Operational Medicine 2001
Field Medical Service School
Student Handbook

HEALTH SERVICE SUPPORT FOR MARINE CORPS MISSIONS

FMST 0302

17 DEC 99

TERMINAL LEARNING OBJECTIVES:

1.      Given the requirement, perform duties of rate in support of Marine Corps missions.  The student must identify the elements of Health Services Support in various Marine Corps missions.  (FMST.03.02)

ENABLING LEARNING OBJECTIVES:

1.      Without the aid of reference materials and given a definition or term, identify the appropriate Principle of Health Service Support, per the student handbook.  (FMST.03.02g)

2.      Without the aid of reference materials and given a list, identify the responsibilities of a Corpsman prior to embarkation, per the student handbook.  (FMST.03.02a)

3.      Without the aid of reference materials and given a list, identify the responsibilities of a Corpsman in preparation for debarkation, per the student handbook.  (FMST.03.02e)

4.      Without the aid of reference materials and given a list of Naval ships, identify the vessels employed in amphibious operations, per the student handbook.  (FMST.03.02f)

5.      Without the aid of reference materials and given a list, identify the unique Health Services Support issues within Military Operations Other Than War (MOOTW), per the student handbook.  (FMST.03.02j)

6.      Without the aid of reference materials and given a list, identify the potential health threats within different Military Operations Other Than War, per the student handbook.  (FMST.03.02k)

7.      Without the aid of reference materials and given a list, identify the purpose of a Non-Combatant Evacuation Operation (NEO), per the student handbook.  (FMST.03.02h)

8.      Without the aid of reference materials and given a list, identify the role of medical personnel in a Non-Combatant Evacuation Operation, per the student handbook.  (FMST.03.02l)

9.      Without the aid of reference materials and given a list, identify the purpose of  Peacekeeping Operations, per the student handbook.  (FMST.03.02I)

10.  Without the aid of reference materials and given a list, identify the purpose of a Humanitarian Assistance Operation, per the student handbook.  (FMST.03.02m)

11. Without the aid of reference materials and given a list, identify the unique characteristics of Military Operations on Urban Terrain (MOUT), per the student handbook.  (FMST.03.02n)

12. Without the aid of reference materials and given a list, identify the medical threats unique to MOUT operations, per the student handbook.  (FMST.03.02o)

13.  Without the aid of reference materials and given a list, describe the positioning for effective utilization of Aid Station assets during MOUT operations, per the student handbook.  (FMST.03.02p)

14. Without the aid of reference materials and given a list, identify the challenges to patient movement and evacuation in MOUT operations, per the student handbook.  (FMST.03.02q)

OUTLINE:

A.  MARINE CORPS MISSIONS

 1.  SOLDIERS OF THE SEA

 a.       The United States Marine Corps is tied to the Naval Service through organization, doctrine, tactics, equipment and training.  The unique characteristics of the Marine Corps Operating Forces to execute National Command Authority missions from sea-based platforms makes them unique among the world's military forces, and a valuable asset to America's defense capabilities.

b.      Navy and Marine Corps doctrine describes future operations as less focused upon large-scale war and more upon responding to regional contingencies where immediate and decisive action may divert greater and costlier conflicts.  Additionally, with political, religious, and non-allied turmoil in multiple locations around the world, Naval and Marine Corps forward presence is well suited to respond to varied contingencies.

c.       The basis of this doctrine is "Operational Maneuver From the Sea"(OMFTS).  OMFTS relies upon Naval presence, maneuverability, Marine Corps force projection, sustainability, and support.

d.      The crises faced in the future dictate the nature of the missions the Marine Corps will be called upon to accomplish.  Examples include:

1.      Amphibious Operations - The Marine Corps' main mission is to conduct sea-based operations.  Whether to conduct a direct assault upon an enemy or to participate in Military Operations Other Than War (MOOTW), Marine Corps doctrine and tactics call for them to be conducted from Naval platforms.

2.      Force-on-Force - The Marine Corps is still committed to the application of overwhelming firepower, maneuver, and tactics to prosecute a mission against the enemy.  While the potential for large, land-based conflict has diminished, the Marine Corps remains prepared to engage in traditional warfare.

3.      Military Operations Other Than War (MOOTW) - MOOTW is an aggregate description for the non-traditional missions that are expected in future operations.

