The Brigade Role 2 MTF has the capability to provide packed red blood cells (liquid), limited x-ray, clinical laboratory, operational dental support, combat and operational stress control, preventive medicine, and when augmented, physical therapy and optometry services. The Role 2 MTF provides a greater capability to resuscitate trauma patients than is available at Role 1. Those patients who can return to duty within 72 hours are held for treatment as long as the Role 2 remains in place and/or has the lift capacity to move patients during a displacement. The Role 2 is also responsible for evacuation of patients from each battalion’s Role 1 (ATP 4-02.55).
Observations
a. Few BCTs (2 of an observed 19 rotational units) incorporate adequate medical training into combined home station training events prior to CTC rotation and deployment. Adequate medical training includes processing patients from point of injury (POI) through the Role 2 including CASEVAC, MEDEVAC, and MASCAL at echelon.
b. The BCT’s senior medical NCO is rarely, if ever, involved in medical planning.
c. Successful BCT medical communities communicate constantly, via FM, JCR, and face-to-face, to ensure shared understanding that facilitates effective medical planning at echelon. BCT’s achieve the most successful medical support by ensuring that health service support integrates with the rest of sustainment and the maneuver warfighting function through over-communication.
Best Practices
a. Patient simulation, and therefore CASEVAC/MEDEVAC, is rarely exercised from POI through Role 2 during home station training. Consequently, medical planners are unable to identify friction points in unit SOPs prior deployment. Most unit’s died of wounds (DOW) rate improves over the course of an exercise where medical systems are tested, which enables process refinement. Units that conduct rigorous medical training at all echelons, or conduct a dedicated medical planning event prior to deployment have significantly lower DOW rates in all phases of the operation. While those medical professionals still encounter challenges, very few are those addressed during home station training. Units that stress their medical system from POI through Role 2 achieve shared understanding between the BCT Surgeon Cell, SPO Medical Logistics Officer, and the Brigade Support Medical Company (BSMC), which results in a notably lower DOW rate.
b. When possible, the BCT’s senior medical NCO should be involved with medical planning. The 68W50 who holds the BSMC 1SG position is the most senior medical NCO in the BCT and is typically an untapped resource. Failing to integrate that NCO into planning is a lost opportunity for the BCT to capitalize on their wealth of knowledge and experience.
c. Proactive communication and over communication across a BCT’s medical activities is essential to a successful medical support plan. A steady horizontal and lateral flow of information between the battalion and brigade medical planners is essential, but not always achieved. The BCT medical community should practice constant communication and collaboration during home station training. There are often systems that support this style of communication built in to a BCT’s daily reporting requirements. The medical common operating picture (MEDCOP) is generally required from BNs to BDE twice daily. What though, does the BCT Surgeon Section do with that information? How do they compile it into a useful product for operations? Will the Role 1s and Role 2 receive that compiled information, whether as a JCR overlay or a raw data push? Is the data compiled in a medium that is largely inaccessible to the medical nodes during large-scale combat operations (LSCO) through a system such as CPOF?
- Generally, medical nodes update the community every time they relocate. If that is not SOP, it needs to be. This must be executed for planned Role 1 and Role 2 displacements and for unplanned survivability moves and minor location adjustments. For example, if an AXP is pushed out to a location chosen by map recon and the personnel on ground determine it needs to adjust because it is too inaccessible to be useful or it is too exposed, then bottom-up refinement is critical. However, every Medical Officer (MEDO) is responsible for ensuring they have the most up to date information regarding the elements and capabilities around their unit, which makes reaching out for updates or confirmation of no-change crucial to effectively plan for and coordinate area support medical coverage.
- As the medical community works to ensure proactive communication within, they also need to include planners from the maneuver and the rest of the sustainment warfighting functions. Often medical planning occurs in a vacuum, even when the plan is operationalized though the BCT S3, understanding is not shared across the formation. At a minimum the BCT S3 and S4 must receive the medical plan and MEDCOPs daily to create that shared understanding. This is crucial when a First Sergeant in the company trains is looking for the nearest Role 1 to expedite CASEVAC.
- It behooves BCT medical planners to integrate with the other warfighting functions to further shared understanding, and to ensure that their plan is nested with the Concept of Support and Concept of Operations. The medical community needs to maximize every available touchpoint to verify that the Health Service Support (HSS) plan adheres to the Army Health System principle of conformity, which requires inclusion in the Combined Arms Rehearsal (CAR) and Sustainment rehearsal. The BCT CAR is the best venue for medical planners to assist the BCT’s leaders in rehearsing CASEVAC through every phase of the operation. Similarly, the sustainment rehearsal presents a frequently underutilized opportunity to ensure that the medical plan is synchronized with sustainment and supportable.
POC: CPT Etta S. Buss, Goldminer 24, BSMC Trainer, etta.s.buss2.mil@mail.mil
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