Long-gone are the days of wide area security operations from static, built-up locations. The changing nature of war will reward flexibility and an expeditionary mindset, and punish conformists. Commanders and units have become comfortable with medical plans that assume very little risk regarding placement of the Battalion Aid Station (BAS). With the Army’s renewed focus on large scale combat operations (LSCO), leaders must consider employing the BAS and medical platoon in ways that have largely went untrained and unpracticed. To save as many lives as possible, commanders and leaders must consider placement of the BAS as far forward as tactically feasible.
Some of the concepts of employing the BAS presented in this article may be foreign to planners. For example, in some instances, placing the BAS forward of and away from other sustainment units is the best option. This article focuses on the placement of the BAS and factors for the commander and staff to consider. When properly executed and supported, the reward of placing the BAS in far forward locations greatly outweighs the risk.
Doctrine Provides Flexibility Medical Planners
Current doctrine doesn’t specify where to place the BAS and gives planners flexibility. However, most illustrations from doctrine place the BAS with or near the Combat Trains Command Post (CTCP).
ATP 3-90.5 Combined Arms Battalion. Figure 7-3a. CAB trains during offense or defense
Leaders must evaluate multiple factors when determining placement of the CTCP. Distance from the FLOT is just one factor. These factors don’t always align with the priorities of the BAS. Additionally, when the CTCP is co-located with the unit maintenance control point (UMCP) it’s more likely that the BAS will not be in an advantageous location if it is collocated. The size of the area needed and the amount of traffic associated with the CTCP demands that it’s placed far enough away as not to compromise unit locations and activities. Independent placement of the BAS allows it to be much closer to the FLOT and much less detectable than the CTCP.
Time as a Critical Planning Factor
Time distance analysis is arguably the most critical factor in medical evacuation planning for the battalion medical officer (MEDO). By shortening the time it takes to get a casualty into the hands of a physician’s assistant (PA) or doctor at the BAS, planners greatly increase a casualty’s chances of survival. Medical planners can significantly reduce the time of evacuation from the POI to the BAS by placing the BAS closer to the FLOT. Proximity to the maneuver unit’s objective also gives the unit more time to prioritize tactical objectives before executing tactical evacuation (TACEVAC). The greater the distance the BAS is from the FLOT, the less flexibility the unit has when weighing TACEVAC versus other unit priorities and objectives.
The medical platoon must be prepared to project its evacuation assets forward to clear casualty collection points (CCPs) during combat operations. Tactical objectives will prevent units from conducting TACEVAC prior to achieving a tactical advantage. Sending evacuation assets forward from the Battalion Aid Station doubles the time it takes to conduct a TACEVAC. Planners must consider this factor when placing the BAS to ensure the time from CCPs to the BAS is as short as possible. When facing a mass casualty situation, commanders should consider moving medical platoon evacuation assets to the CCP or point of injury (POI) to evacuate casualties and ease the burden from the maneuver unit.
Security Considerations
Tactical leaders must weigh the risks of enemy attack by direct, indirect, and CBRN weapons when considering placement of the BAS. Planners certainly understand that attaching security to the BAS at all times is unfeasible due to the demand for combat power at the objective. Therefore, commanders may have to accept risk in that the medical platoon will need to move independently on the battlefield to clear casualties, or to reposition for better coverage of the area of operation. Medical platoons must be able to accomplish these tasks without attached security elements.
Planners must consider the size, speed, and agility of the element against the attachment of a security element. The BAS should be able to jump quickly and conceal itself in areas of limited tactical value. When battle tracking properly, the medical platoon leader can use positions of friendly units, terrain, and concealment to provide relative security (see figure). By using relative security, the BAS has another option to get closer to the supported unit, and lower the time and distance needed to get casualties to Role 1 care.
Aid Station Security figure by Capt. Dana Messer, Scorpion 24, Operations Group, National Training Center
MEDOs Must Conform to the Maneuver Plan
To minimize preventable deaths, medical planners must clearly understand the differences and similarities in the way that armor, infantry, and stryker units fight and sustain themselves. The mental agility needed to place medical assets in the right place, at the right time, starts with tactical expertise and a clear understanding of unit SOPs. MEDOs must be present and participate in the planning of all operations. MEDOs must also brief the medical evacuation plan at the combined arms rehearsal (CAR) and the sustainment rehearsal. In addition to briefing the locations of the Role 1 and Role 2, battalion MEDOs must brief all aspects of casualty treatment and movement from POI to Role 2. To conform the medical plan properly to the maneuver plan the MEDO should brief (not limited to) the following:
- Brigade plan for air and ground evacuation (to create a shared understanding)
- Location of AXPs from POI to Role 1 and from Role 1 to Role 2
- Location and disposition of adjacent unit Role 1s
- Primary and alternate Battalion Aid Station jump locations by phase
- Triggers to jump or split the Battalion Aid Station by phase
- Chemical casualty decontamination, evacuation, and treatment plan
- Communications PACE plan (if different from the BN PACE)
- Medical PACE plan for all phases (include when/where will air evac be available)
Preparing the Medical Platoon for LSCO
Medical leaders must continue to emphasize 68W sustainment training and prolonged field care. However, re-focusing training on skill level-one and -two warrior tasks, particularly land navigation and communications training, will ensure medical platoons can operate independently. The medical platoon must train movement and communications in a variety of conditions to be prepared for the LSCO fight. By demonstrating competency in these and other areas, the medical platoon can alleviate apprehension that leaders and commanders might have in placement of the BAS in far forward locations.
Planners and leaders must also rethink what how they task our medical platoons at training exercises at home station. They should certainly do more than sick call or simple “medical coverage” during training events. Instead, incorporate casualty evacuation, MASCAL exercises, FAS/MAS operations, and aid station jump operations into field training events to increase readiness. Focusing on and adding these elements to the medical platoon-training plan mitigates some of the risk associated with placing the BAS far forward and independently.
Having trained and ready medical platoons that are able to operate independently on the battlefield gives leaders and planners the flexibility to place them farther forward, also giving the maneuver unit flexibility in when and how to conduct TACEVAC operations. By assuming risk and placing the Battalion Aid Station closer to the FLOT, units can significantly improve a casualty’s chances of survival.
The views expressed in this article are solely those of the author. They don’t necessarily reflect the views of the National Training Center, the Medical Center of Excellence, or the Panther Team.
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