4.      Humanitarian Assistance (HA) - Natural and man-made disasters displace populations with little or no capacity for maintaining health and security.  The forward presence of the Marine Corps ideally suites them for immediate insertion into unstable situations and the ability to provide direct support to displaced and at-risk populations.

5.      Peacekeeping Operations - Geo-political, ethnic, and religious strife may displace populations and lead to limited or large-scale regional conflicts resulting in U. S. and/or multi-national efforts to maintain peace.  The Marine Corps is a proven force in disciplined intervention and is flexible enough to participate in joint service and multi-lateral operations.

6.      Non-Combatant Evacuation Operations (NEO) - Internal disputes, terrorism or unfriendly governments may dictate the need for U. S. and other foreign citizens to be evacuated from embassies and/or large urban areas.  Marine Expeditionary Units at sea are the standard for rapid insertion and security of evacuees around the world.

7.      Military Operations on Urban Terrain (MOUT) - By the year 2020, 80% of the world's largest economies will be located on the Pacific and Indian Ocean Rim.  Coupled with an equal number of the world's population being located regionally near a coast, it is understandable that the reliance upon Navy and Marine Corps presence and responsiveness is critical to world stability and our national interests.  Within these population and economic centers are urban environments where many of our future conflicts may take place.  The unique challenges of Military Operations on Urban Terrain (MOUT), is a concept for which we must train and prepare.

B.     HEALTH SERVICE SUPPORT TO THE MARINE CORPS OPERATING FORCES

     1.  PRINCIPLE OF HEALTH SERVICE SUPPORT

a.       Military operations are complex, dynamic events that require detailed planning and observance of sound principles for success.  Health Service Support is essential to the success of all operations.  While a Hospital Corpsman or Dental Technician may not be involved in the planning process of a large operation, there are principles of Health Service Support that can be applied to any situation.  Understanding these principles can help medical personnel to better prepare for their role in supporting the Marine Corps Operating Forces.

1.      Principle of Responsiveness - Providing the right health services at the right time and in the right place,  The nature of the operation and commander's intent must be understood to determine the level of support.  Lowered mortality and morbidity can result from placing medical care close to where injuries or illnesses occur.

2.      Principle of Flexibility - The ability to adapt the HSS function to changing situations.  HSS must shift resources to meet changing requirements.

 3.  Principle of Continuity - Providing uninterrupted HSS to the sick and injured.  The system must be well coordinated and planned in order to ensure that no gaps or faults occur.  Continuity of care is delivered by progressively staged treatment facilities from far forward to as far rearward as the patient's condition dictates.

 4.  Principle of Economy - Delivering the most cost-effective care through coordinated efforts.

 5.  Principle of Attainability - To have on hand that which is required to provide reliable, effective HSS.  This is accomplished with detailed planning and resources.

 6.  Principle of Sustainability - To maintain support throughout the length of the operation.

 7.  Principle of Simplicity - Development of HSS that is not complicated.  Standardized, executable HSS resources must be well planned.

 8.  Principle of Survivability - To prevail when facing adversity and/or destruction.  Providing protection, security and reinforcement when required.

C.  AMPHIBIOUS OPERATIONS

1.      An amphibious operation is defined as an attack launched from the sea by naval and landing forces embarked in ships or craft involving a landing on a hostile or potentially hostile shore.  Such a complex and risky operation demands an integrated, seamless Health Service Support system that extends from the initial evaluation and care given in the forward areas of the combat zone and reaches to the treatment and patient disposition provided by continental United States, (CONUS) facilities.

 2.      The Marine Corps is capable of carrying out many different types of missions from the amphibious platforms of the Navy.

a.       Direct Assault (from landing craft or helicopter)

b.      Raids (from landing craft or helicopter)

c.       Special Reconnaissance

d.      Non-combatant Evacuation

e.       Rescue (Downed Aircrew or Hostage)

f.        Feints (Amphibious Ops used to divert enemy strength)

g.       Show of Force

3.      Medical Department personnel have a vital role in the success of amphibious operations.  Thorough preparation is essential for Hospital Corpsmen and Dental Technicians to assure their Marines and fellow health care providers are ready for the multiple missions that amphibious operations may perform.

