward of the river barrier. Near shore treatment facilities are located farther to the rear to preclude their having to displace in a cross-river withdrawal. Defilade locations are avoided for medical elements because they are prime target areas for enemy artillery and air attack. c. CHS in the attack of river lines, while conforming in general to the CHS doctrine of offensive operations, present special problems during ferrying and bridging operations. CHS must concern itself with the support of the combat troops during the advance to the river line (preliminary phase); during the river crossing and capture of the initial objective (phase); during operations to seize the intermediate objective (phase II); and during the attack to gain the bridgehead (phase III). (1) Combat Health Support, preliminary phase. There are relatively few patients resulting from this phase when secrecy in movement to the river is maintained. Patient collecting points may or may not be established along the main approaches to the crossing sites. 178

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM (2) Combat Health Support, phase I. At the end of the preliminary phase, BAS and DCSs are established to provide normal support in the area of each crossing. Litter bearers may be employed near each crossing site. Ambulances are moved as near to the river as possible. Medical platoons furnish close CHS; combat medics accompany their companies in the crossing. Ambulance squads organic to the medical platoons cross in succeeding waves; and the treatment squad establishes the BAS on the far bank as soon as the situation permits. Patients are placed on returning craft for evacuation to the near bank. When helicopters are employed as a means of air landing assault troops, the returning aircraft may be used to evacuate casualties to medical treatment elements on the near bank. Air ambulance elements provide air evacuation of patients from the far bank during phase I if the tactical situation allows air assault operations. (3) Combat Health Support, phase II. During this phase, the FSMC provides evacuation on both banks of the river until a DCS has been established on the far bank. When phase II is nearing completion, the DCS is moved forward to a position close to the near bank or across to the far bank as conditions dictate. A relatively high priority is granted to division CHS elements for movement across any established bridges. In the absence of bridges, movement of CHS elements is accomplished by surface craft or air. (4) Combat Health Support, phase III. During this final phase, CHS units are moved across the river as rapidly as possible; they resume normal operations on the far bank. Division clearing stations may be called upon to care for a larger number of patients, pending the establishment of bridges and the resumption of normal evacuation by higher command. 13. CHS for Light Infantry Task Force - “Deliberate Attack”. a. Recent trends illustrate the fact that echelon I CHS planning is not integrated or well developed for the deliberate attack. Plans have frequently included deploying treatment teams forward to maneuver with the company headquarters section. This is a good concept when terrain/mission dictates. However, to simply send a dismounted treatment team forward without the appropriate amount of Class VIII supplies, medical equipment, or a well-rehearsed, integrated MEDEVAC plan, is not a sound TTP. Units forward deploy the physician and PA to decrease the died of wounds rate, which is laudable. Yet, several other key factors are not addressed. A forward deployed treatment team can only provide medical treatment commensurate with the tactical situation and medical supplies/equipment available. The medical planner must determine the most feasible CHS plan that provides far forward treatment, casualty acquisition, and rapid evacuation. Training medics to perform airway management skills, breathing management, bleeding control initiating IVs, applying bandages and splints is critical to the success of these types of missions on the modern battlefield. 179

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“Combat Health Support in Specific Environment” Article Reference, “Military Medicine, Tactical Combat Casualty Care in Special Operations” 13. CHS for Light Infantry Task Force - “Deliberate Attack” (Cont.) b. Echelon I CHS includes providing immediate lifesaving measures, emergency medical treatment (EMT) and advanced trauma management (ATM) to stabilize the patient for evacuation to the echelon of medical treatment required. It also provides routine medical treatment to return the soldier to duty. Echelon I is not capable of performing surgery or patient holding. The battalion aid station consists of a treatment squad that can spilt into two treatment teams. c. The ability to provide continuous combat casualty care forward of the LD/LC is a considerable challenge. "The prehospital phase of caring for combat casualties is critically important, since up to 90 percent of combat deaths occur before the casualty ever reaches a medical treatment facility." A casualty management protocol is important to develop and train for when considering operational deployments. In a recent article "Tactical Combat Casualty Care in Special Operations," the authors present three distinct phases which include the following: (1) Care under fire: care rendered by the medic at the scene of the injury while he and the casualty are still under effective hostile fire. Available medical equipment is limited to that carried by the medic in his aid bag. (2) Tactical field care: care rendered by the medic once he and the casualty are no longer under effective hostile fire. It also applies to situations in which an injury has occurred on a mission but there has been no hostile fire. Available medical equipment is still limited to that carried into the field by the medic and other personnel. (3) Combat casualty care evacuation: care rendered once the casualty has been picked up by an aircraft, vehicle, or boat.2 The key to keeping soldiers alive is to provide treatment as far forward as the tactical situation permits and aggressively executing an effective evacuation plan. These phases offer a sound plan that medical platoons should strive to become proficient with and incorporate into their training program. d. The battalion surgeon and the PA play a critical role in helping the medics achieve and sustain the standards identified in the protocols listed in Figure 1. To deploy a treatment team forward without proper supplies, equipment, and a responsive evacuation plan is not a combat multiplier. Physicians, PAs, and medics require certain tools and supplies to provide EMT and ATM. The Battalion Aid Station is outfitted to provide these supplies and equipment which are packed in medical chests. If treatment teams do not establish SOPs/battle drills and packing lists to conduct dismounted treatment teams, then casualties will die. The doctrinal method to determine the most feasible course of action for a deliberate attack is through the TDMP and CHS estimate. 180

