Maximizing MEDEVAC

by Lieutenant Colonel Terry Carroll

In combat operations, air medical evacuation (MEDEVAC) can be a great combat multiplier. Air MEDEVAC eases the burden on already-scarce evacuation assets and speeds the flow of critically wounded patients to the rear. However, recent experience at the Combat Maneuver Training Center at Hohenfels, Germany, suggests that better coordination and preparation are needed to improve use of air MEDEVAC. In particular, brigades must improve coordination before a deployment among the forward support medical company (FSMC), its forward support MEDEVAC team (FSMT), and the forward support battalion (FSB) staff.

Aeromedical evacuation assets greatly enhance the evacuation capabilities of the FSMC. However, to achieve maximum results the FSB must provide maintenance, supply, and life support to the FSMT and fully integrate it into logistics operations. And while using helicopters improves MEDEVAC capabilities, it also generates new information, training, and safety requirements for the FSB and FSMC. Let me present some ideas on how brigade leaders and planners can integrate the FSMT into brigade logistics operations and improve the team's effectiveness.

Whether a brigade works independently or as part of a deployed division, the bulk of its combat service support (CSS) will be provided by the FSB. The FSB commander and staff and the brigade combat team's S1 and S4 are well versed in ground logistics but rarely are familiar with aviation logistics. The first step for the brigade in using MEDEVAC is to review basic medical operations doctrine and mission training plans (MTP's) for the support of a brigade, division, and corps. Some basic references include-

FM 8-10-1, The Medical Company.

FM 8-10-3, Division Medical Operations Center.

FM 8-10-6, Medical Evacuation in a Theater of Operations.

FM 8-55, Planning for Health Service Support.

FM 63-20, Forward Support Battalion.

ARTEP 8-058-30-MTP, MTP for Forward Support Medical Company.

ARTEP 8-44-MTP, MTP for Medical Evacuation Battalion Headquarters.

The next step is ensuring that the FSMC support operations section and the brigade S3 (Air) understand the basic tenets of corps-level ground and air medical evacuation and their specific responsibilities. Brigade planners should request officer and noncommissioned officer (NCO) professional development plans for MEDEVAC operations from the supporting medical evacuation battalion at least 90 days before deployment. In the long term, MEDEVAC use should be part of the FSB's annual professional development program. Officer and NCO professional development should include the mission essential task lists (METL's) for the FSB, evacuation battalion, and air and ground ambulance companies, including current METL assessments.

Exchanging this information will link the training strategies of the FSB and the evacuation battalion and identify areas that should be emphasized. The units then can develop mutually supporting training objectives and incorporate them into priority training events. This basic understanding of organization, functions, capabilities, and the state of unit training will clarify the expectations of all units.

The FSMT should detail all the support it requires from the FSB. Some examples include-

Supply: Class III (petroleum, oils, and lubricants), including requirements for aviation-quality fuel and gallons per day; class IX (repair parts); common class I (subsistence) and water.

Maintenance: Support for aviation unit maintenance (AVUM) and aviation intermediate maintenance (AVIM) support, including data on aircraft density and type; automotive maintenance, including vehicle density information; communications and avionics.

Life support: Billeting; rations.

Operations: Parachute zone and landing zone organization and operations; weather data access; Army airspace command and control requirements; aircraft security.

Training: UH-60 Black Hawk helicopter orientation; aviation safety; forward area refueling equipment operations and refueling.

Health service support planning.

Let's look more closely at some of these areas.

Maintenance

The FSMT normally includes an AVUM capability for conducting preventive maintenance, replacement of components, and limited repairs. AVIM support requires early coordination among the division materiel management center (DMMC), the aviation support battalion, and corps aviation support units.

In general, the divisional AVIM company or the aviation support battalion can provide maintenance support for the FSMT to augment the medical evacuation battalion's AVIM capability; but these support procedures must be mutually agreed upon before deployment.

Brigade planners should identify all scheduled maintenance and all sets, kits, and outfits needed to perform scheduled maintenance. Scheduled inspections must take place during deployments. Early coordination with the DMMC to throughput aviation repair parts to the FSB will improve repair timeliness.

In short, brigade and unit planners should identify AVIM and aviation class IX procedures early, coordinate with all associated units and activities before deployment, and establish specific planning milestones to implement aviation-specific support.

Communications

The FSMT deploys with no organic ground communications capability. FSB's must consider the FSMT's requirements in planning their operational communications nets and ensure that the FSMT has access to and use of AM and FM radios.

Early decisions on radio nets used for MEDEVAC will lessen confusion at every level. Army doctrine does not specify a particular radio net for MEDEVAC; units can use either the brigade administrative-logistics, the FSMC command, or the ambulance platoon net. The brigade must identify one net, publish and disseminate the frequency, and validate the procedure during all CSS synchronization drills and rehearsals. To help everyone know how to contact MEDEVAC, units can attach the 9-line MEDEVAC request format to radios.

The flight operations specialist from the FSMT should be the FSB's link to the FSMT. He should be located in the support operations section. This arrangement facilitates communications and ensures that the FSMT remains in the information loop.

Army Airspace Command and Control

The brigade S3 (Air) and the FSMT must formalize and rehearse critical Army airspace command and control (A2C2) procedures. The support operations section, FSMT flight operations specialist, and brigade S3 staff should work together to ensure that all appropriate flight data arrive at the FSB in a timely manner. Support operations graphics should always include flight hazard and air defense data. The brigade should schedule joint FSMT and FSB flight operations training so FSB personnel become familiar with aviation operations procedures.