4.      Pre-Embarkation responsibilities of the Hospital Corpsman and Dental Technician include but are not limited to:

a.       Unit training for coordination and familiarization

1.      Understanding of mission.

2.      Familiarity of teammates and unit.

3.      Practice of skills (Marine Corps and medical).

4.      Environment and regional focus.

a)      Hot weather

b)      Cold weather

c)      Mountain warfare

d)      MOUT

e)      Populations, customs and courtesies.

 b.      In-garrison medical/dental support.

1.      Routine sick call.

2.      Health/Dental Record maintenance.

3.      Support of training evolutions.

4.      Physical Fitness training.

5.      Preventive Medicine/Force Protection.

a)      Immunizations

b)      Eye glasses and Gas Mask Inserts

c)      Medical Warning Tags (allergies and medicines)

d)      NBC training

e)      STD

f)        Hygiene and sanitation

g)      Dangerous plants, animals and marine life

6.      Dental Readiness.

a)      Class I or II prior to deployment

b)      Ensure annual exams done before deployment

 c.       Training.

1.      In-service training for standard HM/DT knowledge.

2.      Advancement training.

3.      Training of Marines in Self and Buddy-Aid.

4.      Specialty training.

 d.      Equipment and Supplies.

1.      Training for familiarization with Authorized Medical/Dental Allowance List (AMAL/ADAL) equipment and supplies.

2.      Conduct Limited Technical Inspection (LTI), of AMAL/ADAL sets to accompany unit on deployment.

 3.      Familiarize with deployed re-supply process.

 4.      Devise logistics plan for shipboard storage of AMAL/ADAL.

 5.      Develop contingency plans for shipboard retrieval of gear for sustaining operations ashore.  

e.  Planning and Coordination.

1.      Liaison with Amphibious Group Medical representatives.

 2.      Develop and obtain sources of medical intelligence.

 3.      Plan and review evacuation standards and procedures.

 4.      Liaison with embarked ship medical/dental departments.

 5.      Meet with different MAGTF element medical departments.

 5.  Embarked responsibilities of the Hospital Corpsman/Dental Technician.

a.       While embarked upon amphibious shipping, the HM/DT must continue to train and prepare for operations ashore.  Among these responsibilities are:

1.      Establish routine for sick call and scheduled medical/dental programs

2.     Continue in-service training to keep knowledge and skills sharp.

 3.      Train Marines in self/buddy-aid.

 4.      Keep abreast of missions and potential medical threats.

 5.      Continue health/dental record maintenance.

6.      Physical training.

7.      Check embarked gear daily to insure AMAL/ADAL integrity.

8.      Check personal gear daily to insure serviceability.

9.      Know your debarkation station and responsibilities.

     6.  Amphibious Ships of the Navy.

a.       The primary mission of amphibious ships are to transport troops and equipment and to land them ashore by landing craft or helicopter.

b.      After troops have debarked for the Ship-to-Objective Movement (STOM), certain designated amphibious ships will provide casualty receiving and treatment in support of the landing forces.

c.       These ships are designated as Casualty Receiving and Treatment Ships (CRTS).  They are augmented with personnel and material to their medical facilities in order to provide surgical support, evacuation regulating, and patient holding.

d.      Amphibious ships by class:

1.      LHD - Helicopter, Dock Landing - Multipurpose Assault

a)      Wasp Class, largest and most versatile ship, transporting troops to shore by Landing Craft Air Cushion (LCAC), helicopter and Amphibious Assault Vehicle (AAV).

b)      Provide air support with AV/8 Harrier and AH-1 Cobra.

c)      Designed to transport Marine Expeditionary Unit (MEU) sized MAGTF.

d)      6 Operating Rooms.

e)      17 ICU beds.

f)        47 Primary Care beds.

g)      540 Overflow beds.

h)      X-ray, Laboratory, and Frozen Blood Bank.

i)        Oral Surgery Operatory.

 2.      LHA - Helicopter, Attack Landing - General Purpose Assault

a)      Second greatest medical capability next to a LHD, transports troops via helicopter, landing craft and tracked vehicles.

b)      2 major and 2 minor Operating Rooms.

c)      48 Primary Care beds.

d)      225 Overflow beds.

e)      X-ray, Laboratory, and Frozen Blood Bank.

f)        Oral Surgery Operatory.

