C Company, 307th Forward Support Battalion, treats casualties at a triage area set up near the road. The treatment teams are in the foreground. The tent at left in the background houses the forward surgical team.
Airfield Seizure Combat Health Support
by Captain Brian J. Bender
| C Company, 307th Forward Support Battalion, treats casualties at a triage area set up near the road. The treatment teams are in the foreground. The tent at left in the background houses the forward surgical team. |
Airborne operations
and airfield seizures are inherently dangerous. The danger arises from
the fact
that, during airfield
seizures, paratroopers typically conduct
a parachute assault deep into enemy territory in the midst
of a pitched battle and are at great risk of incurring multiple injuries
and
wounds.
Consequently,
medics are always needed on the drop zone (DZ). Throughout
the Army’s
history of airborne operations, combat health support (CHS)
has proven to be a significant
combat multiplier to conserve fighting strength. In World War
II, medics jumped with their units and established medical clearing stations
on
the DZs of France
and The Netherlands. In fact, many of these medical clearing
stations
landed in gliders on austere landing zones.
Since World War II, medical personnel have jumped in all airborne operations.
During Operation Just Cause in December 1989, medics from battalion
aid stations and medical personnel from the 307th Medical Battalion
participated in airborne
operations during the seizure of Panama’s Torrijos-Tocumen
Airport. Medical personnel were with the 82d Airborne Division
en route to Haiti in September
1994 during Operation Uphold Democracy when the division was
turned back from the jump. Most recently, medics were among
the “Sky Soldiers” of
the 173d Airborne Brigade who parachuted into northern Iraq
to seize key objectives during Operation Iraqi Freedom.
Airfield Seizure
The 82d Airborne Division’s mission is to “deploy worldwide within
18 hours of notification, execute a parachute assault, conduct combat operations,
and win.” Seizing an airfield is critical to the success
of their combat operations. Airfield seizures are executed
to secure
key terrain
that can
be used to create a lodgment that will enable the continuous
flow of combat power
and supplies into an area of operations.
The key tasks associated with an airfield seizure are—
• Conducting pre-assault fires to suppress enemy air defenses.
• Seizing assault objectives and key facilities to eliminate a direct-fire threat.
• Blocking high-speed avenues of approach.
• Repairing the field landing site to receive airland forces.
• Seizing key terrain in and around the airhead so the enemy cannot observe the airfield. [An airhead is a designated area in a hostile or threatened territory that, when seized and defended, ensures the continuous airlanding of troops and equipment.]
Organization
Airborne operations have changed little since World War II. Medical personnel
still accompany the infantrymen, artillerymen, and engineers,
known as alpha echelon, who execute a parachute assault to conduct and
support
airfield
seizure. Medical personnel are cross-loaded onto multiple aircraft
to ensure that the
loss of one aircraft does not keep the mission from being completed.
Some of the medical personnel who parachute onto the objective
are members of
the infantry
battalion’s medical platoon. Generally, 16 to 20 medical personnel, including
line medics with the rifle companies, physician assistants, and physicians from
the medical treatment squads of the medical platoon’s
battalion aid station (BAS), jump with the initial assault
forces onto
the airfield.
Twenty-five medical personnel from the division’s forward support medical
company (FSMC) also jump during an airfield seizure. The FSMC personnel typically
include two seven-man treatment squads that have one physician’s
assistant each, five ambulance platoon personnel, the dental
officer (who serves as
triage officer), a patient administration specialist, a laboratory
technician, the treatment
and ambulance platoon leaders, a communication specialist,
and the company commander. These numbers can be tailored to
support
the mission.
The division’s organic forward surgical team (FST) is normally attached
to the FSMC during an airfield seizure. Since only limited numbers
of support personnel accompany the infantrymen in the initial assault,
the FST usually is split into two sections—one that parachutes
into combat and one that arrives later aboard an Air Force cargo aircraft.
The
parachute assault
section usually
includes two surgeons, four operating room nurses, one nurse
anesthetist, two practical nurses, and three operating room technicians.
The bravo echelon is made up of personnel who do not jump but arrive on
fixed-wing aircraft. If the airfield has only minimal damage,
the bravo echelon should
begin arriving at P+6 (6 hours after the first jumper leaves
the first aircraft). The
rest of the infantry battalion BASs arrive among these elements.
Similarly, the remainder of the FSMC, consisting mostly of the area
support treatment
squad,
the area support squad, and the company headquarters, also
arrives by airland. The FSMC also is normally augmented with combat stress
control and preventive
medicine assets from the division’s main medical support
company.