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“Health Service Support in Specific Environment” Article Reference, “Military Medicine, Tactical Combat Casualty Care in Special Operations” 13. CHS for Light Infantry Task Force - “Deliberate Attack” (Cont.) e. Planning Checklist for CHS for Light Infantry. Does the platoon have the experience/training to conduct a dismounted treatment team operation? Is the BAS at 100-percent strength? Does the platoon have an SOP battle drill for conducting dismounted treatment team operations? Has the platoon ever conducted this type of mission before? Do the infantry companies have all authorized combat medics? How many combat lifesavers do they have? Do the infantry companies have SKED litters and/or poleless litters? Do they know how to make and use improvised litters? Do combat medics have all required Class VIII? Are Class VIII supplies cross-loaded among platoon members? Does the first sergeant have a resupply chest in his vehicle to get resupplied? How do combat lifesavers get resupplied? Does the medical platoon issue IVs to each individual soldier? Who maintains the starter sets? Do treatment teams have an established packing list for the minimal types of supplies and equipment required for the mission? Does the platoon have a plan to cross-load Class VIII supplies with supported unit and with attached litterbearers? Are medics trained to initiate IVs with night-vision devices? Are soldiers physically fit? Are litterbearers capable of moving casualties over extended distances? Can each medic on the treatment team perform the following procedures? Is the equipment available to perform the following procedures? a. nasopharyngeal airway b. endotracheal intubation c. laryngeal mask airway d. cricothyroidotomy e. needle thoracostomy f. apply tourniquet g. start an IV h. administer Morphine i. splint fractures j. administer antibiotics k. perform cardiopulmonary resuscitation l. apply bandages Do the infantry companies have aid/litter teams identified? Does the treatment team have FM communications or access to a radio? Does the unit have a sound air/ground evacuation plan? Is the plan coordinated with the FSMC/MEDEVAC unit? Are CASEVAC procedures rehearsed along with the maneuver rehearsal and at the Brigade CSS rehearsal? 181

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“Health Service Support in Special Operations” Article Reference, “Military Medicine, Tactical Combat Casualty Care in Special Operations” f. Planning Checklist for Medical Support for Light Infantry (Cont.) Does the battalion have a plan to clear a ground route for CASEVAC? Are landing zones/patient collecting points identified? Do the MEDEVAC helicopters have hoist capabilities. Is there a CHS plan for actions at the breach site? Is the Mech/Armor team M113 ambulance integrated into the CHS plan? Does the senior medic attend the Task Force rehearsal? Are additional litter bearers requested from the field trains/brigade support area? Are non-standard CASEVAC vehicles/aircraft on standby and identified? Do they have litters/communications capability? Are reinforcing treatment teams provided from the FSMC? Is there a plan to use ambulance exchange points (AXPs)? Is there any treatment capability at the AXP? Can a helicopter land at the AXP? Is the MEDEVAC communication net identified? Does the task force conduct a communications exercise? Is there a contingency plan to bring additional medical assets forward for MASCAL situations? Is CHS planned beyond the objective? Is there a plan for marking casualties during limited visibility operations? Is there a plan to leave personnel with the wounded to treat for shock? The medical platoon leader should answer these questions for the mission analysis. Once the questions are answered, then develop courses of action to best support the mission. Medical platoons must have the opportunity to train this complex task at home station prior to deploying to a contingency mission. 182

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM 14. Rear Operations and Area Damage Control. a. Rear operations consist of those actions, including area damage control, taken by all units (combat, CS, CSS, and host nation) singly or in combination to secure the force; to neutralize or defeat enemy operations in the rear area; and to ensure freedom of action in deep and close-in operations. It is a system designed to ensure continuous support. b. Area damage control operations are those measures taken before, during, or after a hostile action or a natural or man - made disaster to minimize its effects. c. Combat Health Support is provided by division medical companies and medical platoons. These elements establish and operate a BAS/DCS on or near the edge of the damage area. d. See FM and FM for additional information on area damage control operations. 15. Military Operations on Urbanized Terrain. a. General. Throughout history, battles have been fought on urbanized terrain. Some recent examples are the battles for Manila, Stalingrad, Hue, Beirut, and Panama City. Military operations on urbanized terrain (MOUT) are planned and conducted on a terrain where man-made structures impact on the tactical options available to the commander. This terrain is characterized by a three-dimensional battlefield, having considerable rubble; ready-made fortified fighting positions; and an isolating effect on all combat, CS, and CSS units. In this environment, the requirement for a detailed CHSPLAN cannot be overstated. Medical and tactical planners must plan, train, prepare, and equip for medical evacuation from under, at, and above ground level. An additional concern in urbanized terrain is the increased potential for disease transmission due to disruption of utilities (water, sewage, waste disposal), the large numbers of refugees and displaced persons, and breakdowns in sanitation and personal hygiene. b. Equipment Requirements. Materiel requirements for CHS of MOUT includes unique equipment, especially for the extraction and the evacuation of patients. Axes, crowbars, and other tools used to break through barriers. Special harnesses, portable block and tackle equipment, grappling hooks, collapsible stretchers and SKED stretchers, lightweight collapsible ladders, heavy gloves, and blankets with shielding for use in lowering patients from buildings or moving them from one building to another at some distance above the ground using ropes and pulleys. Equipment for the extraction of patients from tracked vehicles, safe and quick retrieval from craters, basements, sewers, and subways. Patients may have to be extracted from beneath rubble and debris. 183