 3.      LPD - Amphibious Transport, Dock

a)      LPD's are used to land Marines by landing craft and amphibious tracked vehicles.  They have limited helicopter capability.

b)      One minor Operating Room (no anesthesia apparatus).

c)      No ICU/CCU beds.

d)      9 General Ward beds.

e)      90 Overflow beds.

f)        X-ray, small laboratory, and 50 unit Blood Bank.

g)      Mess Deck triage area.

h)      Not a good choice for (CRTS).

4.  LSD - Dock Landing

a)      Ships with large well decks and serve as mother ships for repair and maintenance of landing craft and tracked vehicles.

b)      Limited cargo and troop capacity.

c)      One small Operating Room (no anesthesia apparatus).

d)      9 General Ward beds.

e)      60 Overflow beds.

f)        No ICU/CCU beds.

g)      Portable X-ray.

h)      Limited Laboratory, no Blood Bank.

i)        Mess Deck triage.

4..      LST - Tank Landing

a)      The only amphibious ship which is designed to beach itself.  This facilitates the offloading of equipment, supplies and vehicles.

b)      Minor Surgery (no anesthesia apparatus).

c)      9 General Ward beds.

d)      No ICU/CCU beds.

e)      Main Deck triage.

f)        Beaching capability can enhance evacuation as vehicles can deliver wounded directly to ship at shore location.  However, with limited medical facility, wounded should be stabilized and definitive care available within reasonable time.

 5.  LCC - Amphibious Command

a)      Two ships of the Blue Ridge class.  They serve as command and control ships for the 7th and 2nd Fleets.

b)      Not directly involved in the landing or sustaining of amphibious operations.  By its very nature, this ship is stationed over the horizon to direct operations.

c)      Could be utilized as a medical command and control ship to direct evacuation and placement of medical resources.

d)      One Operating Room.

e)      Laboratory and X-ray.

f)        No ICU/CCU beds.

g)      23 General Ward beds.

h)      No Overflow beds

i)        No Blood Bank.

D.  MILITARY OPERATIONS OTHER THAN WAR (MOOTW)

1.      Current doctrine describes MOOTW as a wide range of activities where the military instrument of power is used for purposes other than the large-scale operations usually associated with war.

2.      Many activities participated in by U. S. Forces fall under the definition of MOOTW.

a.       Foreign Humanitarian Assistance.

b.      Nation Assistance.

c.       Support to Insurgency.

d.      Arms Control.

 e.       Support to Counterinsurgency.

f.        Show of Force.

g.       Enforcement of Sanctions.

h.       Protection of Shipping.

i.         Strikes and Raids.

j.        Combating Terrorism.

k.      Counterdrug Operations.

l.         Ensuring Freedom of Navigation.

m.     Noncombatant Evacuation Operations.

n.       Peace Operations.

3.      Although the severity of conflict and potential for casualties may be much less in MOOTW, HSS must be appropriate and well planned to meet the needs of U. S. Forces. 

E.  NON-COMBATANT EVACUATION OPERATIONS (NEO)

1.      Non-combatant Evacuation Operations (NEO), are conducted to evacuate civilian noncombatants and nonessential military personnel from locations in a foreign (host) nation during time of endangerment to a designated safe haven.  These operations are normally conducted to evacuate U. S. citizens whose lives are in danger from a hostile environment or natural disaster.  They may also include the evacuation of U. S. military personnel and dependents, selected citizens of a host nation, or third country nationals.

2.      These operations are of a short duration and consist of rapidly inserting a force, occupying the objective, and withdrawing as planned.

3.      The amount of force used is normally limited to that required for self-defense and the defense of the operation.  The level of hostilities encountered varies with each specific mission.

 4.      NEO may occur in "permissive" or "non-permissive" environments.

a.       Permissive - where the host nation has given explicit permission for U. S. forces to conduct the evacuation.  Little resistance or hostility is expected and casualties are expected to be minimal.  This does not minimize the potential for evacuee health to be compromised or for the security situation to deteriorate.

b.      Non-Permissive - where no guarantee of safe passage exists for the evacuees or for the forces to conduct the NEO.  HSS must be planned to cover all contingencies.

