When the tactical decisionmaking process for a brigade task force begins, what priority is assigned to combat health support (CHS) planning? Is it conducted concurrently with planning for all other battlefield functions, or is it assigned a low priority within the brigade staff estimate process? How does CHS get synchronized into the maneuver plan? Is it necessary to do so? Or is CHS an area in which everything is perceived as fine until something bad happens-a vehicle accident or a squad ambush-and then everyone discovers that the casualty evacuation plan has not been rehearsed or synchronized?
What happens when CHS is not synchronized into the maneuver plan? One answer is provided by a casualty evacuation study of Army exercises conducted by the BDM Management Services Company and dated April 1994. According to this study, "A significant factor determining the effectiveness of casualty evacuation (CASEVAC) planning was reported to be the commander's guidance and involvement in the process." However, the comments of observer-controllers interviewed for the study revealed that commanders at all levels rarely placed emphasis on CASEVAC planning. Deficient command emphasis in turn influenced the amount of staff oversight of medical support. Inadequate involvement by brigade and battalion commanders and lack of comprehensive staff planning resulted in an overall lack of detailed planning at all echelons. CASEVAC planning was a low-priority task; when a large number of casualties did occur, CASEVAC was conducted as a contingency operation rather than a carefully planned part of the mission.
After-action reviews from all of the combat training centers confirm what the BDM study found-CHS planning at the brigade task force level often occurs after the maneuver plan has been decided upon. CHS often is not synchronized as a battlefield operating system. This lack of planning for CHS creates a tremendous risk for soldiers-a disaster waiting to happen. CHS planners must be part of the tactical decisionmaking process. Here are some planning tools for accomplishing this task effectively and efficiently.
Involvement-From the Start
Several officers are responsible for synchronizing CHS, including the forward support medical company commander, the brigade surgeon, the forward support battalion (FSB) support operations officer, the forward support medical evacuation (or MEDEVAC) team leader, and the health service support officer in the FSB support operations section. FM 8-55, Planning for Health Service Support, provides valuable information on CHS.
CHS planners must understand the tactical commander's plan, intent, and concept of operation in order to provide the right support at the right time. They must be an integral part of the tactical decisionmaking process from the beginning in order to effectively and efficiently synchronize support. A technique for ensuring that this occurs is to place a liaison officer (possibly the brigade surgeon or the health service support officer) with the brigade staff during the staff planning process.
CHS planners gain from participating in tactical decisionmaking. Helping to develop the mission analysis and course of action (COA) gives high visibility to the CHS planners and arms them with the information they need to conduct the CHS estimate.
CHS Estimate
The CHS estimate for the brigade task force uses the same format as that used at the division or corps levels, with a few exceptions. FM 8-55 outlines the CHS estimate.
The first paragraph of the CHS estimate is the mission. The CHS planner must analyze the maneuver brigade's mission from a CHS perspective. This paragraph forms the basis for the CHS concept of support and the brigade CHS annex.
The second paragraph is situation and consideration. This section focuses on the enemy situation, the friendly situation, the characteristics of the area of operations, the strengths to be supported, and the health of the command. The CHS planner must consider all of these areas and analyze their impact on the CHS mission.
CHS Analysis
The third paragraph is the CHS analysis. This paragraph determines the support required to accomplish the mission. The planner must consider the type of operation being conducted, patient densities, lines of patient drift, assets available (including those available from unit attachments), nonstandard evacuation assets, surgical team assets, nuclear-biological-chemical (NBC) decontamination teams, class VIII (medical materiel) resupply, and similar factors. By taking this information into consideration, the planner develops COA's that support the maneuver COA. The key is to provide the right stuff at the right time and not hinder the maneuver plan.
The number of COA's considered should be manageable. How much time is available for planning will dictate how many should be developed. COA's should also meet the commander's intent and concept of operation. The COA is the "what, when, where, why, and how" of the operation.
The first step in developing CHS COA's is to array the friendly and enemy forces. This should be easy, because the brigade S2 already has provided this information at the brigade COA development briefing. The analysis will indicate areas of patient density and the best locations for CHS assets. Each COA must be significantly different; significant difference is defined as a difference in task organization, use of assets, time-phased force deployment, or location of assets on the battlefield.
The second step is to develop a concept of support. This is a narrative description of how the unit will accomplish the commander's intent. It should address points or areas within the area of operation and indicate times when decisive actions may occur. The planner must also array the CHS assets at this time to include primary and alternate positions.
Step three determines the command and control mechanisms for the CHS function. At a minimum, command and control must be established for MEDEVAC requests (for both air and ground evacuation), forward medical treatment, class VIII supply, security of CHS assets, the brigade mass casualty plan, NBC operations, and the CHS communication plan.
The fourth step in developing CHS COA's requires the CHS planner to prepare a COA statement and sketch. This step provides the "how" of the operation. The sketch includes a generic graphic representation that may include, but is not limited to, the following: ambulance exchange points, evacuation routes, forward treatment sites, and forward support medical company and main support medical company locations. This sketch will become the CHS overlay in the brigade operations order when the latter is published.