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM 15. Military Operations on Urbanized Terrain. b. Equipment Requirements (Cont.) The anticipated increase in wounds and injuries requires increased supplies of intravenous (IV) resuscitation fluids. Individual soldiers may carry these fluids to hasten their availability and shorten the time between wounding and initiation of vascular volume replacement. Air ambulances equipped with a rescue hoist may be able to evacuate patients from the roofs of buildings or may be able to insert needed medical personnel and supplies. The use of SKED stretchers expedites patient hoisting. Effective communications face many obstacles during MOUT. Line of sight radios are not effective. Individual soldiers will not have access to radio equipment. Alternate forms of communications, such as markers, panels, or field expedients (fatigue jacket or T- shirt), which can be displayed by wounded or injured soldiers indicating where they are, may be employed. c. Nonmaterial Requirements. (1) Patient collecting points should be established at relatively secure areas accessible to both ground and air ambulances. Life- or limb threatening injured or wounded soldiers should be evacuated by air ambulance, when available. Patient collecting points should be designated in advance of the operation and should -- Offer cover from enemy fires. Be located as far forward as the tactical situation permits. Be identified by an unmistakable feature (natural or man-made). Allow rapid turnaround of ambulances. (2) Route markings to the MTF and display of the Geneva Red Cross at the facility must be approved by the tactical commander. Camouflaging the Red Cross can forfeit the protections, for both medical personnel and their patients, afforded under the Geneva Convention. Refer to Appendix H for additional information. The site selected must be accessible, but separated from lucrative enemy targets, as well as civilian hazards such as gas stations or chemical factories. 184

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM c. Nonmaterial Requirements (Cont.) (3) Medical evacuation in the MOUT environment is a labor-intensive effort. Much of the evacuation effort must be accomplished by litter teams; this is due to rubble, debris, barricades, and destroyed roadways. When this occurs, an ambulance shuttle system or litter shuttle should be established. Medical personnel must be able to use and teach manual carries, as well as improvise as the situation dictates. In moving patients, you should -- Use covered evacuation routes such as storm water drains and subways. Sanitary sewers should not be used; there is a danger of methane gas buildup in these systems. Use easily identifiable points for navigation and patient collecting points. Rest frequently by using a litter shuttle system. (4) Self-aid, buddy aid, and the CLS skills are essential in this environment. Due to the nature of MOUT, injured and wounded soldiers may not be reached by the combat medic for extensive periods of time. The longer the period between injury or wounding and medical treatment, the poorer the prognosis. Therefore, units operating in this environment must ensure that all soldiers are proficient in self-aid and buddy aid, and that CLS are trained. In paragraph b above, it is recommended that each soldier carry IV resuscitation fluids with him so that the CLS can initiate replacement fluid therapy before the combat medic reaches the casualty. The soldier's chance for survival increases when he begins receiving IV resuscitation fluids early. d. Ground Evacuation. When using ground evacuation in support of MOUT, the CHS planner must remember that built-up areas have many obstructions to vehicular movement. Factors requiring consideration include -- Vehicular operations within the urban terrain are complicated and canalized by rubble and other battle damage. Bypassed pockets of resistance and ambushes pose a constant threat along evacuation routes. Land navigation using tactical maps proves to be difficult. Commercial city maps can aid in establishing evacuation routes, when available. Ambulance teams must dismount, search for, and rescue casualties. Movement of patients becomes a personnel intensive effort. There are insufficient medical personnel to search for, collect, and treat the wounded. Litter bearers and search teams will be required from supported units, as the tactical situation permits. 185

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM d. Ground Evacuation (Cont.). Refugees may hamper movement into and around urban areas. Civilian personnel, detainees, and enemy prisoners of war are provided medical treatment in accordance with the command policy and the Geneva Convention. e. Aeromedical Evacuation. When using aeromedical evacuation assets in support of MOUT, the medical planner must consider enemy AD capabilities and terrain features (both natural and man-made) within and adjacent to the built-up areas. (1) Factors which may affect the use of air ambulances are -- Movement is highly restricted and is canalized over secured areas, down wide roads, and open areas. Telephone and electrical wire and communications antennas hinder aircraft movement. Secure landing zones must be available. Landing zones may include buildings with helipads on their roofs or sturdy buildings, such as parking garages. Snipers with AD capabilities may occupy upper stories of taller buildings. (2) Helicopters remain the preferred method of evacuation. f. Training. In addition to the self-aid, buddy aid, and CLS training, CHS personnel must be familiar with the tactics, techniques, and procedures used by the combat soldier in MOUT. (1) For CHS personnel to survive and serve in this environment, they must know how to --Cross open areas safely. Avoid barricades and mines. Enter and depart buildings safely. Recognize situations where booby traps or ambushes are likely and are advantageous to the enemy. 186

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM f. Training (Cont.) (2) Many of the techniques used in a mountainous terrain for the extraction and evacuation of patients can be applied to medical evacuation in a MOUT. By using the SKED stretcher, the patient can be secured inside the litter for ease in vertical extractions and evacuations. (3) Health service support personnel must practice and become proficient in using a grappling hook, scaling walls, and rappelling. Rappelling techniques can be used to gain entry into upper levels of buildings as well as accompanying the patient during vertical extraction and evacuation. (4) Detailed information on the conduct of combat operations in the urban environment is contained in FM Additional information on CHS to MOUT is contained in FMs 8-42 and Health service support planners and providers must be proficient in the skills required for this environment. 16. Combat Health Support In A Nuclear, Biological, Chemical, Or Directed Energy Environment. a. On future battlefields, the enemy may employ NBC weapons and directed energy (DE) devices. Chemical, biological, and DE protective measures and procedures to mitigate the effects of nuclear weapons must be included in the medical platoon training programs and daily operations. This section provides guidance for CHS during nuclear warfare, enemy biological or chemical attack, and enemy employment of DE devices. The material presented in this section emphasizes contingency planning for immediate problems confronting CHS units following enemy actions. The large numbers of patients, the loss of MTFs and personnel from NBC attacks, and DE device employment will reduce our capability to provide CHS. b. Nuclear, biological, chemical, and DE actions create high casualty rates, materiel losses, obstacles to maneuver, and contamination. Mission oriented protection posture Level 3 and 4 results in body heat buildup, reduces mobility, and degrades visual, touch, and hearing senses. Laser protective eyewear may degrade vision, especially at night. Individual, and ultimately, unit operational effectiveness and productivity are degraded. c. Contamination is a major problem in providing CHS in an NBC environment. To increase survivability as well as supportability, the medical platoon must take necessary action to avoid NBC contamination. Maximum use must be made of -- Alarm and detection equipment. Unit dispersion. Overhead cover, shielding materials, and collective protective shelters. Chemical agent resistant coatings. 187