5.      Combat health support to NEO is tailored to the size of the military force and the anticipated health needs of the evacuees.  Every effort is made to use the existing medical skills of the evacuees.  HSS must take into consideration the following when planning for NEO:

a.  Assessment of the Medical Threat:

1.      Anticipated level of hostilities and size of the opposing force.

2.      Numbers and health of the evacuee population.

3.      Anticipated duration of the operation.

4.      Health of the general host nation population.

5.      Environmental risks.

b.  Medical requirements can then be planned.

1.      Location of definitive hospital/surgical care.

2.      Size and location of medical supplies.

3.      Evacuation procedures.

4.      Potential sources of food, water and host medical assets.

5.      Security for patients and medical personnel.

6.      Medical tasks in NEO.

6.      Medical personnel are generally tasked with assisting the NEO commander on the scene to ensure that casualties and evacuees are expeditiously screened, treated and evacuated.

a.       Screening - during a NEO, security is extremely important to prevent acts of aggression, sabotage and to ensure an orderly flow of the evacuee.

1.      Medical personnel are located behind the initial security screeners to evaluate evacuees who request assistance or are obviously in need.

2.      Sufficient medical personnel and equipment are staged to provide initial life-saving treatment.

3.      Non-urgent medical care is deferred until the evacuees are safely moved from the danger zone. 

4.      Medical personnel must take note that evacuees are under a great deal of stress and perceptions by the evacuees of the severity of medical conditions can vary.  Every effort should be taken to alleviate concerns and aid in the comfort of the evacuees.

b.      Treatment - medical personnel must be prepared to manage a wide variety of conditions in a diverse population. Maintaining patients for an extended period of time may become necessary if the security situation deteriorates.

1.      Pediatrics.

2.      Geriatrics.

3.      Mental Stress.

4.      Foreign Nationals.

5.      Pregnancy.

6.      Communicable Disease.

7.      Malnutrition and Dehydration.

c.       Medical Threat in NEO

1.      Mass casualties from surge in hostilities.

2.      Civilian casualties.

3.      Dehydration.

4.      Communicable disease.

5.      Unique Geriatric or Pediatric illnesses.

6.      Complicated pregnancy and childbirth.

7.      Inadequate medical supplies.

 d.      Evacuation - Medical evacuation may occur without the benefit of dedicated MEDEVAC aircraft.  Corpsmen must be able to prepare and manage evacuation of patients at a moments notice, with available resources.  Hospital Corpsmen must maintain good communication with the on-scene commander as well as supporting medical controllers in order to relate unusual encounters and to maintain situational awareness. 

F.  PEACEKEEPING OPERATIONS

1.      Peacekeeping Operations include such activities as monitoring and supervising truces to facilitate diplomatic efforts to reach a political settlement of the dispute.  HSS in a peacekeeping operation is normally designed to provide services to only U. S. forces or to other multi-national forces as agreed upon.  United Nations (UN), Non-Government Organizations (NGO), Host Nation (HN) and U. S. government personnel can also fall under the "beneficiary" definition in a peacekeeping operation.

 2.  HSS for a peacekeeping force is often very limited in size, therefore it is important to carefully tailor this support to meet the needs of the peacekeepers. 

a.       Preventive medicine measures must be employed and receive command emphasis to minimize the medical threat.  Disease, Non-Battle Injuries (DNBI) rate is more significant in these operations than are combat wounds.  Pest control has been shown to be a key to the health and quality of life for deployed personnel.

b.      Operational factors in peacekeeping may cause stress disorders.  These disorders include misconduct stress behaviors which may threaten the success of the mission.  Mental health professionals can help prevent or manage these complications.

c.       The local environment may present health risks not encountered by peacekeeping forces in their previous experiences.  Dangers from weather, pollution, and strained field conditions may exacerbate the U. S. forces' physical condition.

d.      Mass casualty plans must be prepared and coordinated.

e.       Medical evacuation plans are well planned.  Include alternate routes, other nation support and the potential for poor communications.

f.        HSS personnel and facilities will employ passive defensive measures to reduce their vulnerability against sabotage or terrorist incidents.  These include light and noise discipline, and restricting access into an area by channeling or diverting the flow of traffic and persons within the area.

3.      Contingency plans are prepared for HSS in the event of withdrawal of the peacekeeping force or the escalation of hostilities.

a.       Medical supplies, blood and hospitalization/surgical support should be identified and monitored at all times.  Alternate evacuation practices and communication failures should be addressed.

b.      Responsibilities to other nations' personnel, local inhabitants and hostile forces should be considered.