Heavy Drops
In addition to personnel requirements for conducting airfield seizures,
military equipment is required. Medics must have medical equipment
to provide CHS
successfully during an airborne assault. Although all medics
jump with an aid bag in their
packs, most of the equipment they need arrives on vehicles
that are heavy-dropped before the paratroopers jump. A heavy drop is defined
as
any large piece
of equipment that can be rigged to a G–11B heavy-cargo
parachute. The heavy-drop equipment is rigged before the plane
is loaded, and,
immediately before any paratroopers
jump, Air Force personnel push the loads from the ramp of the
aircraft for
deployment on the battlefield.
The BAS usually heavy-drops one M998 cargo high-mobility, multipurpose, wheeled
vehicle (HMMWV) containing trauma and sick call medical equipment
sets, tents, litters, and generators. The FSMC usually heavy-drops two M998
cargo HMMWVs and
one M998 with mounted radios for command and control. The FSMC
cargo vehicles contain the same types of equipment as the BAS vehicles, but
twice the amount.
The FSMC also has 15 units of blood strapped into the passenger
seat of each M998 cargo vehicle. An FST heavy drop consists of two M998 cargo
vehicles carrying
a surgical medical equipment set, operating room tables, 30
units of blood, tents, and generators. Once downloaded on the objective, the
heavy-drop vehicles become
evacuation platforms.
Paratoopers from the 82d Airborne Division evacuate a comrade on the drop zone. |
Airborne Operations
An airborne operation begins at parachute-hour (P-hour), which is when
the first paratrooper exits the first aircraft. Once on the
ground, an airborne
medic must
get out of his parachute harness, ready his weapon for operation,
pick up his equipment, and move to his planned assembly area. The
place where the
FSMC normally
assembles is called an “assembly area support” and
is typically located on the DZ, away from the major initial
assault objectives.
The FSMC commander must execute several tasks within the first few hours
of the operation. First, he must account for all of his personnel. The
division
standing
operating procedure requires the commander to have 90-percent
troop accountability by P+1. Second, he must establish the capability
to treat and
evacuate casualties. Establishing this capability involves the commander
sending out a heavy-drop recovery team with security to locate,
derig, and return with
the FSMC’s three heavy-drop HMMWVs. Third, a helicopter
landing zone for medical evacuation (MEDEVAC) must be established
before
P+2 for evacuating
casualties
to a level III or higher medical facility. [A level III medical
facility is normally a corps-level medical treatment facility
that has intensive
care and resuscitative
surgery capabilities.] An ambulance platoon two-person team
with a radio must establish the pickup zone (PZ) by P+2. The
treatment
platoon
must
assemble the
advanced trauma life support (ATLS) tents and equipment by
P+2 to receive, treat, and prepare casualties for further evacuation.
Part of the establishment of the treatment area includes the FST. The FST
tent is set up next to the FSMC ATLS tent. The dental officer
triages casualties and
sends them to either the FST tent for surgery or the ATLS tent
for treatment and stabilization. Once a patient is stabilized, he is
placed in the appropriate
evacuation category (Urgent—evacuate within 2 hours; Priority—evacuate
within 4 hours; or Routine—evacuate within 24 hours)
and then taken to the MEDEVAC PZ for evacuation by helicopter
to
the nearest
level III
facility. At the FSMC treatment area, casualties are manifested
and moved by HMMWV
or M-Gator
to the field landing site for fixed-wing evacuation from the
theater. [An M-Gator is a multipurpose six-wheeled, all-terrain
vehicle used
primarily
for casualty
evacuation and supply.] Medics accompany these casualties and
monitor them while they await evacuation.
Flexibility is key to success. All medics must be able to perform each medical
task on the DZ regardless of their rank or section assignment.
For example, treatment personnel also must be prepared to establish the MEDEVAC
PZ if needed.
Airfield Seizure CHS Assembly Plan
Normally, two infantry battalions under the command and control of a brigade
task force headquarters execute airfield seizures. Therefore,
two BASs typically take part in an airfield seizure.
CHS assets initially present on the DZ usually are limited. Therefore,
a thorough CHS assembly plan must be developed that includes
using all available
assets
for evacuation and treatment of casualties. For example, during
one rotation at the Joint Readiness Training Center (JRTC) at Fort Polk,
Louisiana, the BASs and FSMC operated together on the DZ to provide
CHS.
The factors
of
mission,
enemy, troops, time, terrain, and civilians (METT–TC)
drove this collaboration, which enabled the brigade task force
to combine
limited
treatment teams and
evacuation personnel and vehicles.
Drop Zone Evacuation
As mentioned, evacuation assets are very limited on the DZ. Front line ambulances
are not part of the initial airfield seizure package; instead,
nonstandard M998 cargo HMMWVs are the preferred evacuation platforms. The medical
team does not
have enough assets to conduct all evacuations alone, so M-Gators,
antitank vehicles, and mortar vehicles also must be used.