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM 16. Combat Health Support In A Nuclear, Biological, Chemical, Or Directed Energy Environment (Cont.) Generally, a biological aerosol attack will not significantly impact materiel, terrain, or personnel in the short term. Detailed information on characteristics and soldier dimensions of the nuclear battlefield; NBC operations; extended operations in contaminated areas; NBC decontamination; NBC contamination avoidance; and NBC protection are contained in Field Manuals 8-285, 8-250, 8-50, , 3-4, and 3-3. d. On the integrated battlefield CHS is focused on keeping the soldier in the battle. Effective and efficient triage and emergency treatment in the operational area saves lives, assures judicious evacuation, and maximizes the return to duty rate. e. Medical Planning Factors. (1) To provide CHS, definitive planning and coordination is required at all levels of command. This includes provisions for treatment, evacuation, and hospitalization. Field Manuals 8-285, 8-55, 8-9, and TM contain additional information in planning for CHS operations. Higher headquarters must distribute timely plans and directives to subordinate units. Provisions for emergency medical care of civilians, consistent with the military situation, must be included. (2) The medical platoon leader should make a quick appraisal to determine the expected patient load. Consider the use of triage and EMT decision matrices for managing patients in a contaminated environment. A sample decision matrix is shown in Figure 6-2. Training medical personnel in the use of these matrices should enhance their effectiveness in providing CHS. f. Logistical Considerations. (1) The medical platoon is organized and equipped to provide support in a conventional environment. However, it must be trained and prepared to operate in all battlefield situations. Employment in an NBC environment will necessitate the issue of chemical patient treatment sets, and chemical patient decontamination sets. (2) The DMSO maintains a 48-hour contingency stock level of Class VIII supplies. These medical supplies and equipment must be protected from contamination by chemical agent. Class VIII stocks are dispersed to prevent or reduce damage or contamination caused by NBC weapons. Health service support plans include the protection (NBC hardening) of contingency stocks and the rapid resupply of affected units. Contaminated items are decontaminated prior to issue to using units. (3) The division PVNTMED section is responsible for testing the quality of water for the division. Water from local sources (lakes, ponds, or public water systems) is subject to being contaminated; therefore, it is essential to test the local source for contaminants before use. Frequent retesting by water production personnel is recommended. Once a water source is contaminated, it is marked with appropriate NBC 188

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM f. Logistical Considerations (Cont.) contamination markers. The water is not used until a determination is made that it is safe for use, or water treatment equipment capable of removing the contaminants is employed. When water becomes contaminated, it is disposed of in a manner that prevents secondary contamination; the area is marked. All water dispensing equipment is monitored frequently for possible contamination. Water supply on the NBC battlefield is provided on an area basis by elements of the supply and transportation battalion. Water supply is normally provided to maneuver elements through unit distribution. g. Personnel Considerations. During NBC actions, CHS requirements will increase and medical reinforcement may be necessary. Following an enemy NBC attack, or employment of DE devices, medical personnel will be fully active in providing emergency medical care; they will provide more definitive treatment as time and resources permit. Nonmedical personnel should provide search and rescue of the injured or wounded; provide immediate first aid; and perform decontamination procedures. Nonmedical personnel will be needed to man the patient decontamination station at the BAS (FM and TO 8-12). The requirement for nonmedical personnel should be included in the battalion tactical SOP. h. Disposition of Treatment Elements. Site selection factors dictate that the BAS not be located at or near likely target areas. Selecting a covered and concealed site is extremely important in a potential NBC environment. (1) A minimum of eight medical personnel are required to operate a collective protective shelter (CPS) system and provide medical care. One EMT NCO performs triage and EMT on patients before decontamination. One aidman monitors the patient during decontamination procedures. Two aidmen monitor and provide care to patients when they leave the decontamination site. These individuals care for patients awaiting admission to the CPS; they also provide care for RTD or other patients requiring evacuation without receiving treatment in the CPS. One medic operates from the CPS airlock. He removes patient’s protective mask and monitors patient’s prior to their entering the interior of the CPS. He also assists with treatment in the CPS. The physician and PA operate inside the CPS with the assistance of the airlock aidman and one additional aidman. (2) Operation of CPS systems at the BAS in a chemical environment requires more than four medical personnel. This is why the squad does not split into teams. A viable method of obtaining additional CHS in the area of operations would be to request additional medical teams from the FSMC. 189

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM h. Disposition of Treatment Elements (Cont.) (3) The BAS is equipped with two medical equipment sets for chemical agent patient treatment and one medical equipment set for chemical agent patient decontamination. Each set has enough consumable supplies for the decontamination and treatment of sixty chemical agent patients. These sets are also used at clearing stations, corps and COMMZ hospitals, and dispensaries to decontaminate and treat chemical agent patients. The number of sets vary, depending on the treatment site. i. Civilian Casualties. Civilian casualties may become a problem in populated or built-up areas; the BAS may be required to provide assistance when civilian medical resources cannot handle the workload. Aid to civilians, however, will not be undertaken at the expense of health services for US personnel. j. Nuclear Environment. The medical platoon must be capable of supporting the maneuver unit's operations in a nuclear environment. The three damaging effects of a nuclear weapon are blast, thermal radiation (heat and light), and nuclear radiation (principally gamma rays and neutron particles). Well - constructed foxholes with overhead cover and expedient shelters (for example, reinforced concrete structures, basements, railroad tunnels, or trenches) provide good protection from nuclear attacks. Armored vehicles also provide protection against both the blast and radiation effects of nuclear weapons. Nuclear radiation casualties fall into three categories: Irradiated casualty. The irradiated casualty is one who has been exposed to ionizing radiation, but is not contaminated. They are not radioactive, and pose no radiation threat to medical care providers. Casualties who have suffered exposure to initial nuclear radiation will fit into this category. Externally contaminated casualty. The externally contaminated casualty has radioactive dust and debris on his clothing, skin, or hair. He presents a "housekeeping" problem to the BAS, similar to the vermin infested patient arriving at a peacetime MTF. The externally contaminated casualty should be decontaminated at the earliest time consistent with required CHS. Lifesaving care is always rendered, when necessary, before decontamination is accomplished. Radioactive contamination can be monitored with a radiation detection instrument such as the AN/PDR-27 or AN/VDR-2. Removal of the outer clothing will result in greater than ninety-percent decontamination; soap and water can be used to further reduce the contamination levels. Internally contaminated casualty. The internally contaminated casualty is one that has ingested or inhaled radioactive materials, or has had radioactive material injected into the body through an open wound. The radioactive material continues to irradiate the casualty internally until radioactive decay and biological elimination removes the radioactive isotope. Attending medical personnel are shielded, to some degree, by the patient's body. Inhalation, ingestion, or injection of quantities of radioactive material sufficient to present a threat to medical care providers is highly unlikely. 190

