Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XIV: War Surgery Within the Division

Organizational and Operational Aspects

United States Department of Defense

One essential prerequisite for the effective discharge of the unit and division medical officer's medical duties is a knowledge of the tactical deployment of the units the officer supports and the current level of intensity of their operations. The following text covers several of the more important functions of medical platoons and companies. Although emphasis is placed upon the function of the battalion surgeon, most of this information is also applicable to the division level medical officer. Medical officers must not forget that what they are able to do and how they do it can be profoundly influenced by current operational doctrine and by the prevailing tactical situation. The latter will dictate whether or not medical evacuation is possible and by what means it can be accomplished.

The battalion surgeon has two primary missions:

1. Insure the health of the command

   • apprise the commander of ways to improve or preserve the health of the command

   • conduct disease surveillance

   • educate on preventive measures

   • inspect the state of health, morale, and hygiene of subordinate units

   • assess the medical threats for planned operations

2. Provide combat casualty care

   • provide the commander with medical annexes to operational plans

   • supervise the battalion aid station

   • triage casualties

   • train combat medics

   • supervise evacuation and extraction of casualties

   • conduct medical reconnaissance*

   • prevent overevacuation of those only slightly injured who can be quickly returned to duty

*This includes map or terrain reconnaissance to determine the most secure lines of evacuation and potential location of secure casualty treatment areas near the battle areas. This should be accomplished before the battle and is part of the medical annex to the operational plan.

The battalion surgeon is responsible for the location, operation, and deployment of the battalion aid station. This involves movement to a properly located site, usually co-located with battalion headquarters and battalion trains, as well as distribution of medical elements of the battalion aid station to the rifle companies.

Two factors must be balanced against one another in selecting a site for the battalion aid station. One considers the security of location versus its nearness to supported forces. The battalion aid station is austere in both equipment and personnel and must rely on the other elements of the battalion trains (maintenance, supply, communications, and other battalion headquarters troops) to provide the necessary security for the battalion aid station. Cover, concealment, and the choice of a position in defilade to direct enemy fire contribute to the security of the battalion aid station as well as its ability to perform the medical support mission. Many other factors are considered when deciding where to site the battalion aid station: proximity to lines of drift of sick or wounded troops, proximity to water, ease of ingress and egress by ambulances, protection from the elements (this can include the use of commandeered structures when available, i.e., barns, houses, shops), ease of abandonment of position to keep pace with the supported unit, ease of access by next higher echelon of medical care, and a landing zone for air ambulances. To take advantage of the protection afforded by the Geneva Convention, the battalion aid station site must be suitably marked.

The battalion aid station does not necessarily require shelter unless weather or night operation light discipline mandate cover. The battalion aid station should be considered an area rather than a facility. After an appropriate site is chosen, it must be further divided into functional areas: triage, immediate treatment, delayed or minimal treatment and sick call, expectant casualties, battle stress casualties, and morgue. Ease of casualty flow in either a linear or circular manner is an essential consideration. Each area of the battalion aid station should be marked with signs and the entrance to the battalion aid station must be obvious.

Battalion aid station medical equipment should be functionally arranged. The triage and immediate casualty areas must have lifesaving equipment and supplies near at hand. The sick call chest should be maintained near the minimal and sick call area, well clear of the triage and treatment area. Litters should be at the entrance to the battalion aid station for exchange by litter teams or for use by exhausted walking wounded casualties. All sections must have Field Medical Cards to insure appropriate and necessary recordkeeping.

Even though the tactical situation may allow the position of the battalion aid station to become relatively fixed and upgraded by physical improvements, it must always be prepared to rapidly advance or withdraw. Practiced and efficient set-up and take-down of the battalion aid station makes for responsiveness and mobility which allow the aid station to move more efficiently with changes in the tactical situation. This ability to respond to changes and move rapidly keeps the medical support close to those being supported.

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Operational Medicine 2001

Health Care in Military Settings

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