The 15th Sustainment Brigade operating in
Multi-National Division-Baghdad was one of the first sustainment
brigades to deploy to Iraq. While this new unit evolved
out of the former division support command (DISCOM), it
has substantially fewer medical assets than a DISCOM, and
its medical mission is different. This poses unique challenges
for planners and medical providers.
While the DISCOM, with its main and forward support battalions,
had robust level I (sick call and emergency stabilization)
and level II (laboratory, x ray, pharmacy, medical hold, and
medical supply) assets, the sustainment brigade’s organic
medical treatment assets are comparable to those found in
an infantry battalion. The sustainment brigade’s total
organic medical assets are within its headquarters element:
a brigade surgeon section and a medical platoon. The brigade
surgeon serves as special staff to the brigade commander and
oversees the two surgeon sub-sections: medical plans and operations
and medical logistics and sustainment. With the mission of
providing level I care to approximately 400 personnel in the
headquarters section, the medical platoon is composed of a
treatment squad (with one doctor, one physician’s assistant,
two medical sergeants, and five medics) and an ambulance squad
(with two ambulance teams and four medics).
When the sustainment brigade deployed and assumed command
and control of numerous other battalions, its numbers increased
to several thousand. Most of the units did not have medics,
and none had medical providers (physicians or physician’s
assistants) or medical equipment. Coordinating for level I
and II care for these troops posed the first of many challenges
for sustainment brigade medical planners.
Medical Support Command
The medical support command (MSC) is the organization responsible
for providing support to units, such as the sustainment brigade,
that do not have sufficient internal medical assets and for
providing theater level III (combat support hospital) medical
support. Within the MSC, units can deliver all facets of theater
medical care and logistics. The MSC and the sustainment brigade
have a synergistic relationship and, by doctrine, the potential
for a command relationship. The sustainment brigade moves
medical supplies for the medical command and provides area
logistics support to MSC units. The MSC is designed to augment
medical care in the sustainment brigade with additional personnel
or by positioning area support medical companies to provide
level I and II care, medical logistics battalions, preventive
medicine assets, and optometry and mental health services.
prepares an Anthrax shot for one of many Soldiers
receiving their vaccinations.
Evolving from the former DISCOM, some sustainment
brigades retained pieces of the equipment and personnel that
are no longer true parts of the sustainment brigade modification
table of organization and equipment (MTOE). The 15th Sustainment
Brigade is an example of a sustainment brigade in transition.
Located at Camp Taji, Iraq, the 15th Sustainment Brigade initially
provided forward operating base- and area-level optometry
support and mental health services using assets formerly assigned
to the division. These services were not carried over in the
restructured MTOE and were therefore contracted through the
MSC during the transition of authority planning. The brigade
medical platoon’s mission was to provide level I medical
care to sustainment brigade Soldiers at Camp Taji—a
population of approximately 2,500.
Soldiers serviced by the MSC were located at many different bases within Iraq;
these bases relied on several different aid stations for medical care. This
made the 15th Sustainment Brigade surgeon section’s requirement to provide
medical oversight and planning a unique challenge. Tracking disease and nonbattle
illness trends, ensuring preventive medicine measures were in place, and keeping
abreast of Soldiers placed on medical profile and evacuated to higher levels
of care were made more difficult by the geographic dispersion.
brigade surgeon listens to a Soldier's lungs.
Approximately half of the brigade’s over 4,000 Soldiers were collocated
with the brigade headquarters element at Camp Taji. Level I care was provided
by the organic medical platoon without augmentation, stretching resources allocated
for a smaller population. Moreover, the medical platoon had the important and
labor-intensive mission of training nonmedical Soldiers to be combat lifesavers.
Since medics are not assigned to most sustainment brigade battalions, the combat
lifesaver (the nonmedical Soldier with first aid training) is the first medical
responder on sustainment brigade logistics convoys, which travel dangerous
roads in the combat zone. A 40-hour course must be completed to receive initial
combat lifesaver certification, and an 8-hour recertification course must be
Combat brigades, similar in size to sustainment brigades, have dedicated
level II facilities with additional providers and services, such as laboratory,
x ray, medical hold, and dental care. At Camp Taji, the 15th Sustainment
Brigade relied on the assets of the 1st Brigade, 1st Cavalry Division, level
The brigade combat team (BCT) C Company (medical) is often the unit that
provides level I and II care for the collocated sustainment brigade in lieu
of an area
support medical company. Sustainment brigade planners should take into consideration
the possibility that the BCT’s primary responsibility is to support the
division and that, if the mission dictates, the BCT could move locations. When
sustainment brigade units rely on BCT assets, a lack of medical coverage for
the sustainment brigade can result.
If no level II facility is located in the area of operations, additional
personnel from the MSC may be added to the sustainment brigade’s treatment platoon
to augment organic resources to provide some level II services, such as laboratory
and x-ray capabilities. This was the case with the 45th Sustainment Brigade
operating in northern Iraq, which ran a level II facility at Forward Operating
Base Q West with the addition of a healthcare provider, laboratory technician,
and radiology technician from the MSC. However, even with these additional
assets, the staffing level and capabilities were still less than those of a
BCT medical company that runs analogous level II facilities in theater. This
adaptive ability of the sustainment brigade to become a level II facility will
diminish as the sustainment brigades mature and shed additional equipment left
over from the DISCOMs.
The 15th Sustainment Brigade deployed to a theater with established levels
II and III medical support. In future conflicts, close coordination between
the sustainment brigade and the MSC will be crucial to ensuring area medical
coverage is in place for all deployed Soldiers and determining if it makes
sense for the sustainment brigade to have operational control of these units.
Major Bonnie H. Hartstein, M.D., is the Brigade Surgeon for
the 15th Sustainment Brigade at Fort Hood, Texas. She has
a B.S. degree from the University of Michigan and an M.D.
degree from Boston University School of Medicine.