In the event of a true no-notice deployment of the 82d Airborne Division
to a remote location, it may be impossible to have dedicated
rotary-wing aircraft
for support. In such a situation, the 82d Airborne Division
must work with Air Force medical personnel to coordinate the strategic
lift
of casualties
from the
DZ. The Air Force’s Aeromedical Evacuation Liaison Team
(AELT) is designed to help the FSMC plan, coordinate, and certify
the evacuation
of casualties
on fixed-wing aircraft. The AELT usually works directly with
the FSMC commander.
Together, they work to evacuate casualties as quickly as possible.
The sooner casualties are certified and manifested, the sooner
they are evacuated
to
higher
echelons of medical care. Therefore, it is critical to have
all patients manifested by the AELT before the first aircraft
lands.
A mobile aeromedical staging facility (MASF) also can play a critical role
in evacuation from the DZ. A MASF is an Air Force asset designed
to provide shelter,
medical supplies, and medical care while casualties are awaiting
evacuation. The MASF can be located near the “hammerhead” of
the field landing site. [The hammerhead is the area of the runway
where aircraft
normally turn
around.]
Drop Zone Sweeps
It is imperative to provide rapid treatment and evacuation of soldiers in the
DZ. To accomplish this, dismounted and vehicle-mounted medical
personnel must sweep the DZ for casualties. To avoid fratricide, initial assault
objectives
should be secure before the DZ sweep is executed. To conduct
the sweep, the DZ is divided into grid sectors, and the BASs and the FSMC sweep
the sector assigned
to them. Established routes are used in each sector. Depending
on the terrain, medics may need to dismount and walk through areas where casualties
may be concealed.
A DZ sweep can be difficult to accomplish because of limited evacuation assets.
A balance must be established between sending assets on DZ
sweeps and evacuating casualties from casualty-collection points.
Follow-on Missions
Out-of-sector air assaults are common follow-on missions after securing the
airfield and subsequent objectives. Rotary-wing aircraft from an intermediate
staging
base usually land on the airfield to load paratroopers for
the air-assault mission. Casualties from the air assault are loaded on the
last aircraft and flown back
to the PZ, where they are offloaded and treated by the medical
personnel. Once stabilized at the PZ, the casualties are evacuated to the FSMC
or the nearest
level III medical facility. This mission is accomplished by
a treatment team from either the BAS or the FSMC, depending on the size and
complexity of the
air assault operation.
Ground Operations
As the infantry battalions clear their assigned areas and expand the lodgment,
they move and their BASs follow. The bravo echelon arrives
once the field landing site is cleared and repaired. When the planes arriving
with the bravo echelon
land and the vehicles and equipment are offloaded, the arrival
airfield control group receives the vehicles and places them into unit chalks
(convoy groups).
The FSMC vehicles will be directed to the brigade support area (BSA) and will
arrive according to a priority vehicle listing. The first vehicle
in the priority vehicle listing is usually a light medium tactical vehicle
(LMTV) loaded with
area support treatment equipment. Once this vehicle arrives
in the BSA and links up with the FSMC quartering party, it is downloaded and
the area support treatment
squad establishes its area.
The FSMC BSA quartering party typically consists of the treatment platoon
sergeant, a physician’s assistant, and two medics. The
treatment platoon sergeant calls the FSMC commander and informs
him that he
is ready to receive
casualties
at the BSA. Once this information is sent to the brigade, the
patient flow shifts from the DZ ATLS tent to the BSA for treatment.
The MEDEVAC
PZ is
moved from
the DZ to the BSA. Once downloaded, the LMTVs are moved to
the DZ ATLS site. The LMTVs then move casualties from the DZ
to the
BSA
or, depending
on the
scenario, to the field landing site for fixed-wing evacuation.
Assets are limited during an airfield seizure. Medics have important responsibilities,
so they must move quickly at the assembly area and recover
the heavy-drop vehicles that contain their equipment. Evacuation assets are
limited on the DZ, so the
evacuation plan must be well integrated into the overall
plan. A well-planned, rehearsed, and executed combat health support plan
can save
many lives during
an airfield seizure. ALOG
Captain Brian J. Bender is a special assistant to the Chief of the Medical Service
Corps. He served as a forward support medical company commander, as the 82d Airborne
Division Medical Planner, and as the 1st Brigade Task Force Medical Planner.
He has a B.S. degree from the University of Miami and is a graduate of the Army
Jumpmaster School, the Army Air Assault School, and the Army Airborne School.