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM j. Nuclear Environment (Cont.). Medical units operating in a residual radiation environment will face three problems -- Immersion of the treatment facility in fallout, necessitating decontamination efforts. Casualty production due to gamma radiation. Hindrances to evacuation caused by the contaminated environment. k. Medical Triage. Medical triage, as discussed in earlier sections, is the classification of patients, according to the type and seriousness of injury. This achieves the most orderly, timely, and efficient use of medical resources. However, the triage process for nuclear patients is different than for conventional injuries. The four categories for triage of nuclear patients are: Immediate treatment group (T1). Those requiring immediate lifesaving surgery. Procedures should not be time-consuming and concern only those with a high chance of survival, such as respiratory obstruction and accessible hemorrhage. Delayed treatment group (T2). Those needing surgery but whose conditions permit delay without unduly endangering safety. Life -sustaining treatment such as intravenous fluids, antibiotics, splinting, catheterization, and relief of pain may be required in this group. Examples are fractured limbs, spinal injuries, and uncomplicated burns. Minimal treatment group (T3). Those with relatively minor injuries, such as minor fractures or lacerations, who can be helped by untrained personnel or look after themselves. Buddy care is particularly important in this situation. Expectant treatment group (T4). Those with serious or multiple injuries requiring intensive treatment, or with a poor chance of survival. These patients receive appropriate supportive treatment compatible with resources, which will include large doses of analgesics as applicable. Examples are severe head and spinal injuries, widespread burns, or high doses of radiation; this is a temporary category. 191

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM l. Biological Environment. (1) A biological attack (using bomblets, rockets, or spray/vapor dispersal, release of arthropod vectors, and terrorist/insurgent contamination of food and water, frequently without immediate effects on exposed personnel) may be difficult to recognize. The medical platoon must monitor biological warfare indicators such as: Increases in disease incidence or fatality rates. Sudden presentation of an exotic disease. Other sequential epidemiological events. (2) Passive defense measures such as immunizations, good personal hygiene, physical conditioning, using arthropod repellents, wearing protective mask, and good sanitation practices will mitigate the effects of most biological intrusion. NOTE: Normally, biological agents delivered as a vapor will be nonpersistent. (3) Decontamination of most biologically contaminated patients can be accomplished by bathing with soap and water. (4) Treatment of biological agent patients will require observation and evaluation of the individual to determine necessary medications. m. Chemical Environment. (1) Handling chemically contaminated patients may provide the greatest challenge to medical units on the integrated battlefield. All casualties generated in a liquid chemical environment are presumed to be contaminated. Due to the vapor hazard associated with contaminated patients, medical personnel operating BAS and DCS without a collective protective shelter (CPS) system may be required to remain at MOPP level 4 for long periods of time. When CPS systems are not available, clean areas must be located for treating patients. 192

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM m. Chemical Environment. (2) A patient processing station for chemically contaminated patients must be established by the medical platoon to handle the influx of patients. Generally, the station is divided by a "hotline" into two major working areas; a contaminated working area situated downwind of a clean working area. Personnel on both sides of the "hotline" assume a MOPP level commensurate with the threat agent employed (normally MOPP 4). The patient processing station should be established in a contamination-free area of the battlefield. When CPS systems are not available, the clean treatment area should be located upwind 30 to 50 meters of the contaminated work area. When personnel in the clean working area are away from the hotline, they may reduce their MOPP level, especially the physician and PA. Chemical monitoring equipment must be used on the clean side of the hotline to detect vapor hazards due to slight shifts in wind currents; if vapors invade the clean work area, medical personnel may have to remask to prevent low level chemical agent exposure and minimize clinical effects (such as miosis). (3) Initial triage, emergency medical treatment, and decontamination are accomplished on the "dirty" side of the hotline. Life-sustaining care is rendered, as required, without regard to chemical contamination. Secondary triage, ATM, and patient disposition are accomplished on the clean side of the hotline. When treatment must be provided in a contaminated environment, outside of CPS, the level of care may be reduced to first aid procedures because treaters are in MOPP 3 or 4. (4) Medical platoons will require augmentation with nonmedical personnel to meet patient decontamination requirements created by a chemical attack. This augmentation must come from the supported units. n. Directed Energy Environment. A new dimension on the battlefield of the future will be the employment of directed energy devices. These may be laser, microwave, or radio frequency generated sources. Medical management of casualties from these sources will compound the already overloaded medical treatment resources. Medical management of DE patients at the BAS will consist of evaluation, application of eye ointment, patching, and evacuation. Injuries from microwave and radio frequency sources will be discussed in other publications as data becomes available. Refer to FM for additional information on prevention and medical management of laser injuries. o. Special Operations. Possible enemy employment of NBC weapons in the extremes of climate or terrain warrants additional consideration. Consideration must include the peculiarities of urban terrain, mountain, snow and extreme cold, jungle, and desert operations in an NBC environment; also the NBC-related effects upon medical treatment and evacuation. 193