Brigade Support Area Defense

The addition of helicopters to the brigade support area (BSA) defense plan creates several challenges. The aircraft have no capability for self-defense and therefore depend on the FSB for security. They also present a significant sight-and-sound signature for an enemy and require an open landing zone near the FSMC in order to transfer patients rapidly. These considerations affect the FSB S3's defense planning and influence how the base cluster is formed. They also complicate decisions about where the FSMC and the FSMT should be located: in the center of the base cluster, as a separate base, or on the BSA perimeter (in accordance with FM 63-20). Air corridors in and out of the BSA also must be planned carefully.

Intelligence

The FSMT needs extensive friendly and threat intelligence data to conduct its operations. The FSB S2/3 should understand the scope and intensity of the FSMT's requirements and should view the FSMT as both a consumer and producer of intelligence data. Aviation-specific intelligence updates, provided on call, should be added to the responsibilities of the S2/3 section. Specific debriefing procedures for MEDEVAC crews also should be developed; flight crews can provide accurate, timely updates to the overall BSA and brigade intelligence-preparation-of-the-battlefield process.

Standing Operating Procedure Exchange

The last step in the initial planning required for a successful deployment is exchange and deconfliction of training and field standing operating procedures (SOP's). The complete integration of the FSMT into SOP's must precede its operational use, and the FSB must know in detail the costs, in resources and time, of an enhanced evacuation capability.

Preparation and Training

Many required predeployment training events are easily incorporated into unit training plans. Helicopter orientation, litter drills, aviation refueling operations, and related individual and collective tasks should be incorporated into company and battalion training programs; this should be done no later than 90 days before deployment.

Specialized training, such as landing zone operations, may require external assistance from the FSMT or the divisional aviation brigade; this support should be requested early. The FSB S3 should maintain oversight of all required predeployment training and provide the FSB commander with weekly updates.

Units should schedule and conduct inventories no later than 60 days before deployment to determine the serviceability of critical support items. These items include the forward area refueling equipment, fuel tankers (which must be certified), landing zone marking kits, and sling-loading sets. Conducting inventories well before deployment ensures that there will be sufficient time to reorder, service, or repair equipment as necessary. Units must bring all the documentation required to validate the serviceability of all systems. The FSB S4 should be tasked to maintain visibility of these actions.

The FSMC commander, the support operations officer, and the FSMT leader must jointly develop a methodology for health service support (HSS) planning before deployment. Doctrine on this issue appears contradictory because FM 63-20 and FM 8-10-5 name the support operations officer and the FSMC commander, respectively, as the HSS planner. Actually, HSS planning must also include the FSMT leader and the brigade surgeon. HSS planning may take any form the FSB commander wishes, provided that no aspect of treatment or evacuation is omitted.

HSS planners should allocate specific responsibilities to all HSS players. They also should establish a linkup date, time, location, and procedure well before deployment. No later than 7 days before deployment, the brigade should issue the appropriate signal operation instructions to the FSMT and conduct rehearsals of aircraft access and egress into various BSA bases. The FSMT leader and the air defense artillery team leader need to conduct face-to-face coordination to verify identification and operational procedures before deployment. Once deployed, the FSMT becomes a fulltime member of the BSA team.

Operational Use of the FSMT

After planning, preparation, and execution of a deployment, the brigade can improve MEDEVAC effectiveness by adopting the following operational procedures-

Ensure copies of all orders, annexes, and overlays reach the FSMT. The FSMT should participate fully in HSS planning, including mission, threat, and terrain analysis. Require the FSMT leader to produce an air ambulance support annex to the HSS plan.

Require an FSMT representative to attend all air mission and orders briefs at FSB and brigade. Backbrief air crews on mission requirements. Include the FSMT in the daily BSA tenants meeting.

The FSMT leader should attend all brigade CSS rehearsals as a full player and present aviation-specific considerations for the mission plan.

Develop procedures to maintain current A2C2, threat, and weather data in the support operations section and maintain liaison with the brigade aviation liaison officer and S3 (Air).

Formalize the prelaunch air evacuation checklist to facilitate rapid exchange of critical flight data. Develop and rehearse a hasty displacement plan for FSMT aircraft.

Like all BSA tenants, the FSMT must attend daily intelligence updates (normally provided during tenant meetings) and remain aware of the tactical situation. The FSB should develop and provide an aviation-specific, short-notice threat briefing update for air crewmen that includes terrain, hazard areas, current activity, and known unit locations.

Plan for and rehearse contingency operations, such as downed aircraft recovery team operations, search and rescue operations, and reconstitution and reinforcement of medical assets using MEDEVAC aircraft.

Clarify launch authority for the FSMT. The FSMC commander retains this authority for the brigade area. The FSMC must keep the support operations officer informed of aircraft availability and use.

Organize and operate the FSMC landing zone with a designated officer and NCO in charge, ground crew, and security element, as required. (See FM 8-10-6, chapter 10, section III.)

Verify the operability of all air survivability and identification-friend-or-foe equipment before every mission, and conduct a risk assessment.

The use of these operational procedures assumes that the FSMT, FSMC, and FSB are full players in the brigade combat team mission analysis and orders process.

The air ambulance provides the brigade with a capability that can profoundly reduce died-of-wounds rates. But implementing MEDEVAC requires resources, preparation, and cooperation. The brigade must identify and remedy training, material, and procedural shortfalls at home station before deployment. FSMT assets, coupled with proactive planning and operationally sound use, will provide a significant combat multiplier to the brigade. ALOG

Lieutenant Colonel Terry "Chip" Carroll is senior combat service support observer-controller at the Combat Maneuver Training Center, Hohenfels, Germany. He was commander of the 125th Forward Support Battalion, 1st Armored Division, in Germany from 1992 to 1994. He holds a Ph.D. in education and psychology from the University of Southern Mississippi in Hattiesburg, Mississippi. He is a Medical Service Corps officer and a graduate of the Army Command and General Staff College.