4.      Medical Threat in Peacekeeping Operations. 

a.       A population mix of elderly, children, and infants.

b.      Disruptions or lack of water, waste treatment, and garbage services.

c.       Infectious and communicable diseases unique to the area.

d.      Trauma from small skirmishes.

e.       Terrorist activities and land mines.   

f.        Casualties to Peacekeeping force.

1.      Snipers or small skirmishes.

2.      Land mines.

3.      Communicable disease.

4.      Environmental hazards.

5.      Industrial/military pollution.

6.      Mental stress.

G.  HUMANITARIAN ASSISTANCE OPERATIONS

1.      Humanitarian Assistance (HA) operations are those that are conducted to provide immediate assistance to a population under stress from either emergent or long-term conditions in which life and/or political stability is in peril.  HA operations differ from Peacekeeping operations in that there is normally no truce or opposing forces to contend with.  HA, however, finds generally a greater need for a robust HSS structure.  Natural disasters such as earthquakes, hurricanes and drought induced famine can bring on the need for HA.  Man-made populations at risk arise from war, refugee movement and political strife.

2.      HA also typically has multi-national and Non-Government Organization, (NGO) involvement.   U. S. forces must be able to operate under mandates that are not designed by our government and under direction from coalition groups such as the United Nations.

3.      Health Threat in Humanitarian Assistance Operations.

a.       Total disruption or lack of local food, water, waste and medical systems.

b.      Populations in dire physical condition, suffering from famine and disease.

c.       Outbreaks of infectious and communicable disease.

d.      Open mistreatment of ethnic or religious persons, with denial of services by those programmed to assist.

4.      Medical personnel must have the same appropriate operational planning and support as in Peacekeeping Operations:

a.       Preventive Medicine.

b.      Capability to support general population.

c.       Contingency plans for mass casualties or hostilities.

d.      Evacuation planning.

e.       Mental Health Services.

f.        Unit security.

H.  MILITARY OPERATIONS ON URBAN TERRAIN (MOUT)

1. Throughout history, battles have been fought on urbanized terrain.  Recent examples are Hue, Beirut, Panama City, and Mogadishu.  Military Operation on Urban Terrain (MOUT), are those military actions planned and conducted on a terrain where man-made structures impact on the tactical options available to the commander.  This terrain is characterized by a three-dimensional battlefield with the following features:

a.       Considerable rubble.

b.      Ready-made, fortified fighting positions.

c.       An isolating effect on all combatants.

2. The military commander must take many factors under consideration when planning MOUT operations.

a.       Terrain - The buildings above and underground passages below the streets add a vertical dimension to the urban battlefield.

1.      Enemy observation positions are likely in high, isolated structures such as steeples, or lone high-rise buildings.

2.      Assaulting forces can become quickly isolated, confused and cut-off by a tangle of unfamiliar structures.

3.      A great disadvantage occurs when small units assault structures due to multiple floors, rooms, stairways and doors.  The enemy may make great use of these obstacles to inflict serious losses.

b.      Rules of Engagement - The inhabitants of an urban setting cannot be quickly sorted and addressed as to their hostile nature in MOUT.  Commanders must rely on responsive intelligence and the ability of on-scene leaders to determine hostile from friendly or non-involved persons.  In Mogadishu, Somalia, the aggressors would frequently fire upon our forces from crowds of non-combatants and structures occupied by innocents.  Besides minimizing losses to civilians, limiting fire can also accomplish the following:

1.      Avoids alienation of the local population.

2.      Reduces the risk of adverse world opinion.

3.      Preserves structures and facilities for future use.

4.      Preserves vital cultural facilities and grounds.

c.       Logistics and Support - Timely combat service support, particularly in the areas of ammunition resupply and casualty treatment and evacuation, is critical in MOUT.  Built up areas can cause delays in movement of supplies due to the nature of traffic patterns and the risk of convoy ambush.  Helicopter activity is often a prime target for assault by the enemy.  Commanders must ensure the safety of logistics support operations.

d.      Maneuver - Combat in urban terrain is time-consuming and tiring.  It is characterized by a series of small battles for blocks, streets, buildings, and rooms.  Units must both attack and defend along greatly reduced frontages.  Small unit tactics must be well rehearsed and controlled in order to reduce the possibility of casualties from friendly fire and surprise assault by the enemy.