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM Figure 6-1, Battalion Aid Station Using the M51 Shelter System. Figure 6-2, Battalion Aid Station interior layout of the M51. 194

195 “Combat Health Support in Specific Environment”
Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM Figure 6-3, Layout of a chemical agent patient decontamination station, in an uncontaminated area, without collective protective shelter. 195

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Chapter COMBAT HEALTH SUPPORT IN A TACTICAL OPERATIONS “Combat Health Support in Specific Environment” Reference FM p. Humanitarian Assistance. The attitude of host governments varies from helpful cooperation to forbidding a peacekeeping force from providing aid to its citizens. However, a force within a buffer zone is justified in providing humanitarian assistance to individuals within the AOR. A special humanitarian staff can be established whose areas of concentration can include the following: Investigation of missing persons. Emergency medical treatment (for life-threatening illnesses or injuries). Resupply of minority communities separated by a buffer zone. Transfer of minority populations. Repatriation of prisoners of war. Repatriation of human remains. Return of property. 196

197 United States Air Force
Chapter EVACUATION CAPABILITIES United States Air Force Type of Aircraft Litter Ambulatory Remarks C C-9A 40 40 C C-5 70 C-17A 36 54 KC-135 & KC *BOEING B litter/22 ambulatory The BOEING B-767 is a Civil Reserve Air Fleet Aircraft used only when activated. United States Army Type of Aircraft Litter Ambulatory Remarks M M or 1 litter/3 ambulatory M or 2 litter/4 ambulatory M998 (4 Man) 3 4 M998 (2 Man) 5 0 Trk Cgo 2 1/2 Ton 12 16 Trk Cgo 5 Ton 12 16 C12 0 8 C or 3 litter/3 ambulatory CH UH-60 (w/o hoist) 6 7 or 4 litter/1 ambulatory UH-60 (w / hoist) 3 4 UH-1H/V 6 9 or 3 litter/4 ambulatory United States Navy Ship/Aircraft Litter Ambulatory Remarks LHD Amphib Assault Ship LHA GP Assault Ship LPH Amphib Assault Ship LPD Amphib Transport Dock LSD Dock Landing Ship LKA Amphib Cargo Ship LCC Amphib Command Ship CH Sea Knight CH-53D Sea Stallion V Osprey 197

198 Chapter 6 DIVISION LEVEL MEDICAL ASSETS BATTALION AID STATION
Personnel: 40 Mobility: % Boa: One unit per maneuver battalion Assigned To: Battalion Mission: Provide echelon I CHS To assigned battalion and attached slice elements. BAS Capabilities: 1. Prevention of disease and illness through applied preventive medicine programs. 2. Acquisition and immediate treatment of the sick, injured, and wounded. 3. Clinical stabilization of the critically injured or wounded. 4. Provision of routine medical care (sick call) and the immediate return to duty of soldiers fit to fight. Organization: Headquarters Section Treatment Squad (A & B) Ambulance Section Combat Medic Section (Line Medics) Mechanized Infantry/armor: 8 X M113 Armored Ambulances Light Infantry/airborne: 8 X M997/998 HMMWV Ambulances 198

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FORWARD SUPPORT MEDICAL COMPANY Personnel: 64 Mobility: % BOA: One per FSB, operates in BSA Assigned To: Forward Support Battalion, DISCOM MISSION: Provide Echelon II CHS for organic and attached brigade elements and other units operating in the Brigade Support Area. FSMC CAPABILITIES: 1. Provide triage, initial resuscitation, and stabilization. 2. Prepares sick/injured/wounded patients for evacuation. 3. Performs emergency/sustaining dental care and limited preventive dentistry. 4. Provides limited medical laboratory and radiology services. 5. Provides patient holding, up to 40 patients who will return to duty with 72 hours. 6. Provides ground ambulance support from BAS to FSMC and to units within the BSA. 7. Reconstitutes/Reinforces Battalion Aid Stations. ORGANIZATION: Company HQ Treatment Platoon - Plt HQ - Treatment Squad x 2 - Area Support Section (Area Treatment/Pt Holding/Area Support) Ambulance Platoon - Platoon HQ - Wheeled Ambulance Sqd - Tracked Ambulance Sqd (Heavy/Cav Division Only) 199

200 Chapter 6 DIVISION LEVEL MEDICAL ASSETS MAIN SUPPORT MEDICAL COMPANY
Personnel: 114 Mobility: % BOA: One per division, operates in DSA Assigned To: Forward Support Battalion, DISCOM MISSION: Provide Echelon I & II CHS to units operating in the division support area (DSA) and to provide reinforcement and reconstitution of supported FSMC elements. MSMC CAPABILITIES: 1. Provide triage, initial resuscitation, and stabilization. 2. Prepares sick/injured/wounded patients for further evacuation. 3. Performs emergency/sustaining dental care and limited preventive dentistry. 4. Provides limited medical laboratory and radiology services. 5. Provides patient holding, up to 40 patients who will return to duty with 72 hours. 6. Reconstitutes/Reinforces FSMC’s. 7. Provides ground ambulance support to units within the DSA. 8. Provides mental health support (limited psychiatric care) to combat stress casualties, evaluates effects of battle fatigue, operates the division mental health program. 9. Provides preventive medicine services to division units. 10. Provides optometry support, to include routine eye examinations, emergency treatment for eye injuries, and fabricates/repairs single-vision lens devices. 11. Operates the Division Medical Supply Office (DMSO), procuring/storing/distributing medical supplies for the division and performs maintenance on biomedical equipment. 200