Evaluation and Comparison of COA's
Paragraph four of the CHS estimate is evaluation and comparison of COA's. This step determines which maneuver COA can best be supported from a CHS perspective. In order to do this, screening and evaluation criteria must be defined. Screening criteria are used to screen out unsatisfactory and impracticable COA's.
Evaluation criteria are used to further evaluate COA's for suitability, feasibility, and acceptability. Some examples of evaluation criteria, as well as criteria definitions, include-
Evacuation: the COA represents the best use of assets for evacuating casualties.
Command and control: the COA provides unity of command.
Location: the COA provides suitable locations for CHS assets.
Combat service support: under this COA, nonstandard evacuation assets are used efficiently.
Treatment: the COA provides for the best use of the treatment surgical squad.
Risk: the COA imposes minimal risk on unit personnel.
Security: the COA provides the best security posture for CHS assets.
Class VIII resupply: the COA promotes ease of resupply.
Airfield location: under this COA, an airfield is within close proximity of the forward support medical company.
The CHS planner has to determine if the maneuver COA's are supportable. For each of the evaluation criteria, a plus (+) value, minus (-) value, or neutral (0) value can be recorded on a chart. A plus rating indicates that the criteria being evaluated facilitate a COA. A minus rating indicates that the criteria impede a COA. A neutral rating indicates that the criteria do not impact on the COA. The criteria selected for evaluation depend on the situation.
Decision Matrix
Once the most supportable COA has been determined, the CHS planner must determine how best to support the maneuver plan. A decision matrix is a systematic technique for doing this. Facts and assumptions from paragraph 2 (situation and consideration) of the CHS estimate provide the information needed to complete paragraph 4 (evaluation and comparison).
An objective definition of the criteria is important. Thresholds for each criteria should be established in order to differentiate advantages and disadvantages. An example of a threshold for evacuation is having an attachment of three corps MEDEVAC helicopters. More than three is an advantage; less than three is a disadvantage.
A decision matrix provides the CHS planner with a tool for evaluating COA's. It is a graphic illustration of the evaluation process. The CHS planner may desire to emphasize particular criteria by assigning weights to each criterion based on its relative importance. The scores are totaled to provide a "best" COA. The CHS planner may find it useful to enlarge and laminate the decision matrix for use in tactical environments.
Incorporating CHS into the Brigade Plan
After evaluating and comparing COA's, the CHS planner will join with the brigade staff to present COA recommendations to the commander at the decision briefing. The commander will decide on a COA at that time. After the decision has been reached, the CHS planner prepares the CHS annex to the brigade operation plan and order (or provides the same information to be published in the personnel annex or service support annex).
One technique for providing the information for the CHS annex in an understandable manner is a synchronization matrix and a CHS overlay and CHS concept of support sketch. An example of a CHS synchronization matrix is shown at the top of the opposite page.
The tactical decisionmaking process may seem overwhelming for the CHS planner. The members of the brigade CHS planning cell have a difficult job, because they are responsible for synchronizing CHS into the maneuver plan. If the CHS planners are an integral part of the brigade staff planning process, their knowledge, experience, and creativity will increase the probability of achieving synchronization. However, if CHS planners are not included in the brigade planning process, then synchronizing CHS is left up to luck and the hope that nothing significant requiring CHS occurs.
The brigade task force rehearsal is conducted after the plan has been briefed to the brigade commander. The integration of a CHS planner and the forward support MEDEVAC team (FSMT) leader into the rehearsal is critical to the success of the operation. The combat service support portion of the rehearsal lends itself to CHS integration. The FSMT leader rehearses the air evacuation plan and communication plan, while the CHS planner drills the ground evacuation plan. This ensures that task force members understand the plan.
The rehearsal also serves to highlight significant problems. For example, the suppression of enemy air defenses plan or the gun target line may conflict with the MEDEVAC flight routes, or the mine and obstacle plan may obstruct the ground evacuation plan. Casualty evacuation, both ground and air, is a combat operation that has to be integrated into the plan from the start and understood by everyone. If time and the situation allow, the forward support medical company commander and task force medical platoon leaders should "wargame" the CHS concept of support.
CHS requires extensive planning, preparation, battlefield initiative, and coordination. The effectiveness of CHS influences a unit's morale and combat effectiveness. Commanders must ensure that their CHS planners are involved in the tactical decisionmaking process from the start. A proactive CHS planner is also required. Effective CHS may never have been the cause of victory; however, ineffective CHS may lead to bitter defeat in battlespace. ALOG
Captain Stephen D. Sobczak is an instructor for the Army Medical Department Officer Advanced Course at Fort Sam Houston, Texas. He previously served as forward support medical company commander and forward support battalion S3, 101st Airborne Division (Air Assault), Fort Campbell, Kentucky.