Recently I had the pleasure of serving as an assessor at a war game. The war game scenario included a joint sustainment command that was part of a joint task force. In preparing for my assessor duties, I reread Colonel Larry D. Harman’s commentary, “Asymmetric Sustainment: The Army’s Future,” in the July–August 2003 issue of Army Logistician. His article offered intriguing insights into the future of sustainment.
Both the war game I observed and Colonel Harman’s commentary addressed the complex challenges of commodity and distribution management in an environment of elevated customer expectations. As an Army alumnus, I found it intellectually rewarding to again engage in the challenges confronting the Army, the sustainment community, and logisticians.

Defining Sustainment

Since leaving active duty, I have been involved in information architecture, a field that requires a well-defined integrated data dictionary. Such a dictionary defines meanings and classifies hierarchical relationships among words to reduce confusion and enhance the clarity of the context of words. As the Army continues to march into the Information Age, logisticians must define words clearly, being careful to address their full context.

Take the word “sustainment,” for example. Joint Publication 1–02, DOD [Department of Defense] Dictionary of Military and Associated Terms, defines sustainment as “the provision of personnel, logistic, and other support required to maintain and prolong operations or combat until successful accomplishment or revision of the mission or of the national objective.” To understand this definition fully, the reader must look for precise meanings of three words it contains: “personnel,” “logistic,” and “other support.” Joint Publication 1–02 defines personnel and logistics but fails to offer a definition of “other support.” If a joint sustainment command is to encompass the full breadth of sustainment, logisticians must address all aspects of sustainment with equal enthusiasm and knowledge.

Healthcare

One important aspect of “other support” is healthcare. Military personnel are exposed to a variety of health threats that are mitigated through prevention, detection, and protection. In the last decade, improvements in healthcare and in detecting and protecting against health threats have significantly reduced disease and nonbattle injury (DNBI) rates in theater. In fact, DNBI rates are lower in theater than at home stations. Again, healthcare is an area in which definitions are important.

Look at the word “casualty,” for example. Joint Publication 1–02 defines casualty as “any person lost to the organization by having been declared dead, duty whereabouts unknown, missing, ill, or injured.” Thus, only those DNBI and battle injury (BI) personnel lost to the organization are casualties. By definition, a person who is treated and immediately returned to duty is not a casualty. However, a significant part of the medical workload is devoted to personnel who are returned quickly to duty and thus are not a loss to their unit. Therefore, it is important to consider the return-to-duty medical workload when determining casualty capacity.

Casualty Capacity Versus Casualty Estimation

Determining the medical system’s casualty capacity is a complex calculus of interacting variables. Some variables are the population at risk, length of time a soldier is held in theater before he is returned to duty in his unit (evacuation policy), post-operative length of stay before a patient is stable enough to evacuate to the next level of care (evacuation delay), conditions necessary for a patient to skip the next level of care without a medical intervention (skip factor), and estimated medical workload in numbers of patients and range of DNBI and BI. It is when determining the medical workload that estimating the medical system’s casualty capacity intersects with casualty estimation.

Major David R. Gibson’s article, “Casualty Estimation in Modern Warfare,” in the November–December 2003 issue of Army Logistician, addresses several salient points on estimating casualties. An additional point to consider is that opposing force casualties may become friendly force prisoners of war requiring medical attention. However, these prisoners of war are not included in the friendly force casualty-estimation process. Likewise, displaced civilians and civilian casualties usually are not considered in casualty estimates.

Opposing force casualties may become friendly force prisoners of war requiring medical attention. Above, an injured insurgent is treated at the 31st Combat Support Hospital in Baghdad, Iraq.

 

Although Major Gibson’s article is on friendly force casualty estimation, his opening comments highlight the dilemma that occurs when deploying medical capacity to manage an estimated casualty load. His sources reported a medical capacity of 13,000 beds positioned in 44 in-theater hospitals at the beginning of Operation Desert Storm to manage the estimated number of friendly casualties. Today, even if there were a similar friendly casualty estimate, the deployed medical capacity would be reduced because of changes in the population at risk, evacuation policy, evacuation delay, and skip factor.

Excess or Idle?

When preparing for a conflict, it is important to focus on medical capacity rather than on friendly force casualty estimation only. When focusing on friendly force casualty estimation, it is easy to confuse excess with idle medical capacity. An example of excess capacity is a family of four buying a six-passenger car when it is highly unlikely that six passengers will ever be transported in the car. Idle capacity is one member of the family using the car to run an errand. Capacity is idle during the errand, but not when the whole family goes on vacation.

Casualties are rarely generated evenly and consistently throughout the military forces each day. Pauses between casualty peaks create idle capacity, which gives the medical units the time and resources to refit and resupply. Most war games avoid realistic casualty play, so it is doubtful that meaningful insights can be drawn from correlating a friendly casualty estimate with a casualty outcome. Focusing on a force’s medical capacity is a more meaningful indicator for an insightful dialogue with the combat commander. The joint force commander surely would want to know when in-theater casualties exceed the medical capacity to manage them.

If a joint sustainment command is to embrace the full breadth of sustainment, its logisticians must understand and address all aspects of sustainment. By understanding the relationship between sustainment and casualty capacity, logisticians will be better prepared to consider the implication of “other support” required by the Army’s most critical resource: its soldiers.

Colonel David L. Nolan, USA (Ret.), is employed by BearingPoint, Inc., in McLean, Virginia, and works in the Office of the Army Surgeon General’s Enterprise Architecture Program Management Office as a consultant and project leader. He has a B.A. degree in history from The Citadel and an M.B.A. degree from Western New England College. He is a graduate of the Army War College.