201 Chapter 6 USAF COMMAND AND CONTROL
AEROMEDICAL EVACUATION COORDINATION CENTER MISSION: Serves as the operations center where overall planning, coordinating, and directing of AE operations are accomplished. CAPABILITIES: 1. Advises the senior airlift commander on AE issues 2. Coordinates the selection and scheduling of theater airlift aircraft allocated for AE mission 3. Monitors AE crews 4. Coordinates special medical equipment/supplies 5. Maintains statistical data/provides reports 6. Monitors resupply for subordinate AE units 7. Monitors field equipment maintenance 8. Serves as the HF radio net control station 1 x Flight Surgeon on 100% Tactical/ 80% Strategic 2 x Nurses 3 x Aeromedical Technicians AEROMEDICAL EVACUATION CONTROL ELEMENT MISSION: Serves as the functional manager for AE operations at a specific airfield. 1. Supervises ground handling and on/off loading of patients 2. Manages special equipment requirement tracking 3. Arranges for casualty in-flight feeding 4. Coordinates mission prep, to include aircraft configuration. 5. Maintains communication between AECC, ASF, and MTFs 201

202 Chapter 6 USAF LAISION & TRANSPORT TEAMS
AEROMEDICAL EVACUATION LIAISON TEAM Personnel: 6 MISSION: Provides a direct HF radio communications link and immediate coordination between the user service requesting aeromedical evacuation and the AECC. CAPABILITIES: 1. Coordinates casualty movement requests and movement activities between the AECC and the user service. 2. Determines the time factors involved for the user service to transport patients to the designated staging facility. 3. Determines requirements for special equipment and/or medical attendants to accompany casualties during flight. PERSONNEL: 2 x MSC’s 1 x Nurse 3 x RTO’s AEROMEDICAL EVACUATION TEAMS Personnel: 5 Mobility: % Assigned To: USAF Aeromedical Evacuation Squadron MISSION: Provide in-flight supportive nursing care, 1 per 50 patients. Ensures aircraft is properly configured and loaded for aeromedical evacuation. 1 x Flight Surgeon on 100% Tactical/ 80% Strategic 2 x Nurses 3 x Aeromedical Technicians CRITICAL CARE TRANSPORT TEAMS Personnel: 3 Assigned To: USAF Medical Group MISSION: Augments the traditional aeromedical evacuation team. Enhances in-flight capability without depleting forward medical resources. 1 x Critical Care Physician 1 x Critical Care Nurse 1 x Respiratory Technician 202

203 Chapter 6 USAF STAGING FACILITIES AEROMEDICAL STAGING FACILITY
Mobility: Non-Mobile, Fixed Facility Location: Located on or near an enplaning/deplaning airbase or airstrip. Strategic Aeromedical Evacuation. CAPABILITIES: to 250 bed holding facility 2. Has physicians assigned. 3. Can hold patients for up to 24 hours. 4. Provides patient reception, administrative processing, ground transportation, feeding, and limited medical care for patients entering, en route to, or departing the aeromedical evacuation system. MOBILE AEROMEDICAL STAGING FACILITY Assigned To: OPCON to AECC or AECE Mobility: Mobile and Tactical Location: Near runways/taxiways of forward airfields or operating bases Tactical Aeromedical Evacuation. beds, 4-6 hour holding capability 2. Staffed by flight nurses/AE technicians, and RTOs 3. Notifies AECC when AE aircraft has departed. 4. Prepares patient manifests 5. Assist in configuring aircraft for patients. USAF Elements Do Not Exchange Blankets and Litters! 203

204 Reference GTA 7-6-1, FM 5-34, FM 5-103,
Chapter TWO MAN FIGHTING POSITION WITH BUILT-DOWN OHC Reference GTA 7-6-1, FM 5-34, FM 5-103, FM 7-8, FM 21-75 STAGE 1 (SITE POSITION - H+0 - H+.5 HRS): CHECK FIELDS OF FIRE FROM PRONE POSITION Assign sector of fire Emplace aiming and limiting stakes Decide whether to build OHC up or down, based on potential enemy observation of position Prepare: Scoop out elbow holes Trace position outline Clear primary and secondary fields of fire Inspect: Site location tactically sound Low profile maintained OHC material requirements identified STAGE 2 (PREPARE - H+.5 - H+1.5 HRS): OHC supports to front and rear of position Front Retaining Wall, at least 10 inches high Rear Retaining Wall, at least 10 inches Flank Retaining Walls, at least 10 inches high INSPECT: Set back for OHC Supports - minimum of 1 foot or 1/4 depth of cut STAGE 3 (PREPARE - H H+6 HRS) : DIG POSITION - fill parapets in order front, flanks, and rear Install revetments to prevent wall collapse/cave-in (if soil is unstable) Place OHC stringers Inspect: Stringers firmly rest on structural support Stringer spacing based on values found on page Lateral bracing placed between stringers at OHC supports Revetments built in unstable soil to prevent wall cave-in. Slope walls if needed 204

205 Reference GTA 7-6-1, FM 5-34, FM 5-103,
Chapter TWO MAN FIGHTING POSITION WITH BUILT-DOWN OHC Reference GTA 7-6-1, FM 5-34, FM 5-103, FM 7-8, FM 21-75 STAGE 4 (PREPARE - H+6 -H+11HRS): INSTALL OHC Use plywood, sheeting mat or foxhole cover for dustproof layer Nail plywood dustproof layer to stringers Use minimum of 18 inches of sand-filled sandbags for overhead Use plastic or a poncho for waterproof layer Fill center cavity with soil from dug hole and surrounding soil Camouflage Position - use surrounding topsoil and camouflage screen system INSPECT: Dustproof layer - plywood or panels Sandbags filled 75% capacity Burst layer of filled sandbags at least 18 inches deep Waterproof layer in place Camouflage in place Position undetectable at least 35 meters Soil used to form parapets, used to fill cavity, or spread to blend with surrounding ground Fill cavity made by sandbags with surrounding packed soil and cover top of OHC with waterproof layer 205