e.       Protection - Forces are afforded excellent protection by the very nature of MOUT; buildings, concrete and subterranean holdings can be utilized by troops.  Conversely, enemy forces utilize these same structures.  Commanders must provide the following force protection strategies:

1.      Conservation of the Force - Security in all directions.

2.      Choose safe, defendable structures.

3.      Remain free of hazards such as combustibles and electrical dangers.

4.      Use specialized equipment such as grappling hooks, ropes and pulleys.

f.        Infantry - The ground infantryman bears the brunt of the battle in MOUT, but all assets must work together to carry out a successful operation.  This will require small-unit leadership, initiative and skill.  Command and control will be compromised and lines of communication may not work as designed.

g.       Armor - The use of armor can be the difference between success and failure in MOUT.  Special assault forces supported by tanks has been proven to be the most successful of any other task organization.  Armor is limited by terrain features and must be protected by the infantry.

h.       Artillery - Artillery can be a vital instrument in MOUT when utilized properly.

1.      Indirect Fire - Artillery used to harass the resupply, evacuation and reinforcement of enemy troops.

2.      Direct Fire - Artillery fire onto a specific hardened target.  Very effective when "stronghold" buildings are identified.

i.         Aviation - Air assets give a commander an advantage much like artillery in the disruption of the enemy's efforts and direct targeting of hardened buildings.

       3. The medical threat in MOUT present unique challenges to Health Services personnel.  Each of the tactical considerations requires a parallel plan for medical response.  Combat on urban terrain and the populations encountered can complicate the ability of medical personnel to afford timely, sustainable support.  The risks involved include:

a.       Increased casualties due to blast and building collapse.

1.      Casualty rates may be as high as 25% in MOUT.

2.      Increased risk from orthopedic trauma, burns and lacerations.

b.      Isolation and reduced response to casualties.

c.       Delays in evacuation.

1.      Unstable or unsafe collecting and transfer points.

2.      Ambulance routes may be targeted.

3.      Streets blocked with debris.

4.      Helicopter approach under fire.

5.      Enemy rear guard action.

6.      Difficulties in patient movement.

a)      Collapsed structures.

b)      Stairways.

c)      Windows.

d)      Debris.

e)      Sniper fire.

d.      Imposition of civilian casualties and refugees.

e.       Undefined line of battle that delays medical treatment facility location.

f.        Endemic disease.

g.       Lack of water and sanitation.

h.       Mass casualty/casualty overload situations.

i.         Combat stress.

j.        NBC environment.

4.  Medical personnel should be trained and prepared for the following in MOUT:

a.       Train troops in self and buddy-aid.

b.      Immunizations and medications to prevent disease.

c.       Train in patient extrication and evacuation procedures from buildings and rubble.

d.      Equipment necessary for building evacuation and reaching injured.

1.      Ropes, pulleys, skid litters, axes, crowbars and other tools.

e.       Train litter teams.

f.        Train in alternate forms of communication for locating wounded.

1.      Color panels, flags, smoke.

2.      Runners.

g.       Move aid station far forward.

1.      Ensures timely response.

2.      Take advantage of structural protection.

3.      Reduce communication delays.

h.       Train in NBC response and treatment.

REFERENCE (S):

1.  HEALTH SERVICE SUPPORT (JP 4-02)

2.  MILITARY OPERATIONS OTHER THAN WAR (MOOTW) (JP 3-07)

3.  MILITARY OPERATIONS ON URBANIZED TERRAIN (MOUT) (MCWP 3-35.3)

4.  PEACE OPERATIONS (FM 100-23)

5.  HEALTH SERVICES SUPPORT OPERATIONS (MCWP 4-11.1)

6.  COMBAT HEALTH SUPPORT TO STABILITY

     AND SUPPORT OPERATIONS (FM 8-42)

7.  COMBAT HEALTH SUPPORT IN SPECIFIC ENVIRONMENTS (FM 8-10-1)

8.  INFANTRYMAN'S GUIDE TO COMBAT IN BUILT-UP AREAS (FM 90-10-1)

9.  OPERATIONAL HEALTH SERVICES SUPPORT (NWP 4-02)

Field Medical Service School
Camp Pendleton, California

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Operational Medicine 2001
Health Care in Military Settings

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