206 Reference GTA 7-6-1, FM 5-34, FM 5-103,
Chapter TWO MAN FIGHTING POSITION WITH BUILT-DOWN OHC Reference GTA 7-6-1, FM 5-34, FM 5-103, FM 7-8, FM 21-75 The checklists remain the same as for built-up OHC fighting position. However, there are three major differences / concerns. The maximum height above ground for a built-down OHC should not exceed 12 inches. Parapets may be used up to a maximum height of 12 inches. Leaders must ensure that soldiers taper OHC portions and parapets above ground surface to conform to the natural lay of the ground. The position is a minimum of 3 M16s in length. This provides adequate fighting space between the end walls of the fighting position and the built-down OHC. This requires an additional 2.5 hours to dig. When firing, soldiers must construct a firing platform in the natural terrain upon which to rest their elbows. They position the firing platform to allow the use of the natural ground surface as a grazing fire platform. 206

207 Chapter 6 DEFEND ASSIGNED AREA CHECKLIST Positioning.
Place defensive perimeter inside a wood line to maximize cover and concealment. Place a section perimeter at least 35 meters (hand grenade range) from its vehicles and sleep areas. Fighting Positions. Arrange fighting positions normally in a "Lazy W" configuration. Arrange so that positions are mutually supporting. (A direct attack on a single fighting position must be able to be supported by direct fire from two other positions.) Ensure distance between positions makes maximum use of terrain for dispersion. Locate positions outside of hand grenade range of one another. Stagger positions alternately along the perimeter to achieve depth in the "Lazy W." Range Cards. Prepare range cards for each primary and alternate position. Place range cards by the firing stakes unless the position is not manned at that time. Section Sector Sketch. The platoon leader's section sketch includes-- __ All individual positions identified by individual. __ All dead space to their front. _ __ Wire and obstacles. __ Adjacent section positions to left and right. __ Supplementary positions. Each platoon will: Turn-in initial sector sketches within one hour of arrival. Update as required by priorities of work. Wire Obstacles. Tactical wire. Place tactical wire in section sectors for a minimum of 50 meters. Ensure tactical wire consists of triple strand concertina wire with a single strand of barbed wire run along the top row of wire and another anchoring the base of the friendly side. Hang concertina wire on long pickets tied together with communications wire to avoid breaks. Anchor wire on each end by a short picket. 207

208 Chapter 6 DEFEND ASSIGNED AREA CHECKLIST Protective Wire.
String protective wire in front of individual fighting positions. String protective wire outside hand grenade range of positions not less than 35 meters to the front. Techniques. Start tactical wire meters from the muzzle of the weapon. Lay in tactical wire with a stake string tied to the muzzle of the weapon. Use wire obstacle to confuse the enemy as well as stop, impede, or canalize the enemy's force. Place single strand concertina wire/barbed wire between trees. Improve the wire/barbed wire later with tangle foot. Wire Obstacles. Work Considerations. Keep troops in uniform. One soldier works; one rests or provides security. Ensure troops keep personal gear/weapons within reach at all times. Conceal range cards and other relative object. Maintain effective light discipline. 208

209 Chapter 6 TRIPLE STRAND CONCERTINA
Ensure job site security Organize work into three crews First crew lays pickets Second crew lays out wire. Place one roll on enemy side at every third picket and two rolls on enemy side at every third picket Third crew installs all pickets Reorganize party into four soldier crews Install wire Ensure wire is properly tied and all horizontal wire properly installed Taut Horizontal Support Wire 90cm (36”) Taut Horizontal Support Wire Tacked To Upper Concertina Halfway Between Pickets 90cm (36”) x x x x x x x x x x x x x x x 5 Paces 1 Meter x x x x x x x x x x x x x x x 5 Paces 5 Paces Picket Installation 209

210 - - No. DATA SECTION Chapter 6
RANGE CARD SQD PLT CO May be used for all types of direct fire weapons MAGNETIC NORTH - - DATA SECTION Position Identification Date Weapon Each Mark Equals ___________ Meters No. Direction/ Reflection Elevation Range Ammo Description Remarks: 210

211 t Chapter 6 Magnetic North F SECTOR SKETCH OUTPOST CHEM ALARM
LIKELY AVE OF APPROACH M16 M60 M2 M203 M19 t TRIP WIRE FLARE F TRP ROAD BLOCK XX DEAD SPACE/TREES UNIT:

212 Chapter 6 INFORMAL AFTER ACTION REVIEW 1. Used to:
(a) evaluate unit performance against published Army standard, (b) identify unit strengths & weaknesses, (c) decide how to improve performance during next iteration of the task(s). 2. Planning and Execution Sequence. Planning Select & train OCs. Ensure correct standard by reviewing MTP, STP, SMCT etc. When AAR occur? (Train, AAR, Train, [AAR]). Whose at AAR? (All, squad ldrs only) Where site? (Good for concentration) What training aids? How conduct AAR? (Review the plan) Preparation Make a plan to be at the right place at the right time to assess the right events. Plan to measure performance against a published Army (unit) standard. Recon training site Rehearse assessment plan Conduct assessment using published standard. Include other OC observations. Prepare AAR site Conduct rehearsal of AAR. Know major issues and sequence of events. Practice summation that motivates soldiers not degrades them. Conduct Ground rules - seek maximum participation. Maintain focus on training objectives. Guide discussion by asking questions of participants. -Constantly review teaching points. Emphasize published standard & where to find it. Ensure that "untrained performance assessment" does not equal "unsatisfactory soldier." Follow Up Identify tasks requiring retraining. Fix the problem immediately by retraining, changing SOP, and integrate into next training event for practice. Ensure that AAR has performance based measurable outcome so that the benefits are observable by participants. 212

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